Bariatric surgery is a type of weight-loss surgery that involves making changes to the digestive system to help lose weight. It is done when diet and exercise haven’t worked or when serious health problems are the cause of weight gain. Some procedures limit how much food to eat. Other procedures work by reducing the body’s ability to absorb nutrients. Some procedures do both.

All forms of weight-loss surgery are serious procedures that come with potential risks and side effects. To make sure the surgery is successful in the long term, it is recommended to make permanent healthy changes to diet and lifestyle, and to also get regular exercise.

What Are the Surgical Options?

There is no one surgery that is best for everyone trying to lose weight. It depends on many factors that should be discussed with a doctor.

Biliopancreatic diversion with duodenal switch

The first part of this two-part surgery is similar to a sleeve gastrectomy. The second part involves connecting the end of the intestine to the duodenum near the stomach, bypassing most of the intestine.

This surgery will help you to eat less and also absorb fewer nutrients. Although it is very effective, it does come with greater risks, such as malnutrition and vitamin deficiencies.

There are pros and cons to each type of bariatric surgery. It is important to talk to your doctor about them before making a decision. The most common types of bariatric surgery are: Here’s a look at common types of bariatric surgery:

Gastric Sleeve

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. The 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 hormones or bacteria in the gastrointestinal system that affect appetite and metabolism. This type of surgery is not reversible.

Gastric Bypass

Second, the small intestine is divided and reconnected to the small stomach pouch. Part of the small intestine is reattached to the lower part of the small intestine, bypassing the section where most food absorption takes place. This decreases the amount of calories and nutrients your body absorbs from food. Third, the surgeon reconnects the remaining section of the small intestine to the large intestine. Gastric bypass surgery is performed in three steps. First, the surgeon staples the patient’s stomach, creating a small pouch in the upper section. This decreases the size of the stomach, so the patient feels full sooner and eats less. Second, the small intestine is divided and reconnected to the small stomach pouch. Part of the small intestine is reattached to the lower part of the small intestine, bypassing the section where most food absorption takes place. This decreases the amount of calories and nutrients the patient’s body absorbs from food. Third, the surgeon reconnects the remaining section of the small intestine to the large intestine.

Next, the surgeon cuts your small intestine in half and connects the lower part directly to your small stomach pouch. By doing this, food will bypass most of your stomach and the upper part of your small intestine, meaning that your body will absorb fewer calories.

The surgeon reconnects the upper part of the small intestine to a new location lower down on the small intestine. This allows digestive juices to flow from the bypassed part of the small intestine to the lower part of the small intestine, so that food can be fully digested. The bypass changes hormones, bacteria, and other substances in the gastrointestinal tract, which may affect appetite and metabolism. Gastric bypass is difficult to reverse, but a surgeon may do it if medially necessary.

Adjustable Gastric Band

This type of surgery works by the surgeon placing a ring with an inner inflatable band around the top stomach area. This then creates a small pouch. The gastric band is similar to gastric bypass surgery and gastric sleeve surgery in that it makes you feel full after eating a small amount of food. The inner band has a circular balloon inside which is filled with saline solution. The surgeon can adjust the inner band by injecting or removing the saline solution through a small device, called a port, which is placed under your skin.

You will need to have several follow-up visits after surgery 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.

The gastric band surgery is not as popular in the United States as the gastric sleeve or gastric bypass because it is more likely to cause complications, especially the need to remove the band due to intolerance. Gastric band surgery also usually causes less weight loss and more complications, mostly the need to remove the band because of intolerance.

Why It’s Done

The purpose of bariatric surgery is to help with weightloss and to reduce the risks of obesity related health problems. These health problems can be life threatening and include conditions such as: Bariatric surgery is done to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, including:

  • Heart disease and stroke
  • High blood pressure
  • Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
  • Sleep apnea
  • Type 2 diabetes

This type of surgery is usually only done after you have tried to lose weight through improving your diet and exercise habits.

Who It’s For

You have a BMI above 30 with no other health problems, Your BMI is above 35 with other health problems, You are unable to lose weight by other means, You are willing to commit to long-term changes in your eating and exercise habits. Bariatric surgery could be an option for you if you fit any of the following descriptions: -You have a BMI above 30 with no other health problems -Your BMI is above 35 with other health problems -You are unable to lose weight by other means -You are willing to commit to long-term changes in your eating and exercise habits In general, bariatric surgery could be an option for you if:

  • Your body mass index (BMI) is 40 or higher (extreme obesity).
  • Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure, or severe sleep apnea. In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems.

Weight-loss surgery may be an option for people who are severely overweight and who meet certain medical guidelines. The screening process for weight-loss surgery is extensive, and people who are considering the surgery must be willing to make permanent changes to their lifestyle.

You may be required to participate in long-term follow-up plans that include monitoring your nutrition, your lifestyle and behavior, and any medical conditions you have.

It is important to remember that bariatric surgery can be costly. You should check with your health insurance plan or your regional Medicare or Medicaid office to see if your policy covers this type of surgery.

The best weight-loss surgery for you depends on your specific situation. Your surgeon will take many factors into account, including body mass index, eating habits, other health issues, previous surgeries, and the risks involved with each procedure.

How Is the Surgery Performed?

Weight-loss surgery is mostly done laparoscopically, which only requires small cuts, under general anesthesia. Through these incisions, the surgeon can insert thin tools and a small scope attached to a camera which projects images onto a video monitor. Laparoscopic surgery has fewer risks than open surgery and may cause less pain and scarring. Recovery may also be faster with laparoscopic surgery.

Open surgery, which involves making a single, large incision in the abdomen, may be a better option than laparoscopic surgery for certain people. You may need open surgery if you are very obese, have had stomach surgery before, or have other complex medical problems.

What Should I Expect Before Surgery?

You will first meet with several health care professionals, such as an internist, a dietitian, a psychiatrist or psychologist. After this, you will then meet with a bariatric surgeon to discuss your surgery options.

The internist will question you about your medical history, give you a physical exam, and request blood tests. If you’re a smoker, you may improve your surgery results by quitting smoking at least six weeks in advance.

The dietician will tell you what and how much you can eat and drink after surgery, and help you get used to the changes in your life after surgery.

A psychiatrist or psychologist will assess you to determine if you are prepared to face the challenges of weight-loss surgery.

The surgeonLet me know about the surgery, for example how to get ready for it and what kind of aftercare you will require.

Health care professionals will give you suggestions to improve your health before and after surgery. This includes becoming more active and eating healthier. If you lose weight and lower your blood sugar levels, you’re less likely to have surgery-related issues.

Some weight-loss surgery programs have groups you can attend before and after surgery to help answer questions about the surgery and offer support. These groups can be a helpful resource for patients as they navigate their weight-loss journey.

What Should I Expect After Surgery?

You will need to rest and take it easy after surgery, but walking and moving around may help you recover more quickly. Check with your health care professional first to see what kind of physical activity is safe for you, and start slowly. You can gradually add more physical activity as you feel better.

If you have surgery, you will not be able to eat for one to two days so that your stomach and digestive system can heal. Then, you will follow a specific diet for a few weeks. The diet begins with liquids only, then progresses to pureed, very soft foods, and eventually to regular foods. You may have restrictions or limits on how much and what you can eat and drink.

In addition to regular medical checkups, you may also need laboratory testing, blood work, and various exams in the first few months after weight-loss surgery.

After surgery, you will likely be started on a liquid diet. This diet will gradually transition to soft foods over the course of several weeks, and eventually you will be able to eat solid foods again. Your health care professional will give you guidance on which foods and beverages you can have and which ones to avoid. Diet following surgery will require small meals and chewing food well, and you may need to take dietary supplements prescribed by your health care professional to ensure you’re getting enough vitamins and minerals.

How Much Weight Can I Expect to Lose?

According to one study, people who had weight-loss surgery lost an average of 38 to 87 pounds after one year. The most common procedures are gastric bypass, gastric sleeve, and gastric banding. Gastric bypass typically results in greater weight loss, but has more complications associated with it. Most people regain some of the weight they lose over time, but it is usually a small amount in comparison to how much they initially lost.

The amount of weight you lose after surgery could be different from someone else. It is important to remember that having surgery is only part of the equation, and that maintaining healthy lifestyle habits is essential to achieving your goal weight.

Risks

There are potential health risks associated with bariatric surgery, both in the short term and long term.

Risks associated with the surgical procedure can include: Risks associated with the surgical procedure can include:

  • Excessive bleeding
  • Infection
  • Adverse reactions to anesthesia
  • Blood clots
  • Lung or breathing problems
  • Leaks in your gastrointestinal system
  • Death (rare)

Weight gain The risks and complications of weight-loss surgery vary depending on the type of surgery. Some of these risks and complications include weight gain. They can include:

  • Bowel obstruction
  • Dumping syndrome, which leads to diarrhea, flushing, lightheadedness, nausea, or vomiting
  • Gallstones
  • Hernias
  • Low blood sugar (hypoglycemia)
  • Malnutrition
  • Ulcers
  • Vomiting
  • Acid reflux
  • The need for a second, or revision, surgery, or procedure
  • Death (rare)

Results

Gastric bypass surgery and other types of weight-loss surgery can help you lose a lot of weight and keep it off in the long term. The amount of weight you lose after surgery depends on the type of surgery you have and how well you stick to healthy lifestyle habits. Some people are able to lose half or more of their excess weight within two years.

Conditions often related to being overweight which may improve or resolve after gastric bypass surgery include: weight loss, resolution of obesity-related health conditions, and improved quality of life. In addition to weight loss, gastric bypass surgery may improve or resolve conditions often related to being overweight, including:

  • Heart disease
  • High blood pressure
  • Obstructive sleep apnea
  • Type 2 diabetes
  • Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
  • Gastroesophageal reflux disease (GERD)
  • Osteoarthritis (joint pain)

The surgery can help you with your routine activities, making your life better.

When Weight-Loss Surgery Doesn’t Work

If a weight-loss procedure doesn’t help you lose weight or stops working, you could have health problems.

Weight loss surgery is a big decision and you need to make sure you are committed to the follow-up appointments and process. If you aren’t seeing the results you want or you start to experience complications, reach out to your doctor right away. They will be able to help you track your progress and see what might be holding you back from even more success.

Even if the weight-loss surgery itself is successful, it’s possible to not lose enough weight or to regain weight. This can happen if you don’t follow the recommended lifestyle changes, such as getting regular physical activity and eating healthy foods.

 

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Rhoda is an award-winning dietitian, mature age model, and CEO of Sayvana Women.  

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