Obesity is a complex, chronic disease characterized by excessive body fat that can impair health. For individuals with severe obesity, bariatric surgery is a medical intervention. This surgical approach aims to promote significant and sustained weight loss, often leading to improvements in overall health.
Types of Bariatric Surgery
Roux-en-Y Gastric Bypass
Roux-en-Y gastric bypass involves creating a small stomach pouch and connecting it directly to a section of the small intestine, bypassing a large portion of the stomach and the first part of the small intestine. This procedure works through both restriction, limiting food intake, and malabsorption, as less food is absorbed due to the bypassed intestinal segment.
Sleeve Gastrectomy
Sleeve gastrectomy removes approximately 80% of the stomach, creating a banana-shaped stomach sleeve. This procedure primarily functions by restriction, significantly reducing the amount of food that can be consumed. Removing a portion of the stomach also affects hormones that regulate hunger, such as ghrelin, which can lead to reduced appetite.
Adjustable Gastric Banding
Adjustable gastric banding involves placing an inflatable silicone band around the upper part of the stomach, creating a small pouch above the band and a larger stomach below. The band can be tightened or loosened over time by injecting or removing saline through a port placed under the skin. This mechanism is purely restrictive, limiting the amount of food an individual can eat before feeling full.
Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
Biliopancreatic diversion with duodenal switch (BPD/DS) is a complex bariatric procedure that involves both restriction and significant malabsorption. A smaller stomach pouch is created, and a much larger portion of the small intestine is bypassed. Food travels a shorter path, and digestive enzymes meet the food much further down the intestine, leading to less absorption of calories and nutrients.
Qualifying for Bariatric Surgery
Eligibility for bariatric surgery is primarily based on an individual’s Body Mass Index (BMI). A person qualifies if they have a BMI of 40 or higher, indicating severe obesity. Individuals with a BMI of 35 or higher may also be considered if they have at least one significant obesity-related health condition, such as type 2 diabetes, severe sleep apnea, or high blood pressure.
Candidates must demonstrate a history of unsuccessful attempts at weight loss through non-surgical methods, such as supervised diet and exercise programs. Patients are also expected to show a strong commitment to making long-term lifestyle changes, including dietary adjustments and regular physical activity. A comprehensive medical and psychological evaluation is required to assess readiness for the procedure and post-operative care.
Health Improvements After Surgery
Bariatric surgery often improves or resolves many obesity-related health conditions.
Type 2 Diabetes
Type 2 diabetes often improves, with many patients experiencing normalized blood sugar levels and reducing or discontinuing medication. This improvement is attributed not only to weight loss but also to changes in gut hormones that affect insulin sensitivity and glucose metabolism.
High Blood Pressure
High blood pressure (hypertension) often resolves or improves, allowing many individuals to reduce or eliminate their antihypertensive medications. The reduction in overall body mass and improved metabolic function contribute to healthier blood pressure readings.
Sleep Apnea
Sleep apnea often resolves completely as excess weight is lost, particularly around the neck, which can obstruct airways.
High Cholesterol
High cholesterol and other lipid abnormalities improve following bariatric surgery, reducing the risk of cardiovascular disease. The surgery promotes healthier lipid profiles, including lower LDL (“bad”) cholesterol and triglycerides, and often higher HDL (“good”) cholesterol.
Joint Pain
Joint pain, especially in weight-bearing joints like knees and hips, is alleviated as the burden on these joints decreases with weight loss, leading to improved mobility and quality of life.
Fatty Liver Disease
Fatty liver disease (non-alcoholic fatty liver disease, NAFLD) often regresses or resolves after surgery, reducing the risk of liver damage and inflammation.
Possible Surgical Complications
While bariatric surgery is safe, it carries potential risks and complications. Immediate risks include infection at the incision site, bleeding, and the formation of blood clots, particularly in the legs. Anesthesia-related complications, though rare, are also a consideration.
Specific complications related to bariatric procedures can include:
Leaks from the surgical connections in the digestive tract.
Strictures, or narrowing of the digestive tract, which can lead to difficulty eating or swallowing.
Nutritional deficiencies due to altered absorption of vitamins and minerals, requiring lifelong supplementation.
Dumping syndrome, characterized by symptoms like nausea, dizziness, and rapid heart rate after eating certain foods, which can occur particularly after gastric bypass.
Life After Bariatric Surgery
Life after bariatric surgery requires a lifelong commitment to significant lifestyle changes for successful weight management and overall health.
Dietary modifications are essential, involving smaller, more frequent meals, often six small meals instead of three large ones. Protein intake is a priority to preserve muscle mass, with patients advised to consume 60-80 grams daily.
Lifelong vitamin and mineral supplementation is necessary to prevent deficiencies, as surgical changes can impair the absorption of nutrients like B12, iron, calcium, and fat-soluble vitamins.
Regular physical activity is encouraged, starting with gentle walks and gradually progressing to more intense exercise as recovery allows. This helps with weight loss maintenance, improves cardiovascular health, and boosts mood.
Ongoing follow-up appointments with a multidisciplinary healthcare team, including the surgeon, a registered dietitian, and a psychologist, are important to monitor progress, address challenges, and provide ongoing support.