Surgery for Obesity

Weight loss surgery (bariatric surgery) involves surgically reducing the size of your stomach so that your body absorbs less of the food you eat. Common types of bariatric surgery include laparoscopic adjustable gastric banding (also called the lap band), gastric bypass, a sleeve gastrectomy, and biliopancreatic diversion. Many of these procedures are laparoscopic surgeries, also known as minimally invasive surgeries. This means that they are performed through small incisions using a laparoscope (a small, thin tube with a camera on the tip that is used to see the inside of your body). Laparoscopic surgeries lead to less pain and a quicker recovery time than more invasive surgeries.

Bariatric surgery is not for everyone who is overweight or even obese. Before you can qualify for surgical weight loss, you must have health conditions that are related to your obesity. For example, you must also have been diagnosed with sleep apnea, heart disease, diabetes, or high blood pressure.

What is obesity?

Maintaining a healthy body weight is one of the best ways to avoid weight-related health problems, such as type 2 diabetes or heart disease. But what exactly is a healthy body weight? A measurement based on your height and weight is called your body mass index, or BMI. It is considered to be a better measure of health risk than just your weight in pounds. In fact, the medical terms “overweight” and “obesity” are based on BMI values. A BMI between 25 and 30 is defined as overweight. A BMI of 30 or more is considered obese. The higher your BMI, the greater your risk of developing a weight-related illness. Online calculators can help you figure out your BMI.

Path to improved health

If you want to lose weight, the first thing you should do is talk to your family doctor. Your doctor will help you develop a healthy eating and exercise plan. This plan can help you lose weight, improve your fitness, and decrease the chances of developing heart disease, high blood pressure, or type 2 diabetes. However, in severe cases, diet and exercise alone may not be enough to help you lose weight. If you have a BMI of more than 40 or serious weight-related health issues, your doctor may talk to you about whether you might be a candidate for weight-loss surgery.

What is bariatric surgery?

Weight-loss surgery (also called bariatric surgery) can help you lose large amounts of weight if you are obese. Weight-loss surgery is most successful when used as part of a long-term healthy lifestyle change, including diet and exercise. After surgery, weight loss is often rapid, and then it begins to slow down over the next two years. Weight loss can be maintained over many years after surgery.

What are the different types of weight-loss surgery?

There are several different types of weight-loss surgery. Surgery will reduce the amount of food you are able to eat, reduce the amount of food your body is able to absorb, or both.

One weight-loss surgery that works by restricting the amount of food you can eat is called laparoscopic adjustable gastric banding (also called the lap band). In this surgery, your doctor will make several small incisions in your abdomen (lower belly). In one incision, a laparoscope is inserted into the incision. Your doctor will place a band, like a belt, around your stomach, separating it into two pouches.

There is a small passage between the two pouches. The food that you eat slowly passes through the narrow passage on the way to the intestine. A tube is attached to the band, and at the end of the tube is a port, or an access point, that is left just below the skin. This access point allows your doctor to adjust the tightness of the band by injecting saline (saltwater) into the tube. Making the band tighter will make the passageway smaller, which makes the upper pouch fill faster. This will make you feel full faster.

Other common weight-loss surgeries work by reducing the amount of food your body can absorb.

  • Gastric bypass surgery. During this surgery, your doctor will make a small pouch at the top of your stomach. This reduces the amount of food you can eat before you feel full. The connection to your small intestine is then moved from the bottom of the stomach to the new pouch. When you eat, the food that you swallow goes into the new pouch and then into the small intestine, “bypassing” your stomach and the upper part of your small intestine, where absorption usually takes place.
  • Sleeve gastrectomy. This procedure permanently reduces the size of your stomach. The “sleeve,” or tube-like structure, that’s left will be about 15% of the original size of your stomach. It is performed laparoscopically.
  • Biliopancreatic diversion with duodenal switch. During this surgery, your doctor will remove most of your stomach. This type of surgery is rarely used because of possible side effects, which include being unable to absorb all the vitamins and nutrients your body needs. If you do have this type of surgery, your doctor will closely monitor your progress to make sure you are getting all the nutrients your body needs.

If you are interested in weight-loss surgery, to talk to your doctor. He or she can explain the different procedures, decide if you are a good candidate for surgery, and decide on which surgery would be the best option for you.

What will it be like after surgery?

You may experience some pain or discomfort after surgery. This is normal. Your doctor will prescribe pain medicine to keep you comfortable. Your doctor will also put you on an all-liquid diet for the first two weeks following your surgery. He or she will tell you how much liquid you should be drinking throughout the day. After you finish with the all-liquid diet, you will be on a soft-food diet for two weeks. Four weeks after surgery, you will likely be able to resume eating solid foods. You will need to remember that your eating habits will have to be adjusted after surgery. You will need to eat smaller portions of food, take small bites, and chew your food completely. You should also avoid foods that are high in fat and sugar.

Your doctor will also want you to get out of bed and moving around the day after your surgery. Walking and doing leg exercises will help you avoid developing blood clots in your legs. Try not to stay in bed for long periods of time. You should be able to resume your normal daily activities about a day after surgery. It will take a few weeks before you’ll be able to resume exercise or any type of strenuous activity. Your doctor will tell you when you’ll be able to resume those types of activities.

After your surgery, you’ll have frequent appointments with your doctor. You will see your doctor every 4 to 6 weeks during the first several months after surgery. This is the time when you will be losing weight rapidly, so your doctor will want to monitor your progress and make sure that you are doing well. After your weight loss slows, you will see your doctor every 6 to 12 months. At these appointments, you’ll discuss your diet and exercise plans and the doctor will record your progress. You may also have blood tests done.

What changes should I make after surgery?

Losing weight is only half the battle. Keeping the weight off will require making permanent healthy changes to your lifestyle. Along with a healthy diet that you can stick with and an exercise program that you enjoy, you’ll need support. Finding support among your friends, family, or a support group will be the keys to a successful weight-loss plan. Your doctor will probably advise a regular vitamin supplement if your surgery causes you to not absorb vitamins from food. Make sure you keep taking these to avoid vitamin deficiencies.

Getting Active

Lifestyle changes do not have to be drastic to be effective. Simple measures applied every day can make a significant difference over time. Some examples include:

  • Increase your current physical activity by adding 10 minutes a day, or increase the intensity from low to moderate. Limit time spent online, watching TV, and playing video games to less than two hours total per day.
  • Take the stairs instead of the elevator.
  • Park at the far end of the parking lot and walk to your destination, rather than parking as close as possible. You can also get off the bus one stop earlier and walk the rest of the way.
  • Do more household chores (such as dusting, vacuuming, or weeding).
  • Walk or run with the dog and/or the kids.
  • Take “active” vacations—go hiking or ride bicycles.
  • Buy a pedometer or activity tracker, which measures how many steps you take each day. Gradually increase your daily number of steps. (Pedometers can be purchased at sporting goods stores.)

Almost everyone can benefit from cutting back on unhealthy fat. If you currently eat a lot of fat, try just one or two of the following changes, or those suggested in our list of healthier food choices:

  • Rather than frying meat, bake, grill, or broil it. Take the skin off before eating chicken or turkey. Eat fish at least once a week.
  • Cut back on extra fat, such as butter or margarine on bread, sour cream on baked potatoes, and salad dressings. Use low-fat or nonfat versions of these condiments.
  • Eat plenty of fruits and vegetables with your meals and as snacks.
  • When eating away from home, watch out for “hidden” fats (such as those in salad dressings and desserts) and larger portion sizes.
  • Read the nutrition labels on foods before you buy them. If you need help reading the labels, ask your doctor or your dietitian.
  • Drink no- or low-calorie beverages, such as water, unsweetened tea, and diet soda. Sugar-sweetened drinks, such as fruit juice, fruit drinks, regular soft drinks, sports drinks, energy drinks, sweetened or flavored milk, and sweetened iced tea can add lots of sugar and calories to your diet.

Things to consider

You may think of weight-loss surgery as a quick fix. You should know that having any kind of surgery involves risk. Risks can include infection and bleeding. You could also suffer from complications after surgery. Some complications include intestinal obstruction, leaking, vomiting, and diarrhea.

When to see a doctor

Post surgery, you’ll be required to see you doctor every few weeks so that he or she can monitor your progress. You can address most of your concerns at this time. Don’t be embarrassed to ask questions or tell your doctor exactly how you’re feeling. Be honest about how often you are going to the bathroom (probably a lot more often) and even about your mood. It is common to have mixed feelings about your weight loss and even become depressed. Discuss it with your doctor.

Questions to ask your doctor

  • Am I a candidate for weight-loss surgery?
  • Is there an age limit for weight-loss surgery?
  • Will my insurance pay for weight-loss surgery?
  • How large are the surgery scars?
  • How fast can I expect to lose weight following surgery?
  • Can I eat whatever I want (in smaller quantities) following surgery?

Resources

Centers for Disease Control and Prevention, Obesity

National Institutes of Health: National Institutes of Diabetes and Digestive and Kidney Diseases, Bariatric Surgery

National Institutes of Health: MedlinePlus, Weight-Loss Surgery