Q: Is bariatric surgery right for me?
A: Bariatric surgery involves an operation that helps individuals lose weight by making changes to the digestive system. By causing weight loss, bariatric surgery also helps improve many conditions related to obesity. For example, bariatric surgery can help lower high blood pressure and high cholesterol levels. Those with severe diabetes can undergo bariatric surgery to better control blood sugar levels. Bariatric surgery also is known to reduce risk of heart failure and improve overall cardiovascular function.
While bariatric surgery is an elective procedure, it may be required before undergoing other medical procedures. Bariatric surgery may precede a hip or knee replacement because excess weight poses a high risk for reinjury. Patients waiting to undergo a kidney transplant also can benefit from bariatric surgery, as it may reduce obesity-related complications that lead to greater risk of early death after transplant.
People who want to undergo bariatric surgery must meet one of the following requirements to be eligible:
Body mass index (BMI), a value derived from a person’s weight and height, greater than or equal to 40.
BMI greater than or equal to 35 and at least one obesity-related comorbidity, such as Type 2 diabetes, hypertension, sleep apnea, or nonalcoholic steatohepatitis (NASH), which is inflammation and fat buildup in the liver.
Inability to achieve healthy weight loss sustained for a period of time with prior efforts.
The most common types of bariatric surgery include sleeve gastrectomy, gastric bypass, and duodenal switch. Bariatric surgery promotes long-term weight loss through restriction, malabsorption, or a combination of the two. Restrictive procedures promote weight loss by making changes to stomach capacity. Malabsorptive procedures alter the structure of the digestive tract, allowing food to bypass portions of the small intestine, limiting calorie absorption.
Sleeve gastrectomy is a restrictive procedure that removes approximately 80% of the stomach. The new stomach pouch holds considerably less than the normal stomach, restricting the amount of food that can be consumed. Sleeve gastrectomy is the simplest of the three procedures because it involves no rerouting of the intestines, but it causes less weight loss than gastric bypass and duodenal switch.
Gastric bypass, considered the “gold standard” of weight-loss surgery, shrinks the stomach to the size of an egg and reroutes intestines, making the surgery both restrictive and malabsorptive. The smaller stomach restricts the amount of food that can be consumed, while the rerouting causes the body to absorb fewer calories.
Gastric bypass typically provides greater weight loss than sleeve gastrectomy but also carries increased risk of ulcers and hernias.
Biliopancreatic diversion with duodenal switch (BPD/DS)
With BPD/DS (mostly known as duodenal switch), the first step is to remove a large portion of the stomach, much like in sleeve gastrectomy. The second step involves bypassing the majority of the intestine by connecting the end of the intestine to the duodenum near the stomach, limiting how much one can eat and reducing the absorption of nutrients.
Duodenal switch is very effective at reducing conditions related to obesity and causes the greatest calorie malabsorption of the three procedures. However, the procedure is more complicated, which is why it is generally recommended for people with a BMI greater than 55.
Those who undergo bariatric surgery must make lifestyle changes for sustained weight loss, such as adjusting to smaller portion sizes, consistently exercising and limiting alcohol consumption. An environment of supportive friends and family also helps.
If you are interested in bariatric surgery, consider attending an informational session to learn more.
Piotr Krecioch is a bariatric surgeon at Mercy Catholic Medical Center.