Medical Author: Melissa Conrad Stoppler, MD
Medical Editor: Jay W. Marks, MD
Bariatric surgery refers to surgery performed on the stomach and/or intestines to decrease the amount of food that can be consumed and, as a result, to help a person with extreme obesity lose weight. Adjustable gastric banding and gastric bypass are the two main types of bariatric surgery. In adjustable gastric banding, a reversible procedure, insertion of a band restricts the size of the opening from the esophagus to the stomach. The size of the opening to the stomach determines the amount of food that can be eaten. Gastric bypass is a permanent reduction in the size of the stomach in which a small pouch is created from the proximal portion of the stomach and attached to the intestine in a location that bypasses about 2 feet of normal intestine. The amount of food that can be eaten is limited by the size of the pouch and the size of the opening between the pouch and the intestine.
If you're interested in bariatric surgery (gastric bypass or gastric banding), the following questions can help you decide if this type of procedure might be of benefit for you.
- How much weight do you need to lose? Bariatric surgery is an option for people who have a body mass index (BMI) above 40, indicative of extreme obesity. Bariatric surgery may also be considered for people with a BMI between 35 and 40 who have health problems like type 2 diabetes or heart disease.
- Have you tried other weight loss methods, such diets and exercise, without success? Have you tried such methods repeatedly? Bariatric surgery is considered a last-resort solution for people who are unable to lose weight by any other means.
- Do you have a serious medical condition? Some people with serious heart or lung conditions may not be a good candidate for surgery.
- Are your expectations realistic? Most people who undergo bariatric surgery can expect to lose two-thirds to three-fourths of their excess weight. However, up to 25% of bariatric surgeries are not successful, with patients regaining weight by slowly ingesting high-calorie foods or even eating quantities significant enough to stretch the stomach pouch after gastric bypass. Another aspect of extreme weight loss is the problem of excess skin or unattractive fat pockets and the possible need for plastic surgical procedures to correct these problems.
- Are you prepared for significant lifestyle changes? Following bariatric surgery, your eating patterns and practices will change drastically. Extreme attention to diet is required, and nutritional supplements are necessary. You will have to eat numerous small portions of food throughout the day rather than large meals. You may be also asked to stop smoking prior to the surgery or to begin physical exercise.
- Are you prepared to undergo the risks of a major surgical procedure? As with any operation, there are risks and potential side effects of the procedure. While newer surgical procedures allow for some bariatric surgeries to be performed through a laparoscope with a lower rate of complications, about 1% of persons who have had traditional gastric bypass surgery have died due to medical complications following the procedure. Others may develop nutritional deficits after the procedure that lead to conditions such as osteoporosis or anemia.
- Are you in a state of good emotional health? Psychological screening is used to help determine if a person is a good candidate for bariatric surgery. For example, people suffering from depression or other emotional conditions may be advised to receive treatment for these conditions before making the decision to undergo bariatric surgery.
- Will your health plan cover bariatric surgery? The procedures are very expensive, and your insurer may require you to meet certain conditions before having the procedure or to demonstrate that other methods for weight loss have failed.
If you want to learn more about bariatric surgery, talk to your doctor. He or she can refer you to a bariatric surgeon who can help you decide if this type of procedure is right for you.
REFERENCE: eMedicine, Bariatric surgery.