Weight Loss Surgery: Test Your Medical IQ

Weight loss surgery, also called bariatric surgery, is performed to help a severely obese person lose weight. By reducing the size of the stomach and changing the anatomy of the digestive tract, it helps a person consume fewer calories. Some bariatric procedures can also assist in weight loss by affecting the production of intestinal hormones so hunger is reduced and feelings of fullness are increased.

There are several different types of weight loss surgery, and each procedure has different benefits and disadvantages. Common forms of bariatric surgery include:

• Gastric bypass (Roux-en-Y gastric bypass, or RYGB): Part of the stomach is closed off, leaving only a small pouch for food, which is connected to the middle part of the small intestine. Food can thus "bypass" a part of the stomach and small intestine. This procedure works the fastest and results in the greatest amount of weight loss, but it is the most risky of procedures.
• Gastric sleeve (sleeve gastrectomy): A large portion of the stomach is removed, leaving a narrow tube, or "sleeve." This procedure is safer than gastric bypass.
• Duodenal switch surgery is a combination of a gastric sleeve and gastric bypass surgery.
• Laparoscopic adjustable gastric band (lap-band): A soft silicone ring with an expandable balloon in the center is implanted around the top part of the stomach. It creates two compartments to the stomach, with a smaller part above the band so a person only eats enough to fill the top portion. This is often considered the least invasive procedure.
• Gastric balloon: A type of balloon is inserted via the mouth into the stomach where it remains for up to 6 months, resulting in less space for food. It's considered safe and does not involve any incisions, but it does not result in as much weight loss as the other options.

You may qualify for weight loss surgery if your BMI is:

• Above 40 or you are more than 100 pounds overweight, and you have not responded to diet, exercise, or weight loss medications.
• Above 35 and you also have an obesity-related medical problem, such as diabetes, heart disease, high blood pressure, sleep apnea or other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, or gastrointestinal disorders.
• Above 30, but only if you have certain medical conditions.

The cost of weight loss surgery depends on the procedure and also the part of the country in which you live. Insurance will often cover all or part of the expense.

The average cost nationally for bariatric procedures ranges from $14,000 to $23,000, depending on the procedure. A sleeve gastrectomy may be at the lower end of that range, while a gastric bypass will be more expensive.

Your diet will need to change following weight loss surgery. Immediately following surgery, you will need to be on a clear liquid diet, followed by full liquids and some pureed foods. About 10 to 14 days post-op you may be permitted to eat soft solid foods with an emphasis on protein sources, some carbohydrates, and fiber.

Once you have reached your goal maintenance weight – and the timing on this is different for everyone - you may need to consult with a nutritionist. In general, foods high in protein and low in fat and calories are recommended. You may also need to take vitamin and mineral supplements to stay healthy, because some procedures can make it more difficult for the body to absorb all the nutrients you need from your food.

On average, patients spend about two to five days recovery time in the hospital following weight loss surgery, depending on the procedure. Stays may be longer if there are complications. Follow-up visits with your doctor are typically scheduled anywhere from 10 days to three weeks post-op.

After that, patients are usually scheduled for regular check-ups anywhere from one to three months following surgery, then every two to six months up to one year, depending on the patient and how recovery is progressing. After that, annual visits are recommended.

Do not perform any strenuous activities such as heavy lifting, carrying, or even pushing and pulling motions such as vacuuming for three to six weeks post-operatively. Avoid sitting or standing still for long periods to help prevent blood clots in the legs.

Patients can lose about 50 to 80 percent of their excess weight following weight loss surgery, depending on the procedure. For example, if you have 100 pounds to lose, this means you can realistically expect to lose 50 to 80 pounds post-operatively. It is important to understand that most patients will not lose all the excess weight or reach a normal weight (BMI 20-25) following bariatric surgery. Many factors impact weight loss results including age, medical conditions, physical condition, and adherence to the recommended diet, exercise, and behavioral changes.

Different procedures have different expectations for the amount of excess weight a patient may lose:

• Duodenal Switch: 80% loss of excess weight
• Gastric Bypass: 70% loss of excess weight
• Gastric Sleeve (Sleeve Gastrectomy): 60% loss of excess weight
• Gastric Band (Lap Band): 50% loss of excess weight

Patients can begin moving almost immediately after surgery. While still in the hospital short walks will be encouraged. Start slow, listen to your body, and follow your doctor's instructions. For three to six weeks post-op you should avoid strenuous activities and heavy lifting. Low impact activities are recommended. Swimming should wait until the surgical incisions are healed.

It is common for weight loss surgery patients to regain weight following bariatric surgery. Sometimes it's only 10 or 20 pounds. For some people, it can be 100 pounds or more.

It is important to remember that obesity is a chronic disease and weight loss surgery is not a cure. Surgery is only a tool to help a person achieve significant weight loss when other methods have not worked. But it is up to the individual to maintain the proper diet, exercise, and behavioral changes. Educating yourself and keeping all follow-up doctor appointments is the best way to ensure success.

Weight loss surgery can help a person lose a significant amount of weight when other methods have not worked, but the surgery often provides other benefits. Most people are able to be more physically active and have a better quality of life. In addition, weight loss surgery can get rid of or improve conditions related to obesity, such as:

• High blood pressure
• Type 2 diabetes
• High cholesterol
• Sleep apnea
• Body pain
• Knee and hip pain
• Urinary incontinence