Weighing Your Options
By David Buice
The sad truth is many Americans are carrying around too many pounds. According to the Institute for Health Metrics and Evaluation (IHME), an estimated 160 million Americans are overweight or obes e, including nearly 75% of American men and over 60% of American women.
For those for whom diet, and exercise have not worked in shedding unneeded weight, bariatric (weight-loss) surgery may be the answer. While bariatric surgery can offer many benefits, all forms of weight-loss surgery are major operations with possible side effects and risks, though these are minimal.
If you’re considering this weight-loss option, here are some things you need to know.
A variety of options
In 2018, 252,000 bariatric surgeries were performed in the U.S., and the following are three of the more commonly used procedures.
Sleeve gastrectomy (SG) – The SG procedure involves removing about 80% of the stomach, leaving a long, tube-like pouch. The smaller stomach cannot hold as much food, and it also produces less of the appetite-regulating hormone ghrelin, which may lessen your appetite.
Roux-en-Y gastric bypass (RYGB) – With RYGB, the surgeon cuts across the top of the stomach, creating a pouch about the size of a walnut that can hold only about an ounce of food. Normally the stomach holds up to three pints of food.
Next, the surgeon sews part of the small intestine directly to the pouch. Food then goes into this pouch and the small intestine, bypassing most of the stomach and the first section of the small intestine.
Of these two, RYGB was initially the more popular option, but because SG tends to have fewer post-operative complications, by 2016, the number of SG procedures was three times higher than RYGB.
Gastric banding – This is a third option in which the surgeon places a band around the upper portion of the stomach and injects a saline solution to inflate it. The inflation creates a smaller stomach pouch, reducing the amount of food the stomach can hold.
After surgery – There are, of course, other bariatric options. Still, whatever procedure you undergo, for one or two days, you won’t be able to eat or drink, giving your stomach and digestive system time to heal. Gradually you’ll progress to liquids, then pureed, very soft foods and finally, regular food. For several months you’ll also need regular medical checkups to monitor your post-operative health.
If you don’t lose weight – It is possible not to lose weight or regain weight after bariatric surgery. These complications can happen if you’re not eating healthy foods and exercising regularly. In this case, it’s essential to see your doctor immediately to explore the factors contributing to your lack of weight loss.
Bariatric Surgery: Risks and Benefits
You may be a candidate for bariatric surgery if you are more than 100 pounds over your ideal body weight, have a Body Mass Index (BMI) over 40, or have a BMI over 35 and are experiencing obesity-related conditions like high blood pressure or diabetes.
Before proceeding with surgery, however, you should have a thorough understanding of both the risks and benefits.
The more common risks of bariatric surgery include:
- Excessive bleeding
- Negative reaction to anesthesia
- Blood clots
- Lung or breathing problems
- Leaks in the gastrointestinal tract
Longer-term risks and complications can include:
- Bowel obstruction
- Diarrhea, flushing, lightheadedness, nausea or vomiting
- Low blood sugar (hypoglycemia)
On the other hand, if you and your physician agree that bariatric surgery is your best option moving forward, there are many possible benefits.
- Long-term weight loss – Most studies have concluded that more than 90% of those affected by severe obesity can maintain 50% or more of their surgically-related weight loss.
- Remission from type 2 diabetes – A recent Cleveland Clinic study found almost all obese patients with type 2 diabetes remained free of insulin and other medications for at least three years.
- Improved cardiovascular health – Bariatric surgery can reduce coronary heart disease risk, stroke, and peripheral heart disease.
- Depression relief – A poor body image or social stigma can lead to depression, and losing excess weight can improve emotional health.
- Elimination of sleep apnea – People with sleep apnea can often stop using their CPAP machine at night.
- Joint pain relief – Stress on joints can be relieved, often allowing people to stop using pain medications and enjoy more mobility.
- Improved fertility – Bariatric surgery could improve a woman’s fertility during childbearing years.
Weighing risks against rewards – Dr. Philip Schauer, one of the nation’s leading bariatric surgical specialists, concludes that this surgery’s risks are no greater than a knee or gall bladder procedure, and the outcome could be life-transforming.