Obesity is a complex condition influenced by a multitude of factors, not simply overeating and a lack of self-control. Weight loss surgery, also known as bariatric surgery, is a treatment option for individuals struggling with severe obesity. While it's a potentially life-changing procedure, it's often surrounded by misconceptions. This article aims to dispel common myths and provide a clear understanding of the facts surrounding weight loss surgery.
What is Bariatric Surgery?
Bariatric surgery involves procedures that alter the digestive system to limit food intake or reduce nutrient absorption. These surgeries are effective in maintaining long-term weight loss because they change the body’s natural responses to dieting. Unlike dieting alone, weight loss surgery causes biological changes that help reduce food intake. Energy intake is decreased with surgery by restricting stomach size and limiting absorption. Weight loss surgery also changes the production of certain gut hormones that communicate with the brain to reduce hunger, decrease appetite, and enhance the feeling of being full.
Common Types of Bariatric Surgery
In the early days, doctors often performed gastric band surgery, which sections off the stomach with an adjustable band. Today, the most common procedures are:
- Sleeve Gastrectomy: Reduces the stomach to roughly the size of a banana.
- Laparoscopic Gastric Bypass: Connects a tiny section of the stomach to a later section of the small intestine, bypassing the majority of the stomach and some of the small intestine.
Dispelling the Myths
Let's address some common misconceptions about weight loss surgery:
Myth #1: It’s the easy way out.
Reality: Bariatric surgery is not a shortcut. It's a tool that requires significant commitment and effort from the patient. Preparation for surgery often takes four to six months and includes multiple assessments and appointments with doctors, a dietician, and an exercise physiologist.
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Patients undergo rigorous medical evaluations, nutritional counseling, and psychological assessments before surgery. Post-operatively, they must commit to lifelong changes in diet, activity, and follow-up care. As one patient stated, “Anyone who thinks this is the easy way out should understand what we go through.”
Myth #2: It’s all about diet and exercise; surgery is unnecessary.
Reality: Diet and exercise are important, but they may not be enough for individuals with severe obesity. The National Institutes of Health (NIH) Expert Panel stated that, without surgery, long-term weight loss is nearly impossible for those affected by severe obesity. When people lose weight through dieting alone, the body compensates through biological changes, including increased appetite and slower metabolism. Studies show little long-term success with diet and exercise alone. Bariatric surgery helps you not only lose weight, but keep it off.
Myth #3: Bariatric surgery is dangerous.
Reality: While any surgery carries risks, modern bariatric procedures, especially those performed laparoscopically, are safer than ever. The mortality rate of bariatric surgery can be comparable to gallbladder surgery. Minimally invasive laparoscopic procedures reduce complications and recovery time.
A recent study of 209,116 patients found the risk of death from weight loss surgery was 0.16%, or approximately 1 in 600. This rate is considerably less than most other surgeries, including gallbladder and hip replacement surgery. Large studies find that the risk of death from any cause is considerably less for patients after weight loss surgery than for those who have severe obesity and have never had the surgery. Patients who have weight loss surgery have a reduction in their risk of death by 40%. Death related to diabetes is reduced by more than 90% and from heart disease by more than 50% for patients after weight loss surgery.
Myth #4: The weight will come back.
Reality: While a small group of people may regain weight due to unhealthy lifestyle choices, long-term studies have shown that more patients have kept the weight off 10 years after the procedure compared to patients who lost weight without surgery. In many practices, greater than 70% of patients are still successful after 5 years. Long-term success depends on the patient’s commitment and the support system around them.
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About 30% of weight loss surgery patients regain much of the weight they lost within five years of surgery. That means an estimated 70% maintain their weight loss.
Myth #5: Bariatric surgery is only for individuals with extremely high BMIs.
Reality: Many candidates with obesity-related health issues, such as diabetes, high blood pressure, or sleep apnea, may qualify even if their BMI isn’t extremely high. Typically, physical, psychological, and lifestyle evaluations will be done to determine if you are a good candidate for bariatric surgery before a program will accept you as a patient.
Myth #6: After surgery, patients can eat whatever they want.
Reality: Patients must follow a strict dietary plan to avoid complications and support weight loss. Right after bariatric surgery, your diet will be limited to liquids and soft or pureed food as you recover. Eventually, you will be able to eat a variety of normal foods, but your diet will not look like what it did before surgery.
Myth #7: Bariatric surgery will fix all health problems.
Reality: While surgery often improves or resolves conditions like type 2 diabetes, hypertension, and sleep apnea, it doesn’t automatically fix all health issues. Bariatric surgery is not going to cure everything that ails you. It is about moving from an unhealthy or at-risk health state to an improved health state, which means an improved quality of life.
Myth #8: I will see results right away.
Reality: You will not wake up from surgery with weight loss. You will start to see results about three to six months after bariatric surgery. Most weight loss happens in the first eight to 12 months after surgery, regardless of the patient's lifestyle habits. That's what some doctors call the honeymoon period. Unfortunately, the hormonal effects of surgery diminish over time.
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Myth #9: I will never be able to eat normal food again.
Reality: There's a learning curve with diet after bariatric surgery. Eventually, you will be able to eat a variety of normal foods, but your diet will not look like what it did before surgery. Bariatric surgery emphasizes portion control. Many people find success with smaller, more frequent meals focusing on protein. That does not mean that you cannot incorporate the foods you love in moderation as part of a balanced diet.
Myth #10: Bariatric surgery is a cosmetic procedure.
Reality: Although many people view bariatric surgery as a cosmetic procedure, the truth is surgical weight loss saves lives. Bariatric surgery is metabolic surgery. Yes, it helps with weight reduction, but its real power lies in how it transforms health.
Benefits of Bariatric Surgery
Bariatric surgery can lead to significant improvements in health and quality of life. These include:
- Significant and sustained weight loss: Following bariatric surgery, patients can lose anywhere from 30 to 65 percent of excess body weight.
- Improved health conditions: Bariatric surgery often improves or resolves conditions like type 2 diabetes, hypertension, sleep apnea, and joint pain. Nearly 90% of people with sleep apnea end up with complete resolution of their disease after bariatric surgery, and patients with diabetes end up with lower blood sugar and fewer diabetes-related complications than those who don't undergo the procedure.
- Reduced mortality: Studies report a nearly 90% reduction in premature death from all causes after surgical weight loss, as well as dramatic drops in deadly diseases such as diabetes, hypertension, and heart disease. Patients who have weight loss surgery have a reduction in their risk of death by 40%.
- Enhanced quality of life: Weight loss can dramatically enhance your appearance.
Important Considerations
- Pregnancy: Patients who have weight loss surgery are advised not to become pregnant in the first two years after surgery. After surgery, there is much less risk of experiencing problems during pregnancy and during childbirth. Kids born after mom’s surgery are LESS at risk of being affected by obesity later, due to activation of certain genes during fetal growth. Birth control pills do NOT work as well in patients who are overweight. Birth control pills are not very reliable during the time your weight is changing.
- Nutrient Deficiencies: Some forms of bariatric surgery can change the way the body absorbs vitamins and minerals, and deficiencies can happen. This side effect is preventable by using supplements after surgery. Weight loss surgery can lead to reduced amounts of vitamins and minerals because people eat less and may absorb less in the intestines. Fortunately, nutrient deficiencies following surgery can be easily avoided with a good diet and the use of supplements including vitamins, minerals, and sometimes protein supplements. Before and after surgery, patients are advised of the appropriate diet and vitamin supplement needed. Most weight loss surgery programs also require patients to have their vitamins and minerals checked on a regular basis after surgery.
- Psychological and Emotional Changes: There are many changes that can develop as a result of weight loss after surgery. Those changes can be psychological or emotional, or may even change someone’s personality. After surgery, most patients have improved mental health but there may be a small increase in the risk of suicide. For this reason, comprehensive bariatric programs require psychological evaluations prior to weight loss surgery. Many programs have therapists available for patient counseling after surgery.
- Alcohol Use: A small percentage of weight loss surgery patients report having problems with alcohol after surgery. Alcohol sensitivity is increased after weight loss surgery so that the effects of alcohol are felt with fewer drinks than before surgery. Studies also find that with certain weight loss procedures (such as the gastric bypass or sleeve gastrectomy), drinking an alcoholic beverage increases blood alcohol to levels that are considerably higher than before surgery or in comparison to the alcohol levels of individuals who have not had a weight loss procedure.
Exercise After Bariatric Surgery
The key is to start slow. Listen to your body and your surgeon. Most patients also think of exercise as something that must be intense and painful (like “boot camp”). Regular, modest activity is far more useful in the long term. Instead, work with your surgeon’s program to find a variety of activities that can work for you. There is no “one-size-fits-all” plan.
Pre-Operative Diet
Many bariatric surgeons put their patients on a special pre-operative diet, usually 2 or 3 weeks just before surgery. The reason for the pre-operative diet is to shrink the liver and reduce fat in the abdomen. Some insurance companies require a physician-monitored diet three to six months prior to surgery as part of their coverage requirement.
Is Bariatric Surgery Right for You?
Bariatric surgery is a powerful tool, but it's not a magic wand. It requires a lifelong commitment to healthy lifestyle changes. If you're considering weight loss surgery, it's essential to consult with a qualified bariatric surgeon and undergo a thorough evaluation to determine if you're a suitable candidate.
Bariatric surgery is for people who have had an 'a-ha' moment where they have realized they can't lose weight on their own and need help. People with obesity are at an increased risk for many cancers as well. Have tried many diet and exercise programs through which they have lost weight and gained it back, bouncing from a lower body mass index (BMI) to a higher one. Have a BMI in the 40 to 50 range.
Insurance Coverage
There are several insurance companies that do cover these procedures. Insurance coverage varies from state to state and company to company. Typically, a patient would need to meet certain requirements for insurance to cover the surgery.