Exercise and eating right are usually touted as the ‘best’ ways to lose weight, but many people find it hard to shed the pounds even after years of trying. If you are significantly overweight, or your excess weight is causing health issues, weight loss surgery (known as bariatric surgery) may be right for you.
Are You a Candidate?
In general, candidates for weight loss surgery are at least 100 pounds overweight and have been obese for most of their life. You may be a good candidate if you meet any of the following criteria:
- Unable to loss weight through diet and exercise program
- Have a BMI (body mass index) of 35 or greater with obesity related health conditions
- Have a BMI of 40 or greater without significant obesity-related health conditions
- In some cases, you may qualify if your BMI is 30 to 34 and you have severe weight related health issues.
It’s important to keep in mind, that even if you meet the above guidelines, you may still need to meet other criteria 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 — typically involving a doctor, psychologist, dietitian and surgeon. During the evaluation, the team will consider:
- Current medical condition
- Weight history and nutrition
- Psychological status
It is important to understand that bariatric surgery is not intended as an alternative to dieting or exercising, but rather as a weight loss option for those who have tried unsuccessfully to lose weight through other methods. Many bariatric surgeons require a serious attempt at weight loss for a specified period of time before surgery can be considered. Also, patients must be prepared for substantial lifestyle changes following their procedure.
Types of Weight Loss Surgery
If your approved for weight loss surgery, there is still the decision about which procedure is right for you. Many patients are surprised at the number of bariatric surgery techniques available from which to choose. The right choice for you depends on your goals, your current health, and your surgeon’s preference, among other factors.
There are two basic types: restrictive surgery and malabsorptive surgeries. There are also techniques that use both strategies to help patients lose weight. Within these categories, multiple surgical techniques have been developed.
Malabsorptive procedures focus on stopping the food that is consumed from being absorbed by the body, particularly in the intestines. Biliopancreatic diversion surgery is one option. For the most part, this method has been replaced with the duodenal switch method. During this surgical procedure, a lower part of the small intestine is attached to the stomach, to bypass the duodenum. The Endoluminal sleeve method uses an impermeable sleeve that is implanted into the intestine to block food absorption.
Restrictive procedures physically reduce the size of the stomach, thereby limiting the amount of food that can be consumed. After surgery, patients will feel full after consuming a much smaller amount of food. After surgery, the stomach is reduced in size, sometimes as small as two to three ounces, as compared to about three pints before surgery.
There are several strategies for making the stomach smaller during surgery. Gastric banding procedures such as The Lap Band System or Realize Band use a band to squeeze the stomach, creating a narrow channel through which the food passes. This method slows digestion and physically restricting the amount of food that can pass through the stomach. Depending on the type of band utilized, it may be adjustable, allowing the doctor to change the size of the stomach after surgery.
A similar technique, known as vertical banded gastroplasty, divides the stomach using a band along with surgical staples. Sleeve Gastrectomy is another form of restrictive weight loss surgery, which involves the surgical removal of about three quarters of the stomach. What remains is a narrow tube, leading to the name of the procedure. The gastric balloon procedure involves the placement of a balloon into the stomach to decrease the amount of available space. The technique is not yet approved in the United States, but is widely used in other countries. The balloon may be left in place for up to six months.
- Mixed Procedures
Surgeries using both malabsorptive and restrictive techniques tend to be more invasive. These surgeries remove parts of the intestines and the stomach, limiting food intake while making it harder for the body to absorb the calories that are consumed. The gastric bypass procedure is the most commonly performed type of bariatric surgery, comprising more than three quarters of all weight loss surgeries performed in the United States.
The most common form of gastric bypass is known as Roux-en-Y because of the Y-shaped connection created between the stomach and intestine. Considered a mixed approach, first the surgeon divides the stomach. The upper half is then connected to the lower portion of the small intestine, creating a shortcut that bypasses the lower half of the stomach and the upper half of the small intestine. Biliopancreatic Diversion is a more drastic version of this concept, removing as much of 70% of the stomach and bypassing even more of the small intestine. A variation of this technique includes a duodenal switch, which further reduces the volume of the stomach.
Choosing a specific surgical approach will require consultation with your doctor. No one technique is preferred for all patients; your choice should depend on your specific situation.
Risks & Safety Information
Bariatric surgery is considered a major procedure, and the potential risks should be considered when deciding whether surgery is the right option for you.
Some possible risks associate with the surgery include:
- Adverse reactions to anesthesia
- Blood clots or excessive bleeding
- Breathing problems
- Gastrointestinal leaks
There are also longer term risks and complications that could occur after your surgery, such as:
- Nutritional deficiencies
- Bowel obstruction
- Diarrhea, nausea or vomiting (Dumping Syndrome)
- Low blood surgar
Be sure to discuss all of the applicable risks with your doctor before undergoing surgery.
The recovery time following weight loss surgery should be considered both as a short-term and a long-term process. Your post-surgery recovery will begin with bed rest to allow your body to heal. It’s important to follow your surgeon’s instructions for a safe recovery. The average hospital stay is one to two days. Some patients require assistance for activities such as getting dressed, moving around, and preparing food for a day or two, while others will need several weeks of assistance. Patients can usually drive within two weeks and resume their normal activity level within six weeks of surgery.
After surgery, substantial lifestyle changes are necessary. Patients are temporarily restricted to a diet of clear liquids such as broth, fruit juice, or gelatin desserts. This diet must be continued until the gastrointestinal tract has recovered from the surgery. The next phase is a blended or pureed diet for at least two weeks. Diet restrictions during and following the recovery period demand in part on the type of bariatric procedure performed. After surgery, overeating may cause nausea or vomiting. Patients may need to take a daily multivitamin to compensate for reduced nutrient absorption in the digestive tract. Most doctors recommend a post-surgery diet that is high in protein and low in fat.
What’s the Cost?
Bariatric surgery can be complex, which makes it a fairly costly procedure. Depending on the type of bariatric surgery you undergo (gastric sleeve, LAP Band, etc), the cost can range from approximately $10,000 to $30,000. This includes the cost for the surgeon as well as expenses related to pre-op medical tests, anesthesia, and the hospital facility. After losing the weight, many patients also opt for body contouring plastic surgery, such as a body lift or panniculectomy, to remove excess skin. These additional procedures can add several thousands on top of the cost of bariatric surgery itself.
Items that are included in the cost are the surgeon’s fee as well as pre-op medical tests, anesthesia, and the surgical facility. These costs can vary based on many factors. Surgical costs vary between geographic regions, between surgeons, and based on the specific type of weight loss surgery performed and the length of time you spend recovering in the hospital.
In addition to the cost of the surgery itself, there are also related expenses that you should consider when deciding whether to undergo bariatric surgery. These include nutritional supplements, which are required after surgery to replace nutrients the body is no longer able to absorb through food, as well as the possibility of future body contouring surgeries to lift sagging areas and remove excess skin.
Will it be Covered by Insurance?
Because obesity has both an aesthetic and a medical component, some or all of the cost may be covered by health insurance. This is particularly true if your doctor can establish medical necessity. Your doctor may also need to provide documentation that you have been on a physician-supervised diet and exercise plan for six months or longer prior to surgery. Most cases of morbid obesity (a BMI of 40 or higher) are covered by health insurance. If obesity has contributed to serious health concerns such as heart disease or diabetes, your surgery is more likely to be covered by insurance.
If you think that your insurance policy may cover weight loss treatment, be sure to ask for details before undergoing surgery. There will likely be a pre-authorization process involving medical tests, letters from your doctor, and other steps for you to be approved for coverage. Some policies may provide coverage only for certain types of weight loss surgery techniques. Some will only cover the cost of surgery itself, while others cover all related expenses. Make sure that you know what your insurance will and will not cover before scheduling the surgery.
When it comes to the costs that are not covered by insurance, there are many payment plans and other financing options available. Talk to your surgeon about options to make weight loss surgery affordable for you.
- Bariatric Surgery: Author: Alan A Saber, MD, MS, FACS, FASMBS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF
- FDA: Obesity Treatment Devices (n.d.)
- ASMBS: Bariatric Procedures (n.d.)
- Effectiveness of Bariatric Surgical Procedures (n.d.)
- Real Procedural Costs of Bariatric Surgery (n.d.)