Bariatric surgery is an operation that can be done to help you lose weight when other treatments for severe obesity have not worked. The aim of surgery is to change the gastrointestinal (GI) tract so it limits the amount of food you can eat. It will cause you to feel full more quickly when you eat, which means you will eat less.
Severe obesity is defined as being more than 100 pounds overweight or having a body mass index (BMI) of 40 or higher. The BMI is a measure of your weight relative to your height. You can find your BMI from a chart. Severe obesity is also sometimes called morbid obesity.
Obesity is a serious condition. It increases your risk of poor health and major illnesses, such as heart disease, stroke, cancer, and diabetes. It's also closely linked with depression. And obesity can affect your relationships, employment, and self-esteem, as well as your health. If you are severely obese, it can be deadly.
Surgery to manage obesity is often risky. It may be considered only after careful weighing of the risks and benefits. Usually bariatric surgery is done only if:
To be considered for surgery, you should meet the following criteria. You should have:
Plan for your care and recovery after the operation. Arrange for someone to drive you home when you are discharged from the hospital. Allow for time to rest and try to find people to help you with your day-to-day duties.
Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.
If you need a minor pain reliever in the week before the procedure, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. Also avoid medicines that contain aspirin, such as some cold medicines. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before the procedure.
Follow any other instructions your provider gives you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.
Before the procedure you will be given a general anesthetic, which relaxes your muscles, puts you to sleep, and keeps you from feeling pain.
Four operations are common in the U.S.
The first two are shorter and less invasive because they involve only the stomach. They require less time in the hospital.
Two other operations limit stomach size and also bypass part of the intestine. That limits absorption of calories and nutrients.
Most surgery today is done laparoscopically through tiny cuts and guided by a small camera that sends images to a television monitor. Just small cuts in the belly may be needed with this method, and there is less tissue damage. This leads to less time in the hospital and fewer complications. But not everyone can have laparoscopy. If you are very obese, have had prior abdominal surgery, or have certain medical problems, you may need open surgery, with large cuts in the belly.
Depending on the type of procedure you have, you will stay at the hospital 1 to 6 days. You may be able to return to your normal activities in 3 to 5 weeks.
You will need follow-up after the surgery for postsurgical care and diet management. Your healthcare provider will check you for vitamin deficiencies, amount of weight lost, and speed of weight loss. Your provider may also keep checking you for high blood pressure and diabetes.
Depending on which procedure you have, your diet may need to change in the following ways:
The surgery has a number of risks, including:
Not getting all of the nutrients you need could cause problems such as anemia (lack of red blood cells) or osteoporosis (thinning of the bones). Some of the risks can be life threatening. If there are complications from the surgery, you may need more surgery.
You may not lose as much weight as you had hoped. You may tire of very restricted eating, and you may gain some weight back. You will still have to control your eating.
Usually the surgery helps people lose quite a bit of weight. Depending on the procedure, many very obese patients lose 50 to 90% of their excess weight within 12 to 18 months. The loss of weight can help treat or prevent other serious health problems, such as heart disease and diabetes. Diabetes, GERD (chronic heartburn), sleep apnea, joint pain, asthma, polycystic ovarian syndrome and gout become much less severe and may even disappear. Heart disease risk factors like high blood pressure and high cholesterol go down. The chance of dying within 5 years decreases dramatically. Obese women who have the surgery before getting pregnant can cut their risk of serious pregnancy complications, like eclampsia. And their babies are less likely to be severely obese children.
However, weight loss surgery is still fairly new. How long or well these benefits last is still in question.
