A Guide to Bariatric Surgery
Bariatric surgery, also referred to as weight loss surgery or gastric surgery, is a medical procedure designed to help obese patients lose weight, in which physical changes are made to parts of the digestive system. It is often an option when patients with severe obesity cannot lose weight through less invasive measures, such as diet and exercise, or for patients who experience serious adverse health effects due to their weight.
Bariatric surgery is a serious procedure, and patients who are considering weight loss surgery will need to go through several steps to be approved and prepared for the surgery. Patients need to be aware of both the benefits and risks of bariatric surgery, as well as what to expect in terms of weight loss and how to maintain long-term health after the surgery.
Who Should Consider Bariatric Surgery?
According to the Mayo Clinic, weight loss surgery is generally recommended for patients who:
- Have failed to lose enough weight through diet and lifestyle changes
- Have a BMI of over 40, OR
- Have a BMI of over 35 combined with serious health problems due to their weight
Beyond those basic parameters, prospective bariatric surgery candidates are also evaluated based on their medical history, potential health complications, psychological risk factors, and their ability to follow recommended lifestyle changes after the surgery.
According to the American Society for Metabolic and Bariatric Surgery, the risks and effects of obesity in the U.S. are very serious. Obesity affects around 78 million Americans, and is linked to a 50 to 100 percent risk of premature death. Obesity is also linked to a range of other diseases, including type 2 diabetes, cardiovascular disease, stroke, and cancer.
The good news is that even a modest amount of weight loss can improve the outcomes for people with obesity. Bariatric surgery is considered an extremely effective and long-lasting method of weight control for patients with severe obesity.
In one study, patients who underwent bariatric surgery reduced their risk of obesity-related diseases by 48 percent up to 10 years after the procedure. Patients with diabetes and older patients (over 60) saw the greatest benefits after bariatric surgery in that study. On average, bariatric surgery patients see an average of 50 percent loss of excess body weight in the long term (5 years after surgery).
Bariatric Surgery Types
If you are approved for weight loss surgery, your doctors and surgeons will determine the best type of procedure for you. They will also determine whether laparoscopic or open surgery is the best course of action. Here are some of the most common types of bariatric surgeries:
Gastric Bypass (Roux-en-Y): This is one of the most common (and most successful) types of weight loss surgery. In a gastric bypass procedure, the stomach is made smaller by creating a sectioned-off pouch. Then the small intestine is rerouted so that part of it is bypassed. This way, the stomach’s capacity becomes smaller, and fewer calories are absorbed.
Sleeve Gastrectomy: In another highly effective weight loss surgery option, the stomach is made significantly smaller. This procedure reduces the calories the patient can take in, and also affects the gut hormones in ways that help reduce hunger.
Adjustable Gastric Band: In this type of surgery, a band is placed around part of the stomach, reducing the stomach size and helping the patient feel full after smaller meals. The band can be adjusted to let more or less food to pass through to the rest of the stomach. While the band is less invasive than other forms of bariatric surgery and doesn’t affect nutrient uptake as much, it may not lead to as much weight loss as other methods.
Duodenal Switch: In a DS procedure, a small stomach pouch is created, and a large portion of the small intestine is bypassed. This reduces calorie and nutrient uptake. The duodenal switch can be very successful for weight loss, but also carries a larger risk of complications than other procedures.
Endoscopic Sleeve Gastroplasty: This minimally invasive procedure uses an endoscopically-placed suture to reduce the size of the stomach.
Intragastric Balloon: In a newer type of bariatric surgery, a balloon is placed in the stomach (nonsurgically) and filled with saline. This reduces the stomach’s capacity without surgically altering the digestive system.
How Does Bariatric Surgery Work?
While each type of bariatric surgery uses a slightly different mechanism, they all work by either reducing the size of the stomach, making changes to the small intestine that affect calorie absorption, or both.
Besides physically reducing the amount of food the patient can eat, bariatric surgery can also change the gut hormones to help patients feel more full and experience reduced hunger. Combined with lifestyle changes, the effect is ideally dramatic and long-term weight loss.
What To Expect From Bariatric Surgery
Benefits: While weight loss is usually the primary goal of bariatric surgery, many patients experience further benefits, including:
- Improvement of obesity-related disorders, including type 2 diabetes, high blood pressure, sleep apnea, and more
- Greater mobility
- Improved quality of life
- Psychological benefits
Side Effects: Post-surgery complications can include bleeding, infection, leakage from new stomach and intestinal connections, blood clots, and more. Because many types of bariatric surgery reduce absorption of nutrients, malnutrition can also be a side effect, especially if a patient doesn’t take the recommended nutritional supplements after surgery.
It’s worth keeping in mind that most complications of bariatric surgery are minor, and the rate of postoperative complications has decreased over time as surgeons become more practiced and surgical techniques are refined. One study showed that between 1993 and 2006, complication rates from bariatric surgeries fell from 10.5 percent to 7.6 percent. The risks of obesity itself may outweigh the risks from bariatric surgery.
Length of Procedure: Most bariatric surgery procedures are done under general anesthetic and will take a few hours. Your hospital stay after surgery depends on the type of procedure and any immediate complications, but expect to stay for several days.
Preparation: Before weight-loss surgery, patients may need to follow a specific diet, have lab tests and physical exams performed, and possibly start on an exercise and diet plan.
Recovery: After surgery, patients need to follow specific dietary restrictions. You may need to avoid any food for a few days, start on liquids, and slowly progress to solid food. You can expect several follow-up appointments to ensure your surgery was successful and to check for complications. With an adjustable gastric band procedure, patients will need follow-up appointments to check whether the band needs to be adjusted.
Weight Loss Expectations: While bariatric surgery can be a highly effective treatment option for patients struggling with obesity, achieving long-term weight loss and improved health requires lifestyle changes after surgery. Many patients lose a dramatic amount of weight very quickly, and then gain some of it back. Average weight loss varies depending on the type of bariatric surgery, with some procedures resulting in a 60-70 percent loss of excess weight.
Clinical Trials for Bariatric Surgery
Clinical trials help further research and data about bariatric surgery, resulting in safer, more effective procedures. They help researchers track surgery outcomes, identify potential risk factors, and learn more about how bariatric surgery works.
Prospective bariatric surgery patients who might be interested in participating in a clinical trial can find a list of available trials here.
When You’re Ready For Change
If you’re considering bariatric surgery, it’s important to find the right team to guide you through your weight loss journey. At My New Beginning, a department of City Hospital at White Rock, our qualified team is here to support you in learning more about bariatric surgery, selecting the right surgery type, and going through the preparations, procedure, and recovery. Contact us today to schedule a consultation.