What You Should Know
Bariatric surgery – commonly referred to as weight loss surgery – can seem like a bit of a mystery to those who haven’t taken that step of talking to their doctor about it. However, it’s not only a very safe procedure, but also minimally invasive thanks to technological advancements. Read on to learn more about the procedure, who’s eligible for it, and what the recovery process is like.
By Anna Hill
While the intent of bariatric surgery is to improve health and quality of life through inducing weight loss, not everyone who is overweight is a candidate for it. “Candidates for bariatric surgery are individuals who have suffered from obesity for several years, have tried to lose weight before, have a BMI (body mass index) of 40 or more, or have a BMI of 35 with associated obesity-related medical problems like type 2 diabetes, high blood pressure, sleep apnea, or other conditions,” explains Dr. Jaime Ponce, bariatric surgeon and medical director of bariatric surgery and obesity medicine with CHI Memorial Metabolic & Bariatric Care. The best way to find out if you’re eligible for the procedure is to calculate your BMI and review your medical history with your doctor or a specialist.
WHAT IS BMI?
BMI stands for body mass index, which is a person’s weight in kilograms divided by the square of their height in meters. It’s often used as a screening tool, but doesn’t necessarily provide a definitive diagnosis of body fatness or overall health.
Types of Surgery
There is a range of procedures that fall under the umbrella of bariatric surgery; however, some are much more common than others. “The most commonly performed bariatric surgeries are the gastric sleeve resection and the Roux-en-Y gastric bypass,” says Dr. Christopher Sanborn, a bariatric surgeon and the medical director of the Erlanger Metabolic & Bariatric Surgery Center. “The duodenal switch is less commonly performed, and the laparoscopic adjustable gastric band – commonly known as the lap-band – is still around but is infrequently performed.”
Gastric sleeve resection.
Also known as the sleeve gastrectomy, this method is a minimally invasive, laparoscopic procedure that is performed on the majority of patients. The surgery involves removing a portion of the stomach that holds a significant amount of food and produces ghrelin, which is a hormone that causes hunger. As a result, patients feel full after smaller portions, feel less hunger, and experience improved metabolism without losing out on nutrient absorption.
Roux-en-Y gastric bypass.
Often just referred to as gastric bypass, this surgery is slightly more complex, but is also a laparoscopic procedure. The surgeon creates a small pouch in the stomach, then reroutes the intestine to bypass the lower portion of the stomach and the first portion of the bowel. This procedure achieves similar results compared to the gastric sleeve resection; however, there is an element of nutrient malabsorption following the surgery, and vitamin supplements are often needed in order to prevent deficiencies.
Risks & Complications
There are risks that accompany weight loss procedures, as there are with all types of surgeries. These risks might include infection, trouble with stapling the stomach that can lead to leakage or bleeding, or blood clots. However, it’s important to remember that these complications are rare, and that good outcomes are almost always achieved with patient education, a good surgical team, and diligent follow-up post-op. “Other considerations that patients need to understand are the needed long-term follow-up, monitoring vitamins and minerals to avoid anemia or calcium deficiencies, and that, very rarely, ulcers or hernias can develop,” adds Dr. Ponce. “Patients are encouraged and required to follow up to be monitored and prevent any significant complications.”
Preparing for Surgery
Preparing for bariatric surgery can be one of the most important parts of the entire process, given that the procedure is not a simple “set it and forget it” solution for weight loss. Education about the procedure itself, as well as the recovery and lifestyle changes that will need to come alongside it, is vital. If possible, attend an information seminar or webinar about bariatric surgery before scheduling an initial consultation. If you decide to move forward, you’ll meet with a multidisciplinary team that might include dietitians, psychology support, exercise trainers, and your bariatric surgeons and nurses. “Attending support groups prior to having the surgery can also be a helpful step to take,” says Dr. Sanborn.
Thanks to surgical advances, the two most common forms of bariatric surgery – the gastric sleeve resection and the gastric bypass – are both performed laparoscopically. This method is minimally invasive and is performed with very small instruments and a video camera for assistance. Patients will arrive a few hours before surgery and are prepped and then placed under anesthesia. “The procedure usually lasts one hour under general anesthesia. Patients wake up in the recovery room, and they will be walking and drinking liquids the same day,” explains Dr. Ponce. “Usually, they stay one night and are discharged home the following morning.”
Recovery for bariatric surgery is two-fold: physical recovery and lifestyle changes. “Most patients with jobs that do not require lifting or vigorous physical activity can return to their job within one to two weeks or sooner,” says Dr. Sanborn. “Follow-up is very frequent after surgery – usually within the first week and then again within the first month or two, and likely several more times within just the first year.” All of this follow-up is necessary in order to help the patient achieve the best possible outcome, as permanent lifestyle changes will need to be made to reach such outcomes.
As for diet following the procedure, patients typically stay on a liquid diet for two weeks, then advance to soft, puréed foods for two weeks, then follow that with more solid foods. This allows the patient to heal as well as to adjust to new eating habits and portion sizes. When it comes to exercise, patients are put on a progressive plan of physical activity that begins with walking and increases over time at the patient’s own pace. Vitamins are often needed, and support groups and dietitians can be helpful in the recovery process as well. All in all, it’s important for the patient to take an active role in their recovery.
“In general, healthy habits and activity, along with the surgery serving as a powerful ‘tool,’ enable patients to lose significant amounts of weight, improve their health and quality of life, and get to do things that were previously more difficult for them to do,” says Dr. Ponce. If weight is something you have struggled with significantly on your own, don’t be afraid to reach out to a provider for a consultation to learn more.