Weight Loss

What You Need to Know Before Weight Loss Surgery

What You Need to Know Before Weight Loss Surgery

A recent report published by the American Medical Association states that the national obesity rate in the United States is approaching 40% after hovering around 34-35% between 2005 and 2012 [1]. The continuous increase in obesity has been contributing to the rapid growth of weight loss surgery in the past decade. The current statistics make it clear that this is likely to continue.

We’re going to discuss some essential information you need to know before considering a weight loss surgery.


What Is Weight Loss Surgery?

Weight loss surgery, also known as bariatric surgery, is the common name given for surgical procedures usually performed on obese people. The primary goals of bariatric surgery are to help them lose weight and decrease their risk of morbidity and mortality.

Weight loss surgery should never be considered as the shortcut or alternative to losing weight from adopting a healthy lifestyle. Physicians recommend surgery options to people with a BMI above 35 or 40 who failed to lose weight from healthy diet and exercise programs.


Types of Weight Loss Surgery

Roux-en-Y gastric bypass

Roux-en-Y-gastric-bypass_illustration

Gastric bypass is one of the most common and slightly more complicated weight loss surgery procedure. It involves two significant steps: the creation of the gastric pouch and the creation of the bypass [2].

During the first step, your surgeon will create a small pouch in your upper stomach by stapling it so that your stomach will have a smaller upper section and a larger bottom section. The top part will be about the size of a walnut, and it’s where your food will go when you eat.

During the second step, a small part of your small intestine will be connected to a small hole in your gastric pouch.


How it works: this surgery reduces the size of your stomach and makes you feel satiated with less food. Your body will absorb fewer calories of the food you eat because the food will not reach all parts of your stomach and small intestine.


Laparoscopic adjustable gastric banding

Laparoscopic-adjustable-gastric-banding_illustration

In this surgery, a band is placed around the upper stomach to create a small pouch to hold food. It’s called laparoscopy because it’s done with the help of a camera called laparoscope.


How it works: It works in the same way as the bypass surgery discussed above: by making your stomach smaller, so you get fuller faster. The key difference is that the gastric bypass is an open surgery and banding is done with the help of a camera and minimal cuts.


Sleeve gastrectomy

Sleeve-gastrectomy_illustration

Sleeve gastrectomy is the procedure of removing about 80% of your stomach, and the end size of your stomach will be about the size of a banana [3].


This surgery works in two ways:

1. Limiting food intake by reducing stomach size.

2. Promoting hormonal changes to assist in weight loss.


Duodenal switch with biliopancreatic diversion

Duodenal-switch-with-biliopancreatic-diversion_illustration

Biliopancreatic diversion has been found to produce useful results; however, it’s a major procedure with higher complications than the other three types of weight loss surgeries [4]. It’s usually performed on morbidly obese people with 50+ BMI.

How it works: It works by reducing the size of the stomach via sleeve gastrectomy and allows food to bypass part of the small intestine. The result is that you’ll eat less and absorb fewer calories.


When Do You Need a Weight Loss Surgery?

You should consider weight loss if the following applies to you:

1. You’re obese with a BMI of 35+. Some places may only approve 40+.

2. Have not lost adequate weight via weight loss and medical management.

3. At high risk of morbidity and mortality.

A weight loss surgery should only be considered if you fit into the above criteria. You should not consider it if you’re healthy enough to lose weight from following a healthy diet and exercise program.


Weight Loss Surgery Cost

Weight loss surgery is not only a life-altering procedure, but it’s also pretty expensive ranging from $15 -30 000 minimum. The cost depends on several factors such as the type of procedure, location, the current weight of the patient, and the clinic.

Some health insurance companies may cover all of the cost of a weight loss surgery while some may only cover parts of it and provide affordable plans. Health insurance coverage for bariatric surgery may also depend on the type of procedure, for instance, gastric bypass and gastric sleeve are more likely to get covered than a tummy tuck.

If your health insurance company won’t cover the cost and you have no way of paying for it, you may still receive other options to look into like a medical loan.


Benefits of Weight Loss Surgery

Reduced morbidity and mortality

This is the first main reason why extremely obese patients are recommended to have bariatric surgery. It can help reduce morbidity and mortality and increase their life expectancy [5].


Long term weight loss

One of the huge benefits of weight loss surgery is a dramatic and sustainable weight loss.

The Swedish study is one of the widely referenced studies related to bariatric surgery. In this study, researchers did a two year (4047 participants) and ten years (1073 participants) follow up of obese patients who underwent weight loss surgery or other conventional treatments [6].

The two years follow up report revealed a 23.4 % weight reduction in the surgery group and a 0.1% increase in the control group. The ten years follow up report showed 16.1% weight reduction in the surgery group and 1.6% increase in the control group.

Moreover, the overall calorie intake was found to be lower in the surgery group, and their proportion of being physically active was also higher than the control group.


Diabetes treatment

Another significant benefit of weight loss surgery is that it’s been found to make a notable positive impact on treating diabetes. For instance, the same study discussed above also found that the two years and ten years recovery rate of diabetes, blood pressure, and blood cholesterol were more favorable in the surgery group than the control group.


Reduced risk of obesity-related health conditions

Bariatric surgery can treat and reduce the overall risk of other health conditions associated with obesity such as cardiovascular diseases, some cancers, gallbladder diseases, gout, and sleep
apnea [7,8,9].


Improved psychological health

Weight loss surgery performed in obese people has been found to enhance their self-confidence, self-esteem, and self-worth. It gives them hope for a new life and increases their willingness to adopt a healthier lifestyle.

Obese people are at high risk of suffering from chronic depression which can further increase the disease burden of their life [10]. A successful weight loss surgery may help them recover from depression and improve their social and emotional health.


Preparing for a Weight Loss Surgery

close-up-of-hands-typing-on-laptop-computer-while-using-a-cell-phone

STEP 1: Research

The first and most important step of preparing for a weight loss surgery is to research about it. Read about the different types of surgeries, their costs, benefits, and complications from reliable websites, and forums. Discuss and compare your options with your physicians too.

Read about the experiences of other people, and about the complications they’ve faced after the surgery. This will give you a better idea of what to expect before and after your bariatric surgery.


STEP 2: The cost

The next step is to think about the cost of your weight loss surgery. Research about health insurance policies and if it’s possible for you to find one that can cover the cost of your surgery.

Think about the other options available if you cannot manage to get a health insurance cover. You may also discuss with your doctor about more options such as getting a medical loan.


STEP 3: Quit smoking

Smoking has been found to increase weight loss surgery related complications so give it up if you smoke. Ask your doctor for support if you find it harder to quit smoking.


STEP 4: Eat healthily and plan your meal time.

Reduce and try to give up the refined carb and sugar intake. Start eating healthy and increase your protein intake, fresh fruits and vegetables. Also eliminate soda, coffee, and sugary drinks from your diet.

Switch to sweet potatoes instead of regular potatoes. Swap lemon water and fresh coconut water for soda. Snack on berries instead of chocolates. Eat your burgers without the bun.

Every little change you make to your eating habits can make a huge difference in the before and after the success of your weight loss surgery.


fresh-mixed-salad-with-grilled-cheese-on-grey-wooden-table-with-tomatoes-and-olive-oil-bottle-in-the-background

STEP 5: Keep a food diary

Start tracking your daily food and water intake on a food diary. It can help you see what you’re doing right and wrong and help you improve your eating patterns. Drink adequate amount of water.


STEP 6: Begin training your mind

Start preparing your mind about the benefits and risks associated with weight loss surgery. Remind yourself about the health improvements you will begin to see and how you’d never want to fall back again.

Prepare your mind about the changes you’ll start making to further improve your health and quality of life after the surgery. Will you be more active and look into exercise programs to lose more weight and sustain weight loss?

Perhaps you might want to join a healthy eating community or membership program to motivate you to eat healthier.

Remind yourself that you’re still in control, and it’s up to you to make your life better after the weight loss surgery or to fall back to where you were before.


Risk of Weight Loss Surgery

Here are some common risks associated with weight loss surgery [11].


Excess loose skin

This may not come as a surprise but there will be a lot of excess loose skin, and some people might need to have additional surgeries to remove the excess skin.


Gastric band slipping

There’s a small risk of the gastric band slipping out of place for those who have the gastric band surgery done. Some symptoms of the gastric band moving out of place can include vomiting, feeling sick, and heartburn. Further surgery may be required to remove or put it back in place if the symptoms don’t go away.


Leaky Gut

Some people may experience leaky gut in the early days after bariatric surgery. Symptoms of leaky gut can include fever, tummy pain, chills and shivering, and fast breathing.


Malnutrition

Your gut can find it difficult to absorb vitamins and minerals from the food you consume.


Other complications include:

  • Anastomotic stricture
  • Internal hernias
  • Band erosion

Takeaways

Bariatric surgery (weight loss surgery) is a procedure usually performed to help obese people lose weight and improve their morbidity and mortality rate. The three most commonly practiced weight loss surgeries are a gastric bypass, gastric banding, and sleeve gastrectomy.

Your doctor will recommend surgery if your BMI is above 35+ and you also fit in the other criteria such as increased risk of obesity-related health conditions, and mortality.

Research your options and have a clear understanding before deciding on the surgery type. Follow the tips we’ve included to prepare in advance and also research about your health insurance choices to cover the cost of your surgery.

References

  1. Albert Henry T. Adult obesity rates rise in 6 states, exceed 35% in 7. 2018 November - https://www.ama-assn.org/delivering-care/public-health/adult-obesity-rates-rise-6-states-exceed-35-7
  2. Nguyen NT, MD et al. Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity. 1999 July-September - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113154/
  3. Gajbhiye R et al. A Study on Role of Laparoscopic Sleeve Gastrectomy in the Management of Morbid Obesity. 2016 June - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907904/
  4. Anderson B et al. Biliopancreatic Diversion: The Effectiveness of Duodenal Switch and Its Limitations. 2013 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3929999/
  5. Adams TD et al. All-Cause and Cause-Specific Mortality Associated with Bariatric Surgery: A Review. 2016 December - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055056/
  6. Sjöström L et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. 2004 December - https://www.ncbi.nlm.nih.gov/pubmed/15616203/
  7. Scherer PE, PhD, Hill JA, MD, PhD. Obesity, Diabetes, and Cardiovascular Diseases: A Compendium. 2017 May - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888905/
  8. Romero-Corral A, MD, MSc et al. Interactions Between Obesity and Obstructive Sleep Apnea. 2010 March - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021364/
  9. De Pergola G, Silvestris F. Obesity as a Major Risk Factor for Cancer. 2013 August - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773450/
  10. Barnes ER, DNP et al. Relationships between obesity management and depression management in a university-based family medicine center. 2015 May - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363038/
  11. Monkhouse SJW, Morgan JDT, Norton SA. Complications of Bariatric Surgery: Presentation and Emergency Management – a Review. 2009 May - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2749388/

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