Who doesn’t want to look and feel awesome? Loads of us eat healthy and make the gym our second home. But here’s the kicker: there are many who put in the work, follow their meal plans to the letter, and clock in hours of exercise but still can’t shake off those stubborn pounds.
If that is the case, you may want to consider weight loss surgery as an option. But before doing so, there are also many things you may wish to consider. Are you eligible for weight loss surgery? What weight loss surgery type is best for you? Are you ready to change your lifestyle after surgery? Do you have the resources to undergo such a procedure? What should you expect after undergoing surgery? These are just some of the questions that you should get answers to before you do decide to go through with weight loss surgery.
Bariatric surgery is another name for weight loss surgery or stomach surgery for weight loss. There are several types of bariatric surgery procedures available which are carried out by board-certified bariatric surgeons who guide patients before, during and after the procedure. Most often, it provides important benefits to people who are unable to reach their weight goals through traditional methods of diet and exercise (1).
Bariatric surgery operations help you lose weight by altering and making changes to your digestive system. Operations include making your stomach smaller, limiting how the amount of food you can eat and water you can drink at the same time so that you will feel fuller soon, changing your small intestines, thus reducing the number of calories your body can absorb, or affecting hormones and bacteria in your gastrointestinal tract to reduce appetite and hunger and improve your how your body metabolizes fats (2).
Before any patient becomes eligible for bariatric surgery, candidates are screened to ensure that they are healthy enough to undergo the procedure and that they are committed to maintaining a healthy lifestyle of diet and exercise after the surgery to maintain their weight (3).
Additionally, to be considered for bariatric surgery, a candidate must:
Normally younger teens don’t usually undergo weight loss surgery unless they are extremely obese. (4) Similarly, if you only stand to lose a small amount of weight or haven’t tried diet and exercise programs yet, weight loss surgery is probably not right for you (1).
According to the National Institutes of Health (NIH), weight loss or bariatric surgery could cost between $15,000 to $25,000, or even more, depending on the type of surgery would undergo, whether you have surgery-relation complications, the place where you would undergo surgery, and the amount your medical insurance will pay (2).
Some programs like Medicare and Medicaid might cover the major types of bariatric surgeries provided that you have a health care professional’s recommendation, and you are able to pass certain criteria. Some insurers require you to use surgeons and facilities approved by them. Others would require you to show that you unsuccessfully tried to lose weight by a non-surgical weight loss program (2).
The total cost of weight loss surgery will include more than just the actual procedure. Apart from this, there are also costs for pre-surgery appointments and consultations as well as for aftercare, including any special food your bariatric surgeon may require and any follow-up surgery to address complications as well as cosmetic procedures to manage loose skin (1).
Restrictive surgeries shrink the size of the stomach and slow down digestion. A normal stomach can expand to hold up to 3 pints of food. Directly after the surgery, your stomach may be able to hold as little as one ounce, which could later increase to 2 or 3 ounces. Because of a smaller stomach, you are only able to eat a lesser amount of food. The less food you eat, the more weight you lose (5).
Malabsorptive/restrictive surgeries combine both malabsorptive and restrictive surgeries. Not only is your stomach made smaller but they also bypass or remove parts of your digestive tract, making it harder for the body to absorb calories (5).
This is the newest of the three techniques. What it does is to effect weight loss by interrupting nerve signals between the brain and the stomach (5).
This is a malabsorptive/restrictive surgery which is done in three steps. First, your bariatric surgeon staples your stomach and creates a small pouch in the upper section. Because of the staples, your stomach will become much smaller, thus making you eat less and feeling fuller soon.
Second, your small intestine is divided into two parts, with the lower part being attached directly to the small stomach pouch. This will lead to your body absorbing fewer calories because food will now bypass most of your stomach as well as your small intestine’s upper part.
Lastly, the upper part of your small intestine is reconnected to a farther location down your small intestine’s lower part. Gastric bypass changes the hormones, bacteria and other substances in your gastrointestinal tract, thereby affecting appetite and metabolism (6).
Pros: Weight loss results occur fast. About 50% of the results can be seen within 6 months from surgery and results may continue to occur for up to 2 years. Because of the rapid decline in weight, other weight-related conditions such as high blood pressure, diabetes, heartburn, etc. often get better as well (5).
Cons: The way your body absorbs food changes, and you might not get enough nutrients. This means you always have to be very particular and careful with your diet and you may need to continuously take supplements (5). Gastric bypass is also very difficult to reverse, although it can be done if medically necessary (6).
Another risk of gastric bypass is what is known as the “dumping syndrome”, which means that food is dumped from the stomach to the intestines too quickly before it can be properly digested. In fact, about 85% of patients who undergo gastric bypass experience some form of dumping (5).
This is a type of restrictive surgery and it involves your bariatric surgeon placing a silicone inflatable band around the upper part of your stomach to create a small pouch. This band limits the amount of food a person’s stomach can hold and makes you feel full after only eating a small amount of food (6).
Gastric banding can be adjusted, meaning the amount of food your stomach can hold can be altered by your bariatric surgeon through adjusting the band’s tightness around the stomach (7). To tighten the band, and therefore make the stomach smaller, the bariatric surgeon injects more saline solution to the band. On the other hand, to loosen the band and increase stomach size, the bariatric surgeon uses a needle and removes the saline solution from the band (5).
Out of all the three most common weight loss surgery procedures, the laparoscopic adjustable gastric band or the lap-band is the only FDA-approved procedure for those with a BMI between 30 to 34.9 (7).
Pros: This type of procedure is simpler and safer than gastric bypass. It leaves a smaller scar and heals easily. Further, the band can be removed if it is not working or if it causes problems (5).
Cons: It often does not lead to dramatic weight loss as compared to other procedures and, over the years, the patient is more likely to regain some of the weight. Complications with the band can also happen. It can slip out of place, become too loose or leak (5).
This is another type of restrictive surgery. It involves removing most of your stomach, leaving only a narrow tube or sleeve which connects to the intestine. Through this, the amount of food your stomach can hold is reduced, making your feel full sooner (5).
Pros: It is less risky compared to other surgeries because it is a simpler operation. Thus, it may be the best way to lose weight for those who are very obese or sick. Sleeve gastrectomy also does not affect your intestines and how your body absorbs food. This means that you are less likely to fall short on nutrients. (5)
Cons: Most of your stomach is permanently removed and this procedure cannot be reversed (6).
This is done by implanting an electronic device near the stomach where it is attached to the vagus nerve. The electronic device is operated by a remote control and sends regular impulses to block hunger signals between the brain and the body, signaling that the stomach is full. (1, 5).
Pros: It is the least invasive weight loss surgery procedure. The procedure is outpatient and takes only about one and a half hour while the patient is under general anesthesia (5).
Cons: The battery could completely run out and your doctors have to reprogram it. Possible side effects include vomiting, nausea, chest pains and swallowing problems, among others (5).
Before the surgery, you will meet with several health care professionals who will ascertain your fitness for the procedure. These include internists, dietitians, psychiatrists or psychologists, and bariatric surgeons (6).
The internist will determine your physical fitness for the procedure. He will ask about your medical history, conduct a thorough physical exam and order several tests. The dietitian will advise you on life after surgery, including what food and how much you can eat and drink after surgery. The psychiatrist or psychologist will determine your readiness to deal with the challenges of weight loss surgery. Lastly, your bariatric surgeon will tell you more about the specifics of the procedure you are about to undergo and advise you how to prepare for it (6).
The most important thing to think about after surgery is to rest and recover. After a few days, ask your doctor for advice on what physical activities you can do. You can probably slowly start doing some light physical activities like walking and moving around your house. As you start feeling better, you can also add more physical activities that you can do (6).
After surgery, you will have to start eating on a liquid diet. After several weeks, you can then transition to a pureed soft solid food diet including cheese, soup, or yogurt. Ask your bariatric surgery team’s dietitian on what liquids and soft foods are best for you during this time. Gradually, you can start bringing in other foods to your diet such as meat, bread, fruits, vegetables and rice, depending on the advice of your bariatric surgery team’s dietitian (8).
As your stomach is now smaller than before and it may only have a small opening, you should also expect to change your eating habits and to learn a new way to eat and drink. The small opening can be blocked by food so there is the need to be more careful now with how you eat. Make sure to eat slowly and in small meals. Chew food well and opt for softer foods. Always take vitamins and supplements regularly. Lastly, always follow the personal diet plan prepared for you by your bariatric team’s dietitian (8).
Additionally, there are certain types of food that you should start avoiding post-surgery. These include sugary foods and drinks as well as excessive oils and fats, all of which could slow down your weight loss or cause weight gain. You should also avoid drinking alcohol since it contains many calories but no nutrients. Smoking and taking non-steroidal anti-inflammatory drugs (NSAIDs) on a regular basis must also be avoided since they could cause an ulcer at the bottom of the stomach pouch after gastric bypass (8).
This is probably the question most people want to find out. Well, there is actually no straightforward answer. How much weight is lost depends on the patient and the type of procedure the patient underwent. However, one study has found that people who underwent gastric bypass, adjustable gastric banding, and sleeve gastrectomy lost between 38 to 87 pounds after 1 year from the procedure. While most people who underwent bariatric surgery regained weight overtime, this regained weight was small compared to their initial weight loss (6).
Out of the three procedures discussed above, gastric bypass produced the most dramatic weight loss results. However, it is also the one with the most complications among the three (6).
Further, reaching the desired weight goal depends not only on the surgery but also on the individual’s healthy lifestyle habits thereafter (6).
One of the most important decisions that you have to make when undergoing a weight loss surgery is the choice of your bariatric surgeon. Your bariatric surgeon will be the one guiding you before, during and after the operation (1).
This means that you have to look for a board-certified bariatric surgeon with expertise and specialized experience in the specific type of procedure that you plan to undergo. Luckily, there are medical organizations online from which you could inquire and which could help you find the right bariatric surgeon for you (1).
Before choosing a bariatric surgeon, there are some of the things you might want to keep in mind. Remember that a bariatric surgeon does not work alone. Make sure that you go to a comprehensive bariatric center where your bariatric surgeon has other experts that he could closely work with, including registered internists, dietitians, psychologists, and therapists. Further, you might want to see a bariatric surgeon that is not too far away from home. This way should any complications arise, it would be faster and easier to reach your doctor and it would not entail travelling long distances to get much needed care (1).
Choosing to undertake weight loss surgery is a tough decision to make. Weight loss surgeries will significantly alter not just your digestive tract but your eating habits as well.
Moreover, there are several factors that you may need to take into consideration, including eligibility, costs, physical and mental readiness, as well as the choice of bariatric surgeon and the type of procedure, before finally undergoing weight loss surgery.
Lastly, you should always remember that the journey does not end post-surgery. A commitment to a new and healthier lifestyle is required so as to maintain your desired weight and the benefits derived from the procedure.
(1) https://www.verywellfit.com/weight-loss-procedures-4156991
(2) https://www.niddk.nih.gov/health-information/weight-management/bariatric-surgery/definition-facts
(3) https://www.upmc.com/services/south-central-pa/bariatrics/surgery/choose/decision
(4) https://www.webmd.com/diet/obesity/surgery-for-you#1
(5) https://www.webmd.com/diet/obesity/weight-loss-surgery-making-the-choice#5
(6) https://www.niddk.nih.gov/health-information/weight-management/bariatric-surgery/types
(7) https://www.osfhealthcare.org/blog/what-are-the-three-different-types-of-weight-loss-surgery/
(8) https://www.fairview.org/sitecore/content/Fairview/Home/Patient-Education/Articles/English/a/f/t/e/r/After_Gastric_Bypass_Nutrition_Guidelines_40910#:~:text=After%20surgery%2C%20your%20stomach%20can,to%20plan%20your%20meals%20carefully
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