Obesity is a widespread health concern affecting numerous individuals. Bariatric surgery presents a potentially life-altering solution for those struggling with class III obesity. It is crucial to consider that losing weight and maintaining a healthy weight is a lifelong venture. Proper nutrition, exercise, and other lifestyle modifications are essential for a successful and long-lasting outcome.
Understanding Bariatric Surgery
Weight-loss surgery, also called metabolic and bariatric surgery, is an operation that makes changes to the digestive system. These terms are used in order to reflect the impact of these operations on patients’ weight and the health of their metabolism (breakdown of food into energy). These operations also have an ability to prevent future health problems. The goal of these operations is to modify the stomach and intestines to treat obesity and related diseases. The operations may make the stomach smaller and also bypass a portion of the intestine. This results in less food intake and changes how the body absorbs food for energy resulting in decreased hunger and increased fullness.
Who Qualifies for Bariatric Surgery?
Bariatric surgery isn't for everyone who is severely overweight. You may need to meet certain medical guidelines to qualify for weight-loss surgery. Bariatric surgery requirements begin with establishing a diagnosis of class III obesity. That means that you either:
- Have a BMI of 40 or higher. The Body Mass Index (BMI) is a way of estimating how much body fat you have based on your height-to-weight ratio. A score of 40 or higher is associated with a high risk of related diseases. It usually equates to about 100 lbs. overweight.
- Have a BMI of at least 35 and at least one related health problem. A BMI of 35 without a related health problem is considered class II obesity.
The criteria are slightly higher for adolescents. An adolescent may be a candidate if they have:
- BMI of at least 40 and an obesity-related medical condition.
- BMI of at least 35 and a severe obesity-related medical condition.
While BMI is easily measured, you may have to take some medical tests to diagnose your obesity-related health conditions.
Read also: Diet Before Bariatric Surgery
Debunking Myths about Bariatric Surgery
It's important to dispel common misconceptions surrounding bariatric surgery:
- That surgery is a last resort. Bariatric surgery is the most effective long-term treatment for class III obesity. When studied scientifically, diet and exercise - alone or in combination with medications - are much less effective over the long term.
- That surgery is the “easy way out.” Bariatric surgery can be thought of as a tool that allows a healthy diet and lifestyle to lead to sustained weight loss. Often, patients have made these changes before without long-term success. Surgery allows those changes to be effective.
Preparing for Bariatric Surgery
If you qualify for bariatric surgery, your health care team gives you instructions on how to prepare for your specific type of surgery. Before scheduling your bariatric surgery, your healthcare provider will want to ensure that you’re physically and mentally fit for the surgery. You’ll meet with a team of specialists who will counsel you about the risks and benefits while evaluating your physical and mental health.
You may need to have lab tests and exams before surgery. You may have limits on eating and drinking and which medicines you can take. You also may need to prepare by planning for your recovery after surgery. If you use tobacco, drugs or excessive alcohol, you’ll be required to quit before qualifying for surgery. Your healthcare team can help you with this.
Your surgeon may also ask you to follow a pre-bariatric surgery diet for a few weeks to prepare for your operation. This is to reduce the fat inside your abdomen, where the operation will take place, making the operation safer and reducing the risk of complications. Your surgeon will give you specific guidelines to follow.
How Bariatric Surgery is Performed
Today, most types of bariatric surgery are performed laparoscopically. A laparoscope is a small, tube-shaped instrument with a camera attached. The laparoscope is inserted through small cuts in the belly. The tiny camera on the tip of the laparoscope allows the surgeon to see and operate inside the abdomen without making the traditional large cuts. Weight loss surgery is usually performed through minimally invasive methods (laparoscopic surgery). That means small incisions, faster healing and less pain and scarring than you would have with traditional open surgery. Surgery usually takes several hours. After surgery, you awaken in a recovery room, where medical staff watches you for any complications.
Read also: Bariatric Surgery Outcomes
Types of Bariatric Surgery
Each type of bariatric surgery has pros and cons. Be sure to talk to your doctor about them. The common procedures endorsed by the American Society for Metabolic and Bariatric Surgery are listed and explained below. Each surgery has its own advantages and potential drawbacks. Some weight-loss procedures limit how much you can eat. Others work by reducing the body's ability to absorb fat and calories.
Restrictive Surgeries
Restrictive surgery reduces the size of the stomach, helping you eat less and feel full quicker.
Laparoscopic Sleeve Gastrectomy
The Laparoscopic Sleeve Gastrectomy, often called the “sleeve”, is performed by removing approximately 80% of the stomach. With sleeve gastrectomy, about 80% of the stomach is removed, leaving a long, tube-like pouch. This smaller stomach can't hold as much food. This may be because it’s a relatively simple procedure that's safe to perform on most people with little risk of complications. The gastrectomy simply removes a large portion of your stomach - about 80% - leaving behind a small, tubular portion, like a sleeve. This naturally reduces the amount of food you can consume in one sitting and makes you feel fuller faster.
The new stomach holds less food and liquid helping reduce the amount of food (and calories) that are consumed. By removing the portion of the stomach that produces most of the “hunger hormone”, the surgery has an effect on the metabolism. It decreases hunger, increases fullness, and allows the body to reach and maintain a healthy weight as well as blood sugar control. Advantages to this procedure include significant weight loss and no rerouting of the intestines.
Adjustable Gastric Band
The Adjustable Gastric Band is a device made of silicone that is placed around the top part of the stomach to limit the amount of food a person can eat. It has been available in the United States since 2001. The impact on obesity related diseases and long-term weight loss is less than with other procedures. The feeling of fullness depends upon the size of the opening between the pouch and the rest of the stomach. The opening size can be adjusted with fluid injections through a port underneath the skin. Food goes through the stomach normally but is limited by the smaller opening of the band.
Read also: Is Bariatric Surgery Right for You?
Malabsorptive Surgeries
Other procedures reduce the body's ability to absorb fat and calories.
Roux-en-Y Gastric Bypass
The Roux-en-Y Gastric Bypass, often called the “gastric bypass”, has now been performed for more than 50 years and the laparoscopic approach has been refined since 1993. It is one of the most common operations and is very effective in treating obesity and obesity related diseases. This procedure is the most common method of gastric bypass. This surgery is typically not reversible. With this procedure, your small intestine will end up in that form. First, surgeons create a small pouch at the top of your stomach, separating it from the lower portion with surgical staples. The surgeon cuts across the top of the stomach, sealing it off from the rest of the stomach. The resulting pouch is about the size of a walnut and can hold only about an ounce of food. Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch. Food goes into this small pouch of stomach and then directly into the small intestine sewn to it, bypassing most of the stomach and the first section of the small intestine. Then they divide your small intestine and bring the new segment up to connect to the stomach pouch. Food will now flow through the new, smaller stomach and lower segment of your small intestine, bypassing the rest. This restricts how much your stomach can hold and also how much nutrition your small intestine can absorb. Restricting the small intestine makes this method more effective than gastric restriction alone.
First, the stomach is divided into a smaller top portion (pouch) which is about the size of an egg. The small intestine is also divided and connected to the new stomach pouch to allow food to pass. The gastric bypass works in several ways. Like many bariatric procedures, the newly created stomach pouch is smaller and able to hold less food, which means fewer calories are ingested. Additionally, the food does not come into contact with the first portion of the small bowel and this results in decreased absorption. Most importantly, the modification of the food course through the gastrointestinal tract has a profound effect to decrease hunger, increase fullness, and allow the body to reach and maintain a healthy weight. The impact on hormones and metabolic health often results in improvement of adult onset diabetes even before any weight loss occurs. The operation also helps patients with reflux (heart burn) and often the symptoms quickly improve.
Biliopancreatic Diversion with Duodenal Switch (BPD-DS)
The Biliopancreatic Diversion with Duodenal Switch, abbreviated BPD-DS, begins with creation of a tube-shaped stomach pouch similar to the sleeve gastrectomy. This is a two-part surgery usually performed in one setting. This is the original version of the duodenal switch, an operation that combines a sleeve gastrectomy with an intestinal bypass. (It sometimes goes by a shorter name: Gastric Reduction Duodenal Switch). It’s similar to the Roux-en-Y gastric bypass but more extreme. This operation bypasses most of your small intestine - about 75%. During the second step, the surgeon closes off the middle section of the intestine and attaches the last part directly to the first part of the small intestine, called the duodenum. This is the duodenal switch. The separated section of the intestine isn't removed from the body. Instead, it's reattached to the end of the intestine, allowing bile and pancreatic digestive juices to flow into this part of the intestine.
The smaller stomach, shaped like a banana, allows patients to eat less food. The food stream bypasses roughly 75% of the small intestine, the most of any commonly performed approved procedures. This results in a significant decrease in the absorption of calories and nutrients. Patients must take vitamins and mineral supplements after surgery. Even more than gastric bypass and sleeve gastrectomy, the BPD-DS affects intestinal hormones in a manner that reduces hunger, increases fullness and improves blood sugar control. This surgery both limits how much you can eat and reduces the absorption of nutrients.
Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy (SADI-S)
Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). The Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy, referred to as the SADI-S is the most recent procedure to be endorsed by the American Society for Metabolic and Bariatric Surgery. During the second step of the SADI-S procedure, a section of the small intestine known as the duodenum is closed off just below the new stomach sleeve. This opening below the new stomach is then connected to a part of the lower small intestine called the ileum. A loop of intestine is measured several feet from its end and is then connected to the stomach. When the patient eats, food goes through the pouch and directly into the latter portion of the small intestine. The food then mixes with digestive juices from the first part of the small intestine. The bypass routes food through only about 10 feet of the small intestine, instead of the usual 25. This allows enough absorption of vitamins and minerals to maintain healthy levels of nutrition.
Revisional Surgery
In some cases, weight loss surgery leads to complications. In others, it does not achieve the desired result, despite the patient’s commitment to maintaining post-surgical lifestyle changes. Revisional surgery addresses complications or failures from prior bariatric procedures.
Life After Bariatric Surgery
After weight-loss surgery, you generally won't be allowed to eat for 1 to 2 days so that your stomach and digestive system can heal. Then, you'll follow a specific diet for a few weeks. The diet begins with liquids only, then to pureed and very soft foods, and eventually, to regular foods. You'll also have frequent medical checkups to monitor your health in the first several months after weight-loss surgery.
Postoperative Care
During the first year after your surgery, your healthcare provider will see you regularly for follow-up visits and testing. They will take metabolic blood tests to monitor how your health is improving and screen for any nutritional deficiencies.
Body Contouring
After the first year, if you're in good health and have lost a lot of weight, you may want to discuss body contouring options with your healthcare provider. Body contouring can help remove excess skin folds and tighten loose tissues.
Expected Weight Loss
Gastric bypass and other bariatric surgeries can provide long-term weight loss. The amount of weight you lose depends on the type of surgery and your change in lifestyle habits. Most people - about 90% - lose about 50% of their excess weight after bariatric surgery, and keep it off. Different procedures have slightly different results. The average weight loss after gastric bypass is about 70% of excess body weight. After a duodenal switch, it’s about 80%. Weight loss after sleeve gastrectomy ranges between 30% and 80%.
When Weight-Loss Surgery Doesn't Work
Gastric bypass and other weight-loss surgeries don't always work as well as you might have hoped. It's also possible to not lose enough weight or to regain weight after any type of weight-loss surgery, even if the procedure itself works correctly. Keep all of your scheduled follow-up appointments after weight-loss surgery. If you notice that you are not losing weight or have complications, see your doctor immediately.
Nonsurgical Weight Loss Options
Nonsurgical weight loss should be the beginning of your weight loss journey.
Obesity Medicine Program
The TGH+USF Health Obesity Medicine Program is designed to educate and empower individuals who are committed to losing weight and improving their health. We offer a structured approach that incorporates nutrition planning, physical activity, lifestyle changes and medical guidance, making it an excellent option for those who struggle to lose weight on their own. This program is also well-suited for patients who are not eligible for bariatric surgery, prefer a less invasive option or want to explore conservative weight loss methods before considering surgical intervention.
Medical Weight Management Clinic
Medical Weight Management Clinic - intensive medical treatment for obesity.
Prescription Medications
Work by regulating hormones that control appetite. Are available by prescription only.
The Importance of a Holistic Approach
Bariatric surgery is part of a holistic approach to health and wellness. Proper nutrition, portion control, and an exercise regimen are crucial to making surgery a success.
Finding a Bariatric Program
When you are ready to begin your weight loss journey, we encourage you to register for a free hour-long bariatric surgery information session, where you can ask questions and learn more about our programs.
Multidisciplinary Team
Successful bariatric surgery requires a team-based approach including your surgeon, dietitian, psychologist, nurse case manager, and obesity medicine specialist who will focus on taking you through each step of the journey.
Comprehensive Care
Patients will do better if they continue to eat healthy, engage in physical activity, keep their appointments with obesity medicine providers, and take vitamins and mineral supplements as instructed. Your bariatric care team will provide you with lifelong support to succeed and maintain a permanent healthy lifestyle including changes to your diet and regular physical activity.
tags: #bariatric #weight #loss #program #information