What is Weight Loss Surgery? Types, Health Risks, Success Rates
Guide to surgical operations
Guide to Weight Loss Surgery
Here are answers to a few popular questions about surgical operations to relieve obesity.
What is Bariatric Surgery?
Weight loss surgery (WLS) is also referred to as "bariatric surgery", a term derived from the Greek word "baros" meaning "weight". It evolved out of cancer/ulcer operations involving the removal of part of the stomach or small intestine. As patients undergoing these operations lost weight afterwards, doctors developed the idea of using similar types of surgery to treat morbid obesity. Due to the current high levels of obesity among all US age-groups, and the lack of success with non-surgical weight loss methods, bariatric surgery is becoming a significant option for severely obese patients. Approximately 170,000 bariatric operations have been performed in 2005. At present, the average surgery patient is a 300-pound woman in her late 30s, but operations such as lap band procedure and roux-en-Y stomach bypass are now being performed on adolescents as young as 13 years. See also Bariatric Statistics
An estimated 61.3 million American adults (30.5 percent) are obese.
Severe obesity is also on the rise. An estimated 9.6 million adults have
a body mass index (BMI) of 35-40, while 6 million American adults are
morbidly obese (BMI 40+). (Source: US Census 2000; NHANES III data estimates)
Excessive body fat (obesity), leads to a number of health risks including an increased risk of premature death. Obese patients (BMI 30+) are estimated to have a 50-100 percent increased risk of death from all causes, when compared with people of normal weight (BMI 2025). The risk of premature death increases significantly in cases of morbid obesity (BMI 40+) and super-obesity (BMI 50+). Most of the increased mortality rate from obesity is due to co-morbidities like atherosclerosis, heart attack or stroke. Other obesity-related health conditions include diabetes, hyperinsulimia, insulin resistance, obstructive sleep apnea, shortness of breath, asthma attacks, gastroesophageal reflux disease, low back pain, arthritis, heartburn, urinary incontinence, and venous disorders.
How weight loss surgery works is simple. The bariatric surgeon alters your digestive system (stomach and/or small intestine) to make it impossible for you to eat much food at one sitting without suffering unpleasant side effects such as dumping syndrome. This digestive side effect acts as a brake on calorie intake, and typically leads to significant loss of weight in the 2 years after surgery. There are two main types of weight loss surgery.
Adjustable gastric banding,
or gastroplasty surgeries, (eg. lap-band,
stomach stapling, or vertical
banded gastroplasty) only alters the size of the stomach to restrict
calories, hence it is called restrictive
surgery. Stomach capacity is reduced from melon to egg size using
special staples, or a silicone band. These restriction operations are
easily reversible as they do not fundamentally alter the anatomy of the
digestive system. The drawback is that patients find it easier to "cheat".
Gastric bypass operations (eg. roux-en-Y, biliopancreatic diversion, duodenal switch or fobi pouch) go further. Typically they involve a 2-stage process. First, the surgeon reduces the size of the stomach. Second, the first part of the small intestine is bypassed. This causes food to pass much more rapidly through the digestive tract and significantly reduces the amount of nutrients and calories that can be absorbed, which is why this type of operation is referred to as malabsorptive surgery. The point is, even if patients overeat, they will absorb fewer calories. This is why gastric bypass operations typically lead to greater weight loss than gastric stapling or banding.
Bariatric operations may be conducted using minimally invasive laparoscopic techniques using instruments connected to video monitors. These allow the surgeon to view the inside of the patient without having to make large incisions. Patients who undergo laparascopic operations typically experience fewer perioperative and post-operative health complications than patients who have traditional "open" surgery, and typically remain in hospital for 2-3 days, compared to 4-5 days for open surgery. They return to work within 2-3 weeks, compared to 4-6 weeks for traditional surgeries. Even so, both types involve the usual high risks associated with all major medical surgery. For articles, see: Laparoscopic WLS
As a lap band or bypass surgery patient, you must be prepared for a drastic change of eating habits following your operation. Due to the small size of your new stomach pouch, you will feel full after a very small amount of food. Over-eating or eating too fast after a gastric bypass can trigger extremely unpleasant nausea, called "dumping syndrome". A typical diet after gastric reduction surgery starts with clear liquids only, then broadens gradually to include any liquids, then semi-solids, then a low-fat solid diet. This should become a permanent way of eating if you wish to achieve permanent weight loss. See also: After Weight Loss Surgery
Obesity surgery works successfully for many patients. Typical success
rates range from 45-75 percent for stomach bypass and 40-60 percent for
rates for bariatric surgery far exceed those for conventional dieting,
especially when patients take advantage of bariatric
support groups or other types of weight
loss help. Even so, it's clear that weight loss surgery is not successful
for perhaps half of all patients. This is due usually to lack of patient
commitment in complying with post-operative guidelines on eating and exercise.
As a result, a significant percentage of less-committed patients regain
weight 2-5 years after having surgery, especially those who have stomach
banding or gastric-stapling. However, patients who are well motivated
and who receive proper post-operative support, can achieve significant
lasting weight loss. The effects
of bariatric surgery on mortality are significant, in addition, patients
can expect a number of health benefits.
For example, hypertension is cured in about 50 percent of patients, while
measurements of cholesterol and other blood fats show visible improvements.
Type 2 diabetes is cured in 80 percent of diabetic patients while hyperglycemia
and associated conditions such as hyperinsulimia and insulin resistance
are improved. Sleep apnea is cured in about 75 percent of patients, shortness
of breath is relieved in 75-80 percent of cases, while asthma attacks
are significantly reduced, especially when associated with gastroesophageal
reflux disease. Obesity surgery also relieves back pain, arthritis, heartburn,
urinary incontinence, and venous disorders. See also: How
Effective is WLS?
A bariatric operation carries the same risks and health complications as any other serious surgical procedure. Standard risk factors include: patient condition, expertise of the surgeon and anesthesiologist, as well as the quality of operating room services. Premature death occurs in about 1-2.5 percent of bariatric cases. In addition, there are a range of health risks according to the type of operation performed.
The most common complaints after banding surgery or stomach stapling include: (1) Hernia, in about 10-20 percent of patients. This risk is reduced in bariatric patients who undergo laparoscopic surgery. (2) Blood clots in about 1 percent of patients. (3) Infection in about 5 percent of patients. (4) Breakage of the gastric staple line, after gastroplasty. (5) Band slippage and saline after lap band or other forms of adjustable gastric banding. More rare complications include: bowel obstruction, stomal stenosis and marginal ulcers.
The most common health dangers of gastric bypass surgery include: (1) The need for follow-up operations to correct complications (eg. hernias). These corrective procedures carry a higher health risk to the patient. (2) Nutritional deficiency after stomach bypass is not uncommon, especially deficiencies in nutrients like: iron, calcium, vitamin D and B12. See also: Nutrition After Gastric Bypass. (3) Gallstones develop in about one-third of bypass patients. (4) Bowel problems are very common after bypass.
After gastric bypass or gastric banding, patients may lose up to 80 percent of their pre-operative excess weight. This weight loss can result in the appearance of a large amount of loose skin. Also, weight loss may not occur evenly throughout the body, leading to pockets of excess fat. The only solution for loose skin after bariatric surgery is another operation. Examples of common "plastic surgery" procedures include: tummy-tuck, arm-lift, breast-lift, male breast reduction, neck-lift, panniculectomy and thigh-lift. However, unlike bariatric operations, a plastic surgery operation is typically not covered by medical insurance as it is regarded as a "cosmetic" procedure.
Qualification for gastric weight
loss surgery is typically governed by the National Institutes of Health
Clinical Guidelines on the Identification, Evaluation, and Treatment of
Overweight and Obesity in Adults. These state that you may be a candidate
for obesity surgery only if: your body
mass index exceeds BMI 40+, or if your BMI is 35+ and you have severe
weight-related health problems.
For more, see How to
Qualify For Weight Loss Surgery
Although your physical condition may conform to the above guidelines, this does not guarantee eligibility for weight loss surgery. Most obesity clinics operate a screening policy and only approve candidates who are (1) ready to make long-term changes in their eating, exercise and lifetyle habits; and (2) committed to long-term medical follow-up. This vetting procedure is essential to eliminate candidates who are unlikely to benefit from obesity surgery, due to their inability to manage the psychosocial factors of WLS.
The cost of obesity surgery depends upon factors such as: the bariatric surgeon, the type of procedure, and the range of support services offered. Prices range from $25,000 upwards.
Not always. This is because medical insurance coverage differs according to which state you live in as well as the terms laid down by your individual insurance provider. Several states have legislation which requires insurers to offer obesity surgery for patients, providing it meets health criteria laid down by the National Institutes of Health. That said, getting insurance approval by yourself can be a time-consuming process. The best option is to work with your WLS clinic.
For additional information and advice about how gastric surgery can reduce obesity, plus help finding a good clinic and board certified qualified weight loss surgeon, see:
American Society of Bariatric Physicians (ASBP)
Laparoscopic or open bariatric surgery, such as gastric banding or bypass is not an easy solution to morbid obesity and weight loss. It is a serious surgical procedure, involving health risks. To produce lasting weight loss it requires a long-term patient commitment to eating a healthy diet and following a regular program of physical exercise. Life-long use of nutritional supplements may also be necessary. So, before deciding, discuss your options fully with your doctor. © 2003-2012 Bariatric-Surgery.Info - Terms - Contact - Information - Resources - Add URL