For individuals grappling with severe obesity, bariatric surgery, also known as weight-loss surgery, presents a potentially life-changing option. When diet and exercise have proven ineffective, or when weight-related health problems become serious, bariatric surgery may be considered. These procedures work by either restricting the amount of food the stomach can hold or by reducing the body's ability to absorb calories and nutrients. While offering significant benefits, it's crucial to understand that all forms of weight-loss surgery are major procedures with inherent risks and potential side effects.
Qualifying for Bariatric Surgery
Bariatric surgery isn't a universal solution for everyone struggling with excess weight. Specific medical guidelines must be met to qualify. Generally, candidates for bariatric surgery:
- Have a Body Mass Index (BMI) of 40 or higher, typically equating to being approximately 100 pounds overweight. 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.
- Have a BMI between 35 and 39.9 (obesity) accompanied by a serious weight-related health problem such as type 2 diabetes, high blood pressure, or severe sleep apnea.
Adolescents may be candidates 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.
An extensive screening process is typically required to determine eligibility. It's also important to consider the significant expense associated with bariatric surgery.
Preparing for Bariatric Surgery
If you meet the criteria for bariatric surgery, your healthcare team will provide detailed instructions on how to prepare for the specific procedure. This preparation may include:
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- Lab tests and medical examinations.
- Restrictions on eating and drinking.
- Adjustments to medications.
- Planning for post-surgery recovery.
- Adopting a healthy eating plan.
- Increasing physical activity.
It may be necessary to follow a pre-bariatric surgery diet for a few weeks to reduce fat inside the abdomen, making the operation safer and reducing the risk of complications.
What to Expect During Bariatric Surgery
Bariatric surgery is performed in a hospital setting under general anesthesia. The specifics of the surgery depend on the individual's situation, the type of weight-loss surgery chosen, and the practices of the hospital and surgeon.
Surgical Approaches
- Laparoscopic Surgery: Most bariatric surgeries are performed laparoscopically. This minimally invasive technique involves small incisions through which a laparoscope (a thin, tube-shaped instrument with a camera) and other specialized tools are inserted. The camera allows the surgeon to view and operate inside the abdomen without the need for large incisions. Laparoscopic surgery has fewer risks than open surgery and may cause less pain and scarring.
- Open Surgery: In some cases, traditional open surgery, involving a larger incision in the abdomen, may be necessary. Open surgery may be a better option than laparoscopic surgery for certain people.
Surgery typically takes several hours. After the procedure, patients are monitored in a recovery room for any complications.
Types of Bariatric Surgery
Several types of bariatric surgery are available, each with its own advantages and disadvantages. It's crucial to discuss these options thoroughly with your doctor to determine the most suitable choice for your individual needs.
Common Bariatric Procedures
- Roux-en-Y Gastric Bypass: This is the most common type of gastric bypass surgery and is generally not reversible. The surgeon creates a small pouch at the top of the stomach, separating it from the rest of the stomach. The resulting pouch, about the size of a walnut, can hold only about an ounce of food. The surgeon then cuts the small intestine and connects a part of it directly to the pouch. This allows food to bypass most of the stomach and the first section of the small intestine. The bypass changes hormones, bacteria, and other substances in the gastrointestinal tract that may affect appetite and metabolism. This rerouting of the food results in some bigger hormonal changes, which gives the patients a higher average weight loss and also a bigger impact on blood sugar.
- Sleeve Gastrectomy: In this procedure, approximately 80% of the stomach is removed, leaving a long, tube-like pouch. This smaller stomach restricts the amount of food that can be consumed. Advantages include significant weight loss and no rerouting of the intestines. Taking out part of your stomach may also affect hormones or bacteria in the gastrointestinal system that affect appetite and metabolism.
- Biliopancreatic Diversion with Duodenal Switch (BPD/DS): This two-part surgery is typically performed in one setting. First, a sleeve gastrectomy is performed. Then, the surgeon closes off the middle section of the intestine and attaches the last part directly to the first part of the small intestine (the duodenum). The separated section of the intestine is reattached to the end of the intestine, allowing bile and pancreatic digestive juices to flow into that section. This surgery limits food intake and reduces nutrient absorption. This type of surgery allows you to lose more weight compared with the other three operations described above. However, it is also the most likely to cause surgery-related problems and a shortage of vitamins, minerals, and proteins in your body.
- Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S): This procedure involves a sleeve gastrectomy followed by connecting the duodenum to a part of the lower small intestine called the ileum. The bypass routes food through approximately 10 feet of the small intestine, instead of the usual 25 feet.
- Adjustable Gastric Band: A band is placed around the upper part of the stomach to create a small pouch. The inner band has a circular balloon inside that is filled with saline solution. After surgery, follow-up visits are needed to adjust the size of the band opening. The impact on obesity related diseases and long-term weight loss is less than with other procedures.
Post-Bariatric Surgery Care and Lifestyle Changes
After weight-loss surgery, patients are typically restricted from eating for 1 to 2 days to allow the stomach and digestive system to heal. A specific diet is then followed for several weeks, progressing from liquids to pureed foods, soft foods, and eventually regular foods.
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Dietary Guidelines
- Liquid Diet: Initially, only liquids are allowed.
- Pureed and Soft Foods: Gradually, pureed and very soft foods are introduced.
- Regular Foods: Eventually, a transition to regular foods is made.
Follow-Up Care
Frequent medical checkups are necessary to monitor health in the months following surgery.
Lifestyle Adjustments
Regardless of the specific procedure, bariatric surgery patients must commit to significant and permanent lifestyle changes, including:
- Healthy Eating: Adopting a balanced and nutritious diet.
- Regular Physical Activity: Incorporating regular exercise into their routine.
- Small Meals: Eating small, frequent meals.
- Chewing Food Thoroughly: Taking the time to chew food completely.
- Vitamin and Mineral Supplements: Taking vitamins and mineral supplements as instructed.
Results of Bariatric Surgery
Gastric bypass and other bariatric surgeries can lead to significant long-term weight loss. The amount of weight lost varies depending on the type of surgery and individual lifestyle changes. The number of pounds people lose after weight-loss surgery depends on the individual and on the type of surgery. One study found that after 1 year, people undergoing adjustable gastric banding, gastric sleeve, and gastric bypass lost between 38 and 87 pounds. Of the three most common procedures, gastric bypass produced greater weight loss, on average, but had more complications in the month after surgery. Your weight loss could be different. Most people â about 90% â 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, itâs about 80%. Weight loss after sleeve gastrectomy ranges between 30% and 80%.
Beyond weight loss, bariatric surgery can also improve or resolve many obesity-related health conditions, such as:
- Type 2 diabetes
- High blood pressure
- Severe sleep apnea
- High cholesterol
When Weight-Loss Surgery Doesn't Work
It's important to recognize that bariatric surgery is not always successful. In some cases, patients may not lose enough weight or may regain weight after surgery, even if the procedure itself was performed correctly. The surgery is not a quick fix. It's not a magic pill at all. It's a very strong tool. And depending on the surgery, some are stronger and some are weaker.
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Reasons for Failure
- Inadequate Lifestyle Changes: Failure to adopt and maintain healthy lifestyle habits.
- Surgical Complications: Although rare, complications can hinder weight loss.
Addressing Failure
- Follow-Up Appointments: Keeping all scheduled follow-up appointments is crucial.
- Consult Your Doctor: If you notice that you are not losing weight or have complications, see your doctor immediately.
Risks and Complications
While bariatric surgery offers numerous benefits, it's essential to be aware of the potential risks and complications, which can vary depending on the type of surgery.
Potential Risks
- Longer term risks and complications of weight-loss surgery vary depending on the type of surgery.
Bariatric Surgery: More Than Just Weight Loss
Weight loss surgery, also known as bariatric and metabolic surgery, impacts patientsâ weight and the health of their metabolism (breakdown of food into energy). These operations are very effective in treating diabetes, high blood pressure, sleep apnea and high cholesterol, among many other diseases. These operations also have an ability to prevent future health problems.