When should you consider weight-loss surgery?

Weight-loss surgery — also known as bariatric surgery — is one of the best treatments for obesity and related diseases. As per the American Society for Metabolic and Bariatric Surgery (ASMBS), there are five types of surgeries that your doctor can recommend for permanent weight loss.
Weight-loss surgery — also known as bariatric surgery — is one of the best treatments for obesity and related diseases. As per the American Society for Metabolic and Bariatric Surgery (ASMBS), there are five types of surgeries that your doctor can recommend for permanent weight loss.

Weight-loss surgery — also known as bariatric surgery — is one of the best treatments for obesity and related diseases. You may have heard of gastric bypass, the most well-known type of weight-loss surgery. But that’s just one option. As per the American Society for Metabolic and Bariatric Surgery (ASMBS), there are five types of surgeries that your doctor can recommend for permanent weight loss. Each has its own benefits, risks, and costs. You should weigh all the factors before deciding which one would suit you the best.

While bariatric surgery is a great option for permanent weight loss, it isn't for everyone. All forms of weight-loss surgery are major procedures that involve making changes in the stomach and intestine. Some procedures lower the body's capability to absorb nutrients while others put a cap on how much one can eat. 

You should consider these types of surgeries only if you have tried all other weight-loss options with little or no success or if your weight is posing some serious health problems. Like any major operation, weight-loss surgery also has some risks and side effects. Due to this, doctors don't recommend bariatric surgery unless a patient:

Even if you meet the above criteria, you may not qualify for weight-loss surgery. Your doctor will give a go-ahead only if you meet certain medical guidelines after passing a thorough screening process. Once the operation is over, you should be ready to make permanent lifestyle changes to make the most of your surgery and limit complications.

What are the different types of weight-loss surgery?

Gastric Bypass

Gastric bypass — also called Roux-en-Y gastric bypass — is the oldest form of weight-loss surgery, dating back to over 50 years. It's a relatively complex procedure with a longer hospital stay. During this procedure, the surgeon staples the stomach and creates an egg-sized pouch in the upper part of the stomach. This pouch is then attached to the small intestine. As a result, the food bypasses the stomach and directly enters the small intestine. 

With the stomach becoming smaller, patients feel full sooner and eat less. But as the ability of the stomach and small intestine to digest and absorb food also reduces, they gain less nutrition from their meals. With gastric bypass, you can experience significant and permanent weight loss. It may also help against acid reflux and adult-onset diabetes. The downside is that you can become nutrient deficient over time unless you make some big changes in your diet.

Sleeve Gastrectomy

Sleeve gastrectomy — also called gastric sleeve surgery — is an FDA-approved procedure. It involves the surgeons removing 80% to 85% of the stomach, leaving only a banana-shaped section, which they close with staples. As the small stomach fills faster, patients feel full sooner. Since a part of the stomach is removed, it also affects the bacteria and hormones in the digestive system, leading to changes in metabolism and appetite. 

Sleeve gastrectomy is less invasive than gastric bypass and involves a shorter hospital stay. While the surgery offers permanent weight loss, it cannot be reversed. Also, like gastric bypass, it can lead to long-term mineral and vitamin deficiencies.

Adjustable Gastric Band (AGB)

As the name suggests, the adjustable gastric band is a silicone band that a surgeon places around the upper section of the stomach. Studies show that the band does not limit the amount of food a person can eat. Rather, it works by controlling appetite and reducing hunger.

Surgeries involving AGB are reversible and have the least risk of nutritional deficiencies. Since the procedure is less invasive, patients can return home on the day of the surgery. However, patients may have to make several doctor visits during the first year since the band can need adjustments. 

In the United States, AGB surgery is less commonly performed in comparison to gastric bypass and sleeve gastrectomy. While it causes the least complications early after surgery, over time it can cause many health risks. It also has the highest rate of re-operation, performed mainly to remove the band due to intolerance.

Biliopancreatic Diversion With Duodenal Switch (BPD/DS)

BPD/DS is also called mixed surgery since the operation has two separate parts. The first part of the surgery is similar to sleeve gastrectomy. In the second part of the operation, the surgeon creates two separate tracts in the small intestine. Food streams through one tract, bypassing almost 75% of the small intestine. As a result, the amount of nutrients and calories absorbed is greatly reduced. 

Compared to most other forms of weight-loss surgery, patients lose the most weight with BPD/DS. It's also considered the best metabolic operation for the treatment of weight-related problems like type 2 diabetes. Moreover, this surgery doesn't require patients to make any big dietary changes, allowing them to eat relatively normal meals over time. 

The drawback is that it has the highest rate of complications like heartburn, irregular bowel movements, and in severe cases, even death. Patients who have gone through this surgery face the risk of nutritional deficiencies and may need to make several follow-up visits to the doctor.

Single Anastomosis Duodeno-Ileal Bypass With Sleeve Gastrectomy (SADI-S)

Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy is the most recent procedure endorsed by ASMBS. The first part of the operation is similar to sleeve gastrectomy, resulting in a smaller banana-shaped stomach. In the second part, the surgeon takes a loop from the latter part of the small intestine and connects it to the stomach.    

SADI-S is simpler, takes less time to perform, and allows better absorption of minerals and vitamins than BPD-DS. It also offers greater weight loss with more fullness and less hunger. In regards to obesity-related problems, SADI-S helps against rising blood sugar levels and type 2 diabetes.

Which weight-loss surgery should you consider?

To figure out the best bariatric surgery for yourself, you need to decide if you value safety or the surgery's weight loss potential more. 

The more the body is changed during the procedure, the greater the weight loss. However, more changes can also lead to more complications. For example, while gastric bypass offers permanent weight loss, it also has a high risk of short-term complications.

Another factor you need to consider is the cost. If budget is a constraint, you might want to consider getting a gastric band, which is cheaper than gastric bypass and sleeve gastrectomy. 

To make the right decision, understand your individual medical problems and your objective for getting the surgery. Talk to a surgeon who has experience with multiple weight-loss procedures. In this way, you'll get to learn about different surgical options and be able to choose the right one based on your lifestyle needs.

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Medically Reviewed on 6/20/2022
References
Sources:

Annals of Internal Medicine: "Comparative Effectiveness and Safety of Bariatric Procedures for Weight Loss."

ASMBS: "Bariatric Surgery Procedures."

Obesity Surgery: "IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures."

OFS Healthcare: "What are the Three Different Types of Weight Loss Surgeries."

Seminars in Nephrology: "Bariatric surgery to treat obesity."