Metabolic/bariatric surgery (MBS) stands as the most effective intervention for individuals grappling with morbid obesity and related health issues like type 2 diabetes. The procedure not only facilitates substantial short-term weight loss but also supports the maintenance of a healthier body weight over the long term, significantly enhancing the patient's quality of life and extending life expectancy.
The Growing Problem of Obesity
Obesity, characterized by a body mass index (BMI) exceeding 30 kg/m², has been on a steady rise globally. Statistics from the Organisation for Economic Co-operation and Development indicate an increase from 21% in 2010 to 24% in 2016 among adults over 30, with projections estimating further increases by 2030. This escalating prevalence of obesity and its associated diseases is expected to reduce life expectancy by 0.9 to 4.2 years, depending on the country.
Bariatric Surgery: A Ray of Hope
MBS has emerged as the undisputed champion in the fight against morbid obesity and its comorbidities. Clinical trials consistently demonstrate that surgical treatments yield significantly better weight loss outcomes compared to medical interventions. Moreover, MBS leads to marked improvements or complete resolution of obesity-related conditions such as type 2 diabetes, dyslipidemia, and hypertension. The durability of these results, with lower body weights maintained for decades, underscores the life-changing potential of MBS.
Realistic Expectations: The Key to Success
It is crucial for patients to have a clear understanding of the expected outcomes of bariatric procedures to make well-informed decisions about undergoing surgery. Weight loss is typically the primary concern for individuals considering MBS and a key metric for healthcare providers. Patients seek realistic expectations regarding the amount of weight they can lose, while healthcare professionals need to monitor progress and provide timely interventions for those not meeting their weight loss goals or experiencing weight regain.
Variables Influencing Weight Loss
Weight loss following MBS is influenced by several clinical variables, including initial body mass index, age, gender, ethnicity, and the type of surgical procedure performed.
Read also: Diet Before Bariatric Surgery
Initial BMI
Preoperative BMI significantly influences weight loss outcomes. Studies have shown a correlation between initial BMI before surgery and final BMI after surgery. Patients with a higher initial BMI may lose more kilograms but still end up with a higher BMI compared to those with a lower starting point.
Age
Age at the time of surgery also plays a role. Some studies indicate that younger patients tend to experience greater and more prolonged BMI decreases compared to older individuals. Older patients may exhibit smaller weight loss and a higher tendency for weight regain in the long term.
Gender
Gender is another factor that might affect weight loss outcomes. Some studies suggest that women tend to have higher %EWL than men after bariatric procedures. However, other research indicates that being a woman might be an unfavorable predictor of weight loss in some cases.
Ethnicity
Ethnicity can also impact postoperative weight loss. Studies have revealed differences in weight loss outcomes among various ethnic backgrounds. For instance, weight loss after RYGB has been observed to be highest in Caucasians and lowest in non-Hispanic Black patients.
Type 2 Diabetes
Type 2 diabetes is often associated with poorer weight loss outcomes after MBS. Some studies have found that diabetes is independently associated with poor weight loss, especially in those using insulin before surgery.
Read also: Bariatric Surgery Outcomes
Mental Health Conditions
Mental health conditions, particularly those related to eating behaviors, can also influence weight loss after MBS. While findings have been inconsistent, some studies suggest that preoperative binge eating disorder may attenuate long-term weight loss after MBS.
Type of Surgery
The type of surgery chosen has a crucial impact on weight loss outcomes. While SG and RYGB may produce comparable weight loss in the early postoperative period, differences tend to emerge over time, with RYGB often leading to more sustained weight loss.
Understanding Weight Loss Reporting Systems
To accurately interpret the literature on weight loss after MBS, it's essential to understand the commonly used reporting systems. These include:
- Percentage of Excess Weight Loss (%EWL): Calculated from the excess weight beyond the ideal body weight.
- Percentage of Excess BMI Loss (%EBMIL): Similar to %EWL, but based on BMI.
- Percentage of Total Weight Loss (%TWL): Represents the percentage of total body weight lost.
Weight Loss Calculators: Predicting Your Potential
Weight loss calculators are invaluable tools that provide personalized estimates of expected weight loss after bariatric surgery. These calculators consider various clinical variables to generate realistic outcomes for patients.
How Calculators Work
Bariatric surgery weight loss calculators estimate results based on information a patient provides to their healthcare provider. The information includes prior health history, and the calculation includes the type of surgery, demographic data, and comorbidities, to provide personalized outcomes about expected weight loss at 1, 2, and 3 years and about the resolution rate of comorbidities.
Read also: Weight Loss Guide Andalusia, AL
What Calculators Estimate
These calculators are designed to provide estimates based on various factors including height, weight, and the type of procedure that is going to be performed.
- Estimated Weight Loss: The calculator gives an estimate of how much weight a patient should expect to lose after their procedure.
- Procedure Comparison: Since we provide the option to choose different procedures on our calculator you are able to see which procedure will likely lead to the most amount of weight loss.
- Motivation: When patients see the possibilities for their weight loss they are more likely to embark on the journey.
Important Considerations
It's important to recognize that calculator estimates are not guarantees. Actual weight loss may vary, and the remission of comorbidities cannot be assured. Factors such as individual commitment to lifestyle changes, adherence to dietary guidelines, and consistent physical activity all play a significant role in determining the ultimate success of bariatric surgery.
Types of Bariatric Surgery and Expected Weight Loss
Different bariatric procedures offer varying degrees of weight loss. Here's an overview of some common procedures and their typical weight loss timelines:
Vertical Sleeve Gastrectomy (VSG)
In VSG, a significant portion of the stomach (80-85%) is removed, leaving a smaller, vertical pouch. This restriction limits food intake, increases sensitivity to satiety hormones, and reduces the production of hunger hormones.
- Weight Loss Expectations: Patients can expect to lose almost as much weight as gastric bypass patients while still having a more "normal" diet post-operatively.
- 12 Months: Patients can shed 23.4% of their baseline weight or 63% of their excess weight.
- 3 Years: Patients can expect to lose at least 50% of their excess weight.
- More Than 4 Years: Patients normally lose 17.8% of their total body weight or 43.0% of their excess weight.
Roux-en-Y Gastric Bypass
Gastric Bypass involves separating 90% of the stomach to create a small, walnut-sized pouch, which is then connected to the small intestine, bypassing a large portion of the digestive tract. This combination of restriction and malabsorption leads to sustainable weight loss.
- Weight Loss Expectations: Shedding weight is a result of less food consumption and fewer calories getting absorbed into the body. The rate of weight loss is fast and effective in halting obesity-related comorbidities like type 2 diabetes and cardiovascular disease.
- Less Than a Year: Gastric bypass patients can lose 60 to 80% of their excess weight on average.
- 3 to 5 Years: RNY patients have reported 30% of their total body weight reduced.
- 10 Years: Patients maintain a consistent loss of 28.6% of their total body weight.
Mini Gastric Bypass
The Mini Gastric Bypass (MGB) combines techniques from the gastric sleeve and traditional gastric bypass procedures. It involves creating a smaller stomach pouch and connecting it to a lower portion of the small intestine.
Duodenal Switch (DS)
The Duodenal Switch is designed for patients who need aggressive weight loss and have exceptionally high BMIs (over 45). It involves both restriction and malabsorption.
- Weight Loss Expectations:
- Within the First Year: 84% of DS patients lose at least 50% of their excess body weight and up to 80%+.
- Over 2 Years: Patients usually lose 60% to 80% of their excess body weight.
- 3 Years After Surgery: 84.2% of these patients maintain this weight loss.
Adjustable Gastric Band (LAP-BAND)
The Gastric Band involves placing an adjustable silicone ring around the upper part of the stomach, creating a small pouch. This slows down the digestive process and promotes a feeling of fullness.
- Weight Loss Expectations: The lap-band weight loss results are almost half as effective as other procedures.
- After the 1st Year: Gastric band patients are expected to lose 20% to 60% of excess body weight.
- By the 5th Year After the Surgery: 46% of excess weight loss.
- 10 Years After Surgery: Patients maintain 65% of excess weight loss.
Gastric Balloon
The Gastric Balloon involves placing a temporary balloon in the stomach to take up space and reduce food intake.
- Weight Loss Expectations:
- Within 6 Months (Orbera): 30-47% excess weight loss is expected when it is removed.
- By 6 Months (Spatz): 26.4% excess weight loss.
- After 12 Months (Spatz): 48.8% excess weight loss when it is removed.
Maximizing Your Weight Loss Success
Bariatric surgery is a powerful tool, but it requires commitment to lifestyle changes for effective and long-lasting weight loss. Key adjustments include dietary modifications, medical follow-up, and adherence to recommended guidelines.
Lifestyle Changes
- Dietary Adjustments: Transitioning from a liquids-only diet to solid foods while readjusting to their new, lower appetites and food consumption.
- Vitamin Supplements: Bariatric patients will also have to take vitamin supplements and avoid certain medications based on their needs and doctor’s orders.