As America's average girth has grown and surgery has proven a relatively effective treatment for obesity, procedures that reduce the size of the stomach have grown in popularity and acceptance.
The American Society for Metabolic and Bariatric Surgery says that 200,000 Americans have weight-loss surgery each year. Besides helping people lose weight, the society says the surgery reduces the odds that they will die from cancer, heart disease or diabetes. In more than three-quarters of cases, surgery resolves or improves Type 2 diabetes, high blood pressure, high cholesterol and sleep apnea, the group says.
Patients may lose as much as 60 percent of their excess weight within six months of surgery. Typically, they maintain half of their weight loss at five years, the society says.
In the procedure that Gov. Christie chose, the laparoscopic adjustable gastic band (LAGB), an adjustable band filled with saline is wrapped around the upper part of the stomach. This forms a small pouch that restricts food intake.
Other options include gastric bypass, in which the size of the stomach is greatly reduced and it is attached to the middle of the small intestine. This bypasses part of the small intestine and limits calorie absorption.
In a newer procedure, sleeve gastrectomy, the stomach is stapled vertically, reducing its size by 85 percent.
Of the three, gastric banding has the lowest rate of major complications: 0.09 percent. That compares to 3.6 percent for gastric bypass and 2.2 percent for sleeve gastrectomy.
Still the list of side effects is daunting. The band can erode through the stomach or slip. Patients can suffer from heartburn, ulcers, infection, poor nutrition and belly scarring.
While bariatric surgery was once recommended only for the morbidly obese, medical guidelines now consider it appropriate for people with a body mass index of 30 or higher if they have diabetes or metabolic syndrome.