Understanding Options for Weight-loss Surgery
People struggling with obesity and its related medical complications may wonder if bariatric surgery could significantly improve their lives. But knowing which bariatric surgery procedure is right for them may be even more difficult to figure out.
Approximately one-third of Americans cope with obesity, defined as a body mass index (BMI) of 30 or higher, according to the National Institutes of Health. But obesity isn’t just a cosmetic problem – it markedly raises the risks of a bevy of dangerous or life-threatening diseases, including type 2 diabetes, sleep apnea, heart disease, cancer, joint problems and more. When individuals’ BMIs rise into the 35 to 40 range, these associated medical risks skyrocket, creating a situation where weight loss may be vital to health or longevity, Dr. Ahmed says.
“Having worked with many patients with obesity and health complications over my career whose diligent efforts at weight loss were futile, I know how valuable an option bariatric surgery can be,” explains Dr. Ahmed.
Weight loss surgeries: What do they include?
There are three main types of bariatric surgery. While the goal of all of them is to prompt significant weight loss, each procedure differs in approach. They include:
- Roux-En-Y Gastric Bypass: Considered by many in the obesity field to be the gold standard of bariatric surgeries, gastric bypass surgically creates a small pouch at the top of the stomach that restricts the amount of food that can be consumed. The pouch is then connected to the small intestine, allowing food to bypass the lower stomach and first two parts of the small intestine. Gastric bypass accounts for nearly half of weight-loss surgeries done in the United States today.
- Vertical Sleeve Gastrectomy (VSG): This bariatric procedure reduces the stomach’s volume without altering other digestive tract anatomy – a feature some patients find appealing. In VSG, the stomach is divided vertically and 85% is removed. The nerves to the stomach and nearby outlet valve, known medically as the pylorus, remain intact to preserve normal stomach function.
- Gastric Band/LapBand: Commonly referred to as the LapBand procedure, gastric band surgery is the least invasive of all bariatric procedures and the only one that is reversible. A restrictive procedure to control hunger, the LapBand is placed at the upper portion of the stomach, forming a small pouch. The band is filled by accessing a port secured below the skin. Patients must commit to eating small portions and to more frequent medical follow-up to maintain the band.
Which bariatric procedure is right for which patient?
Roux-En-Y Gastric Bypass is typically used on patients with a BMI or 40 or higher, many of whom also suffer from diabetes and other major health complications. Most patients who undergo gastric bypass experience 60% of excess body weight lost within 1 to 2 years after surgery, he says. Among Dr. Ahmed’s patients who’ve had gastric bypass surgery, the vast majority experience improved overall health, and diabetes is greatly reduced or even gone within 6 to 12 months after surgery.
Vertical Sleeve Gastrectomy (VSG) may be appropriate for patients with obesity of either lower or very high BMIs. VSG is most often done on those who are too heavy to safely undergo other types of weight-loss surgery, and some may eventually require a second weight-loss procedure, he says. But typical weight loss with VSG is 50% of excess body weight within 1 to 2 years after surgery, and obesity-related medical complications often drop significantly afterward.
Gastric Band/LapBand is often considered appropriate for patients with obesity whose BMIs fall into the lower end of the obesity range. Because the procedure is performed laparoscopically – with a tiny camera and only a few tiny incisions – this procedure may be chosen by patients who don’t want to undergo a major, invasive procedure requiring hospitalization. Weight loss from LapBand surgery is typically slower than the other bariatric procedures, hovering at about 45% of excess body weight within 1 to 2 years after surgery.
But regardless of which type of bariatric surgery is chosen, Dr. Ahmed cautions that it’s not a quick fix for obesity. “Undergoing any type of weight-loss surgery will greatly change your lifestyle,” he says. “For optimal results, you must eat healthy foods, control portion sizes and exercise, and all of these efforts pay off in combination with bariatric surgery to lead toward a lower BMI and enhanced health.”
Mustafa Ahmed, MD, FACS, is board certified in surgery, surgical critical care and internal medicine. He is an obesity expert, bariatric surgeon and medical weight loss management specialist and the founder of Southern Nevada Bariatrics.