What is Bariatric Surgery?

Bariatric surgery is one of the best weight loss solutions for individuals struggling with severe obesity. But what exactly is bariatric surgery, how does it work, and what should you expect before, during, and after the procedure.

In fact, Bariatric surgery refers to a group of surgical procedures designed to help individuals with severe obesity lose weight. These procedures work by either restricting the amount of food the stomach can hold, reducing the absorption of nutrients, or a combination of both.

The final goal of bariatric surgery is not just weight loss. Above all it aims to improve or resolve obesity-related health conditions, such as type 2 diabetes, high blood pressure, sleep apnea, and heart disease.

The most common forms of Bariatric surgery are:

1. Gastric Bypass (Roux-en-Y Gastric Bypass)

This procedure involves creating a small pouch at the top of the stomach and connecting it directly to the small intestine, bypassing a large part of the stomach and the first part of the small intestine. Consequently, the food intake is restricted and nutrient absoption is reduced. (See article below by: Irene Artsyshevska, Founder and CEO, Go Light Bariatrics, LLC)

2. Sleeve Gastrectomy

In this procedure, about 80% of the stomach is removed, leaving a tube-shaped stomach about the size and shape of a banana. Therefore, the amount of food that can be consumed is greatly reduced.

3. Adjustable Gastric Band

This procedure involves placing an inflatable band around the upper part of the stomach to create a small pouch above the band, with a narrow opening to the rest of the stomach. Once again, this restricts the amount of food that can be consumed.

4. Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

This complex procedure involves removing a portion of the stomach and bypassing a significant part of the small intestine. It’s very effective for weight loss but also has the highest risk of nutritional deficiencies.

Who is a Candidate for Bariatric Surgery?

Bariatric surgery is typically considered for individuals who meet the following criteria:

• Body Mass Index (BMI) of 40 or higher (extreme obesity)
• BMI between 35 and 39.9 (obesity) and at least one obesity-related health condition
• Inability to achieve sustained weight loss through other methods

Additionally, candidates should be prepared to make significant lifestyle changes and commit to long-term medical follow-up.

Benefits of Bariatric Surgery

Bariatric surgery offers numerous potential benefits, including:

1. Significant and sustained weight loss
2. Improvement or resolution of obesity-related health conditions
3. Enhanced quality of life
4. Increased life expectancy
5. Improved mobility and physical function
6. Reduced healthcare costs in the long term

Risks and Potential Complications

Like any major surgery, bariatric procedures come with risks. These may include:

1. Infection
2. Bleeding
3. Blood clots
4. Leaks in the gastrointestinal system
5. Bowel obstruction
6. Dumping syndrome (rapid emptying of stomach contents into the small intestine)
7. Malnutrition
8. Need for revision surgery

Therefore, it’s crucial to discuss the risks thoroughly with your healthcare provider and weigh them against the potential benefits.

Preparing for Surgery

Preparing for bariatric surgery is a crucial step in ensuring a successful outcome. This process typically begins several weeks or even months before the actual surgery date. Here’s what you can expect:

1. Medical Evaluations: Your healthcare team will conduct a series of tests to ensure you’re physically ready for surgery. These may include blood tests, cardiac evaluations, and sleep studies.
2. Nutritional Counseling: You’ll meet with a registered dietitian who will help you understand the dietary changes you’ll need to make before and after surgery. They may put you on a special pre-surgery diet to reduce the size of your liver and make the surgery safer.
3. Psychological Evaluation: A mental health professional will assess your readiness for the lifestyle changes that come with bariatric surgery and address any underlying psychological issues.
4. Lifestyle Changes: You may be asked to quit smoking, increase physical activity, and make other lifestyle changes to improve your overall health and surgical outcomes.
5. Education Sessions: You’ll attend classes or seminars to learn about the surgery, what to expect during recovery, and how to adapt to your new lifestyle.
6. Insurance Approval: If you’re using insurance to cover the surgery, your healthcare team will work with you to gather all necessary documentation for approval.

The Surgery Process

On the day of surgery, you’ll be admitted to the hospital and prepared for the procedure. Although the specifics of the surgery will depend on the type of bariatric procedure you’re undergoing, generally, it will involve the following steps:

1. Anesthesia: You’ll be given general anesthesia to ensure you’re asleep and pain-free during the surgery.
2. Laparoscopic Approach: In fact, most bariatric surgeries today are performed laparoscopically, meaning the surgeon makes several small incisions rather than one large one. This approach typically results in less pain, shorter hospital stays, and quicker recovery times.
3. Surgical Procedure: The surgeon will perform the specific type of bariatric surgery you’ve chosen (e.g., gastric bypass, sleeve gastrectomy, or adjustable gastric banding).
4. Closure: Once the procedure is complete, the surgeon will close the incisions with sutures or surgical staples.

The surgery itself usually takes between 1-3 hours, depending on the type of procedure and any complications that may arise.

Recovery and Post-Operative Care

Recovery from bariatric surgery is a gradual process that requires patience and dedication. Here’s what you can expect in the days, weeks, and months following your surgery:

Immediate Post-Op Period (1-3 days)

• Hospital Stay: Most patients stay in the hospital for 1-3 days after surgery.
• Pain Management: You’ll be given pain medication to manage discomfort.
• Early Mobilization: You’ll be encouraged to get up and walk as soon as possible to prevent blood clots and promote healing.
• Clear Liquid Diet: You’ll start with a clear liquid diet to allow your digestive system to heal.

First Few Weeks

• Gradual Diet Progression: You’ll slowly progress from liquids to pureed foods, then to soft foods, and finally to regular foods over several weeks.
• Follow-up Appointments: You’ll have regular check-ups with your surgical team to monitor your recovery.
• Incision Care: You’ll need to keep your incisions clean and dry to prevent infection.
• Activity Restrictions: You’ll need to avoid heavy lifting and strenuous activities for several weeks.

Long-Term Recovery (2-18 months)

• Continued Weight Loss: You’ll continue to lose weight rapidly during this period.
• Nutritional Supplements: You’ll need to take vitamins and minerals to prevent nutritional deficiencies.
• Regular Exercise: As you heal, you’ll be encouraged to incorporate regular physical activity into your routine.
• Support Groups: Many patients find it helpful to join support groups to share experiences and tips with others who have undergone bariatric surgery.

Life After Bariatric Surgery

However, Bariatric surgery is not just a one-time event, but a tool that requires lifelong commitment to achieve and maintain weight loss. Here’s what life after bariatric surgery typically entails:

Dietary Changes

Your relationship with food will change dramatically after surgery. You’ll need to:

• Eat smaller portions: Your new stomach pouch will only be able to hold a small amount of food at a time.
• Choose nutrient-dense foods: With limited capacity, it’s crucial to prioritize foods that provide essential nutrients.
• Avoid certain foods: Some foods may be difficult to tolerate or may cause dumping syndrome, particularly after gastric bypass surgery.
• Stay hydrated: You’ll need to drink plenty of water, but not with meals as this can overfill your stomach pouch.

Exercise Routine

Regular physical activity becomes an essential part of life after bariatric surgery. It helps to:

• Maintain weight loss
• Build and preserve muscle mass
• Improve cardiovascular health
• Boost mood and energy levels

However, most bariatric programs recommend starting with low-impact activities like walking and gradually increasing intensity as you become more fit.

Nutritional Supplements

Due to the changes in your digestive system, you’ll likely need to take several supplements for life, including:

• Multivitamins
• Calcium
• Vitamin D
• Vitamin B12
• Iron (especially for menstruating women)

Regular blood tests will help your healthcare team determine if you need additional supplements.

Psychological Changes

The rapid weight loss and lifestyle changes can have significant psychological impacts. Many patients experience:

• Improved self-esteem and body image
• Changes in relationships
• The need to develop new coping mechanisms (as food can no longer be used for emotional comfort)

Some patients may also experience depression or anxiety, particularly if they had unrealistic expectations about how weight loss would change their lives. It’s important to maintain contact with mental health professionals during this time.

Skin Changes

Rapid weight loss often results in excess skin, particularly around the abdomen, arms, and thighs. Consequently, some patients choose to undergo plastic surgery to remove this excess skin, but this is typically considered a cosmetic procedure and may not be covered by insurance.

Cost of Bariatric Surgery

Bariatric surgery can cost anywhere from $10,000 to $25,000. Most people who have a bariatric procedure can have some or all of the costs paid by their health insurance plan. Additionally, Medicare covers some bariatric surgical procedures, like gastric bypass surgery and laparoscopic banding surgery. However, to qualify for Medicare aid you must meet certain conditions related to morbid obesity. Medicare doesn’t cover transportation costs to get to a bariatric surgery center.

Bariatric Surgery For Rapid Weight Loss

Irene Artsyshevska
Founder and CEO
Go Light Bariatrics, LLC

Bariatric Surgery as a Rapid Weight Loss Program

Should Bariatric surgery be considered a rapid weight loss program? Certainly yes! Any weight loss of 2+ pounds per week is considered rapid. However, does it make it “an easy solution” and should it be taken lightly? Absolutely not!

Weight loss surgery (WLS) should be considered after all other resources have been exhausted (dieting and physical activity), not because a person wants to achieve results quickly.

Gastric sleeve or RNY gastric bypass are the most popular bariatric surgery options (compare various surgical procedures at https://golightbariatrics.com/compare-bariatric-surgeries/). Although they are performed laparoscopically (via tiny abdominal incisions), they are major surgeries with the same surgical risks as in any other procedure. The risk of having WLS should always be less than the risk of developing diabetes, cardiovascular issues, sleep apnea, joint damage, low quality of life, and a short lifespan, etc., – comorbidities that are typical for an obese person.

Advantages of having WLS (the list is not exhaustive):

• Significant Weight Loss: Helps achieve and maintain long-term weight loss.
• Improved Health Conditions: Can lead to the resolution or improvement of obesity-related conditions such as type 2 diabetes, high blood pressure, sleep apnea, and heart disease.
• Increased Longevity: May reduce the risk of premature death associated with severe obesity.
• Enhanced Quality of Life: Improves mobility, energy levels, and overall physical function.
• Improved Mental Health: Can reduce symptoms of depression and anxiety related to obesity.
• Better Fertility: Increases fertility and can improve pregnancy outcomes in women of childbearing age.
• Reduced Risk of Certain Cancers: May lower the risk of developing obesity-related cancers.
• Lowered Cholesterol Levels: Improves cholesterol and lipid profiles, reducing the risk of cardiovascular issues.
• Improved Sleep Quality: Can alleviate sleep apnea and other sleep disorders.
• Relief from Joint Pain: Reduces the stress on weight-bearing joints, often leading to decreased pain and improved mobility.
• Enhanced Social and Professional Opportunities: Weight loss can lead to increased confidence and opportunities in social and professional settings.
• Lowered Healthcare Costs: Can reduce the long-term costs associated with treating obesity-related health conditions.
• Better Digestive Health: Helps in reducing acid reflux and other gastrointestinal issues related to obesity.

Consolidating the Achievements

Once a patient achieves desired weight and health improvements, the next goal is to maintain them. This requires:

• Commitment to a healthy nutrition: New eating habits, permanent change of lifestyle.
• Mental attitude: Constant work on the relationship with food (consider therapy).
• Staying physically active.
• Daily efforts: Never relax and get too comfortable, make correct food choices daily. The battle never ends.
• Post-op lab work: It is needed periodically to ensure there is no lack of vitamins, minerals, and other nutrients.
• Achieve hydration and protein goals daily.
• Family support: A healthy family environment where everyone follows a healthy lifestyle and does not create temptations for the patient is very important.
• Stress control: Work on the level of stress in life, general happiness, inner peace, look for reasons for joy frequently, control negative emotions.
• New hobbies: Develop new hobbies that are not related to food. The goal is to substitute food as the main source of pleasure and comfort in life with new healthy sources, such as new hobbies. Consider crafts, outdoor activities, become a gym addict, volunteer in your local community, do charity work, learn new skills, gardening, get a pet, etc.

Irene Artsyshevska

Founder and CEO,
Supervising Patient Coordinator
Go Light Bariatrics, LLC

www.golightbariatrics.com