Bariatric surgery, encompassing weight-loss and metabolic surgery, presents a transformative opportunity for individuals grappling with obesity, enabling them to attain weight loss objectives and cultivate healthier, more fulfilling lives. This article will explore the safest and most effective bariatric surgery options available, their benefits, and what to expect during the process.
Understanding Bariatric Surgery
Bariatric surgery modifies the stomach and digestive system to treat obesity and related diseases. These operations may reduce the size of the stomach and bypass a portion of the intestine, resulting in decreased hunger, increased fullness, and altered food absorption.
The Safest and Most Effective Procedures
The Roux-en-Y gastric bypass and the vertical sleeve gastrectomy (gastric sleeve or VSG surgery) are recognized as the safest and most effective procedures for achieving significant and sustainable weight loss. Both procedures alter the stomach and digestive system, but in different ways.
Roux-en-Y Gastric Bypass
The Roux-en-Y gastric bypass, performed for over 50 years, involves creating a small pouch at the top of the stomach and connecting it directly to the small intestine. This reduces the amount of food that can be consumed and decreases absorption. The gastric bypass works by creating a smaller stomach pouch, limiting calorie intake. The rerouting of food through the gastrointestinal tract decreases hunger, increases fullness, and promotes healthy weight management. This procedure has a profound effect on decreasing hunger, increasing fullness, and allowing 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.
Vertical Sleeve Gastrectomy (Gastric Sleeve)
The Laparoscopic Sleeve Gastrectomy, often called the “sleeve”, is performed by removing approximately 80% of the stomach. 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.
Read also: Learn how spa therapy can enhance your overall health.
Benefits Beyond Weight Loss
The advantages of bariatric surgery extend beyond mere weight reduction, enhancing overall quality of life, self-esteem, and energy levels. Many obesity-related health conditions can be avoided, improved, or completely resolved.
Effective Weight Loss
Bariatric surgery stands as the most effective weight loss tool for many individuals. Contrary to the belief that determination, diet, and exercise are sufficient, research indicates that only 2% of bariatric patients relying on these methods alone achieve sustainable weight loss, compared to up to 80% of those undergoing bariatric surgery. Patients can lose about 72 percent of excess weight by the end of the first year after surgery.
Minimally Invasive and Safe
Weight loss surgery is typically minimally invasive, involving small incisions that lead to fewer complications, less pain, and quicker recovery. Most patients require only a one-night hospital stay and minimal pain medication.
Enjoying Food After Surgery
Despite concerns about dietary restrictions, patients can still enjoy food after surgery. Following an initial three-week recovery period with a full liquid diet, regular foods are gradually reintroduced with the guidance of a registered dietitian. While portion sizes may be smaller and the focus shifts to protein and nutrient-dense foods, three meals and a few snacks daily are common.
Cure for Diabetes
Bariatric surgery is the only known cure for diabetes. Hormonal changes following surgery improve the body's ability to use glucose, often leading to drastic improvements in diabetes even before significant weight loss. A significant number of patients are on medications for diabetes before their bariatric surgery compared to only a small percentage one year after surgery.
Read also: Facial oil: Benefits and how to use
Improvement or Resolution of Other Health Conditions
Bariatric surgery can significantly improve or resolve various health conditions, including hypertension, high cholesterol, heart disease, migraines, asthma, joint pain, sleep apnea, and heartburn.
Other Bariatric Surgery Options
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.
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. 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.
Single Anastomosis Duodenal-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. 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. This allows enough absorption of vitamins and minerals to maintain healthy levels of nutrition.
Determining Candidacy
Bariatric surgery is suitable for individuals with a body mass index (BMI) greater than 35 or a BMI above 30 with related medical problems when non-invasive weight loss methods have proven ineffective. The healthcare team will evaluate age, lifestyle, and behavioral factors to determine suitability.
Read also: The role of alpha-keto acids in metabolism.
Cost and Insurance Coverage
Bariatric surgery is typically covered by insurance, including some Medicaid plans, when deemed medically necessary. Out-of-pocket costs vary by insurance provider. Cash-pay options are available if insurance does not cover the surgery.
Preparing for Bariatric Surgery
Preparation involves education, evaluations, pre- and post-operative activities, and a lifelong commitment to maintaining weight loss and long-term health. The pre-operative journey typically takes 4-6 months after the initial consultation.
Pre-operative preparation
Before scheduling bariatric surgery, healthcare providers ensure physical and mental fitness through a team of specialists who counsel on risks and benefits while assessing physical and mental health. Medical screening tests may be required, and cessation of tobacco, drug, or excessive alcohol use is mandatory. A pre-bariatric surgery diet may be prescribed to reduce abdominal fat, enhancing safety and reducing complication risks.
How Weight Loss Surgery is Performed
Weight loss surgery is typically performed through minimally invasive methods (laparoscopic surgery). This means small incisions, faster healing and less pain and scarring than you would have with traditional open surgery.
Gastric Sleeve
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. But it also reduces the hunger hormones that are normally produced in your stomach. This helps to stabilize your metabolism, decreasing your appetite and regulating your blood sugar.
Gastric Bypass
With this procedure, surgeons create a small pouch at the top of your stomach, separating it from the lower portion with surgical staples. 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.
Biliopancreatic Diversion with Duodenal Switch (BPD-DS)
This operation 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. This is what makes the duodenal switch the most effective surgery for weight loss and for improving metabolic syndromes like diabetes. But it can also make it hard for your body to absorb enough nutrients to stay healthy.
Stomach Intestinal Pylorus Sparing Surgery (SIPS)
This newer procedure is a modified version of the original duodenal switch, intended to reduce complications. Early results are still being studied, but so far it appears promising that this version may eventually replace the original duodenal switch. Like the original, it begins with a sleeve gastrectomy, then divides the first part of the small intestine just after the stomach (the duodenum). This time, the small intestine is reattached as a loop, which requires just one surgical connection (anastomosis) instead of two. It also means that less of the small intestine is bypassed, allowing for a little more absorption of nutrients.
Postoperative Care
Postoperative care includes regular follow-up visits and metabolic blood tests to monitor health improvements and screen for nutritional deficiencies. Body contouring options may be discussed after the first year to address excess skin folds and loose tissues.
Weight Loss Expectations
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%.
Potential Risks and Complications
All surgeries have the potential for complications, but here are some of the frequently noted complications of bariatric surgery:bleedingblood clotsinfectionobstructionstomach leakageGERDstricturestenosisstomach twists or kinksherniastomach ulcernutritional deficiencieshypoglycemiaperipheral neuropathyosteoporosiscomplication with gastric banding, band slippage, or band erosion
Gastric Banding Considerations
Success with a gastric band depends on lifestyle, long-term diet, and exercise habits established after surgery. Mindful, planned eating with healthy food choices, careful chewing, and avoiding mixing solid food and liquid at meals are crucial.
Revision Surgery
If sufficient weight loss is not achieved, or weight regain or complications occur following a previous bariatric procedure, revision surgery may be an option.
Endoscopic Bariatric Surgery
A new form of weight loss procedure uses a flexible endoscope that passes through your gastrointestinal tract safely without making an incision to achieve weight loss results.
Debunking Common Myths
- Myth: Surgery is a last resort.
- Fact: Bariatric surgery is the most effective long-term treatment for class III obesity.
- Myth: Surgery is the “easy way out.”
- Fact: Bariatric surgery is a tool that enables a healthy diet and lifestyle to lead to sustained weight loss.
Qualifying for Bariatric 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.
- 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.