Which Weight Loss Procedure Is Right for You
Bariatric surgery has helped millions of people lose weight. For some individuals, it is a literal lifesaver, helping them get dangerous weight-related conditions like type 2 diabetes and severe sleep apnea under control.
There are several types of weight loss surgery, which are collectively referred to as bariatric surgery. Bariatric surgery changes the anatomy of your digestive system by restricting the amount of food your stomach can hold, reducing the absorption of nutrients, or both.
Ahead, we’ll look at who is a candidate for bariatric surgery, different kinds of weight loss surgery, what steps you must take before and after surgery, and why choosing the right bariatric surgeon is so important.
Who Qualifies for Bariatric Surgery?
Weight loss surgery is usually only an option after you have tried non-surgical weight loss procedures, such as losing weight on your own through diet and exercise, and/or a medical weight loss program. If you meet one of the following criteria, you may be a candidate for weight loss surgery:
- Your body mass index is 40 or higher (extreme obesity)
- Your BMI is 35 or higher, and you have a weight-related health issue like type 2 diabetes, severe sleep apnea, or high blood pressure (hypertension)
- Your BMI is between 30 and 34, and you have a serious weight-related condition, such as uncontrolled type 2 diabetes
On its own, being severely overweight doesn’t automatically qualify you for weight loss surgery. It’s vital to understand the risks and lifestyle changes that will be necessary before and after surgery—you will not be able to eat the same way you did before surgery, and, depending on the type of surgery, you may need to take vitamin supplements for life.
You will also be required to see your doctor regularly after surgery to monitor your nutrition, lifestyle and behavior, and any medical conditions.
Your weight loss doctor will ask you these and other questions to determine whether bariatric surgery is right for you:
- Have you made serious attempts at losing weight in other ways (diet and exercise)?
- What are your expectations after the surgery; are they realistic?
- Are you committed to seeing your doctor and a dietician regularly?
- Are you prepared to accept the risks that come with surgery?
Risks of Bariatric Surgery: All surgeries come with risks, and this includes bariatric surgery. Risks associated with weight-loss surgery can include infection at the surgical site, leaks of your gastrointestinal system, excessive bleeding, blood clots, adverse reactions to anesthesia, and even death (very rare).
Depending on the type of surgery you have, longer-term risks and complication can include dumping syndrome—sudden nausea, vomiting, or diarrhea caused by food or liquid entering the small intestine too rapidly. Gallstones, ulcers, malnutrition, bowel obstruction, hernias, and low blood sugar are among the other possible risks and complications of weight loss surgery.
It’s important to note that, while these complications are possible, the benefits of weight loss surgery generally outweigh the risks. Your weight loss doctor will discuss the risks of surgery with you in detail.
Different Types of Bariatric Surgery
Weight loss surgery is either restrictive (limits the amount of food you can eat), or malabsorptive (reduces the number of nutrients your body can absorb); some are both. Each type of surgery has its pros and cons, which your weight loss doctor can help you understand.
- Sleeve gastrectomy (gastric sleeve): A restrictive surgery in which a large portion of the stomach is removed, gastric sleeve surgery reduces the size of the stomach by an average of 75%. The surgeon creates a much smaller stomach pouch, shaped like a sleeve or banana; this greatly restricts how much you can eat at any one time.
Sleeve gastrectomy is a minimally invasive surgery performed laparoscopically through 4-5 small incisions in the abdomen. The surgeon sends a camera and very small surgical tools through the incisions to perform the surgery. The smaller incisions help reduce blood loss during surgery and pain after surgery.
Gastric sleeve surgery does not impair your body’s ability to absorb nutrients; rather, it restricts the amount of food you can eat. Your smaller stomach pouch will also produce less hunger hormone (ghrelin), which can help you maintain better control over food intake. Most patients lose an average of 70% of their excess weight within 6-12 months, and many will experience complete resolution of weight-related medical conditions like sleep apnea or type 2 diabetes.
- Gastric Bypass (Roux-en-Y): A common weight loss surgery, gastric bypass is both restrictive and malabsorptive. In this procedure, the surgeon cuts across the top of the stomach, creating a much smaller stomach pouch (around the size of a chicken egg) that is then connected to the small intestine below the remaining larger stomach pouch.
The larger stomach pouch remains and continues to produce digestive juices, which then flow into the small intestine.
The much smaller stomach pouch becomes the only part of the stomach to receive food, which greatly restricts how much you can eat or drink.
Since food travels through a smaller portion of the small intestine after Roux-en-Y surgery, fewer nutrients are absorbed (malabsorption). This is why it’s necessary for people who have undergone gastric bypass surgery to take bariatric supplements in order to get all the nutrients they need.
The average patient will lose 70-80% of their excess weight within 6-12 months with Roux-en-Y gastric bypass surgery. Many patients experience complete resolution of weight-related conditions after surgery.
- Gastric banding (Lap Band): Gastric banding is a restrictive procedure in which the surgeon places an inflatable saline silicon band around the upper part of the stomach. When the band is inflated (using a needle), it tightens the stomach like a belt, separating the stomach into two parts: a smaller upper pouch, and a larger lower pouch.
The upper pouch limits the amount of food you can eat, and the band can be adjusted to restrict more or less food. Because gastric banding is a relatively simple procedure, it surged in popularity about 10 years ago. Weight loss is typically slower with gastric
banding, however, and, in the last 5-8 years, many reports have shown higher than expected complications and failure rates. 1
For this reason, many surgeons have opted to discontinue performing gastric banding procedures. People who have complications, such as recurrent nausea, regurgitation, acid reflux, cough, or chest pain, may be candidates for lap band revision surgery.
- Biliopancreatic diversion with duodenal switch: Commonly referred to as “duodenal switch surgery,” biliopancreatic diversion is another type of gastric bypass surgery. It is more complex and involves removing about 80% of the stomach and making more complicated bypasses. Like Roux-en-Y surgery, the duodenal switch procedure is both restrictive and malabsorptive. While it’s a very effective surgery, it also has more risks and is generally only used for people who have a body mass index of 50 or more.
Which Weight Loss Procedure Is Right for You?
Your bariatric surgery team will take many factors into account when evaluating which surgery type is right for you, including:
- Your age and BMI: Your BMI will determine in part which surgery is most appropriate, and age is a factor when determining risk. Generally, surgery becomes riskier the older you get, and bariatric surgery in people under age 18 may not be appropriate.
- Your physical health: Some conditions, such as blood clots, liver disease, heart problems, and kidney stones, can increase the risk of surgery. Your doctor will ask you about what medications you take, whether you smoke, and how much alcohol you consume. Your doctor will also perform a thorough physical exam and order any needed lab tests, all of which will help determine your eligibility for weight loss surgery.
- Your nutrition and weight history: Your doctor will review past weight loss attempts, eating and exercise habits, and your stress level.
- Your psychological health: Certain mental health conditions, such as depression, substance abuse, and anxiety disorders can make it more difficult to maintain a healthy weight after bariatric surgery. While such a condition may not disqualify you as a surgery candidate, your doctor may want to postpone surgery until these conditions are appropriately treated and managed.
- Your level of motivation: This is a big factor, as your willingness and ability to follow the recommendations made by your doctor and change your lifestyle after surgery will be critical to your success.
Steps You Must Take Before Surgery
Once you’re approved for bariatric surgery, your health care team will provide you with instructions and guidance on how to prepare in the weeks and months before surgery. This may include:
- Restrictions on what and how much you can eat or drink
- Undergoing lifestyle counseling to help you cope with the diet and exercise changes that will be necessary after surgery
- Quitting smoking
- Cutting back on or eliminating alcohol consumption
- Starting a supervised exercise program
Some people may be required to lose a certain amount of weight before the procedure to reduce the likelihood of complications during surgery. Your doctor will determine whether you are psychologically and medically ready for surgery and if you have made the required changes in your eating and exercise habits prior to surgery. It’s also important to have a strong support group of family and friends in place to provide encouragement and emotional support.
Choosing the Right Doctor
It’s vital to choose an experienced surgeon with a long-term track record of safety and success. Ideally, your doctor will have performed hundreds, if not thousands, of bariatric surgeries. Choose a doctor who takes a comprehensive approach to weight-loss surgery and who provides continued follow-up care after surgery. The doctor you choose should have experience handling complex cases, (such as gastric bypass revision) resulting from previous bariatric surgeries.
Take Control of Your Weight and Your Health
If obesity is negatively affecting your health and quality of life, Bariatric Care Centers can help. Dr. Brian Mirza MD, FACS is a highly skilled weight loss surgeon who has been performing bariatric surgery in Houston for more than 15 years. He is board-certified, with fellowship training in laparo-endoscopic and laparoscopic bariatric surgery from the world-renowned Cleveland Clinic Foundation. Dr. Mirza has performed thousands of safe and successful bariatric surgeries, and he provides comprehensive care to each and every one of his patients.
Call Bariatric Care Centers to learn more about bariatric surgery and to find whether you are a candidate for gastric bypass surgery or surgery for gastric sleeve in Houston. View our gallery of before and after pictures, learn more about paying for surgery, and read testimonials from our patients.
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