Weight loss surgery is becoming more popular as a substitute for weight loss by dieting. Most people considering surgery have a number of questions they need answers to before they can start to make a decision.
The information in this article should help you start to find answers to some of the most commonly asked questions.
- Who should consider weight loss surgery?
- What are the different procedures?
- Can I lose weight?
- Weight loss surgery seems so drastic, is it worth it?
- Complications associated with surgery?
- Can I reduce the chance of complications?
- What kind of follow-up care will I need?
- Who should consider weight loss surgery?Weight loss or bariatric surgery is a surgical therapy reserved for people who are seriously obese. Obesity is measured by a person’s body mass index, (BMI), which is calculated by a person’s height and weight.In order to be considered for weight loss surgery, a people must have a BMI 40 or BMI 35 with obesity related diseases (e.g. hypertension, type 2 diabetes).Additionally, they must be well informed and motivated, have been unsuccessful at other nonsurgical weight loss options, have a strong desire for weight loss, and be considered an acceptable operative risk.
- What are the different procedures?The two most common types of weight loss surgeries performed in the United States are the Roux-en-Y Gastric Bypass, (RYGB) and the Laparoscopic Adjustable Gastric Banding (LAGB). A procedure called the vertical banded gastroplasty (VBG) is seldom used since the LAGB became available in 2001, and the biliopancreatic diversion is considered investigational.
- Can I lose weight?When the Laparoscopic Adjustable Gastric Banding (LAGB) is performed the surgeon places a band around the upper portion of the stomach. The band can be tightened or loosened by the surgeon. This new pouch will hold only approximately one ounce, which greatly restricts the amount of food or fluids the patient can ingest.The patient will feel comfortably full after eating smaller amounts. Weight loss occurs because of a decrease in calories and nutrients.The Roux-en-Y gastric bypass, (RYGB) is considered the “gold standard” for weight loss surgeries. The surgeon either makes a traditional incision on the patients abdomen or using several small incisions, is guided by a laparoscope. The upper portion of the stomach is divided making a small pouch, which is held in place by staples.The pouch can hold approximately one ounce which limits the volume a person can eat or drink at one time. A Y portion of the small intestine is then attached to the pouch, and the remaining portion of the stomach is “bypassed”.Weight loss occurs due to reduction of caloric intake as well as absorption of nutrients.
- Isn’t surgery a drastic way to lose weight?Weight loss surgery is a major decision. It is not a quick fix, and requires a lifelong commitment to diet, exercise and medical follow-up. This weight loss option is a consideration only for patients who meet strict clinical criteria.Obesity and obesity related illnesses such as hypertension, type 2 diabetes, stroke, cardiovascular disease and several forms of cancer, are increasing at alarming rates in the US .In the year 2000, 400,000 obesity related deaths were reported in this country. Following weight loss surgery, patients experience improvement in obesity related illnesses, and the risk of early death is diminished.For seriously obese patients, who have been unsuccessful trying nonsurgical weight loss options, such as diets, medications, behavioral modifications, or exercise programs, weight loss surgery may be a life-saving intervention.
- What are the risks and complications associated with weight loss surgery?Weight loss surgery is a major surgical procedure, and as with all surgeries there is risk. Although infrequent, serious surgical complications such as pulmonary embolism, intestinal leak, deep venous thrombosis (blood clot), and mortality within 30 days (0.5-1% of patients), may occur following Roux-en-Y Gastric Bypass (RYGB).Complications associated with the Laparoscopic Adjustable Gastric Banding (LAGB) procedure are also infrequent, and may involve movement or erosion of the band. Mortality within 30 days of surgery occurs in less than 0.5% of patients.
- How can I reduce the chance of developing complications?There are several things a patient can do in preparation for weight loss surgery.EducationPerhaps the best way to prepare is by becoming an educated consumer. Learn as much as you can, ask questions; seek additional information from appropriate references and websites. Attend informational sessions provided by hospitals.Identify Family/Friend Support SystemThis is a life altering major surgery, and you will need the involvement and assistance of loved ones. This complex surgery should be performed only by a board certified or board eligible surgeon in a properly equipped high volume weight loss center.Board certification means the physician has successfully completed an approved training program and an evaluation process assessing their ability to provide quality patient care in a specialty. The certification is conferred by the American Board of Medical Specialists.The surgeon should be highly experienced in the procedures having performed at least 50 similar surgeries per year. The center should perform at a minimum 100 weight loss surgeries per year, and should present a multidisciplinary approach to weight loss surgery.If possible, all patients are encouraged to lose weight prior to the surgery. Patients who smoke cigarettes are encouraged to quit 6-8 weeks prior to the scheduled surgery.
- What kind of follow-up care will I need?You will need to be committed to long term follow-up. You will need to take a daily multivitamin, and calcium supplement with added vitamin D for the rest of your life. Your physician may order additional supplements if indicated.A blood test beginning 6 months after surgery and at least annually after that to assess your level of micronutrients is required.
Bariatric surgery is typically reserved for those individuals 100 pounds or more overweight (Body Mass Index [BMI] of 40 or higher) who have not responded to other less invasive weight loss therapies such as diet, exercise, medications, etc.
In certain circumstances, less morbidly obese patients (with BMIs between 35 and 40) may be considered for bariatric surgery (patients with high-risk co-morbid conditions and obesity-induced physical problems that are interfering with quality of life).
Bariatric surgery should not be considered until you and your doctor have evaluated all other options. The proper approach to bariatric surgery requires discussion and careful consideration of the following with your doctor:
These weight loss procedures are in no way to be considered as cosmetic surgery. The surgery does not involve the removal of adipose tissue (fat) by suction or excision.
A decision to elect surgical treatment requires an assessment of the risk and benefit to the patient and the meticulous performance of the appropriate surgical procedure.
The success of bariatric surgery is dependent upon long-term lifestyle changes in diet and exercise. Problems may arise after surgery that may require reoperations.
Success of surgical weight loss treatment must begin with realistic goals and progress through the best possible use of well-designed and tested operations.
As with any surgery, there are operative and long-term complications and risks associated with weight loss surgical procedures that should be discussed with your doctor. Possible risks include, but are not limited to:
Complications due to anesthesia and medications
Deep vein thrombosis
Leaks from staple line breakdown
*Removal of the spleen is necessary in about 0.3% of patients to control operative bleeding.
Due to the many potential complications, weight loss surgery is usually only considered as a last resort. We would recommend first trying a weight loss program designed specifically for people who need to lose more than 100 pounds. The Gabriel Method is one such plan which has been proven to work for many people.