Weight Loss Surgery
Also called: Bariatric surgery, Bypass surgery, Gastric banding, Obesity surgery
Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you cannot lose weight through diet and exercise or have serious health problems caused by obesity.
There are different types of weight loss surgery. They often limit the amount of food you can take in. Some types of surgery also affect how you digest food and absorb nutrients. All types have risks and complications, such as infections, hernias, and blood clots.
Many people who have the surgery lose weight quickly, but regain some weight later on. If you follow diet and exercise recommendations, you can keep most of the weight off. You will also need medical follow-up for the rest of your life.
Who is a Candidate for Bariatric Surgery?
Bariatric surgery is an option if you have severe obesity and have not been able to lose enough weight to improve your health using other methods or have serious obesity-related health problems. The surgery makes the stomach smaller and sometimes changes the small intestine.
Qualifications for bariatric surgery in most areas include:
1. BMI ≥ 40, or more than 100 pounds overweight.
2. BMI ≥ 35 and at least one or more obesity-related co-morbidities such as type II diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.
3. Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts.
Types of Bariatric Surgery
- laparoscopic adjustable gastric band
- gastric sleeve surgery, also called sleeve gastrectomy
- gastric bypass
Surgeons use a fourth operation, biliopancreatic diversion with duodenal switch, less often.
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Laparoscopic Adjustable Gastric Band
In this type of surgery, the surgeon places a ring with an inner inflatable band around the top of your stomach to create a small pouch. This makes you feel full after eating a small amount of food. The band has a circular balloon inside that is filled with salt solution. The surgeon can adjust the size of the opening from the pouch to the rest of your stomach by injecting or removing the solution through a small device called a port placed under your skin.
After surgery, you will need several follow-up visits to adjust the size of the band opening. If the band causes problems or is not helping you lose enough weight, the surgeon may remove it.
Pro
- Can be adjusted and reversed
- Short hospital stay and low risk of surgery-related problems.
- No changes to intestines
- Lowest chance of vitamin shortage
Cons
- Less weight loss than other types of bariatric surgery
- Frequent follow-up visits to adjust band; some people may not adapt to band
- Possible future surgery to remove or replace a part or all of the band system
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In gastric sleeve surgery, also called vertical sleeve gastrectomy, a surgeon removes most of your stomach, leaving only a banana-shaped section that is closed with staples. Like gastric band surgery, this surgery reduces the amount of food that can fit in your stomach, making you feel full sooner. Taking out part of your stomach may also affect gut hormones or other factors such as gut bacteria that may affect appetite and metabolism. This type of surgery cannot be reversed because some of the stomach is permanently removed.
Pro
- Greater weight loss than gastric band
- No changes to intestines
- No objects placed in body
- Short hospital stay
Cons
- Cannot be reversed
- Chance of vitamin shortage
- Higher chance of surgery-related problems than gastric band
- Chance of acid reflux
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Gastric Bypass
Gastric bypass surgery, also called Roux-en-Y gastric bypass, has two parts. First, the surgeon staples your stomach, creating a small pouch in the upper section. The staples make your stomach much smaller, so you eat less and feel full sooner.
Next, the surgeon cuts your small intestine and attaches the lower part of it directly to the small stomach pouch. Food then bypasses most of the stomach and the upper part of your small intestine so your body absorbs fewer calories. The surgeon connects the bypassed section farther down to the lower part of the small intestine. This bypassed section is still attached to the main part of your stomach, so digestive juices can move from your stomach and the first part of your small intestine into the lower part of your small intestine. The bypass also changes gut hormones, gut bacteria, and other factors that may affect appetite and metabolism. Gastric bypass is difficult to reverse, although a surgeon may do it if medically necessary.
Pro
- Greater weight loss than gastric band
- No objects placed in body
Cons
- Difficult to reverse
- Higher chance of vitamin shortage than gastric band or gastric sleeve
- Higher chance of surgery-related problems than gastric band
- May increase risk of alcohol use disorder
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Duodenal Switch
This surgery, also called biliopancreatic diversion with duodenal switch, is more complex than the others. The duodenal switch involves two separate surgeries. The first is similar to gastric sleeve surgery. The second surgery redirects food to bypass most of your small intestine. The surgeon also reattaches the bypassed section to the last part of the small intestine, allowing digestive juices to mix with food.
This type of surgery allows you to lose more weight than the other three. However, this surgery is also the most likely to cause surgery-related problems and a shortage of vitamins, minerals, and protein in your body. For these reasons, surgeons do not perform this surgery as often.
Does bariatric surgery always work?
Studies show that many people who have bariatric surgery lose about 15 to 30 percent of their starting weight on average, depending on the type of surgery they have. However, no method, including surgery, is sure to produce and maintain weight loss. Some people who have bariatric surgery may not lose as much as they hoped. Over time, some people regain a portion of the weight they lost. The amount of weight people regain may vary. Factors that affect weight regain may include a person’s level of obesity and the type of surgery he or she had.
Bariatric surgery does not replace healthy habits, but may make it easier for you to consume fewer calories and be more physically active. Choosing healthy foods and beverages before and after the surgery may help you lose more weight and keep it off long term. Regular physical activity after surgery also helps keep the weight off. To improve your health, you must commit to a lifetime of healthy lifestyle habits and following the advice of your health care providers.
Bariatric Surgery Benefits
What are the benefits of bariatric surgery?
Bariatric surgery can help you lose weight and improve many health problems related to obesity. These health problems include:
- type 2 diabetes
- high blood pressure
- unhealthy cholesterol levels
- sleep apnea
- urinary incontinence
- body pain
- knee and hip pain
You may be better able to move around and be physically active after surgery. You might also notice your mood improve and feel like your quality of life is better.
Who is a good adult candidate for bariatric surgery?
SBariatric surgery may be an option for adults who have:
- a body mass index (BMI) of 40 or more, OR
- a BMI of 35 or more with a serious health problem linked to obesity, such as type 2 diabetes, heart disease, or sleep apnea
- a BMI of 30 or more with a serious health problem linked to obesity, for the gastric band only
Having surgery to lose weight is a serious decision. If you are thinking about having bariatric surgery, you should know what’s involved. Your answers to the following questions may help you decide if surgery is an option for you:
- Have you been unable to lose weight or keep it off using nonsurgical methods such as lifestyle changes or drug treatment?
- Do you understand what the operation involves and its risks and benefits?
- Do you understand how your eating and physical activity patterns will need to change after you have surgery?
- Can you commit to following lifelong healthy eating and physical activity habits, medical follow-up, and the need to take extra vitamins and minerals?
