Weight Loss Surgery

Overview

What is bariatric surgery?

Bariatric surgery, also known as weight loss surgery, is a medical procedure performed on individuals who are severely overweight or obese to help them achieve significant and sustained weight loss. This type of procedure is typically considered when other weight loss methods, such as diet and exercise, have not been successful or when obesity-related health conditions pose significant risks to the patient’s well-being.

How much does weight loss surgery cost?

Is the procedure covered by insurance?

Are you a candidate?

The consensus guidelines covering the criteria for eligibility for bariatric surgery were developed by the U.S. National Institutes of Health in 1991, and have not changed since then. The criteria are:

• BMI (body mass index) of 40 or greater without significant obesity-related health conditions, or
• BMI of 35 or greater with at least one serious obesity-related health condition, including (but not limited to):
• Type 2 diabetes
• High blood pressure (hypertension)
• Obstructive sleep apnea
• High cholesterol (hyperlipidemia)
• NASH/NAFLD (non-alcoholic steatohepatitis/ non-alcoholic fatty liver disease – inflammation and dysfunction of the liver due to excess fat build-up)
• Obesity hypoventilation syndrome (a condition where obesity limits breathing to the point where oxygen is low and carbon dioxide is high in the blood)

Tried proper diet and exercise It is important to understand that bariatric surgery is not intended as a replacement for a proper diet and exercise, but rather as a weight loss option for those who have tried unsuccessfully to lose weight through lifestyle modifications. Many bariatric surgeons (and medical insurance plans) require a serious attempt at weight loss for a specified period of time before surgery can be considered.

Willing to adopt significant lifestyle changes People must also be prepared to adopt and maintain significant lifestyle changes following the procedure. Having bariatric surgery does not mean that people can eat whatever they want or live a sedentary lifestyle without any consequences. It’s possible to gain back the weight they lost.

Specific dietary precautions As well, specific dietary precautions are necessary on an ongoing basis following surgery. For example, the amount of food that can be ingested will change, certain foods must be avoided, and certain nutritional supplements may have to be used (depending on the type of surgery).

Weight loss prior to the surgery Most surgeons require a certain amount of weight loss prior to the surgery. This is so that patients can demonstrate that they have the ability and commitment necessary to engage in meaningful lifestyle modifications, and it also reduces the risk of complications during the surgery itself. In particular, even modest amounts of weight loss will reduce the size of the liver which makes the surgery easier and safer to perform.

Screening process Even if you meet the above guidelines, there are other requirements that must be satisfied to qualify for surgery. For example, you will likely go through an extensive screening process that involves interviews, exams, and laboratory testing with a team of health care professionals. This testing will typically involve a doctor, psychologist, dietician, and surgeon. During the evaluation, the team will consider your:

• Current medical condition (to identify surgical or anesthetic risks)
• Weight history and nutrition
• Psychological status (to rule out undiagnosed mental health disorders or drug or alcohol abuse)
• Social support system
• Motivation
• Ability to observe lifelong nutritional requirements

Got more questions about bariatric surgery? Read our article about the most popular bariatric surgery FAQs to get answers to your questions.

Types of weight loss procedures

Traditionally, bariatric procedures have been classified as either restrictive, malabsorptive or both. Restrictive procedures reducing the size of the stomach, thereby limiting the amount of food that can be consumed, while malabsorptive procedures disrupt the body’s ability to absorb nutrients.

Here are some of the most popular types of weight loss procedures:

• Roux-en-Y gastric bypass. Gastric bypass is a mixed bypass procedure. The stomach is surgically divided, and a pouch is created that holds about one ounce of food (compared to about three pints before surgery). Then, the pouch is connected with the small intestine in a way that bypasses much of the first part of the intestinal tract.
• Vertical sleeve gastrectomy. Gastric sleeve is a form of restrictive surgery, about 80% of the stomach is removed, creating a small tube-like (“sleeve”) stomach. This reduces the amount of food the stomach holds, and accelerates emptying of the stomach.
• Biliopancreatic diversion with duodenal switch. During this mixed surgical procedure, a sleeve gastrectomy is performed, and the lower part of the small intestine is attached to the stomach, thereby bypassing much of the small intestine (specifically, the duodenum). The Duodenal Switch is not used very often due to a higher incidence of complications (both in the short- and long-term).
• Gastric banding. In this restrictive procedure, a band is placed around the stomach, thereby creating a small stomach pouch and stomach outlet. Some gastric bands are adjustable, and the size of the stomach pouch and rate of stomach emptying can be adjusted by a balloon device that is accessed through a port just under the skin. The Lap Band System is an example of adjustable gastric banding product. A similar technique, known as vertical banded gastroplasty, divides the stomach using a band along with surgical staples.
• Endoscopically placed devices. A number of incision-free devices and procedures that are placed or performed by using a minimally invasive scope are under development or just entering clinical use. For example, the gastric balloon procedure involving the placement of a balloon into the stomach to decrease the amount of available food space has recently been approved for use in the U.S. by the FDA. (Wolfe et al., 2016) The balloon may be left in place for up to six months. Another endoscopically-placed device is the endoluminal sleeve, a thin plastic sleeve that is placed in the upper part of the intestine to block food absorption.
• Intermittent vagal blockade. In this innovative procedure, electrical stimulation leads are placed around the nerve that innervates the stomach (the vagal nerve), and produce a reduced appetite and earlier feeling of fullness (satiety) by stimulating the nerve. This is an example of a procedure that is neither restrictive nor malabsorptive.

The vertical sleeve gastrectomy and the Roux-en-Y gastric bypass are the most commonly performed types of bariatric surgery in the U.S. Choosing a specific surgical approach will require close consultation with your doctor. No one technique is preferred for all patients, so your choice will depend on your specific situation.

How long will the recovery take?

The recovery period after bariatric surgery can vary depending on the specific procedure performed and individual factors.

For example, a Roux-en-Y gastric bypass will require a hospital stay and bed rest, while many laparoscopic procedures are done on an outpatient basis. Your surgeon will discuss the specifics about recovery time, functional limitations, and time needed off work for your particular procedure.

Learn more about the bariatric surgery recovery timeline.

When will you see results?

In general, during the first 30 days after weight loss surgery the average patient’s weight loss is between 5 to 15 pounds per week. Males tend to lose weight at a faster pace than women.

After 2 months, most patients average a 20% loss of excess weight. Some patients may lose 30 to 50 percent of their excess weight in the first six months, and 77 percent of excess weight as early as 12 months after surgery.

It’s important to keep in mind results vary between patients and this surgery should not be looked at as a “quick fix” for weight loss.