Bariatric weight loss surgery is a serious and life-altering decision. Anyone thinking about surgery needs a full understanding of what is involved, including the associated personal responsibilities, medical risks and the probability of success.
These are some of the most frequently asked questions about weight loss surgery:
How does bariatric surgery promote weight loss?
Bariatric Banding promotes weight loss by closing off parts of the stomach so that it holds less food, meaning you can only eat very small quantities of food at one time. Operations that solely reduce stomach size are known as restrictive operations because they restrict the amount of food the stomach can hold.
Another kind of weight loss surgery, Bypass Surgery, combines stomach restriction with a partial bypass of the small intestine. Regarded as malabsorptive operations, these procedures create a direct connection from the stomach to the lower segment of the small intestine, literally bypassing portions of the digestive tract that previously absorbed more of the calories and the nutrients in food.
What are the benefits of weight-loss surgery?
A majority of patients lose weight quickly and continue to lose for 18 to 24 months after weight-loss surgery. Although most patients regain five to 10 percent of the weight they lost, many maintain a long-term weight loss of approximately 100 pounds or more.
Surgery improves most severe obesity-related conditions. For example, studies have shown that blood sugar levels of 83 percent of obese patients with diabetes returned to normal after surgery.
What are the risks of weight loss surgery?
While different techniques carry different risks, there are many risks common to all kinds of weight surgeries.
- Abdominal hernia is the most frequently occurring complication requiring follow-up surgery, though laparoscopic techniques have reduced this problem.
- Some patients may develop gallstones, clumps of cholesterol and other matter that form in the gallbladder. Taking supplemental bile salts for the first six months after surgery can help prevent them, but be sure to talk to your doctor first.
- Patients may develop nutritional deficiencies such as anemia, osteoporosis and metabolic bone disease. Fortunately, these deficiencies can usually be avoided with sufficient vitamin and mineral intakes.
- Women of childbearing age who have weight loss surgery should avoid pregnancy until their weight stabilizes because rapid weight loss or nutritional deficiencies could harm a developing fetus.
- Less common complications include breakdown of the staple line and stretched stomach outlets.
What is laparoscopy?
In laparoscopy, the surgeon makes one or more small incisions through which slender surgical instruments are passed. This technique eliminates the need for a large incision and creates less tissue damage. It is usually less painful and allows for a more rapid recovery.
What are the surgical options?
There are two main types of weight loss surgery: restrictive and malabsorptive operations. While similar, each approach offers varied benefits and risks.
Malabsorptive operations, or gastric bypass, restrict both food intake and the amount of calories and nutrients the body absorbs. Roux-en-Y gastric bypass (RGB) is the most common and successful technique. The surgeon creates a small stomach pouch to limit food consumption, then attaches a segment of the small intestine to the new stomach so food bypasses the lower stomach and other areas of the digestive tract.
Malabsorptive operations can produce greater weight loss than restrictive operations, and are considered more effective in reversing the serious health problems associated with severe obesity. Patients who have malabsorptive operations generally lose two-thirds of their excess weight within two years.
At the same time, they carry more risks than restrictive surgery, including increased risk for:
- nutritional deficiencies.
- anemia in menstruating women
- osteoporosis and metabolic bone disease
- "dumping syndrome," caused by stomach contents moving too rapidly through the small intestine
Patients require close monitoring and lifelong adherence to special diets, supplements and medications.
Restrictive operations, or gastric banding, severely limit food intake without otherwise interfering with the normal digestive process. A hollow, adjustable band is placed around the upper stomach to create a small pouch and narrow passage into the lower portion of the stomach. As a result, the patient loses the ability to eat anything but very small amounts of food at any one time.
Although restrictive operations lead to weight loss in about 80 percent of patients, they are less successful than malabsorptive operations in achieving substantial, long-term weight loss. Successful results depend on the patient's willingness to adopt a long-term plan of healthy eating and regular physical activity.
Common risks of restrictive operations include: vomiting, caused by the small stomach being overly stretched by too much food or food that has not been sufficiently chewed; band slippage; and saline leakage.
What is body mass index (BMI)?
Body mass index (BMI) is a measure of body weight relative to height. BMI can be used to determine if you are at a healthy weight, overweight or obese. To figure out BMI, use the following formula:
A BMI of 18.5 to 25 represents a healthy weight, a BMI of 25 to 30 indicates you are overweight, and a BMI of 30 or higher signifies obesity.
Click here to use our interactive BMI Calculator.
What does weight loss surgery cost?
Bariatric surgical costs vary, depending on the hospital, surgeon and procedure. Medical insurance coverage also varies by state and insurance provider. If you are considering weight loss surgery, you will need to contact your insurance company to find out if the procedure is covered under your plan. Your surgeon's office will assist you in obtaining the necessary insurance authorization.
Source: NIDDK: Gastrointestinal Surgery for Severe Obesity