Mental health counseling is considered important before and after this surgery to help individuals adjust to rapid changes in body size, eating behaviors and social life. Because of the potential for these serious side effects, individuals must meet certain criteria. Surgery is reserved for individuals with a BMI of greater than 40 or a BMI of greater than 35, when one obesity related illness is present. Furthermore, surgery is considered an option only when other repeated attempts to loose weight have failed. Psychological evaluation is often requested to identify individuals with the greatest adjustment challenges, and to determine follow up counseling needs.
Weight loss is achieved by limitations set on the volume and nature of food intake.
Due to the small size of the pouch, intake is limited to 2-3 small bites of food per meal. Since the segment of the small intestine where the stomach pouch exits into cannot handle concentrated calories, foods that contain a large amount of sugar or fat need to be avoided. This procedure is performed by creating a tiny stomach pouch that leads to the lower portion of the stomach, which is reinforced by a permanent plastic band. This procedure works by making the stomach-small intestine connection much further downstream so that food has less time to mix with intestinal juices, which reduces its absorption. More weight loss is achieved with this procedure, but at a higher cost.