Bariatric surgery is a surgical treatment for patients who are seriously obese, or obese and have another dangerous medical condition. There are several types of bariatric surgery, each of which makes surgical changes to the stomach and digestive tract that limit how much food can be ingested, and how much nutrition can be absorbed. All types of bariatric surgery are performed to promote weight loss.
Reasons for Bariatric Surgery
Since morbid obesity can lead to early mortality and interfere with quality of life, patients who are unable to lose weight through diet and exercise may decide, with medical consultation, that bariatric surgery is a good solution. Morbid obesity is usually defined as having a body mass index (BMI) of 40 or more. In male patients, this translates into being 100 pounds or more over ideal body weight. In female patients, it means the patient is carrying in excess of 80 pounds or more.
Morbid obesity not only interferes with normal daily activities, it can lead to many serious medical conditions, including type 2 diabetes, high blood pressure, heart disease, severe sleep apnea and cancer. A patient may become morbidly obese for a variety of reasons, including genetic, environmental and psychological.
Candidates for Bariatric Surgery
Bariatric surgery is a last resort for weight loss, and never undertaken lightly. Patients are carefully screened to determine if they are good candidates. Insurance will cover the procedure only if it is deemed medically necessary. Patient guidelines for the surgery must be met. These include the following:
- History of inability to lose weight with diet, exercise or medication
- BMI of 40 or higher, indicating morbid obesity
- BMI of 35 to 39.9, combined with a serious weight-related medical problem
- Slightly lower BMI if combined with very serious weight-related medical condition
Candidates for bariatric surgery must be motivated to make permanent lifestyle changes, since the surgery alone does not guarantee permanent weight loss. In the screening for patients for whom bariatric surgery is appropriate, physicians investigate the following:
- Medical conditions
- Nutrition and weight history
- Psychological status
- Personal motivation
It is possible for patients who do not follow directives about diet and exercise to regain weight after the procedure.
Types of Bariatric Surgery
There are several different types of bariatric surgery, but there are two basic ways in which such procedures affect weight loss. Bariatric surgery can help to limit the amount of food ingested or it can restrict the amount of food digested. Some bariatric procedures work in both ways. Most focus on reducing the size of the stomach. When the stomach is smaller, the patient feels full sooner and presumably ingests less food.
Some bariatric surgery procedures prevent the small intestine from absorbing all of the calories taken in, which also results in weight loss. These types of surgeries are highly successful in weight loss, but carry risks of malnutrition and vitamin deficiencies.
Bariatric surgery may be performed laparoscopically or as open surgery, depending on the patient's overall health. Types of bariatric surgery include the following:
- Gastric bypass or gastric diversion
- Biliopancreatic diversion (BPD)
- Biliopancreatic diversion with duodenal switch
- Gastric banding
- Sleeve gastrectomy
- Roux-en-Y stomach bypass
Laparoscopic procedures are often more desirable because they result in smaller incisions, less pain and scarring, shorter recovery time and fewer risks.
Risks of Bariatric Surgery
Immediate surgical risks of bariatric surgery include excessive bleeding, blood clots, damage to adjacent organs and adverse reaction to anesthesia. Longer-term risks and complications, which include the following, vary according to the type of surgery performed:
- Bowel obstruction
- Gastric dumping syndrome, including vomiting and diarrhea
- Incisional hernia
- Hypoglycemia (low blood sugar)
While there are risks associated with bariatric surgery, there is often greater risk to the patient in remaining morbidly obese. In spite of the risks of bariatric procedures, the mortality rate is very low.
Recovery from Bariatric Surgery
Following surgery, most patients remain in the hospital for several days. Many patients are able to return to work after 2 weeks. Patients are usually able to manage at home without assistance if they follow the instructions and restrictions given by their doctors.
Results of Bariatric Surgery
Patients can expect to be in much better health after bariatric surgery than they were before having it. In most cases, obesity-related illnesses improve after surgery. In many cases, they disappear completely. During a normal recovery, weight loss occurs rapidly during the first months, and can continue for as long as 2 years. Patients who have gastric bypass can expect to lose 60 percent of their body weight. Patients who have banding can look forward to a loss of 45 percent. After bariatric surgery, patients have to readjust to a different body, and be prepared to adopt permanent lifestyle changes in order to reap its full benefits.