Almost everyone desires a nice, svelte body that’s free of health problems. Depending on how far you’re willing to go, some attempt extreme crash diets to lose weight fast, while others take a slow and steady approach that can last from months to years. For a small pool of individuals, surgery might come to mind.
No, I do not mean liposuction, where you remove fat from specific areas of the body surgically. I’m referring to bariatric surgery, which is weight loss surgery that involves making changes to your digestive system to help you lose weight. This could be through reducing the size of your stomach or taking up space in your stomach with a gastric balloon; regardless, the goal is to restrict the amount of calories you consume.
In the past, bariatric surgery was done on severely obese patients with a slew of health problems, such as diabetes and hypertension. Today, I get moderately overweight or even slim patients who ask me questions like:
- Doc, will bariatric surgery make me look like a model?
- Will I really lose my appetite?
- I can slim down quickly, right?!
First, let me get this straight: You can and will indeed lose a lot of weight from bariatric surgery. About at least 65-85% of patients lose up to 50% of their original weight during the first 12 months post procedure. However, it is a major weight loss surgery that requires 4-6 months of preparation, extensive assessments and appointments with doctors, dieticians and exercise physiologists.
Simply put, bariatric surgery is certainly not for those who wish to lose weight on impulse, and the patient’s profile must be carefully considered.
Shortly, I will discuss the criteria for bariatric surgery as well as its outlook, but first let’s have a look at the options we have today.
What are the types of bariatric surgery for weight loss?
Roux-en-Y gastric bypass
A Roux-en-Y gastric bypass involves cutting a portion of the stomach and sealing it off. Whatever that’s left of the stomach is then connected to the small intestine, creating a “pouch”. Any food consumed bypasses most of your stomach and goes straight to the middle part of your small intestine. As a result, the amount of food you can eat is significantly reduced.
Sleeve gastrectomy
A sleeve gastrectomy involves removing about 80% of the stomach, leaving a long, tube-like pouch that looks like a sleeve. Consumption of food is drastically reduced, as well as the production of ghrelin, a hormone that regulates hunger. Most patients find that their desire to eat is a lot less.
Gastric bypass
This involves placing a band around the upper portion of your stomach to reduce stomach size without removing anything. As the tightening and loosening of the band can be done progressively, I usually recommend a gastric bypass to patients who are already motivated and have no problem complying with dietary plans and regular exercise.
Biliopancreatic Diversion with duodenal switch
This is a two-part surgery whose first step is similar to a sleeve gastrectomy, and the second involves connecting the end portion of the intestine to duodenum. What we get is a limit to how much food you can eat. As there are more risks involved, a Biliopancreatic Diversion with duodenal switch is generally recommended for those with a BMI over 50.
Elipse gastric balloon
A gastric balloon isn’t really considered bariatric surgery per se, but the Elipse gastric balloon is one of the most common weight management procedures I offer at my clinic. The balloon is to be swallowed like a pill, in which it expands and takes up space in the stomach, creating a feeling of fullness and eliminating hunger cues.
Unlike other gastric balloons, the Elipse gastric balloon does not require an endoscopy for insertion and is naturally passed out through your faeces after 16 weeks. So on that note, it is a temporary weight loss solution and certainly a lot less invasive.
For those reasons, I recommend this method for patients who need some motivation to lose weight, do not meet the criteria for surgery or are too ill for surgery.
How much weight can I lose with bariatric surgery?
The amount of weight you lose after bariatric surgery really depends on your adherence to the diet and exercise scheme your healthcare team prescribes, but generally, patients lose about:
- 30-40% of excess body weight in the first six months
- 50% or more weight (close to 100 pounds for some patients) a year after
Since it’s close to impossible to eat even half as much as you did pre-surgery, if weight loss stalls, it could be due to the quality of food you consume. Are you eating high calorie dense food, such as junk food? Such food even when consumed in tiny amounts can really pack on the calories!
Is bariatric surgery dangerous?
As mentioned earlier, bariatric surgery is a major weight loss procedure which should not be considered at whim. You should only consider it if:
- You have a BMI of 40 or higher
- You have weight-related health conditions like obstructive sleep apnea, type 2 diabetes and high blood pressure
- Your best efforts to lose weight via diet and exercise have been unsuccessful
The most common risks associated with bariatric surgery include dumping syndrome and malnutrition, but these can be easily overcome if you work with a certified nutritionist.
When compared to the perils of obesity, the risks of bariatric surgery are minimal; most patients see a significant improvement in their health and attitude towards life.
References
- Cadena-Obando, D., Ramírez-Rentería, C., Ferreira-Hermosillo, A., Albarrán-Sanchez, A., Sosa-Eroza, E., Molina-Ayala, M., & Espinosa-Cárdenas, E. (2020). Are there really any predictive factors for a successful weight loss after bariatric surgery?. BMC endocrine disorders, 20(1), 20. https://doi.org/10.1186/s12902-020-0499-4
- Maciejewski, M. L., Arterburn, D. E., Van Scoyoc, L., Smith, V. A., Yancy, W. S., Jr, Weidenbacher, H. J., Livingston, E. H., & Olsen, M. K. (2016). Bariatric Surgery and Long-term Durability of Weight Loss. JAMA surgery, 151(11), 1046–1055. https://doi.org/10.1001/jamasurg.2016.2317
- https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258
- https://www.webmd.com/diet/obesity/features/weight-loss-surgery-what-to-expect-the-first-year#1
This article was written and medically reviewed by Dr. Ganesh Ramalingam, M.D.
