Obesity is a widespread health concern, and for individuals with severe obesity, bariatric surgery, particularly sleeve gastrectomy, has emerged as an effective intervention. This article delves into the expected weight loss after sleeve gastrectomy, also known as gastric sleeve surgery or vertical sleeve gastrectomy, exploring the factors influencing weight loss and the importance of long-term lifestyle changes.
What is Sleeve Gastrectomy?
A sleeve gastrectomy is a bariatric surgery designed to reduce the size of the stomach, thereby limiting food intake and promoting weight loss. During this procedure, a surgeon uses staples to vertically divide the stomach and removes approximately 70-85% of it, leaving a smaller, tubular "sleeve." This restrictive procedure helps patients feel full more quickly, leading to reduced calorie consumption.
How Sleeve Gastrectomy Works
Sleeve gastrectomy is a gastric restrictive procedure, which reduces the amount of food you can eat. The procedure involves removing a large portion of the stomach and reduces the hunger hormones that are normally produced in your stomach. It helps to stabilize your metabolism, decreasing your appetite and regulating your blood sugar.
The removal of a significant portion of the stomach also leads to a decrease in the production of ghrelin, a hormone that stimulates appetite. This hormonal change further contributes to weight loss by reducing hunger and promoting satiety.
Compared to other types of weight loss surgery, the gastric sleeve is a newer procedure, meaning bariatric surgeons have less data about its long-term outcomes.
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Eligibility for Sleeve Gastrectomy
Bariatric surgery requirements begin with establishing a diagnosis of class III obesity. That means that you either:
- Have a BMI of 40 or higher.
- Have a BMI of at least 35 and at least one related health problem.
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.
Weight Loss Expectations After Sleeve Gastrectomy
Most people - about 90% - lose about 50% of their excess weight after bariatric surgery, and keep it off. Weight loss after sleeve gastrectomy ranges between 30% and 80%.
The majority of gastric sleeve patients drop an average of 60-70% of their excess weight in a year. In two years, you may lose up to three-quarters of your excess weight.
On average, most patients can expect to lose 8 to 16 pounds per month. In the first 30 days, most people meet or exceed the average monthly weight loss after gastric sleeve.
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Early Post-operative Phase (First 30 Days)
In the initial weeks following surgery, the weight loss is often rapid. The post-surgical diet of mostly liquids and pureed foods facilitates rapid changes. The average drop in weight is around five pounds per week.
Three Months Post-Operatively
By this point, your body will be healed enough that you should be engaging in regular activities, and you could see up to a 35% reduction in total excess weight.
Six Months Post-Operatively
Half a year after surgery, your body will likely continue to lose weight but not at the brisk pace you saw before (about 2 pounds per week). You will likely have lost around 50-55% of your excess weight at this stage.
One Year Post-Operatively
A year from surgery, your target weight should be well in sight. By this stage, most people have lost an average of 65% of their excess weight.
Beyond One Year
After a year and a half, some patients lost as much as 80% or more of their excess weight.
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Factors Influencing Weight Loss
Several factors can influence the rate and extent of weight loss after sleeve gastrectomy:
- Starting Weight: Individuals with higher starting weights may experience more significant weight loss initially.
- Diet and Exercise: Adherence to a post-surgery dietary plan and regular exercise are crucial for maximizing weight loss.
- Age: Younger individuals may experience faster weight loss due to higher metabolic rates.
- Lifestyle: Healthy lifestyle habits, including adequate sleep and stress management, can positively impact weight loss.
- Existing Health Issues: Pre-existing health conditions may affect weight loss outcomes.
- Commitment to Behavioral Transformation: The biggest difference in results for most patients is the quality of their preoperative education, their commitment to behavioral transformation, and their post-operative diligence to continue what they have learned.
The Importance of Diet and Lifestyle After Gastric Sleeve
Regaining weight after gastric sleeve surgery is likely if you return to your old dietary and exercise habits. Research shows that long-term weight loss after surgery is directly tied to food choices and eating habits.
We encourage all our patients to keep a food journal to help them to document the nutrition intake and identify any triggers. The goal is to consume about 80-100 grams of protein per day and eat plenty of fiber rich fruits and vegetables. Avoid foods with high fat, sugar and salt content. Ensure adequate hydration (at least 64 fl oz of water daily) and sleep (7-8 hours daily) will help prevent weight regain. Avoid late night eating, fast and convenience foods. Practice meal planning and plan grocery shopping ahead of time to avoid purchasing trigger food items.
A good exercise regimen is very important for long-term weight management. The ideal goal is to have 150 minutes of cardio and 2-3 days of strength training per week. Common cardio exercises include dancing, running, swimming, brisk walking, aerobics, kickboxing, skiing, surfing, and bike riding.
Long-Term Weight Maintenance
A subset of patients can regain most lost weight back in a few years after sleeve gastrectomy. Significant weight regain can lead to the recurrence of obesity-related comorbidities and decreased quality of life.
Strategies for Preventing Weight Regain
- Nutritional Guidance: Following a structured eating plan tailored to post-bariatric surgery needs is essential.
- Regular Exercise: Engaging in regular physical activity helps maintain weight loss and improve overall health.
- Support Groups: Participating in support groups provides emotional support and accountability.
- Monitoring and Intervention: Regular monitoring for early signs of weight regain and early intervention with a detailed nutritional and medical evaluation to look for behavioral and surgical explanations for weight regain is crucial.
Medical Interventions for Weight Regain
In addition to dietary and lifestyle modification, the use of weight loss medications should be considered for patients with weight regain after sleeve gastrectomy. Starting weight loss medications after bariatric surgery should be an individualized decision. We encourage all patients with weight regain issues to discuss this option with their bariatric surgeon/bariatrician. Semaglutide (Ozempic or Wegovy) has been shown to have robust weight loss for obese patients.
Conversion Surgeries
During the conversion surgery, the stomach is divided, and a small pouch is created, then the small bowel is connected to this small pouch. If the indication for conversion is due to weight regain/inadequate weight loss, patients can expect to lose 30-70% of the excess weight. With the weight loss, many patients have resolution of obesity related comorbidities.
Conversion of sleeve gastrectomy to OAGB is performed by creating a long gastric pouch (much longer than the standard Roux-en-Y gastric bypass) first. Then the small bowel is connected to this long gastric pouch. The biliopancreatic limb (150-200 cm) in OAGB is longer than the standard Roux-en-Y gastric bypass surgery (50 cm).
Benefits Beyond Weight Loss
Beyond the significant weight loss, sleeve gastrectomy offers a range of health benefits:
- Improvement in Obesity-Related Comorbidities: Many patients experience resolution or improvement in conditions such as type 2 diabetes, hypertension, and sleep apnea.
- Enhanced Quality of Life: Weight loss can lead to increased energy levels, improved mobility, and greater self-esteem.
- Long-Term Health Outcomes: A large Kaiser Permanente study demonstrated that individuals who underwent bariatric surgery maintained significantly more weight loss at 5 years compared to those who did not have surgery.
Risks and Considerations
All weight loss surgeries have pros and cons. Your surgeon will help you decide which procedure is right for you based on your health risks, history, and preferences.
Common myths about bariatric surgery
- That surgery is a last resort. Bariatric surgery is the most effective long-term treatment for class III obesity.
- 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.
Potential Risks
- Smoking increases your risk for blood clots, pneumonia, and other lung problems after surgery.
Pre-operative Preparation
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 pass medical screening tests to make sure the surgery is safe for you. 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.
Types of Weight Loss Surgery
- Gastric bypass 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.
- Biliopancreatic Diversion with Duodenal Switch (BPD-DS) combines a sleeve gastrectomy with an intestinal bypass. This operation bypasses most of your small intestine - about 75%. This significantly reduces the hunger hormones produced in your small intestine as well as in your stomach. It also significantly restricts how much nutrition your small intestine can absorb.
- Stomach Intestinal Pylorus Sparing Surgery (SIPS) is a modified version of the original duodenal switch, intended to reduce complications.
Post-operative 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. 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.
Compliance with Long-Term Follow-Up
People who don’t adhere to lifelong nutritional regimens may want to avoid weight loss surgeries that require this stringent adherence.