7 Things Your Surgeon Wants You to Know About Weight Loss Surgery

Weight loss surgery, also called bariatric surgery, isn’t a cosmetic procedure; it’s an effective tool that can help people with severe obesity shed extra pounds and keep them off, according to the National Institutes of Health. There are actually different types of weight loss surgery. In 2017, 228,000 of these procedures were peformed in the United States—up from 216,000 the year before.

Keep in mind. weight-loss surgery isn’t a magic bullet and will not replace healthy habits. Surgery can help patients with a high body mass index (BMI)—a measure used to determine if people are a healthy weight for their height—who have not been able to lose weight and keep it off. These surgical weight-loss procedures help people consume fewer calories and move more easily, but they don’t eliminate the need to follow a healthy diet and exercise regularly. People who undergo weight-loss surgery usually need to adopt some new eating habits and be physically active in order to avoid complications and maintain a healthy weight after their procedure.

Weight-loss surgery isn’t for everyone. There is a lot you should consider and talk to your doctor about before deciding if one of these procedures is right for you. We spoke with Lloyd Stegemann, MD, a bariatric surgeon with Corpus Christi Medical Center in Corpus Christi, Texas, and he helped shed some light on the possible benefits and risks of weight loss surgery.

There are four main types of weight loss surgery. Your doctor will take your individual preferences into account when deciding if you are a candidate for one of these procedures and recommending which one would be best for you. Available weight-loss procedures include:

• Adjustable gastric band (AGB) surgery involves an inflatable band placed around the upper portion of the stomach, making a small pouch. This creates the sensation of a smaller stomach, helping patients feel full after eating a small amount of food. It's reversible, adjustable and doesn’t require the stomach to be cut, but is only effective for about 50 percent of patients.
• Sleeve gastrectomy removes about 80 percent of the stomach, leaving a small, banana-shaped section behind. It reduces the amount of food the stomach can hold and, research suggests, alters hormones responsible for signaling hunger and satiety. Data collected three to five years after surgery shows patients can lose more than 50 percent of excess weight from this procedure.
• Gastric bypass works by creating a smaller stomach pouch and shortening the path of food between the stomach and the intestines. The smaller stomach restricts the amount of food a person can consume and reduces how many calories the body can absorb. This procedure results in 60 percent to 80 percent loss of excess weight, but may lead to long-term nutrient deficiencies.
• Biliopancreatic diversion with duodenal switch (BPD/DS) is a two-part procedure that combines the sleeve gastrectomy with a bypass surgery. Your surgeon will create a small banana-shaped stomach and connect it to the last part of the small intestine, bypassing a majority of this digestive organ. BPD/DS reduces the amount of food a person can eat, limits the body’s ability to absorb calories and impacts hormone levels that control hunger and satiety. This is considered the most effective form of weight loss surgery, but requires a longer hospital stay and has the highest risk of nutrient deficiencies and complications.

Speak candidly with your doctor about all potential risks and benefits of each of the procedures.

Not everyone is eligible for bariatric surgery. In fact, there are some pretty specific qualifications. “They have to be a reasonable surgical candidate from a health standpoint,” says Stegemann. “They can't have any active substance abuse problems or be so sick they're not going to tolerate an operation,” he adds.

Beyond that, those who qualify for bariatric surgery have:

• A BMI of 40 or greater OR
• A BMI of at least 35 in addition to one or more obesity-related conditions, like diabetes or hypertension OR
• A BMI of 30 or greater and at least one related condition—these people are candidates for gastric band surgery only, but don't qualify for other procedures  

You must also have tried—and failed—to maintain weight loss with diet and exercise, but remain willing to adopt healthy habits before and after surgery. “They need to have a basic understanding of how the operation works, that they’ll be eating less, will still need to exercise and that they’ll need to commit to the post-operative follow-up,” Stegemann says.

There are also mental health qualifications. Candidates are evaluated for conditions like depression, binge-eating disorder and anxiety, which can make weight maintenance more challenging. Doctors may recommend waiting for surgery until these conditions are being effectively treated and under control.

Almost 40 percent of Americans are obese, or have a BMI of 30 or higher. Obesity is linked to an increased risk of health conditions like:

• Type 2 diabetes
• High blood pressure
• Stroke
• Heart disease
• Sleep apnea
• Certain types of cancer
• Depression
• Joint pain
• Infertility

Shedding pounds, regardless of how you choose to do it, will likely improve these conditions, and your overall health. “We know that weight can cause significant health problems for individuals,” says Dr. Stegemann. “By improving somebody’s weight, we dramatically improve their health and quality of life,” he adds.

Obese adults with diabetes are at high risk for cardiovascular disease, and new research suggests weight loss surery may lower this risk more than typical diabetes treatments. An October 2018 JAMA study analyzed the medical records of more than 20,000 Americans with severe obesity—a BMI of 35 or higher—and type 2 diabetes. Compared to those treated with usual diabetes treatment, like medication and insulin, the people who had weight-loss surgery had a 40 percent lower risk of cardiovascular event, like heart attack or stroke five years after the procedure. Most of the 5,300 surgical patients had gastric bypass surgery, but some had a gastric sleeve or band procedures.

Preparation for weight loss surgery is mental and physical. Luckily, you won’t have to go it alone; your bariatric team will guide you along the way. Some lifestyle adjustments you may have to make could include  adopting a healthy diet and exercise regimen. It’s common for bariatric surgeons to set weight loss and fitness goals for patients who are going to have one of these weight-loss procedures.

Work with your bariatric team to address any mental health concerns, too. Depression, food addiction and tobacco use as well as  alcohol or drug abuse should be controlled before a bariatric procedure. Even with surgery, weight loss takes tremendous focus, and these issues can undermine your efforts.

Depending on your hospital, doctor and type of procedure, your surgery experience will vary. But there are a few things you can expect the day of:

• Surgery will be performed in a hospital.
• You will be put under general anesthesia.
• Most surgeries are performed laparoscopically, using small incisions and cameras.
• The procedure will typically take between one and two hours.

Your hospital stay is determined by your procedure and how quickly your body recovers. Generally, it lasts one to two days, but can be as long as a week. “Two weeks after surgery you're pretty much back to your normal routine, and by six weeks, you are completely healed,” says Stegemann.

Bariatric surgery is relatively safe, but no surgical procedure is risk-free. In fact, one study even suggests that about 1 in 5 people who underwent an AGB procedure needed to have a follow-up surgery within five years.

Your risk of having a complication is often related to your overall health before surgery; this is something you’ll discuss with your bariatric team before the procedure. As with almost any surgery, patients run the risk of bleeding, infection and blood clots. That’s not all: many weight loss procedures alter the way your body absorbs nutrients, making it possible to develop deficiencies, which can lead to anemia and osteoporosis.

These operations also raise your risk of hernias and strictures, the narrowing of the stomach or the connection between the stomach and small intestine. This makes eating solid foods a challenge and can lead to nausea, vomiting or trouble swallowing. Ulcers and low blood sugar are other possible complications.

The amount of weight you should expect to lose after surgery is determined by a number of factors, including:

• Type of surgery
• Starting weight
• Age
• Ability to exercise
• Willingness to adopt healthy habits

Surgery can help kick-start this weight loss, but a healthy lifestyle must be followed for life. This includes eating better, exercising more, getting adequate sleep and managing your stress.  Diverging from this healthy lifestyle plan raises the risk of complications, like regaining weight over time.

Consuming too many calories can limit the number of pounds you drop, and may even result in weight gain. Even a single meal that’s too large, or loaded with excess fat or sugar, can cause discomfort almost immediately, resulting in nausea, vomiting and constipation.

Post-surgery dietary recommendations vary, and you should follow any guidelines give to you by your doctor. These might include:

• Eating and drinking more slowly
• Sipping liquids beween meals, but not with meals
• Avoiding fatty and sugar-rich foods
• Chewing thoroughly
• Eating smaller meals
• Getting more protein in your diet
• Taking vitamin and mineral supplements as directed by your doctor
• Avoiding carbonated or high-calorie beverages
• Avoiding alcohol 

To keep you on track, you’ll meet with your healthcare team several times to check on your progress and discuss your diet and exercise plan. "We follow patients closely for the first year as they're really starting to work on all of these lifestyle changes," says Stegemann. "They'll work with a dietician, behavioral health specialists, and exercise physiologists or trainers to really start working on all of those areas."

If you take prescription or over-the-counter medications, your body could metabolize these drugs differently after weight-loss surgery. Some medications, such as diabetes and high blood pressure drugs, might need to be adjusted as you lose weight. Your doctor may decide to change your dosage or treatment plan. Larger pills, which could become stuck in your digestive tract, may also need to be crushed or replaced with another form of the medication, such as a liquid or chewable tablet. 

Keeping up with your appointments will help give you the best chance at a happy and healthy life post-surgery. Stegemann also advises patients who’ve had bariatric surgery to follow up with their medical team for years following their procedure to help ensure they maintain a healthy weight long-term.