How much weight a person who has weight loss surgery depends on multiple factors including the type of procedure chosen. On average, a patient who has a lap band procedure can expect to lose about 45% of excess body weight (i.e., 45% of the amount of weight over the patient’s ideal body weight.) With a sleeve gastrectomy, the average is about 60% excess body weight loss. With gastric bypass, the average excess body weight loss is about 65-70%.
Weight loss surgery can help reduce health problems like high blood pressure, high cholesterol, and diabetes. Weight loss surgery is probably the healthiest thing that morbidly obese individuals can do for themselves. Most patients who are morbidly obese have some sort of comorbidity or other medical problem related to weight, such as diabetes, high cholesterol, or hypertension. In general, when an individual has weight loss surgery, most of these medical problems get better or may even completely disappear and in the process the patient becomes healthier.
There are many ways to become morbidly obese including consuming too many calories (and not burning those calories off with exercise). Other factors (stress, medication, pregnancy and other hormone changes, aging, etc.) that can cause someone to be at a greater risk of becoming obese. Additionally, there is a genetic component to obesity. There isn’t yet a clearcut gene identified, but obesity runs in families (or even countries) where large populations of people and families are all morbidly obese.
A person is considered morbidly obese when they have a BMI (Body Mass Index) of 30 or higher. In the United States, the obesity rate is about 30% and that translates to about 20 million Americans who would potentially qualify to have weight loss surgery. The medical problems that you can develop from being morbidly obese include type 2 diabetes, high blood pressure, high cholesterol, sleep apnea, heartburn, reflux, problems with your bones and joints, etc.
An individual’s Body Mass Index (BMI) is a formula that takes your height and weight into consideration. To have weight loss surgery (and to have your insurance company cover the cost), a patient needs to have a body mass index of 40 or greater if they have no medical problems. Insurance may still cover weight loss surgery with a BMI as low as 35 or greater if the patient has medical problems that are related to their weight, such as diabetes, high blood pressure, high cholesterol, and/or sleep apnea.
Weight loss surgery is for people who are morbidly obese, not for someone who is only 20-30 pounds overweight. Weight loss surgery candidates need to lose weight because of medical problems that can develop as a result of being morbidly obese.
Most insurance companies cover weight loss surgery for patients who meet certain requirements. Requirements vary from plan to plan, so it’s important for you to contact your insurance company to ask if the plan that you have covers weight loss surgery in your situation.
Before weight loss surgery, your doctor will likely work with you to change your lifestyle, diet, and exercise routines to lose some weight before surgery. This is to demonstrate that once you have the weight loss surgery, you are in the proper mental state to keep the weight off and maintain a healthy lifestyle. After consulting a surgeon, most patients will wait anywhere from 6 weeks to several months before having the operation to meet with various specialists to make sure that the patient is optimized and ready for the operation.
Weight loss surgery is a major operation, can be complicated, and has significant effects on your health. It is important to see multiple specialists when being considered for weight loss surgery. That usually includes seeing a surgeon, a gastroenterologist, a dietician, and a psychologist. These specialists will determine if both your body and your mind are healthy enough to undergo the rigors of weight loss surgery.
There are various types of weight loss operations. The most commonly performed weight loss operations in this country would be the gastric bypass, the sleeve gastrectomy, and the lap band. The gastric bypass has been around for over 50 years and is still considered to be the gold standard when it comes to weight loss operations. The sleeve gastrectomy is relatively new in that it has only been around for about 7-8 years but it has now become the most common (or the most popular) weight loss operation. The lap band (otherwise known as the adjustable gastric band) has been around for about 20 years, and at one point was the most commonly performed weight loss operation in the United States and in other countries around the world. However, currently it only accounts for about 5% of all of the weight loss operations. Bariatric surgery is a term used to cover all different types of weight loss operations, and that typically includes the gastric bypass, the sleeve gastrectomy, and the lap band. A newer type of weight loss surgery is the intragastric balloon.
The gastric bypass is an operation in which the surgeon cuts off the upper portion of the stomach and creates that as your new stomach pouch. A patient’s stomach goes from the size of a football to the size of a large egg. The small intestine is then brought up and connected
the stomach pouch. Food can go into the stomach pouch and directly into the small intestine, bypassing the old stomach and part of the small intestine.
People lose weight for multiple reasons with the gastric bypass:
(1) They have a smaller stomach so they can’t eat very much food.
(2) Patients absorb a little bit less food than they normally would because part of the stomach and small intestine is “bypassed.”
(3) When food goes directly into the small intestine, patients generally cannot tolerate eating sweets like ice cream or cake in any large quantity. If they do, they experience something called Dumping Syndrome, with symptoms that include stomach ache, diarrhea, cold sweats, and racing heartbeat. This is very uncomfortable, but it’s quite effective in keeping patients from eating sweets.
The sleeve gastrectomy is an operation in which the surgeon removes about 85% of the stomach. The patient is left with a stomach that is in the shape of a tube or banana (rather than the size of a football). Patients eat much less food, causing significant weight loss. This operation is permanent and is a lifelong change for the patient.
A lap band or gastric banding is where a surgeon places a silicone band around the upper part of the stomach. This decreases the size of the stomach and doesn’t allow the patient to eat as much because the stomach can’t hold as much food. Reducing the size of the stomach helps the patient feel full, reducing feelings of hunger and lowering overall food intake.
The newest procedure that is available to patients in the United States is the intragastric balloon. This is a saline-filled silicon balloon. The surgeon will place the empty balloon inside a patient’s stomach, then fill the balloon with fluid through a tube. Once the balloon is full, the tube is disconnected, leaving the balloon inside the patient’s stomach. The balloon takes up space within the stomach, so the patient can’t eat a lot of food. It also has a weight to it, which helps the patient feel that they have eaten a large meal. This sense of fullness in the stomach helps a patient eat less and lose weight.
There are several complications that can occur with weight loss surgery. The typical complications for any type of operation are bleeding, infection, injury to other organs, and the risks of general anesthesia. The sleeve gastrectomy or the gastric bypass both use stapling devices to both cut the stomach and to seal it, so a patient could possibly develop a leak where fluid actually leaks out between the staples. A leak is the most common cause of death from either a sleeve gastrectomy or a gastric bypass. The leak rate nationwide is somewhere around 2-3%. However, the leak rate at well established and experienced practices is generally about 0.5%.
Other complications include developing an intestinal obstruction, something that may occur in a gastric bypass at the rate of about 1% but occurs even more rarely in a sleeve gastrectomy or a lap band. Another type of complication that could occur with any surgery is blood clots that can break off and travel to the lungs or brain. Patients who are morbidly obese have a much higher risk of developing blood clots.
The success rate for weight loss surgery can be as high as 90%. Everything depends on how well the patient continues lifestyle changes. Patients who are most successful at long-term weight loss remain engaged with either their physician or their weight loss surgeon, coming to support groups, nutritional groups, and routine follow ups with their weight loss surgeon.
Patients are often very eager to start exercising after they have weight loss surgery and that’s encouraged. However, it’s important for them to remember that they cannot perform any strenuous exercises (meaning lifting weights greater than 20 pounds or running or doing sit-ups) for a period of at least 6 weeks. Six weeks or more after surgery, after they have been cleared by their doctor, they can do any type of exercise that they want.
During the first 2-3 weeks after having weight loss surgery, most patients will experience some degree of discomfort from their incisions. They may also feel fatigued or tired because of the dramatically decreased calorie intake. However, that improves gradually with time and usually by the end of 2 or 3 weeks, most patients feel fairly well.
When an individual loses a significant amount of weight, he or she will have some degree of laxity (or looseness) of their skin. Some patients will have very elastic skin that snaps right back with no excess. However, most patients who lose a significant amount of weight will have some degree of saggy skin. Sometimes there’s a large amount of skin that can be removed. Once it’s removed, an individual looks fairly normal.
There aren’t any particular medications that an individual needs to take before surgery. After surgery, patients receive several prescriptions which may include pain medication, anti-nausea medication, and medication to reduce the amount of acid that your stomach produces, which helps with the healing process. Some patients are already taking multiple medications to treat their conditions, which might be for high blood pressure or high cholesterol. In general, patients continue taking those medications after surgery. However, the goal is to end up gradually weaning them off of medications. Each patient should work closely with their doctor to adjust medications.
After surgery, one of the main concerns that patients have is regaining weight. Although that can occur, as long as the patient continues to eat relatively healthy food in small portions and continues to exercise, it’s very unlikely that that patient would regain weight. When patients regaining significant amounts of weight, it’s usually because the patient has stopped following all of the recommendations given by the doctor, and they are now eating junk food, eating a lot of carbs, eating a high volume of food, eating a lot of sweets, and generally eating foods that are unhealthy for them. If you follow the guidelines set forth by your medical team and adopt a healthy lifestyle, it will be possible for you to maintain a significant amount of weight loss for the rest of your life and improve your health long term.
Follow up visits after weight loss surgery are extremely important. In fact, it’s as important as having the operation itself. These visits make sure that you are healing properly from the operation. Visiting your weight loss surgeon frequently also holds you accountable and helps to make sure that you adopt and maintain a healthy lifestyle. Patients are expected to come for follow-up appointments after surgery at 1 week and 1 month. Then patients come at 3, 6, 9, and 12 months. After 12 months, patients are to come in at 6-month intervals for 2 years, then once a year for the rest of their lives.
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