Gastric sleeve surgery is a powerful tool for individuals struggling with obesity, offering a path to improved health and quality of life when traditional weight loss methods have proven unsuccessful. This article delves into the details of gastric sleeve surgery, what to expect in terms of weight loss, and the factors that influence those results.
Gastric Sleeve Surgery: A Primer
Gastric sleeve surgery, also known as sleeve gastrectomy, is a bariatric procedure designed for individuals with a body mass index (BMI) of 35 or higher. The procedure involves the removal of 70-85% of the stomach, creating a smaller, banana-shaped "sleeve." This physical alteration achieves weight loss by:
- Limiting Food Intake: The reduced stomach capacity restricts the amount of food a person can consume, leading to a feeling of fullness with smaller portions.
- Hormonal Changes: Removing a significant portion of the stomach decreases the production of ghrelin, often dubbed the "hunger hormone." Ghrelin stimulates appetite, encourages food intake, and promotes fat storage. With less ghrelin, patients generally experience reduced hunger and increased satiety.
Unlike some other bariatric surgeries, gastric sleeve surgery doesn't require the placement of a foreign object in the body or the rearrangement of intestinal organs.
Typical Weight Loss Expectations
It's normal to wonder how much weight you can lose with bariatric surgery if you're considering it. The surgery isn't just for aesthetic reasons-it also helps improve health conditions like diabetes, high blood pressure, sleep apnea, and joint pain. After gastric sleeve surgery, most patients can expect to lose, on average, 60-70% of their excess weight within the first year. In two years, you may lose up to three-quarters of your excess weight. Some gastric sleeve patients saw resolution of comorbidities (such as the risk of heart attack, diabetes and other weight-related ailments) in 1-2 years.
Weight loss at each stage of the journey will depend on several factors, including your starting weight, post-surgery diet, age, lifestyle, and existing health issues.
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- Monthly Weight Loss: On average, most patients can expect to lose 8 to 16 pounds per month.
- Individual Variation: Your weight loss journey after sleeve gastrectomy is just that: yours. Your body type, nutrigenomics, and metabolism are unique to you. Your body may respond to surgery by rapidly shedding large amounts of weight, or you may struggle to achieve results.
The Weight Loss Timeline
Weight loss typically follows a predictable pattern, though each person's situation varies.
- The First Month: In the first 30 days, most people meet or exceed the average monthly weight loss after gastric sleeve. The post-surgical diet of mostly liquids and pureed foods facilitates rapid changes. The average drop in weight is around five pounds per week. Men tend to lose weight more quickly than women.
- 3-6 Months Post-Surgery: By this point, you’ll have gradually transitioned from a liquid diet to solid foods. Also, your body will be healed enough that you should be engaging in physical activities. 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.
- 6 Months Post-Surgery: Half a year after surgery, your weight loss continues but at a slower pace (about 2 pounds per week). You will likely have lost around 50-55% of your excess weight at this stage.
- 12 Months Post-Surgery: At the 12-month point, you should be getting close to your goal weight if you’ve not reached it already. Most people lose an average of 65-75% of their excess weight by this stage.
- 18 Months and Beyond: Expect your weight loss to level off a year and a half after your gastric sleeve surgery. After a year and a half, some patients lost as much as 80% or more of their excess weight. It should be noted that because people are different, results can be different as well.
After the first year, weight loss generally slows down, with most people reaching their maximum weight loss around 18-24 months after surgery. Some continue to lose small amounts in the second year, particularly with consistent exercise.
Factors Influencing Weight Loss
Several factors can impact the amount of weight lost after gastric sleeve surgery:
- Adherence to Post-Surgery Diet: There’s a strong correlation between the amount of excess weight loss with your adherence to the post-surgery dietary plan. If you don’t take the correct precautions, you can easily stretch your stomach sleeve and regain unwanted weight.
- Lifestyle Habits: Healthy lifestyle habits play a key role in weight loss after gastric sleeve surgery.
- Exercise Regimen: Exercise helps maintain muscle mass, enhances metabolism, and prevents weight regain.
- Preoperative Education: While genetics cannot be changed, the biggest difference in results for most patients is the quality of their preoperative education.
- Commitment to Behavioral Transformation: While genetics cannot be changed, the biggest difference in results for most patients is their commitment to behavioral transformation.
- Post-Operative Diligence: While genetics cannot be changed, the biggest difference in results for most patients is their post-operative diligence to continue what they have learned.
- Genetics: Your body type, nutrigenomics, and metabolism are unique to you.
- Age: Your weight loss at each stage of the journey will depend on several factors, including your age.
- Existing Health Issues: Your weight loss at each stage of the journey will depend on several factors, including your existing health issues.
The Importance of a Healthy Lifestyle
While surgery can significantly aid in weight loss, your post-surgical habits play a crucial role in determining your results.
- Dietary Guidelines: Adherence to dietary guidelines is perhaps the most important factor within your control.
- Physical Activity: Regular physical activity significantly improves weight loss results and improves your overall health. Within hours after surgery, you'll be encouraged to walk regularly, gradually increasing your activity level.
- Psychological Support: Psychological support also plays a vital role in your long-term success. Many people have emotional connections to food that surgery doesn't address.
- Follow-Up Care: Follow-up care also ensures you stay on track and address any issues promptly. Regular check-ups with your bariatric team allow them to track your weight loss, nutritional status, and overall health.
Potential Challenges and How to Address Them
While the bariatric surgery expected weight loss numbers are impressive, the journey isn't without challenges.
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- Nutritional Deficiencies: Nutritional deficiencies are common concerns after bariatric surgery, especially with procedures that affect nutrient absorption. You'll need to take vitamin and mineral supplements daily for life. Common deficiencies include vitamin B12, iron, calcium, vitamin D, and protein. Regular blood tests can help find and address these issues before they cause symptoms.
- Psychological Adjustments: Psychological adjustments also continue long after physical healing. Your relationship with food, your body image, and even your relationships with others may change after significant weight loss. Others struggle with the attention their changed appearance attracts.
- Lifestyle Modifications: Some people might struggle with the permanent lifestyle modifications required after bariatric surgery.
- Medical Complications: Medical complications, which can occur shortly after surgery and years later, are also a concern. Short-term risks include infection, bleeding, and blood clots. Long-term issues might include hernias, bowel obstructions, ulcers, or gallstones. Some people experience dumping syndrome after eating foods high in sugar or fat.
Long-Term Maintenance
Years after surgery, you'll need to stay consistent with your healthy diet. Regular physical exercise is also important for long-term success. It helps maintain muscle mass, enhances metabolism, and prevents weight regain. Many people who maintain their weight loss for 5+ years report that regular physical activity is non-negotiable in their routine. It's also crucial to attend regular medical checkups to ensure good health and nutritional status. Annual visits are typically recommended to check vitamin levels, weight maintenance, and other health markers. Support systems provide encouragement and accountability for the long haul. Whether through formal support groups, online communities, or friends and family who understand your journey, having people to share challenges and successes with makes maintenance easier.
The Role of Hormones
Changes in gastrointestinal hormones resulting from bariatric surgery may not totally explain the effects of bariatric surgery on weight loss. It does appear likely that they explain some of the remarkable effects of surgery on weight loss. The gastrointestinal tract, the largest endocrine organ in the body, is a complex neuroendocrine system. More than 30 known peptide hormone genes are expressed in the digestive tract, with more than 100 different hormonally active peptides produced. Because they may play important roles in weight loss following surgery, it is of interest to review changes in hormones that have been investigated in relation to bariatric surgery.
Glucagon-Like Peptide-1 (GLP-1)
Glucagon-like peptide-1 is a 30 amino acid peptide released from L-cells in response to meal ingestion. L-cell stimulation increases not only GLP-1 but also GLP-1-related peptides, all derived from the same proglucagon molecule: glicentin, oxyntomodulin, intervening peptide-2, and GLP-2, as well as PYY and perhaps glucose-dependent insulinotropic polypeptide (GIP). GLP-1-releasing cells are located throughout the intestine, with a greater concentration in distal ileum and colon. After release, GLP-1 is rapidly degraded by the ubiquitous enzyme dipeptidyl peptidase (DPP) 4.
Glucagon-like peptide-1 is involved in multiple ways in glucose homeostatic regulation, as well as in energy balance through effects on satiety and food intake. Together with GIP, GLP-1 is a major insulinotropic hormone responsible for the incretin effect, enhancement of insulin secretion by oral glucose versus an isoglycemic intravenous load. Over the long term, GLP-1 increases beta-cell mass by stimulating beta-cell growth and proliferation and by inhibiting apoptosis. Glucagon-like peptide-1 also improves plasma glucose by inhibiting glucagon secretion and by slowing of gastric emptying and intestinal motility. By acting on the central nervous system, GLP-1 inhibits food and water intake and promotes satiety.
Postprandial plasma GLP-1 increments have been reported as early as 2 days after RYGB and 1 week post-BPD; plasma GLP-1 is elevated as late as 3 years after RYGB or 20 years after JIB. There may be a progressive postprandial plasma GLP-1 increase after bariatric surgery, at least up to 24 months. Surgical procedures with intestinal rearrangement (RYGB, BPD, and JIB, compared with AGB and VBG) result in larger increases in plasma GLP-1. The GLP-1 postprandial plasma levels were higher in RYGB than in AGB 6-36 months after surgery, even though weight loss in the two groups was the same. Available evidence suggests that a greater exposure of distal gut to nutrients post-bariatric surgery could result in higher GLP-1 secretion from the L-cells.
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Gastric Sleeve vs. Gastric Bypass
If you are eligible for bariatric surgery, two procedures can be considered: gastric sleeve surgery and gastric bypass surgery. Both procedures are aimed at helping qualifying individuals lose weight. “Which surgery we recommend depends a lot on the patient’s other medical issues,” says Ellen Morrow, MD, MS, FACS, a bariatric surgeon at University of Utah Health.
Gastric Sleeve
A sleeve surgery reduces the size of your stomach, which will make you fill full more quickly. Your surgeon will use a stapler to divide the stomach and remove about two-thirds of it, leaving a narrow pouch shaped like banana. Total recovery time: An average of two weeks.
Gastric Bypass
Gastric bypass surgery, also known as Roux-en-Y gastric bypass, involves creating a small stomach pouch about the size of an egg. “That 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,” Morrow says. Hospital stay length: Gastric bypass surgery takes about two and a half hours. Total recovery time: An average of two weeks. Weight loss timeline: Weight loss is rapid and mostly occurs in the first six months post-op.
Eligibility and Insurance Coverage
Most insurance companies cover bariatric surgery, when you meet the following criteria:
- BMI greater than 40, or
- BMI of 35-39.9 with one of the obesity related health problems such as:
- Hypertension
- Type 2 diabetes
- Sleep Apnea
- Fatty liver disease, or
- Hyperlipidemia
For patients with BMI of 30-34.9, insurance will not cover bariatric surgery procedures. However, there are self-pay options for those individuals who have struggled with obesity for a long time, especially those with obesity related health problems.
Recovery After Surgery
- The surgery takes approximately 40-70 minutes
- Discharge from hospital typically occurs after 1-2 nights
- All patients are encouraged to walk as early as 3-4 hours after surgery
- In general, the pain is easily manageable after surgery. Most patients take less than the recommended pain medication
- Most patients go back to work and/or school after 2-4 weeks. Fatigue is common the first 2 weeks due to low calorie intake from liquid diet. However, the majority of patients do not feel hungry during this stage of the diet. The energy level improves quickly after the introduction of the soft diet, which is approximately 3 weeks after surgery.
- Patients can begin exercising 4 weeks after surgery
Diet After Gastric Sleeve Surgery
- Day 1: Clear liquid diet. Some surgeons allow patients to drink water a few hours after surgery
- Days 2-21: Full liquid diet including protein shakes, yogurt, broth, milk, and juice
- Weeks 4-6: Soft food diet
- Patients can begin introducing regular food 6 weeks after surgery. They are encouraged to eat a small amount of food each time and have meals that are more frequent.
- All patients must take multi-vitamin and B complex after surgery