Although 8,841 obese Israelis underwent bariatric (stomach-narrowing) surgery at public expense to lose weight in 2014, and 14 of them died of complications, there is no requirement here – unlike in most other countries – to undergo medical follow-up to ensure that it will be successful in the long term.So says the Association of Clinical Dietitians and Nutritionists, which has just issued a comprehensive position paper on the subject.The aim of the paper is to bring together all the latest knowhow on the subject, including dietary advice for those who have already undergone the surgery and for professionals in the field.It includes recommendations based on research and dealing with special populations, including pregnant women and teenagers.Doctors and other medical staffers follow up their patients’ conditions only if they are “interested” in doing so, it is claimed.There has been a dramatic increase in bariatric surgery here and around the globe.In 2003, there were only 146,000 such operations around the world, compared to 468,600 in 2013. The figure has further increased since.The average age at which the operation has been performed is 41.6 years. According to the association, the rate of the operation compared to Israel’s population is significantly higher than in most other countries.The procedure was made famous here when then-education minister Shai Piron underwent the surgery and became svelte. Transport Minister Yisrael Katz has also lost a considerable amount of weight following the procedure, as have others.Health funds cover the cost of the surgery for the morbidly obese at the recommendation of a special committee that includes an internal medicine specialist or endocrinologist, a dietitian, and a psychologist or social worker.There are currently six different types of bariatric procedures, including the insertion of a ring, a sleeve procedure (which is most popular in Israel) and a stomach bypass. Two involve the duodenum (small intestine) and a mini-stomach bypass.Clinical dietitian Shiri Sharf Dagan noted that bariatric surgery has been proved to be the most effective treatment for obesity. It causes metabolic changes, such as the production of hormones in the digestive system that affect the mechanism of fullness and hunger, and changes in intestinal flora. It also leads to a change in the amount and type of food eaten, and daily lifestyle. In most cases, it also reverses Type II diabetes and lowers LDL cholesterol, blood pressure levels and the rate of sleep apnea.The procedures are regarded by many as a sort of “magic potion,” as if patients go in obese and come out thin. This is an exaggeration, said Dagan, as there are risks and even deaths, and without changing one’s diet and lifestyle, those who undergo the surgery can balloon back to obesity.Most of the weight loss is seen between a year and 18 months after the operation.After the sleeve procedure, patients lose 60-70 percent of their excess weight. But five years later, there is often a partial reversal of the success if the patient is not careful.