Weight Loss With Bariatric Surgery

Bariatric surgery can be life-saving for obese patients

Our relationship with food can be complicated. As we consider our daily options, thoughts of “I shouldn’t eat that” bump up against “I deserve that” or “I feel good when I eat that,” and a tussle between logic and feelings ensues. When what’s on our plate goes beyond serving as physical nourishment and increasingly becomes a comforting habit to reach for, or an attempt to fill an emotional hole, we wander into dangerous territory, where the very thing that’s meant to sustain us can harm or even kill us.

One in every three adults is obese and nearly one in five youths between the ages of 6 and 19 is obese, according to the Centers for Disease Control and Prevention, putting those people at increased risk of diabetes, heart disease, stroke, certain types of cancer, orthopaedic trouble and other serious health problems. Although poor eating and exercise habits are undeniably to blame for many cases of obesity, medications, genetics and medical conditions can also play a contributing role, says Connie Campbell, MD, FACS, surgical director of the Obesity Treatment Center at Catholic Medical Center in Manchester.

Bariatric, or weight-loss, surgery is not an appropriate choice for everyone. Doctors consider many factors when determining whether the surgery might be a good option for a particular patient, but chief among them is the patient’s body mass index (BMI), a calculation that estimates body fat based on height and weight. A BMI of 40 or greater, or a BMI of 35 or more that is accompanied by obesity-related medical conditions such as Type 2 diabetes, sleep apnea and high blood pressure generally makes a person a candidate for bariatric surgery, says Campbell.

In most instances, weight-loss surgery is now performed laparoscopically, through small incisions that minimize the invasiveness of the procedure. One of the surgeries, the Roux-en-Y gastric bypass, entails dividing the stomach and creating a small pouch in the stomach’s upper portion, says William S. Laycock, MD, director of the Bariatric Surgery Program at Dartmouth-Hitchcock Medical Center in Lebanon. The entire stomach remains, but only the egg-sized pouch receives food. Even as it stretches over time, the pouch will be capable of holding only about a quarter of the food that an unaltered stomach can handle, so the patient will feel full sooner while eating. The surgeon also re-routes the small intestine up to the stomach pouch in a manner that will cause food to bypass part of the small intestine, which will lessen calorie absorption, Laycock says.

The other two common types of bariatric surgery, the gastric sleeve and gastric banding, do not affect nutrient absorption, but focus solely on limiting stomach capacity. Gastric sleeve surgery permanently removes part of the stomach so that only one banana-shaped sliver remains. During gastric banding surgery, the surgeon places an inflatable silicone band around the upper part of the stomach to restrict the stomach’s usable area. Although gastric banding tends to get a lot of coverage in the media and might be the bariatric technique that is most familiar to people, the surgery is becoming less popular as concerns about long-term complications surface, Laycock says.

In fact, like all major surgeries, no bariatric procedure is without risk, and patients need to be aware of possible side effects following weight-loss surgery, including heartburn, sensitivity to certain foods, and nausea and diarrhea that can occur if food is eaten too quickly. In addition, many patients need to take daily vitamin and mineral supplements for life, to offset post-surgery nutritional deficiencies.

The amount of weight that patients can expect to lose following bariatric surgery varies, but on average, patients lose from 50 to 75 percent of their excess weight. In general, the higher the starting BMI, the greater the expected weight loss, Campbell says. Patients who comply with prescribed diet and exercise plans will do best, of course. But even those who don’t lose every pound of excess weight can achieve significant and dramatic health benefits related to ailments such as Type 2 diabetes, high blood pressure, unhealthy cholesterol levels and sleep apnea.  

Plus …

Weight-loss, or bariatric, surgery isn’t just about shedding pounds. It can lead to significant health improvements too.
According to the American Society for Metabolic and Bariatric Surgery, research has shown that, in addition to losing between 62 and 75 percent of their excess weight, bariatric surgery patients can experience the following results:

• Type 2 diabetes remission in 76.8% and significant diabetes improvement in 86% of patients
• Hypertension elimination in 61.7% and significant improvement in 78.5% of patients
• High cholesterol reduction in more than 70% of patients
• Sleep apnea elimination in 85.7% of patients
• Weight-loss surgery can also bring relief from joint disease, asthma, infertility, migraines and depression.

A Long Road

Although surgically reducing stomach capacity might seem at first glance to be a sure-fire, efficient way to shed lots of pounds in a hurry — without the misery of dieting or the effort of exercise — patients looking for a quick fix for their excess weight problem will have to keep searching. Following weight-loss surgery, it is still possible to overeat, so life-long adherence to diet and exercise guidelines is a must.

Plus, most hospitals and insurance plans expect a great deal of patient commitment before and after surgery, says Maureen T. Quigley, APRN, MS, clinical director of the Bariatric Surgery Program at Dartmouth-Hitchcock Medical Center in Lebanon. “For instance, some patients have to go to nutritional counseling for a certain number of months in order to be considered a candidate for surgery,” she says. Psychological evaluations are also common, as are appointments with a physical or occupational therapist if the patient has mobility difficulties.

Indeed, “there’s no other operation that has nearly the pre-operative educational component to it,” Laycock says, so people shouldn’t believe television shows that suggest that patients first meet “the doctor on Tuesday and have the surgery on Thursday,” he says. “It’s not that easy at all, and not that simple.” With weight-loss surgery, how the patient behaves “is probably as important as the operation itself,” Laycock says. “You can absolutely gain all your weight back if you don’t follow the lifestyle changes. The operation that allows you to behave and eat whatever way you want and lose weight doesn’t exist.”

But considering the potential benefits of bariatric surgery, the effort can be well worth it. Prior to surgery, many patients “are really struggling. They can’t exercise, they can’t keep up with their kids, they’re in pain all the time because they need orthopaedic joint replacement, but the orthopaedic surgeon won’t operate on them until they lose weight, and they can’t lose weight because it hurts so bad to exercise,” Campbell says. “It’s quite amazing to see so many of these patients come in on all their medications and get rid of them one by one."