According to the National Center for Health Statistics, nearly 42% of U.S. adults over age 20 are considered obese, with 9.2% considered severely obese. And while diet and exercise alone can in many cases help patients overcome obesity, sometimes more help is needed. For patients who are severely overweight and are unable to lose weight via traditional means, or who suffer from serious health problems related to obesity, bariatric surgery may be an effective option for losing weight — and keeping it off.
What is bariatric surgery?
Also known as weight-loss surgery or metabolic surgery, bariatric surgery involves making physical changes to the body’s digestive system to help a patient lose weight. The most common types of bariatric surgery employed in the United States include:
- Adjustable gastric band, which sees surgeons place a small, bracelet-like band around the top of a patient’s stomach to limit the amount of food he or she can consume during meals. The AGB procedure produces a small pouch at the top of the stomach that reduces the amount of food that can be eaten before the patient feels full. After the procedure, the band can be tightened or loosened without the need for additional surgery, allowing the pouch to be made larger or smaller to accommodate the patient’s specific needs.
- Gastric bypass, which works to restrict a patient’s food intake and decrease the body’s absorption of food. The procedure used for gastric bypass sees surgeons create a small pouch at the top of the stomach that, as with AGB, leaves patients feeling fuller, faster when they eat. In addition, with gastric bypass surgery, the digestive tract is routed directly from the pouch to the small intestine. This serves to exclude most of the stomach, duodenum, and upper intestine from direct contact with food, thereby reducing the body’s absorption of food.
- Sleeve gastrectomy, an operation that reduces a patient’s food intake by removing a substantial portion of his or her stomach, resulting in the patient feeling satiated after consuming smaller amounts of food. In many cases, the procedure also reduces the body’s production of a hunger-inducing hormone called ghrelin, further lowering the patient’s drive to eat.
- Biliopancreatic diversion with a duodenal switch (BPD-DS), a more complex bariatric procedure with three main components:
- removing a large portion of the stomach to make patients feel fuller, faster, leading to smaller meal sizes
- routing food away from much of the small intestine, reducing the body’s absorption of nutrients, including proteins and fats
- re-routing bile and other digestive juices in the body in an effort to impair digestion, further limiting the body’s absorption of food
- SADI-S (single anastomosis duodeno-ileal bypass with sleeve gastrectomy) is a newer variant of duodenal switch surgery. The surgery has been around for about 30 years, helping obese patients control their weight. With SADI-S, one intestinal bypass is made, rather than two. That means less time in surgery and lower risk of intestinal leakage. The two-step laparoscopic procedure begins with the removal of 80 percent of the stomach. The process slims down the stomach to a cylinder-shaped “sleeve” that will hold much less food. That results in a much smaller stomach and also suppression of the appetite-triggering hormone ghrelin.
Who qualifies for bariatric surgery?
Bariatric surgery may be an option for patients who have exhausted non-surgical weight-loss methods such as diet and exercise, but have still been unable to lose weight and keep it off. Procedures are typically considered for patients with:
- a Body Mass Index (BMI) of 40 or higher
- a BMI between 35 and 39.9 along with other obesity-related health issues, such as type 2 diabetes, high blood pressure or severe sleep apnea
What conditions can bariatric surgery treat?
Bariatric surgery is typically performed to help patients who are considered obese lose excess weight, as well as to treat or reduce the risk of a range of (sometimes) obesity-related health conditions such as high blood pressure, high cholesterol, heart disease, and stroke, type 2 diabetes, kidney disease, osteoarthritis, and sleep apnea. Further, by helping patients lose excess weight, the procedures can often enable those who undergo them to maintain a healthier lifestyle, attain a higher quality of life, and ultimately, live longer.
The steps to pursuing bariatric surgery
Any patient with an interest in bariatric surgery should begin the process by having a conversation on the topic with his or her primary care provider. Next, qualified patients should seek a referral from their doctor for an appointment with a bariatric specialist. And before proceeding with any form of weight-loss surgery, patients should check with their health insurance providers to ensure that any bariatric procedure they and their specialist may choose to pursue is covered by their insurance plan. (Additional information on the process can be found here.)
Getting bariatric surgery? Here’s what to expect
Bariatric surgery is typically performed in the hospital using general anesthesia, meaning that most patients undergoing the procedure will be unconscious as it is done. While some bariatric procedures require open surgery via sizable incisions in the abdomen, today, most are performed via a minimally invasive procedure known as laparoscopy. This type of procedure sees a small, tubular instrument fitted with a small camera inserted into the body through small abdominal incisions and then used to carry out the surgery.
The surgery itself usually takes several hours, and patients are typically taken to a recovery room for monitoring after the procedure is complete. Depending on the type of procedure performed and the condition of the patient, a post-surgical hospital stay of up to a few days may be required.
Typically, patients will be asked to refrain from eating for one to two days after the surgery to facilitate proper healing of the stomach and digestive system. After that, patients are often prescribed a specific diet for a few weeks post-surgery, typically consisting of only liquids initially, then progressing to soft and pureed foods. This is typically followed in time by a return to a regular diet — sometimes with longer-term restrictions on what the patient can eat and drink. Most patients will also be asked to return for regular checkups in the months after surgery, along with possible lab tests, blood work, and other exams.
Bariatric surgery is considered successful when patients who undergo it lose half of their excess weight and keep it off. And by that standard, it is highly effective — achieving these results roughly 90% of the time.
The risks of bariatric surgery
As with any major surgical procedure, bariatric surgery carries potential health risks for patients who undergo the procedures. And each of the different bariatric procedures discussed above has its own specific risks and benefits — so patients considering the surgery should discuss all of these in-depth with their care providers.
Short-term risks associated with undergoing any of the surgical procedures can include excessive bleeding, infection, blood clotting, adverse reactions to anesthesia, breathing problems, gastrointestinal system leaks, and, in rare cases, even death. Further, while varying based on the type of surgery, the longer-term risks, complications, and side effects of weight-loss surgery can include bowel obstruction, gallstones, hernias, low blood sugar, malnutrition, ulcers, acid reflux, nausea, dehydration, constipation, vomiting, a condition known as rapid gastric emptying and, rarely, death. Also in rare cases, a need for a second revisional surgery or procedure may arise.
Want to learn more about bariatric surgery? Visit the Wilmington Health Bariatric Surgery website. And if you think bariatric surgery may be right for you, talk with your primary care provider about getting a referral to a bariatric specialist.