I understand that achieving your ideal body image can be a tough journey, especially when diet and exercise don’t seem to bring the results you’re hoping for. But don’t lose heart just yet. Another avenue that might hold the answer to your weight loss struggles is bariatric surgery.
Bariatric surgery is more than just a procedure - it’s a gateway to a new lifestyle. It’s a medically recognised approach for those who have faced challenges with obesity, offering a chance to reset the body’s weight management system.
If you’re feeling like you’re at a crossroads with your weight loss journey, bariatric surgery could be the transformative step you need. Let me break it down for you in this comprehensive guide.
What is bariatric surgery?
Bariatric surgery, commonly known as weight loss surgery, is a group of procedures designed to help you with morbid obesity, manage your weight and improve related health conditions such as Type 2 diabetes and metabolic syndrome. It is adopted when no other weight loss strategy works for you and you’re having obesity-related health issues.1
Generally, the procedure involves either reducing the size of the stomach with a gastric band or removing a portion of the stomach, or rerouting and reconfiguring the small intestine to a small stomach pouch. These changes help you to limit food intake and nutrient absorption, which leads to weight loss.1
It’s a serious healthcare decision that requires a commitment to a new, healthier lifestyle post-surgery.
What are the pros and cons of bariatric surgery?
The table below summarises the pros and cons of bariatric surgery.2
| Pros | Cons |
| Significant and long-lasting weight loss | Underused worldwide due to inadequate access to medical care |
| Improvement or remission of obesity-related comorbidities | Patient concerns about surgical complications |
| Enhanced quality of life | Altered gastrointestinal anatomy can pose challenges in managing other diseases |
| Recognised as an effective treatment for obesity | May require novel treatment options post-surgery |
| Superior to nonsurgical strategies in short-term outcomes, such as remission of type 2 diabetes | High cost |
| Increased life expectancy | Risk of nutrient deficiency |
Why is bariatric surgery done?
Bariatric bypass surgery, also known as stomach bypass surgery is typically considered when you’ve class II or III obesity, a condition that increases the risk of developing several life-threatening diseases.
The primary aim of this surgery is to act as a preventive measure, addressing obesity before it leads to more serious health complications. Among the conditions that obesity can contribute to are:
- Heart disease: obesity is a major risk factor for cardiovascular issues, including heart attacks and heart failure3
- High blood pressure: excess weight can strain the heart, leading to elevated blood pressure levels3
- Metabolic syndrome: a cluster of conditions including high blood sugar, excess body fat around the waist, and abnormal cholesterol levels3
- Type 2 diabetes: obesity is a leading cause of type 2 diabetes, which can result in insulin resistance if not managed properly3
- Kidney Disease: the kidneys can be affected by the strain of filtering excess waste caused by obesity3
- Osteoarthritis: additional weight can wear down joint cartilage, leading to pain and stiffness3
- Non-alcoholic fatty liver disease (NAFLD): excess fat can accumulate in the liver, causing inflammation and damage3
- Obstructive Sleep Apnea: excess weight can interfere with normal breathing during sleep3
- Cancer: obesity increases the risk of several types of cancer, including breast, colon, and endometrial cancer3
By undergoing bariatric surgery, you can significantly reduce your weight, which in turn can lower the risk of these obesity-related diseases and improve overall health and longevity. It’s a proactive step towards a healthier future.
Bariatric surgery requirements?
Thinking about bariatric surgery? It’s a big step, but knowing if you’re a good candidate is key.
According to 1991 NIH Consensus Development Conference, here’s a quick checklist for eligibility4:
- Age: 18 or older
- Weight Loss Efforts: Tried non-surgical methods for 5+ years
- Psychological Health: No significant untreated psychological conditions
- Medical Conditions:
- Not having causes for weight gain that cannot be eliminated after surgery
- Not having severe underlying medical conditions that would make surgery unsafe
- Body Mass Index (BMI):
- 40 or higher
- < 35 with at least one serious weight-related health issue
Preparing for weight loss surgery
Wait! Before you can have weight loss surgery, there’s a bit of homework to do to make sure you’re fit for the operation.
Preparing for bariatric surgery involves several steps.5
- A thorough nutritional assessment
- Biochemical testing
- Psychiatric evaluation
- Diet changes
Attention to appropriate patient selection, preoperative workup, and preparation are essential to ensure the safety and efficacy of bariatric surgery.
Types of bariatric surgery for weight loss
There are 5 different types of bariatric surgery. Below I have described each in detail.
Sleeve gastrectomy (SG)
Sleeve gastrectomy (SG) also referred to as gastric sleeve, is a commonly performed bariatric surgery procedure that has shown excellent long-term weight loss and improvement in obesity-related comorbidities.6
SG involves removing a large portion of the stomach (about 80%), leaving behind a sleeve along the lesser curve, which restricts the amount of food that can enter the stomach.6
It has been found to induce remission of type 2 diabetes mellitus (T2DM) and lead to changes in lifestyle and eating habits that are crucial for maintaining the effects of the surgery.7
Roux-en-Y gastric bypass (RYGB)
Roux-en-Y gastric bypass (RYGB), also known as gastric bypass, involves creating a small pouch from the upper stomach and connecting it directly to the small intestine, bypassing the rest of the stomach and the duodenum.8
However, RYGB can also have complications, including gastroesophageal reflux disease (GERD) and the risk of developing cancerous lesions in the excluded remnant stomach.9,10 Abdominal pain is a common symptom reported after RYGB, and it can have various causes.11
Studies have identified indications for RYGB reversals, but there is limited information on the long-term effects of the procedure.12
Adjustable gastric band (AGB)
The adjustable gastric band (AGB) procedure involves placing a silicone band below the gastro-oesophageal junction to restrict the passage of food, resulting in reduced portion size and prolonged satiety.13
Several complications can occur with AGB, such as weight regain, band intolerance, and slippage.13 In cases of complications or failure of AGB, conversion to other bariatric surgeries, such as laparoscopic sleeve gastrectomy (LSG) or laparoscopic one anastomosis gastric bypass (OAGB), can be performed.14
Conversion of AGB to LSG or OAGB is safe and effective, with varying degrees of weight loss achieved.14 Endoscopic management is also an option for complications such as intraluminal erosion of the gastric band, and it is a feasible and effective approach.15
Biliopancreatic diversion with duodenal switch (BPD/DS)
Biliopancreatic diversion with duodenal switch (BPD/DS) is a combination of restrictive and malabsorptive techniques to achieve weight loss and resolution of comorbidities. The procedure involves rerouting a portion of the small intestine to reduce the absorption of nutrients and calories.16
BPD/DS results in significant weight loss post-surgery. The procedure also leads to the resolution or improvement of comorbidities such as type 2 diabetes, hypertension, and hyperuricemia.16
Potential complications associated with BPD/DS include nutritional deficiencies, especially for vitamins A and E, as well as an increased risk of gallstones.16
Single anastomosis duodenoileal, bypass with sleeve gastrectomy (SADI-S)
Single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) combines both restrictive and malabsorptive mechanisms to achieve weight loss and metabolic improvements.17
SADI-S involves creating a single anastomosis between the duodenum and the ileum, while also performing a sleeve gastrectomy to reduce the size of the stomach. This procedure is effective in achieving significant weight loss and remission of comorbidities such as type 2 diabetes mellitus, obstructive sleep apnea syndrome, and hypertension.17
Monitoring postoperative symptoms and nutritional deficiencies is important for long-term follow-up. Animal models have been used to study the mechanisms and outcomes of SADI-S, but more research is needed to fully understand its effects.18
Post-surgery requirements
Bariatric surgery is not the ultimate solution to weight loss. You need to stick to a strict diet plan and exercise regimes to keep you healthy and fit.
Post-bariatric surgery nutrition
Post-bariatric surgery nutrition is an important aspect of patient care. Nutritional deficiencies are common before and after bariatric surgery, and it is crucial to address them through dietary modifications and supplementation recommendations
Follow this diet plan after surgery:
- Chew your food thoroughly to a pureed or baby-food consistency and eat slowly to prevent food from getting stuck and aid in absorption19
- Follow a very low-calorie Ketogenic diet. Prioritise protein, followed by vegetables, fruits, and starches19
- Avoid fried and processed foods and minimise drinking within 30 minutes of a meal. Drink ideally only when having trouble swallowing food20
- Take at least 60 to 120 grams of protein daily. Opt for protein shakes to meet protein needs20
- Nutritional counselling is important to prevent nutritional deficiencies and maintain weight loss after surgery20
- Supplementation may be necessary due to restricted absorption. Consult your doctor before taking any supplement20
Overall, the post-bariatric surgery diet plan should be individualised and guided by experienced nutritionists and dieticians.
Bariatric surgery exercise program
Exercise programs after bariatric surgery have positive effects on various aspects of health.
Most studies focus on exercise interventions in the post-operative stage, with only a few conducted before the scheduled procedure.
Aerobic training (AT) and resistance training (RT) combined exercise programs effectively improve clinical parameters such as cardiac function, lower extremity function, muscle strength and endurance, cardiovascular parameters, and functionality. However, the effects of only AT on bariatric surgery patients have not been specifically studied.21
Multicomponent exercise interventions improve balance with severe obesity following bariatric surgery, potentially reducing falls and associated injuries.22
Exercise training performed after bariatric surgery improves physical fitness, leads to additional weight and fat loss, and may prevent you from bone loss and weight regain.23
Transtheoretical model (TTM)-based exercise training can also help you in the early stages after bariatric surgery advance through exercise stages of change, increase exercise self-efficacy, and improve exercise adherence and physical function.24
Success rate of bariatric surgery
Bariatric surgery success rates vary depending on the criteria used to define success. Different studies have used various criteria such as weight loss percentage, comorbidities resolution, and specific outcome variables.
One study found success rates ranging from 72.7% to 92% based on different criteria.25 Another study reported that 20% of patients did not achieve an excess weight loss of 50% or more after 12 months.26
Factors that determine the success of bariatric surgery:
Various factors influence the success of gastric bypass surgery.27
- Choice of surgical technique
- Age
- Initial BMI
- Ethnic origin
- Presence of eating disorders
- Metabolic factors
- Body image
- Psychological well-being
- Genetics
- Hormones, metabolism
- Compliance with nutrient recommendations and diet control
Bariatric bypass surgery risks and complications
While bariatric bypass surgery can be a transformative procedure for those struggling with obesity, it’s important to acknowledge that it comes with its own set of risks and potential complications. Here’s a clearer picture of what to consider:
- Surgical complications - include the need for non-invasive and invasive treatments, with surgical options being complex and requiring detailed counselling about the risks and benefits of revision surgeries28
- Metabolic complications such as dumping syndrome, osteoporosis, hypothalamic–adrenal axis dysfunction, gonadal dysfunction, and kidney stones29
- Hematological complications, such as hemorrhage and venous thromboembolism, can occur early in the postoperative period30
- Hepatic complications, including acute liver failure and chronic liver disease leading to cirrhosis, possibly due to rapid weight loss, malnutrition, gut microbiota alteration, bacterial overgrowth, and pre-existing chronic hepatic diseases31
- Cardiovascular complications, particularly in patients with a higher baseline risk32
It’s crucial to go into surgery informed and prepared, understanding both the life-changing benefits and the serious considerations that come with it.
FAQ's
What is the life expectancy after bariatric surgery?
Bariatric surgery is associated with longer life expectancy. Studies suggest that it may reduce the risk of death from obesity-related health conditions.
What foods can't you eat after bariatric surgery?
After bariatric surgery, it's recommended to avoid caffeine, carbonated beverages, alcoholic drinks for a certain period, and foods that are tough, dry, greasy, heavily seasoned, or contain sugar alcohol.
Can I live a normal life after bariatric surgery?
Yes, most patients can live a normal life after bariatric surgery. It involves a new lifestyle with healthy eating, exercise, and regular visits to healthcare providers.
Is bariatric surgery painful?
While under anaesthesia, you won't feel pain during the surgery. Post-surgery, pain can be managed with medication, and you may experience some discomfort.
What is the bariatric surgery recovery time?
Recovery time varies depending on the procedure but generally ranges from a few days to 6 weeks for full recovery. Most patients can return to work within 2 to 3 weeks.
Summary
To sum up, bariatric surgery stands as a viable solution for those who have exhausted all other means in the battle against obesity and its associated health issues. However, it’s not the end of the road; it’s the beginning of a new chapter that requires ongoing commitment. Regular follow-ups, adherence to a nutritious diet, and consistent exercise are essential to sustain the benefits of the surgery and lead a healthy, fulfilling life.
References
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