Weight loss isn’t just a trend. For some people, such as people with severe obesity, it’s a medical necessity. If you need to lose a significant amount of weight for medical purposes, you could be a candidate for bariatric surgery.
What Is Bariatric Surgery?
Bariatric surgery refers to a group of surgeries used to promote weight loss. These procedures are reserved for people who have a body mass index of 40 or above, or a BMI of 35 or above in addition to a co-occurring condition, such as Type 2 diabetes, sleep apnea or hypertension.
Many bariatric surgery candidates are people who have been unable to lose weight or sustain weight loss, likely due to epigenetics — or genetic factors that influence how the body stores fat or responds to diet and exercise.
[READ: Semaglutide vs. Weight Loss Surgery: Which Is Better?]
Who Qualifies for Bariatric Surgery
Some people have incorrect assumptions that people who undergo bariatric surgery haven’t tried hard enough to lose weight through other methods.
In reality, obesity is a “disease process that needs notable medical and surgical help — just like depression, hypertension and heart disease,” says Dr. Michael Snyder, a medical advisory board member of FuturHealth and the medical director of the Bariatric Surgery Center at Rose Medical Center in Denver, Colorado. “That is science, not opinion.”
“Everyone who struggles with severe and morbid obesity really cannot control their weight, despite notable personal efforts at dietary and behavioral changes,” he adds.
In fact, Snyder explains, that it is “pretty much impossible” for many people with high BMIs to lose weight and maintain weight loss for more than five years. This has been demonstrated by research studies conducted over the last two decades and into today, he adds.
In a large cohort study from 2023 — which looked at more than 13 million U.S. patients with a BMI of 25 or higher — researchers found that the annual probability of losing 5% or more weight was 1 in 10. While researchers noted that people with higher BMIs were more likely to lose the weight, they also said the annual probability of reducing BMI to the “healthy weight category” was less likely, particularly for people with starting BMIs of 45 or higher. The study found that for people with starting BMIs of 45 or higher, the probability of entering healthy weight category — which they defined as a BMI between 18.5 to 24.9 — was 1 in 1,667 individuals.
While it is by no means an “easy way out” — the surgery itself, as well as prep work and aftercare, are physically and emotionally intense and require a person to be an active participant in their health journey — Snyder says bariatric surgery offers a weight loss option to people who face weight loss barriers and don’t have another good option.
“These procedures give them a tool that helps level the playing field with their weight loss efforts. It allows them to fight the genetics of weight loss in an extremely effective and safe manner,” he says. They finally get “a win.”
[READ: Post-Bariatric Surgery Diet: What You Can Eat.]
Bariatric Surgery Types
Today, two of the most common forms of bariatric surgery are the vertical sleeve gastrectomy — also known as the VSG or sleeve — and the Roux-en-Y gastric bypass — also known as the bypass or RYGB. Both of these surgeries have the end goal of major, sustainable weight loss through metabolic changes and calorie restriction — but they take slightly different paths to get there.
Vertical sleeve gastrectomy (VSG)
In a VSG procedure, surgeons take out a large chunk of the stomach — about 70% — leaving the patients with what looks like a “narrow tube” or banana-sized piece, Snyder says.
This promotes weight loss as it removes some key areas where the hunger hormone — ghrelin — is created, making people feel “notably less hungry,” Snyder says. It is considered a restriction-based procedure, because it can result in people eating less food (restricting calories) and thus losing weight.
VSG is a minimally invasive procedure, conducted through robotic or laparoscopic surgery techniques. Patients who undergo a VSG may expect to lose about 60% to 70% of excess weight in the 12 to 18 months following their procedure.
Roux-en-Y gastric bypass (bypass or RYGB)
Bypass is considered a “combination” procedure — it’s a bariatric surgery that promotes weight loss through restriction and malabsorption mechanisms, encouraging people to eat less food and reducing their body’s ability to absorb foods that enter it, respectively.
In a gastric bypass procedure, the stomach is divided into a small, egg-sized pouch and a larger lower remnant. The pouch serves as the functional part of the stomach and, due to its decreased size, places limitations on how much a person can eat.
The small intestine is also divided, and the lower part is connected to the stomach pouch. This allows food to bypass the upper part of the small intestine — as well as the non-pouch area of the stomach — decreasing food absorption. The bypassed section of the small intestine is reconnected to the another area of the stomach to help with digestion later on.
Like VSG, bypass is a minimally invasive procedure, conducted through robotic or laparoscopic surgery techniques. Patients who undergo a gastric bypass may expect to lose about 50% to 80% of excess weight in the 12 to 18 months following their procedure.
Less common types of bariatric surgery
Other types of bariatric surgery that are less frequently used include:
Duodenal switch
This involves surgically removing part of the stomach and rerouting the small intestine. Like bypass, it promotes weight loss through both restriction and malabsorption mechanisms. This surgery can have some of the most dramatic weight loss results, but can also come with higher risks for complications.
Lap-band surgery
This involves surgically placing a silicone band, known as the lap-band, around the stomach. The band restricts the expansion of the stomach, reducing capacity and slowing down the passage of food. It can cause patients to want to eat less, resulting in restricted food intake and weight loss. The lap band can be adjusted and is reversible.
Though it was once a frequently used procedure, Snyder says that now, the band is “really of historical nature; no one is really doing it.”
[SEE: How to Lose Weight: the Best Foods for Weight Loss]
What Type of Bariatric Surgery Is Best for You?
Various bariatric surgeries are effective for weight loss; however, different patients may benefit more from one option over another. To decide on the best procedure for you, talk to your surgeon about your personal preferences and ask them about how they think the different methods would support your weight and metabolic goals.
“The average patient seeing a bariatric surgeon has spent many hours on the Internet and in various forums learning about the procedures and which one ‘feels right to them,'” Snyder says. “That is a great entrance point into thinking about the procedure, but then the surgeon’s job is to put together the patient’s goals, procedure tolerance and expectations in-line with the scientific reality”
When it comes to reaping results from the procedures, he says that the people may feel the benefits of a bypass procedure sooner than a sleeve, but that the bypass will require a few more dietary modifications — that will be lifelong undertakings.
Whatever you pursue, “the metabolic power of both is huge,” he adds.
Deciding between a sleeve or bypass procedure may also come down to the extent to which obesity is impacting your life. If your condition negatively impacts your day-to-day activities, such as your ability to walk around, or if you are experiencing a related condition like metabolic syndrome — which pertains to a group of conditions including high blood pressure, high blood sugar, high cholesterol, high levels of triglyceride fat and other excess fat that heighten your risks for heart attack, stroke and diabetes — gastric bypass may give you more life-changing results.
[READ: What You Need to Know About the Dr. Now Diet.]
Questions to Ask Your Bariatric Surgeon
There’s a lot to unpack about bariatric surgery, including how it works, whether it’s right for you and if so, the best procedure to meet your individual needs. These are some questions to ask:
— What benefits might I experience from weight-loss surgery?
— What are my individual risks?
— What medical alternatives do you offer?
— On average, how much weight do patients lose with each procedure?
— What is your recommendation for my surgical treatment?
— How long does recovery take?
— How will my eating habits and lifestyle change?
Bariatric Surgery Benefits
About 70% of people are overweight or have obesity, which can be risk factors for other chronic diseases. If you are eligible and in medical need of bariatric surgery, doctors say the procedure may greatly benefit your health and quality of life.
Some types of victories you may experience after your procedure include:
— Significant weight loss
— Improvement of health conditions linked to obesity, such as Type 2 diabetes
— Self-esteem improvements
Bariatric Surgery Risks
Despite its benefits, weight loss surgery also comes with risks. Some risks include:
— Noncompliance, such as if you are not ready to change your lifestyle habits after the surgery
— Unsuccessful weight loss (or not losing as much weight as you had hoped)
— Gaining weight back
— Dumping syndrome, which can be a side effect from consuming sugars or simple carbohydrates after gastric bypass surgery and involves symptoms like transient nausea, diarrhea or feeling ill
— Surgery or anesthesia complications, similar to other procedures
Dr. Mir Ali, a board-certified bariatric surgeon and the medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California, explains that people with higher BMIs may have some heightened anesthesia and surgery risks, such as complications with being put to sleep or fitting a breathing tube in before surgery.
Additionally, pulmonary and cardiac complications can be higher for people with higher BMIs. Still, Ali says the surgery is much safer than many people believe — and safer than other common surgeries.
“To put it in perspective, a more common surgery done nationwide worldwide is removing the gallbladder — and bariatric surgery has a better safety profile than gallbladder surgery,” Ali says.
What to Expect Before and During Bariatric Surgery
Bariatric surgery is not a quick in-and-out procedure. It involves intensive preparation and post-operative work from you and your doctors.
In the weeks or months leading up to bariatric surgery, you will likely have several meetings with your surgeon and other medical professionals to make sure you are ready for the procedure and to take care of any lingering health issues that could complicate the big day.
Some specialists that you might meet with leading up to the surgery include:
— Cardiologist
— Pulmonologist
— Psychiatric professional
— Registered dietitian
— Insurance consultants
Leading up to the surgery, your surgeon and team members will likely recommend a dietary protocol for you to follow. The Dr. Now diet, a restrictive 1,200 calorie-per-day diet designed by bariatric surgeon Dr. Younan Nowzaradan for people prepping for weight loss surgery, may be one option. Talk to your doctor. Together, you will come up with a meal plan to prepare for the procedure that will probably look a lot like Dr. Nowzaradan’s diet plan.
Some protocols that may be required include:
— Upholding a liquid diet for one or two days
— Significantly modifying your diet for two weeks
— Eating in such a way that will not lead to weight gain
On the day of the surgery, you will typically receive general anesthesia and should not feel or be aware of the procedure taking place. If you are undergoing a sleeve procedure, this may take between 30 minutes to an hour, and if you are undergoing a gastric bypass procedure, this may take between 90 minutes to 2.5 hours.
Depending on the pain you feel after the surgery, you may need to stay longer in the hospital or be administered narcotics. However, Snyder says that most people with bariatric surgery go home within a day, commonly without narcotics.
After bariatric surgery, your body may need some time to heal. It is important to listen to your doctor’s advice pertaining to activity and dietary recommendations, as these will have shifted from before your surgery. You may work with a dietitian to ensure that you are meeting your dietary needs now that the volume of food you are eating and/or absorbing has decreased.
Life After Bariatric Surgery
Many people who undergo bariatric surgery go on to have sustainable weight loss success. However, this does not come from the procedure alone. Changing lifestyle habits, which can include food and exercise agendas, is essential to keeping weight off and securing your goals.
“It’s not a miracle,” Ali says. “They still have to put in the work, but it provides a really good tool for them to use to change a healthier diet and lifestyle.”
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What Is Bariatric Surgery? originally appeared on usnews.com
