When it comes to weight loss surgeries, there are various options accessible to people depending on their BMI and medical conditions. It's vital to talk to a doctor about the pros and downsides of each procedure before deciding.
Being overweight is a problem for one-third of American adults, and obesity affects two-thirds of the population. If left untreated, severe obesity and obesity-related diseases, including diabetes and stroke, can have life-threatening consequences.
What You Need to Know About Bariatric Procedures
Weight loss may be aided by various currently available methods, including bariatric surgery. There were an estimated 256,000 persons in the United States who underwent weight-loss surgery in 2019, according to the American Society for Metabolic and Bariatric Surgery (ASMBS).
There are numerous weight-loss surgeries, each with pros, disadvantages, and risks.
What is the Purpose of Weight Loss Surgery?
Those who have tried and failed with various non-surgical techniques of weight loss may potentially benefit from surgery.
Obesity is broken down into three categories by the Centers for Disease Control and Prevention:
- Class 1: Body mass index (30–35) or below
- Class 2: a body mass index (BMI) of 35–40
- Doctors define class 3 obesity as having a body mass index (BMI) of more than 40.
For bariatric surgery, one must meet current requirements by having a BMI of 40 or greater (Class 3) to be eligible.
In addition, those with a BMI of 35–39 (Class 2) may be eligible if they have an obesity-related ailment that can be alleviated or improved by the procedure in question. Among them are:
- Type 2 diabetes, heart attack, and death
- Blood pressure that is out of whack
- Severe obstructive nocturnal breathing (OSA)
- Pancreas and colon cancer patients with fatty liver, for example
The American Society of Metabolic and Bariatric Surgery (ASMBS) has proposed decreasing the bariatric surgery eligibility criterion for those with a BMI of 30–34. (Class 1). Another consideration is whether a patient has medical disorders, including gastroesophageal reflux disease (GERD), type 2 diabetes, or uncontrolled high blood sugar levels.
Weight Loss Surgery Overview
Bariatric surgery is a surgical technique that tangibly alters the digestive system. As per the American Society of Metabolic and Bariatric Surgery (ASMBS), the primary goal of the treatment is to help people lose weight.
The following bariatric surgery procedures are possible:
- These operations reduce the size of the stomach, which slows digestion. This procedure may assist a person in reducing their meal intake by decreasing their calorie intake by limiting the stomach's capacity to store food.
- They are shortening or altering the digestive tract's anatomy, resulting in maladjustment. As a result, nutrients and calories are lost due to food bypassing or bypassing digestive tract sections.
- Malabsorption is caused by several procedures, which also restrict food intake.
- These modern treatments aim to reduce the generation of the stomach-produced hunger hormone, which is then delivered to the brain's hypothalamus for processing.
There are numerous advantages to having bariatric surgery. They observed subclinical (non-symptomatic) heart function improve in a 2021 study.
Bariatric surgery has also been shown to improve weight reduction and diabetes outcomes compared to nonsurgical approaches, according to a 2020 study.
People who are candidates for weight loss surgery can choose from various procedures detailed in the table below. Each method has its advantages, disadvantages, and potential risks.
1. Gastric bypass
Gastroplasty or gastric bypass surgery is a treatment that reduces stomach capacity while simultaneously limiting the absorption of nutrients. Gastric bypass is also known as Roux-en-Y surgery.
In gastric bypass, an egg-sized pouch is formed by cutting the top section of the stomach. Small intestines are also separated and attached to the stomach pouch by the surgeon.
After completing this technique, food will enter the intestines directly from the stomach. By omitting a portion of the digestive tract, fewer calories are absorbed by the body, resulting in weight loss.
Among the many advantages of gastric bypass are:
- A quick and long-lasting reduction in weight
- Filling up your stomach
- Fast and complete remission of both type 2 diabetes and gastroesophageal reflux disease
Gastric bypass also has several downsides, such as:
- More complex than other operations may produce dumping syndrome or symptoms such as exhaustion or nausea following a meal because of the quick emptying of the stomach.
There are some things to keep in mind, such as:
- Deficiency in nutrients such as vitamins and minerals
2. Adjustable gastric band
Procedures such as gastric banding are known as restrictive. Unlike other methods, this one is non-invasive and can be reversed.
Inflatable silicone bands, known as adjustable gastric bands, are secured to the top of the stomach by a surgeon. This one results in a pouch above the bar.
The gap between the pouch and the rest of the stomach determines whether or not you'll feel satisfied after consuming a substantial amount of food. One can use the access point under the skin to inject fluid to fine-tune the opening.
According to medical experts, the following are some of the advantages of this procedure:
- Outpatient treatment with no cuts to the gastrointestinal tract
- Lowest possible danger of problems or inadequacies for quick recovery and detachable band
One or more of the following disadvantages is possible:
- Other operations have a lower impact on weight-related health issues, such as diabetes
- A high reoperation rate due to the implant remaining inside the body
There is the potential for the following:
- Slippage or erosion of the band into the stomach may cause long-term damage to the stomach, necessitating additional surgery.
3. Sleeve gastrectomy
Sleeve gastrectomy (often known as "sleeve") is a restricted form of weight loss surgery.
Surgeons use staples to seal a banana-shaped piece of the stomach that they remove from the rest of the stomach.
Ghrelin, a hunger hormone, is produced by a large portion of the stomach that the doctor surgically removed. It also aids in the management of blood sugar levels.
A "sleeve" has numerous advantages, including:
- This technique is an excellent first step for patients with medical issues that puts them at higher risk of complications because it is quick, simple, and safe.
The method has some drawbacks, such as:
- A treatment that you cannot undo
- In comparison to a gastric bypass, the minor impact on metabolism can produce or aggravate heartburn
Risks of this technique include:
- Internal bleeding due to a blood clot
4. Biliopancreatic diversion with duodenal switch
More weight can be lost with diversion with duodenal switch than with a gastric bypass, thanks to biliopancreatic diversion with a duodenal switch. This procedure is less prevalent compared to sleeve gastrectomy and Roux-en-Y gastric bypass. It is, nevertheless, becoming increasingly popular.
According to doctors, people with a BMI of 50 or more are good candidates for this surgery.
The upper half of the small intestine and two-thirds of the stomach are removed to produce a new stomach pouch. The small intestine's final third is attached to the new bag in the tummy.
The surgeon reattaches the intestine's middle portion to the end. In this way, stomach fluids and enzymes can reach this location and break down food.
The small intestine is bypassed in approximately 75% of the operation, resulting in drastically reduced absorption of calories and nutrients.
The following are the advantages of this procedure:
- Gastric bypass, which is most beneficial for type 2 diabetes, has a slower and less significant weight loss effect because it affects hormone production.
The consequences of this method are as follows:
- Complicated surgeries that take a long time to complete necessitate long-term vitamin and mineral supplements.
There are numerous dangers to be aware of, such as:
Chronic malabsorption syndrome, which includes bleeding, blood clots, hernias, infections, and even mortality, is associated with stomach leakage and other symptoms of chronic malabsorption syndrome.
5. Gastric balloon
Balloon systems, such as Orbera, have been approved by the Food and Drug Administration (FDA) as a restrictive weight-loss approach. A little sedative is used during this outpatient operation, completely reversible.
This procedure entails inserting a deflated balloon into the stomach using a narrow, throat-passed tube (gastroscopy). Once the patient is comfortable, the doctor will inject saline solution into the balloon.
There are several advantages to using this method:
There aren't any incisions or adjustments to the body's structure.
A saline solution composed of salt and water is used to keep the balloon in place for six months.
There are, however, a few issues with balloon systems:
Because the surgery is short, it may not have long-term consequences on the body, but it might produce muscle pain and nausea, stomach aches, feelings of indigestion, and stomach ulcers.
Among the known dangers of this operation are the following:
- Esophageal or stomach perforation
- A life-threatening hypersensitivity reaction
- Irritable bowel syndrome
- Hyperinflation wherein the balloon is overfilled with air or fluids, which causes acute pancreatitis to be removed too soon.
Since 2016, the FDA has received reports of 12 deaths that occurred in patients with liquid-filled balloon systems globally. To ensure the safety and effectiveness of these devices, the FDA continues to monitor and evaluate potential risk factors.
6. Vagal blockade
Procedures like laparoscopy and general anesthesia allow minimally invasive procedures like vagal blockade or vBloc. The vagus nerve, which connects the stomach to the brain, inhibits hunger signals.
Three to five incisions are made in the skin near the ribs to insert a medical device.
Intermittent electrical pulses with low intensity and high frequency are sent to the intra-abdominal vagal trunks for a predefined time each day.
There are a few advantages to using this strategy, such as:
- Minimally invasive and reversible, it is safe and effective.
- Weight-loss surgery has fewer side effects than other procedures.
- Weight reduction and a drop in blood pressure have been observed
The following are some possible downsides of vagal blockade:
- Dyspepsia and difficulty swallowing (dysphagia), pain at the site of implantation or incision due to malfunction, and battery drainage
The following are some of the possible side effects:
- The risk of infection and anesthesia-induced nausea and vomiting necessitate a change in implant position
FAQs Before Weight Loss Surgery
- Bariatric surgery: am I a candidate?
- What is the difference between each procedure?
- Exactly how much weight and how rapidly will I shed?
- Is there a chance that any of the procedures will cause harm?
- Whether or not the doctor can reverse the surgery is an important question.
- Several techniques are minimally invasive.
- For how long will it be okay for me to eat?
- Does my insurance cover it?
The first few months after surgery are when most people lose weight. The rate of weight loss will slow down after a few months.
A surgery's success rate is determined by the proportion of excess weight that a patient loses following the procedure.
One can expect to lose an average of: within the first two years;
- Fifty percent with gastric banding.
- 60% of those who have undergone the procedure are satisfied with the results.
- sixty-seven to seventy percent of those who have gastric bypass surgery
- The type of surgery isn't the only determinant determining how much weight a person can reduce.
Among them are:
- Age and weight at the time of the operation
- General well-being, physical fitness, and dietary recommendations for follow-up
- Following a healthy diet and increasing your level of physical exercise may help you keep your weight in check
Bariatric surgery can be an option for those who have tried and failed other weight loss procedures. They must, however, meet specific requirements to be considered. At this time, bariatric surgery is only available to those with a BMI of 35 or higher.
Depending on the type of operation, there are a variety of side effects and complications that might occur. Patients need to explore their options with their doctors to identify the best surgical procedure.
Facts You May Not Know About Weight Loss Surgery
There are numerous ways in which weight loss surgery can benefit you. However, misunderstandings regarding bariatric surgery and obesity in general continue. Karen Schulz, CNS, a bariatric and metabolic nurse specialist, explains everything you need to know about weight-loss surgery.
Schulz explains that the secret to a successful bariatric weight loss operation is preparation. "Discuss your options with your doctor to see if you're a good candidate for this procedure."
13 Bariatric Surgery Myths Debunked
- Obesity is more than just a weight issue. Obesity is a metabolic condition that is difficult to treat. Even if you eat only a few hundred calories a day, your metabolism slows to the point that you are still very overweight. Disappointing, to say the least. Maintaining a healthy weight requires a consultation with your doctor.
- You can reverse the metabolic alterations through surgery. After bariatric surgery, "you can feel full and content after eating a modest meal," Schulz explains. "Many patients are not aware of this."
- As with gallbladder surgery, bariatric surgery carries the same level of risk as weight loss surgery. Bariatric surgery has far fewer health hazards than obesity alone, which may shock you.
- Emotions that lead to overeating can be affected by bariatric surgery. Before beginning this trip, you should seek help for your mental health and nutrition.
- Its health advantages extend far beyond weight loss. ' High blood pressure, sleep apnea, joint discomfort, Type 2 diabetes, fertility, and depression are just a few of the conditions that can be helped by bariatric surgery.
- They said that surgery could cure newly diagnosed type 2 diabetes. Diabetes patients who have bariatric surgery may no longer require insulin injections. According to one study, the remission of Type 2 diabetes can be achieved by bariatric surgery.
- The operation is usually covered by state-run health insurance. Many people are unaware that Medicare and Medicaid cover weight loss surgery. You should consult your insurance company or a financial counselor at your healthcare facility before making any decisions.
- You won't be scarred for life. Both of the most popular bariatric treatments include three to five incisions around 1/2 to 1 inch long. With the help of your healthcare team, you can learn how to minimize and care for scars following a surgical procedure.
- Surgery recovery is surprisingly quick. Within two to four weeks of your bariatric surgery, you should be able to return to a desk job or any other type of work.
- Eating is labor-intensive for one to two months following surgery. As the swelling subsides and you get used to lesser portions, eating slowly becomes enjoyable again. “Learning how to eat after surgery takes practice and patience,” Schulz explains. Your medical team will inform you of what to expect and be available to answer any questions you may have.
- During meals, you'll want to limit your intake of liquids. This one makes it easier to eat solid foods and reduces nausea.
- Having weight loss surgery is a process, not a goal. Many people lose half of their excess weight six to 12 months after surgery.
- About 85% of patients are still alive five years afterward. More than a million people have maintained their weight loss thanks to bariatric surgery. The fact that it has been around since the 1970s means that some people have not been able to maintain their weight loss. Keep in mind that you'll be on this path for the rest of your life, and it's important to remember that.
Take the time to learn about bariatric surgery and ask questions, but don't forget to live your healthiest life while you're doing it.