Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you cannot lose weight through diet and exercise or have serious health problems caused by obesity.
There are different types of weight loss surgery. They often limit the amount of food you can take in. Some types of surgery also affect how you digest food and absorb nutrients. All types have risks and complications, such as infections, hernias, and blood clots.
Many people who have the surgery lose weight quickly, but regain some weight later on. If you follow diet and exercise recommendations, you can keep most of the weight off. You will also need medical follow-up for the rest of your life.
Insurance companies require that patients first try to lose weight by eating healthy foods, cutting portions, and exercising for at least six consecutive months. If that fails, they meet the criteria for weight-loss surgery. Most people attempt this by working with their primary physician or through classes at a medical center, Furtado says. But it can also be done through Weight Watchers, Jenny Craig, NutriSystem, or other weight-loss programs.
Part of the screening involves meeting with a psychologist at the weight-loss surgery center to make sure you are not binge eating and don’t have untreated depression. If you’re experiencing a condition like binge eating, you may need cognitive-behavioral therapy before you can have the surgery, Furtado says.
When a patient tells Furtado that she wants weight-loss surgery in order to be a size 2 or to look like her personal trainer, she explains that those are unrealistic expectations and may be a sign that she’s not ready for the surgery. The same goes for patients who refuse to give up drinking soda or won’t quit smoking before the surgery. “It’s a red flag that they’re not ready,” Furtado says.
Excess weight can cause or aggravate medical conditions such as diabetes, sleep apnea, high cholesterol, heart disease and high blood pressure. In some cases, these conditions may make you a good candidate for weight loss surgery. But in other cases, they may affect your ability to withstand the surgical procedure. Your physician will be able to tell you more about how your condition will affect the procedure.
Most surgeries require that you continue to see your doctor to monitor your health in the years following treatment. Your doctor will monitor your weight loss, but may also adjust medications if necessary, provide recommendations for vitamin and mineral supplementation, and possibly suggest adjustments to your surgery. Patients who have lap band surgery, for example, may need to have the size of the band adjusted to meet their weight loss needs.
There are several different procedures available for patients who choose weight loss surgery. Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric banding (LAGB), and laparoscopic sleeve gastrectomy are three common types of laparoscopic surgery. Each procedure has different risks and benefits. You should find out more about each procedure before choosing one.
Weight loss surgery isn’t a magic wand. If you choose to undergo surgery, you will still have to modify your diet and eating habits. Patients who have the greatest success with bariatric surgery adopt moderate eating and exercise habits to maintain their weight loss over a long period of time.
Gastric bypass surgery, also called Roux-en-Y gastric bypass, has two parts. First, the surgeon staples your stomach, creating a small pouch in the upper section. The staples make your stomach much smaller, so you eat less and feel full sooner.
Next, the surgeon cuts your small intestine and attaches the lower part of it directly to the small stomach pouch. Food then bypasses most of the stomach and the upper part of your small intestine so your body absorbs fewer calories. The surgeon connects the bypassed section farther down to the lower part of the small intestine. This bypassed section is still attached to the main part of your stomach, so digestive juices can move from your stomach and the first part of your small intestine into the lower part of your small intestine. The bypass also changes gut hormones, gut bacteria, and other factors that may affect appetite and metabolism. Gastric bypass is difficult to reverse, although a surgeon may do it if medically necessary.
In the laparoscopic adjustable gastric banding procedure, a band containing an inflatable balloon is placed around the upper part of the stomach and fixed in place. This creates a small stomach pouch above the band with a very narrow opening to the rest of the stomach.
A port is then placed under the skin of the abdomen. A tube connects the port to the band. By injecting or removing fluid through the port, the balloon can be inflated or deflated to adjust the size of the band. Gastric banding restricts the amount of food that your stomach can hold, so you feel full sooner, but it doesn’t reduce the absorption of calories and nutrients.
In gastric sleeve surgery, also called vertical sleeve gastrectomy, a surgeon removes most of your stomach, leaving only a banana-shaped section that is closed with staples. Like gastric band surgery, this surgery reduces the amount of food that can fit in your stomach, making you feel full sooner. Taking out part of your stomach may also affect gut hormones or other factors such as gut bacteria that may affect appetite and metabolism. This type of surgery cannot be reversed because some of the stomach is permanently removed.
As with sleeve gastrectomy, this procedure begins with the surgeon removing a large part of the stomach. The valve that releases food to the small intestine is left, along with the first part of the small intestine, called the duodenum.
The surgeon then closes off the middle section of the intestine and attaches the last part directly to the duodenum. This is the duodenal switch.
The separated section of the intestine isn’t removed from the body. Instead, it’s reattached to the end of the intestine, allowing bile and pancreatic digestive juices to flow into this part of the intestine. This is the biliopancreatic diversion.
As a result of these changes, food bypasses most of the small intestine, limiting the absorption of calories and nutrients. This, together with the smaller size of the stomach, leads to weight loss.
What it is: An intragastric balloon is a type of restrictive weight loss surgery in which a deflated balloon is placed in the stomach (through the mouth). Once in place, it is filled with saline solution that provides a sense of fullness, thereby curbing hunger. The intragastric balloon is not meant for people who’ve had weight loss surgery or who have bowel disease or liver failure.
There’s no surgery involved and no hospital stay required. The balloon is temporary; it stays in place for six months. A person can lose about 10 percent of his excess body weight during that time.
AspireAssist is a device that takes a malabsorptive/restrictive approach to weight loss. A tube is placed through an abdominal incision that has a disk-shaped port that sits flush against the abdomen outside. About 20-30 minutes after a meal, the patient attaches the tube to an external draining device that removes food matter into the toilet. The device, approved for weight loss in 2016 by the FDA, removes about 30 percent of calories consumed.
An implanted pacemaker-like device sends regular electrical impulses to the vagus nerve, which signals the brain that the stomach is full. The vagus nerve extends from the brain to the stomach. The blockade device is placed under the rib cage and is operated by remote control that can be adjusted outside the body.