Is Weight Loss Surgery for You?

With the climbing obesity rate, more Americans are considering weight loss surgery as a way to permanently lose excess weight. Obesity has a host of negative physical, psychological, societal, and financial implications. Despite the plethora of diet plans, weight loss medications, self-help books, personal trainers, and healthy food options, the vast majority of people who try to lose weight will never keep it off. Bariatric surgery has presented as a viable option for life-long weight loss, but these procedures are not without their risks, costs, and implications.

Candidacy

Approval for surgery is based on a range of factors, including age, weight, health conditions, and psychological factors. A typical candidate for surgery has a body mass index, or BMI, of 40 or more, which is considered “severely obese.” Patients with a BMI of 30 or higher who also have serious obesity-related conditions, such as diabetes, sleep apnea, or heart disease, may also be candidates for surgery. These are general guidelines that may vary by procedure; for instance, the gastric band surgery has been approved for patients with BMIs as low as 30.
BMI is one of many factors taken into consideration to determine candidacy for surgery. Bariatric surgery is designed for patients who have tried losing weight and failed repeatedly, so patients must prove that they have made multiple weight loss attempts using a variety of methods. Bariatric surgeons, the healthcare practitioners who perform weight loss surgeries, want to be assured that a patient realizes the reality of life after surgery and is willing to make the lifestyle changes of diet and exercise after the surgery. Before a patient received final approval for surgery, he will have undergone a psychological evaluation, nutritional counseling, and support group meetings. In addition, a patient must be determined to be healthy enough to undergo major surgery.

Surgical Procedure

The term “weight loss surgery” actually refers to multiple procedures designed for weight loss. Gastric bypass surgery, sleeve gastrectomy, and gastric banding are the three most commonly performed weight loss surgeries.
• Gastric bypass surgery represents 80 percent of weight loss surgeries performed. During gastric bypass surgery, the surgeon separates the upper portion of the stomach from the lower portion and attaches the upper portion to the small intestines. When a person eats, food is directed away from a portion of the stomach and small intestines, which results in fewer calories being absorbed.
• Sleeve gastrectomy, the newest of these three procedures, is the process of surgically removing about three-quarters of the stomach and leaving a slim tube of stomach that connects to the small intestines.
• Gastric banding, which involves placing an inflatable band around the stomach to create a small opening for food to pass through, is the least invasive of the surgeries. This smaller opening restricts the amount of food a patient can eat.

Benefits

Bariatric surgery has proven significantly more effective than any other weight loss method, especially in the long-term. The long-term weight loss from diet and exercise is 10 percent, while the long-term weight loss from bariatric surgery is 55 to 60 percent.
Some of the health complications that can be resolved after bariatric surgery, and the percentage of patients that experience an improvement of these conditions, include
• Type 2 diabetes – 83 percent
• Migraines – 57 percent
• Polycystic ovarian syndrome – 79 percent to 100 percent
• Cardiovascular disease – 82 percent
• GERD – 72 percent to 98 percent
• Degenerative joint disease – 41 to 76 percent
• Gout – 77 percent
• Depression – 55 percent
• Asthma – 82 percent
• Sleep apnea – 74 to 98 percent

Risks

Weight loss surgeries are major surgeries and carry inherent risks. Complications from surgery may include bleeding, infection, hernia, dehydration, and blood clots. The risk of death is typically between one and two percent, depending on the type of surgery. After surgery, other health risks may be present. Each person responds differently to the surgery, so complications can vary. Gas, diarrhea, constipation, gallstones, or vomiting may occur. After surgery, patients are at risk for malnutrition because nutrients may not be absorbed, so they take daily vitamin supplements. An estimated 30 percent of patients develop conditions caused by malnutrition like anemia. Dumping syndrome is a condition that may result from bariatric surgery; vomiting, nausea, or diarrhea may occur when a patient eats too much food or foods high in fat or sugar.
Other risks may affect a patient’s ability to lose excess weight and maintain weight loss. It is possible for patients to stretch out their stomachs by overeating, which lowers the effectiveness of the surgery. After gastric banding surgery, the band may slip or loosen, which can lead to overeating or the need for a second surgery. An estimated 20 percent of patients will need another surgery to re-do procedures of fix complications. A number of patients have excess skin caused by their dramatic and quick weight loss; some may have additional surgeries to eliminate excess skin.

Questions to Consider

Weight loss surgery involves a significant, life-long commitment that should not be entered into lightly. When thinking about bariatric surgery, consider these questions:
• Does your weight present significant health and psychological concerns that affect your daily life and are likely to worsen?
• Have your tried to lose weight many times in the past using many resources and programs? Do you feel that you will be unlikely to lose the excess weight without surgery?
• Do you understand the surgical process, lifestyle after surgery, risks, and potential complications?
• Are you able to commit to life-long changes in diet and exercise?
• Are you able to cover the cost of surgery, which averages $25,000 and may not be covered by insurance?
• Do the benefits of surgery outweigh the risks?
The answers to these questions will help you determine whether or not to further pursue the surgery by meeting with a bariatric surgeon.