Bariatric surgery is sometimes called weight loss surgery. The term comprises multiple procedures, each involving altering the digestive system in some way. While these surgeries offer many benefits to those who qualify, each is a major procedure with potential risks and side effects.
Bariatric surgery is not a quick fix; even after the procedure, maintaining a healthy diet and exercising are essential to long-term weight loss success.
Not everyone who is overweight qualifies for bariatric surgery, but it is an option for people with obesity who are unable to lose weight by improving diet and exercise.
People with a BMI of 40 or higher are often good candidates for these procedures. Doctors may recommend bariatric surgery for people with BMIs between 30 and 40 if they also have serious weight-related health problems, including high blood pressure, heart disease, sleep apnea, non-alcoholic fatty liver disease, or type 2 diabetes.
One form of bariatric surgery is a sleeve gastrectomy. In this procedure, the surgeon removes about 80 percent of the stomach, leaving it about the size and shape of a banana. The part of the stomach that releases hunger hormones is also removed, which affects the metabolism, decreasing hunger and supporting healthy blood sugar control.
A sleeve gastrectomy is not as complicated as other bariatric procedures and is suitable for people with high-risk conditions. On the downside, it is not reversible and may not be as effective as other bariatric surgeries.
Gastric bypass surgery, also called Roux-en-Y gastric bypass, has three parts. The surgeon creates a small pouch in the upper section of the stomach that holds only a small amount of food. Then, they divide the small intestine into two parts, attaching the top part to the small stomach pouch and the bottom part further down the GI tract.
Food bypasses most of the stomach and small intestine, so the body absorbs fewer calories. This procedure is a reliable and long-lasting way to control weight. It is a more complicated procedure than a sleeve and has more risks and complications.
Another form of bariatric surgery is an adjustable gastric band. In this procedure, the surgeon places an adjustable silicone band around the top of the stomach to limit how much food the person can eat.
Although this option has the lowest rate of complications and does not require any surgical division of the GI tract, it is not as effective as other bariatric procedures. Weight loss is slower, there is a chance that the band can slip out of place. It can also cause damage to the stomach and esophagus over time.
Biliopancreatic diversion with duodenal switch has the best results for reducing weight in people with obesity, but it comes with a slightly higher risk of complications than other options.
This surgery has multiple steps. The first is similar to a sleeve gastrectomy, reducing the size of the stomach. The second step divides the remaining portion of the small intestine into two tracts, diverting food through one and gastric juices from the stomach through the other. The two tracts both empty into the colon. Less food is absorbed since it bypasses a large part of the small intestine. While this is the most effective procedure for treating type 2 diabetes, it also has the highest risk of malabsorption and nutritional deficiencies.
Single anastomosis duodeno-iileal bypass with sleeve gastrectomy is a newer type of bariatric surgery. This procedure starts as a sleeve gastrectomy, with the first part of the small intestine divided just after the stomach. A loop of the small intestine is then attached to the stomach so that when the person eats, food travels from the pouch into a lower part of the small intestine, where it mixes with digestive juices.
This surgery is an excellent option for people who have already had a sleeve gastrostomy but are looking for more weight loss, but it is a newer procedure without a lot of long-term data.
Although the benefits vary by case and the type of procedure, weight loss surgery has many benefits. It can add years to the lives of people with severe obesity and improve many health problems, including type 2 diabetes, high blood pressure, sleep apnea, high cholesterol, heart disease, and joint pain.
Losing weight can also improve physical activity, further improving health outcomes. In addition, people who see improvement in their health may be able to cut back on prescription medications.
All bariatric surgeries have some side effects, but they vary depending on the procedure. Some of the possible side effects include infection, bleeding, blood clots, and diarrhea.
About a third of patients require follow-up interventions and additional surgery within five years. In time, the new connections between the stomach and small intestine can narrow, making it difficult to eat solid food and requiring interventions to stretch the opening. Hernias are also common in people who have had bariatric surgery.
Bariatric surgery is not a quick fix, and people must pay close attention to how they approach food after any of these procedures.
Patients must follow a strict diet immediately after surgery, starting with a pure liquid diet and slowly advancing to pureed foods, soft foods, and then a stabilization diet they will follow for the rest of their lives. Everyone's weight loss is different, but some lose up to 50 percent of their body weight after surgery.
Regaining weight after bariatric surgery is possible, and it can occur for many reasons. These include diminishing returns from hormone alterations, glucose fluctuations, and mental health conditions like depression or binge eating disorder.
Sometimes, people who have had bariatric surgery regain weight because they stop following a healthy diet and consume too many calories. Surgical failure is also possible, particularly if the stomach pouch stretches.
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