Primary bariatric surgery involves making changes to the digestive system to achieve significant weight loss and improve health. This type of surgery is considered when other weight loss methods, such as diet and exercise, have not been successful or when an individual experiences serious health complications due to their weight. The procedures aim to either limit the amount of food that can be consumed, reduce the body’s ability to absorb calories and fat, or both. Bariatric surgery can lead to long-term weight loss and may help resolve or improve various weight-related health issues.
Eligibility for Bariatric Surgery
Individuals considering primary bariatric surgery must meet specific criteria. A body mass index (BMI) of 40 or higher is a common requirement. Those with a BMI between 35 and 39.9 may also qualify if they have at least one serious weight-related health problem. These associated health conditions, often called co-morbidities, include type 2 diabetes, high blood pressure (hypertension), severe sleep apnea, heart disease, high cholesterol levels, and nonalcoholic fatty liver disease.
In some situations, certain bariatric procedures may be an option for individuals with a BMI of 30 to 34 who have serious weight-related health problems. A history of unsuccessful weight loss attempts through diet and exercise is also a consideration. Furthermore, a comprehensive medical evaluation, including consultations with a dietitian and a psychological assessment, is necessary to ensure individuals are prepared for lifestyle changes after surgery. This evaluation helps determine if surgery is appropriate and identifies any underlying conditions that could affect outcomes.
Types of Primary Bariatric Procedures
Several types of primary bariatric procedures are commonly performed, each altering the digestive system to promote weight loss. These operations modify the stomach and intestines, leading to reduced food intake and changes in how the body processes food for energy.
Roux-en-Y Gastric Bypass (RYGB)
The Roux-en-Y Gastric Bypass (RYGB) involves creating a small stomach pouch and connecting it directly to a segment of the small intestine, bypassing a portion of the stomach and small intestine. This procedure restricts food intake and reduces nutrient absorption. Gastric bypass can lead to significant long-term weight loss, with individuals potentially losing 70% or more of their excess weight within two years. It is also highly effective at improving or resolving conditions like type 2 diabetes, often leading to remission. Potential complications include dumping syndrome, causing symptoms like cramping and diarrhea, and a risk of nutritional deficiencies due to altered absorption.
Sleeve Gastrectomy
Sleeve Gastrectomy involves removing approximately 80% of the stomach, creating a tube-like stomach. This procedure restricts food intake. It also prompts hormonal changes, such as a decrease in ghrelin, which reduces appetite and increases feelings of fullness. Patients undergoing sleeve gastrectomy can expect to lose around 60% or more of their excess weight within two years. Potential complications include staple line leaks, bleeding, and the development or worsening of gastroesophageal reflux disease.
Adjustable Gastric Banding (AGB)
Adjustable Gastric Banding (AGB) involves placing an inflatable silicone band around the upper part of the stomach, creating a small pouch above the band. This procedure is purely restrictive, limiting food intake. The band can be adjusted by adding or removing saline solution through a port under the skin. AGB is less invasive than other procedures, as it does not involve cutting or rerouting the digestive tract and is reversible. However, it results in slower and less overall weight loss compared to gastric bypass or sleeve gastrectomy, with lower long-term success rates and a higher need for re-operations due to complications like band slippage, erosion, or inadequate weight loss.
Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
The Biliopancreatic Diversion with Duodenal Switch (BPD/DS) is a less common but highly effective two-stage procedure. The first stage is a sleeve gastrectomy; the second reroutes a large portion of the small intestine, significantly reducing the absorption of calories and nutrients, particularly fats and proteins. BPD/DS leads to the greatest average total weight loss, with individuals potentially losing 70% to 80% of their excess weight within two years, and it is highly effective at resolving type 2 diabetes. However, it carries a higher risk of nutritional deficiencies, especially fat-soluble vitamins (A, D, E, K), and may lead to side effects like ongoing diarrhea and malabsorption-related issues.
Preparing for and Recovering from Bariatric Surgery
The journey to bariatric surgery involves a preparation phase to optimize safety and outcomes. This pre-operative period includes health screenings, such as blood tests, ultrasounds, X-rays, and electrocardiograms, to assess health and identify conditions. An endoscopy may be performed to examine the stomach for issues affecting surgery. Individuals also undergo consultations with a dietitian to plan for post-surgery dietary changes and a psychological assessment to ensure readiness for lifestyle adjustments.
Dietary modifications are a significant part of pre-operative preparation, often involving a low-calorie, low-carbohydrate, and high-protein plan to reduce liver size, making surgery safer. Patients are advised to stop smoking several weeks before surgery and to avoid eating or drinking after midnight before the procedure. Specific medications, such as aspirin, ibuprofen, and blood thinners, may need to be stopped or adjusted before surgery to minimize bleeding risks.
Following surgery, patients spend one to two days in the hospital, where post-operative care focuses on pain management, preventing nausea and vomiting, and monitoring for leaks. Pain is managed with oral medications, and early mobilization is encouraged, with patients walking within hours of surgery to promote circulation and prevent clots. Compression devices may be used on the legs for the same purpose.
Initial dietary progression begins with a clear liquid diet, gradually advancing to full liquids and then pureed foods over weeks after discharge. This staged approach allows the digestive system to heal and adapt to its new anatomy. Patients are advised to consume small, frequent portions, prioritize protein intake, and avoid carbonated beverages and high-sugar foods to prevent discomfort or complications.
Life After Bariatric Surgery
Life after primary bariatric surgery requires a sustained commitment to new lifestyle habits for success. Dietary adjustments are permanent, emphasizing high-protein foods, fruits, and vegetables, while limiting carbohydrates and sugars. Patients are advised to eat small, balanced meals frequently and to stop eating before feeling overly full. Staying well-hydrated by drinking at least 64 ounces of fluids daily is also important to prevent dehydration.
Lifelong vitamin and mineral supplementation is necessary after bariatric surgery due to altered nutrient absorption. Common deficiencies include vitamin B12, vitamin D, calcium, and iron, with fat-soluble vitamins (A, D, E, K) requiring attention after malabsorptive procedures. Patients take a bariatric-specific multivitamin, along with additional supplements like calcium citrate and vitamin B12, often in chewable or liquid forms. Regular blood tests are performed to monitor nutrient levels and adjust supplementation as needed.
Physical activity is also important for sustained weight management, with recommendations including at least 30 minutes of moderate exercise most days, along with strength training. Starting with achievable goals, such as walks, and gradually increasing intensity helps build consistent habits. Ongoing medical follow-up appointments with the bariatric team, including surgeons and dietitians, are scheduled regularly, especially during the first year, and then annually. These appointments help monitor weight loss, address any complications, and manage co-morbidities. Participation in support groups can also provide emotional and practical assistance, fostering accountability and improving outcomes.