Is Weight-Loss Surgery for You?

03/16/2017 11:22 am ET Updated Apr 18, 2017

Subhash Kini, MD, Bariatric Surgeon, Mount Sinai Program for Surgical Weight Loss, Associate Professor of Surgery, Icahn School of Medicine at Mount Sinai

Is Weight-Loss Surgery for You?

A few years ago, I saw a patient whose obesity had led to such poor liver function that her doctor referred her for the national transplant waiting list. She needed to lose weight and lose it now. Following weight loss surgery, her liver function eventually returned to normal, and she was taken off the transplant list. Her diabetes and high blood pressure also resolved, and she feels like a new person today.

For the right candidates, weight-loss surgery—also known as bariatric surgery—can yield remarkable health benefits, and even be lifesaving.

What Is Bariatric Surgery?

There are several types of bariatric surgery procedures, but the most common are sleeve gastrectomy and gastric bypass. Today, nearly all of them are performed using laparoscopic surgery, a minimally invasive technique.

Sleeve Gastrectomy: In this procedure, the surgeon removes a large portion of the stomach, transforming this digestive organ from a bag-like shape to a smaller tubular shape resembling a “sleeve.” The capacity of the stomach is greatly reduced, as is the amount of ghrelin, the “hunger hormone,” that it produces. This suppresses the appetite and makes one feel full more quickly after eating a small amount of food.

Gastric Bypass: This operation also decreases stomach volume and hunger hormone production, as well as reducing the amount of calories the intestines absorb. The surgeon partitions the stomach into two parts: a small pouch and the rest of the stomach, or gastric remnant. Food bypasses the gastric remnant and part of the intestine as it travels through the much smaller pouch directly into the middle portion of the small intestine, which is surgically connected to the pouch through a Y-shaped configuration.

Another procedure, laparoscopic gastric banding or LAP-BAND™ surgery, was once widely performed, but in recent years it has become less common because its weight-loss results are relatively low and its rate of complications is high.

Are You a Candidate for Bariatric Surgery?

Bariatric surgery is not for everyone who struggles with weight. You may be a candidate if you:

· Are 18 to 70 years old;

· Have a body mass index (BMI) of 40 or more; or a BMI of 35 or more plus a serious disease (a “comorbidity”), like type 2 diabetes, coronary artery disease, high blood pressure, high cholesterol, or sleep apnea. (For instance, a woman 5 feet 4 inches tall would qualify if she weighs more than 235 pounds and has no comorbidity, or if she weighs more than 205 pounds and has, say, diabetes.)

· Have been obese for many years and tried persistently, yet unsuccessfully, to achieve and maintain weight loss through methods like working with a doctor, going on multiple diets, and exercising;

· Understand what undergoing bariatric surgery involves: a preoperative workup, including heart and lung tests and psychological evaluation; a preoperative diet; the surgical procedure and its risks and benefits; postoperative diet; and follow-up visits;

· Are psychologically healthy and medically able to withstand surgery;

· And are ready to commit to lifestyle changes, like permanently altering your diet and exercising three to five times a week.

Alterations Required

When people who have not had surgery start dieting, they may get hungrier as the diet progresses. It may become so difficult that they give in after a week or two and go back to their old eating habits. Bariatric surgery makes committing to lifestyle changes much easier because patients feel satiated more quickly and for longer periods after eating much smaller meals.

You could still lose weight at first if you continue bad eating habits, like consuming high-carbohydrate, sugary, or fried foods. However, the low appetite afforded by surgery is not lifelong; it may last a few years or less. That’s why it is important to make permanent, healthy changes in diet and exercise during this window of time. People who don’t modify their lifestyle could easily regain the weight they lost once their appetite returns to normal.

Bariatric surgery does alter your digestive anatomy. Your smaller stomach and reconfigured intestines (in the case of gastric bypass) decrease absorption of certain nutrients, so you must eat a balanced diet and take daily supplements like multivitamins and calcium.

Lifesaving Advantages

This is not cosmetic surgery; it is for people who have serious health issues linked to obesity. Because of significant post-surgery weight loss, health problems like diabetes, high blood pressure, high cholesterol, and sleep apnea eventually resolve in 60 percent to 80 percent of patients. Other conditions, like arthritis, polycystic ovary syndrome, stress incontinence, fatty liver disease, and gastroesophageal disease, also display marked improvement after surgery.

Many obesity-related illnesses can lead to strokes and heart attacks. Obese individuals who undergo surgery tend to live longer than their counterparts who don’t have surgery. For instance, one study demonstrated that bariatric surgery lowered the risk of death by up to 89 percent over five years.

Lifestyle Advantages

Weight-loss surgery can also greatly enhance one’s day-to-day quality of life, making it easier, for example, to walk up the stairs or tie your shoelaces. One patient whose sister lived in a building without an elevator told me, “Before my surgery, I never visited her because walking up one flight of stairs was such a monumental task.” Another patient, a mother in her 30s, was finally able to play with her children outdoors; before the surgery, she was so heavy she couldn’t walk or run with them.

If you have been significantly overweight for a long time despite trying your best to shed pounds, consider discussing your options with a bariatric surgeon. Weight-loss surgery is remarkably safe, especially when performed at a nationally accredited bariatric center. To find a qualified facility near you, search the online Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program list.

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