Bariatric Weight-Loss Surgery: Is It For You?

Obesity in the U. S. has reached epidemic proportions, and is now considered the No. 1 cause of diabetes and heart disease in the nation. For many people, traditional methods like calorie restriction and exercise have failed to produce initial or sustained weight loss results. If you have failed to lose weight through other methods and are considering a more aggressive approach to deal with the issue, you are not alone. Nearly 200,000 people underwent weight loss surgery in the U.S. in 2015, an increase of more than 25 percent over 2011 figures.

Cur r e n t e s t i m a t e s are that one i n every three Americans have obesity, and 6 percent are “extremely obese,” with a Body Mass Index ( BMI) greater than 40. A recent study by the National Institute of Health ( NIH) revealed that those living with obesity are likely to die an average of 14 years earlier than if they lived at a healthy weight.

While the most obvious frustrations around obesity are often cosmetic, the real impact of excess body weight is on the patient’s health and longevity. The majority of people living with obesity also deal with associated pain, diabetes, high blood pressure or depression, and experience a significant impact on their energy levels and quality of life.

Is 2017 the time for a change for you or a loved one? There are a variety of procedure options in weight- loss surgery and many can be done through small incisions for minimal scarring and faster recovery. Here are some important facts if you’re considering a surgical solution:

Gastric Bypass — This is considered the gold standard of weight- loss surgeries, and is the most commonly performed of the procedures worldwide. The procedure creates a new stomach pouch that is considerably smaller than before, facilitating smaller meal portions and resulting in fewer calories consumed daily. Advantages of Gastric Bypass i nclude i t s ability to promote significant longterm weight loss (up to 60 to 80 percent), and its ability to physically restrict the amount of food that can be consumed. It also induces beneficial changes i n gut hormones t hat reduce appetite, reduce the risk of type II diabetes, and may lead to feelings of increased energy. Typical patients maintain weight loss of greater than 50 percent after gastric bypass.

The Ad j u s t abl e Gastric Band procedure — Also known as Lap Band or “the band,” it places an inflatable band around the upper portion of the stomach, creating a small stomach pouch above the band, and the rest of the stomach below the band. The size of the stomach opening can be adjusted by filling the band with sterile saline, which is injected through a port placed under the skin. Advantages of the Lap Band procedure include a reduction in the amount of food the stomach can hold, and the procedure is both reversible and adjustable. It involves no cutting of the stomach or rerouting of the intestines, and has the lowest rate of complications among the approved bariatric procedures.

Sleeve Gastrectomy — Often referred to as “the sleeve” — this procedure is performed by removing approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that resembles a banana. Similar to band and gastric bypass procedures, the size of the new stomach pouch reduces the amount of food that can be consumed. But research suggests that the greater impact may be the effect the surgery has on gut hormones and blood sugar control. Advantages of the sleeve include a more rapid and significant weight loss, similar to results of the gastric bypass. Typical patients experience and maintain a loss of excess body weight at 50 percent or greater. It also requires a relatively short hospital stay ( approximately two days), no foreign objects, and no re- routing of the food stream. It’s estimated that half of the weight loss surgeries conducted in 2015 were sleeves, as this procedure has steadily grown in popularity in recent years.

B i l i o pancreat i c Diversion with Duodenal Switch — Also known as the “duodenal switch” — this procedure has t wo components. First, a smaller stomach pouch is created by removing a portion of the stomach. Next, approxi mately t hree- fourths of the small intestine is bypassed. Similar to the other surgeries described above, the duodenal switch initially helps to reduce the amount of food that is consumed; however, over time this effect lessens and patients are able to eventually consume near “normal” amounts of food.

There are two notable advantages to the duodenal switch procedure. First, typical patients experience greater weight loss compared to the other procedures — an average of 60 to 70 percent of excess body weight at the five- year point. Second, this procedure is the most effective of the four procedures in fighting diabetes. However, it also has a higher rate of complications than the band, the sleeve or gastric bypass surgery, and requires a longer hospital stay.

As with any health issue, surgery should be considered only after other, less invasive methods have failed.

The patient’s compliance with pre- surgical education and post- surgical nutrition and follow-up guidelines are the key indicator for initial weight loss success and longterm maintenance. This is a health condition that is very much within the patient’s control.

Changes to the body after weight loss surgery are mostly positive, and are an important benefit of the surgical weight loss route. But some of the physiological changes can lead to long- term vitamin and mineral deficiencies. Patients must commit to a lifelong plan of healthy food choices and vitamin and mineral supplementation.

And while there is risk associated with any surgical procedure, the 30- day mortality rate for bariatric surgeries is actually only 1 in every 1,000 patients, much l ower t han t he number of deaths caused by obesity itself.

If you are considering a surgical solution for your weight loss goals, hospitals offer many resources to help you understand your options, and throughout your entire journey.