Reading Time: 10 minutesJackie Bese / CC BY
People spend billions trying to lose weight. They spend more than anything on slimming pills, diet plans and magic mantras for losing weight. Many even opt for science and choose weight loss surgery. There are many health risks associated with obesity and one in three adults are overweight. Obesity is a growing epidemic among children and teens as well. Does bariatric surgery seem the only recourse when diet, exercise and food plans do not make a difference?Let’s dissect the science behind weight loss surgery and see the pros and cons associated with each type of bariatric surgical procedure.
Bariatric Surgery: Know More
Bariatric surgery is another term for weight loss surgery. It is an umbrella term for weight-loss surgeries that can be used for altering the digestive system in some way. People nearing obesity are likely candidates as the procedure becomes fairly commonplace. The amount of people opting for weight loss surgery is swelling even more with advancements in technology. What are the different types of weight loss surgery?
Types of Weight Loss Surgery
There are four kinds of bariatric surgery– 3 of these are widely used. The three standard bariatric surgery procedures are:
- Laparoscopic gastric adjustable band
- Gastric sleeve surgery
- Gastric-bypass surgery
Laparoscopic adjustable gastric band surgery is also known as gastric band surgery. Gastric sleeve surgery is referred to as sleeve gastrectomy. Gastric bypass is also called Roux-en-Y.
In gastric band surgery, the ring with the inner band (which is inflatable) is positioned atop the stomach of the patient. This surgery creates a tiny pouch, which in turn reduces the stomach’s size, so less food is needed to feel satiation. Within the band, a balloon is filled with saline solutions. The pouch’s opening can be increased or decreases through solution removal or injection.
In gastric sleeve surgery, a portion of the gut is also removed. This makes it easier for patients to feel satiated after consuming small servings of food. This is because, in sleeve gastrectomy, only a small section is left behind. Gastric bypass surgery is quite complicated because it reroutes digestion and decreases the size of the stomach. The surgery involves stapling the stomach so that you get a pouch that works like your stomach.
Consequently, less is consumed and more satiation is experienced. Another key feature of this type of surgery is that the surgeon cuts up the small intestine, attaching it to the stomach pouch. What is then eaten is bypassing the upper small intestine and stomach, resulting in the body absorbing far fewer calories from the items consumed. The bypassed section is, however, linked to the central stomach part, permitting digestive fluids to reach it. Various weight loss surgeries have consequently evolved and refined over some time.
While gastric banding and gastric sleeve surgery are linked with restriction, gastric bypass limits the food and prevents its absorption. All three operations are performed as a keyhole surgery using laparoscopy. The small incisions are made in the ab area, instead of a big cut. The benefit of this is that there are quicker recovery and less pain. The surgeries are carried out using general anesthesia.
This surgery takes about 60 minutes to complete. Small instruments are placed through cuts. An inflatable gastric band divided the stomach into a pouch and the remainder. The aim is to cut the amount of food consumed. The logic is simple: Less food is required to fill the pouch and make you feel satiated. For each patient, a gastric band is connected to an access port. This is placed underneath the skin. This allows bands to be adjusted even post-surgery.
This involves the use of surgical staples to create a pouch atop the stomach. This is then connected to your small intestine, to ensure food is neither reaching nor taken in by the upper section of this body part and portions of the stomach.
This involves removal of parts of the stomach restricting the intake. Satiation levels are high even after consuming small portions of food.
All these surgeries have advantages and drawbacks. The gastric band causes 50% weight loss while gastric bypass or sleeve surgery causes decrease of 2/3 of body weight. A gastric bypass carries more complications, while a gastric band is reversible. The other two types of surgery cannot be undone.
Other Types of Weight Loss Surgery
Different kinds of bariatric surgery are discussed here. A bilo-pancreatic division is like a gastric bypass. It is when a slightly larger section of the small intestine is bypassed. This division can cause even more significant loss (up to 80% of body weight), but it leads to complications such as stomach upset too. This type of surgical intervention is only recommended for those with chronic health conditions such as heart disorders.
Another type of weight loss surgery (albeit a temporary one) involves the insertion of a small silicone balloon implanted surgically on to the stomach. This is filled with air or sterile salt water. This cuts down the amount needed as food to induce a feeling of satiation. This balloon is taken out after six months, usually. The balloon can also be endoscopically inserted rather than making an incision on the abs.
Benefits and Drawbacks of Major Weight Loss Surgeries
Gastric Bypass Surgery: Pros and Cons
This procedure was first developed during the 60s. Creating a smaller stomach ensures lesser calorie consumption and absorption.
The advantages of this type of surgery are its fast, apparent results in a short period. In just six months, you can lose up to 50% of the weight. This continues for as long as two years in terms of benefits. Rapid weight loss releases you from a host of medical conditions like sleep apnea, hypertension, and diabetes. The results also continue for a more extended period. Another benefit is that this procedure is permanent but reversible. Weight-related co-morbid conditions are avoided. It is perfect for those with diabetes, GERD and also leads to fewer chances of developing food intolerance. Another benefit is the absence of foreign objects in the body.
As the food enters the digestive tract rapidly, there is a chance that at the end of it all, your body may lose critical nutrients it needs. Fewer calories are absorbed by the body. This means fewer nutrients like calcium, vitamins, and magnesium which are critical for essential body functions. Gastric bypass surgery also requires people to undertake a lifelong course of nutritional supplements. Major surgery carries a risk too. There is a possibility of developing blood clots. Infections may necessitate removal of small and large intestines. Gallstones can also result. While this procedure is reversible, the procedure for that is extremely complicated. High chances of nutritional deficiencies and surgery-related problems make this difficult for some patients.
Gastric Banding: Pros and Cons
A gastric band is inflatable. So, you get a smaller upper stomach and food is consumed in lesser amounts for greater satiation.
Unlike the gastric bypass, which is permanent, this type of weight loss surgery is not. If the band is to be removed, the procedure is straightforward. Gastric band surgery is also safer and more comfortable to recover. The band can be increased or decreases in tightness based on removal or injection of saline by the doctor. The gastric band can, therefore, be adjusted or removed. This type of surgery makes no difference to the intestines. It involves a shorter duration of hospital stay and there is less chance of nutrient and vitamin shortage. Quicker recovery time and safer to adjust are some of the other benefits.
A downside is that you may lose less weight as compared to other forms of surgery. A serious drawback is that follow-up visits are needed for adjusting the band on a frequent basis. There is also a chance that your body may reject the band. Eventually, it may have to be replaced or removed. Weight loss takes a longer time and requires a dedicated change in lifestyle to manage weight loss. There is a chance that device-related complications may ensue. For example, the patient operated upon may be unable to consume food fast. The band may leak or become maladjusted. Certain types of lumpy foods will also be hard to eat. There is also a chance of developing gallstones.
Gastric Sleeve: Pros and Cons
Gastric sleeve (also known as sleeve gastrectomy) is another bariatric surgical procedure where 3/4 of the stomach are removed and what is the present is a sleeve connecting the esophagus with your small intestine.
This kind of surgery is ideal for those at a high propensity for developing complications at the time of surgery. Unlike gastric band surgery, there is no alien device inserted into the body. This is linked to fewer complications such as slip-ups or infections. Sleeve gastrectomy is associated with more weight loss. A staggering 30 to 50 percent of weight loss is within the first 6 months. The effects of the weight loss can persist for 2 years at least. This surgery can even be before a gastric bypass surgery. For those who want to avoid major surgery, gastric sleeve surgery is a better bet. More weight loss, shorter hospital stay, and no bands or foreign objects in the body are some of the advantages. It is suited for patients at a higher surgical risk. Lowest side effects and loss of over 80% weight in one year are some of the other benefits.
Unlike gastric banding, a sleeve gastrectomy is irreversible. This means it cannot be reversed. Weight gain is also not impossible. With wrong dietary decisions, the positive impact of a gastric sleeve surgery can be undone. The surgery cannot be canceled and there is a higher risk of surgery associated problems. Moreover, after one year, weight loss is not significant. There is a chance of development of gallstones, and poor dietary habits will lead to weight gain again.
Should You Go For Any Weight-Loss Surgery?
As with any massive surgical treatment, your unique circumstances need to be taken into account while deciding whether to go for this surgical option. Weight loss surgery is not a temporary, low maintenance fix. It involves a major procedure with physiological and psychological effects. The general guidelines involve considering that diet and exercise as means of weight loss before opting for bariatric surgery. You need to fall into one of the following categories to be a candidate for weight loss:
- BMI or body mass index should be 40 or more, indicating extreme obesity.
- BMI should be in the range of 35 to 39.9 with more than one co-morbid health problem that can be improved with weight loss.
- You need to be at least 100 pounds over healthy body weight
Remember that just meeting one of these criteria does not mean you need to consider the operating table. There are other factors which come into play as well.
The medical condition prior to surgery plays a critical role when it comes to bariatric surgery. The medical team evaluates the risks involved, whether one is on medication, the amount of alcohol ingestion or smoking and overall physical health.
The issue of mental health is also essential. Factors like eating disorders, substance abuse, and high levels of anxiety could influence if health benefits of surgery can be obtained.
Another factor is that those under 18 face a lot of hurdles when it comes to major surgery. Moreover, for people above a certain age, the procedure carries an entire plethora of risks as age rises.
Does Weight Loss Surgery Work?
Another question is, does weight loss surgery work? Again, this depends on your circumstances. You need to consider both the positives and negatives.
On the positive side, plus-sized people have been shown to lower in overall mortality with the development of fresh health-related conditions. A study of around 49,000 obese patients found that those who had undergone surgical procedures were less likely to pass away five years later. Death due to heart conditions significantly rose in those who were not undergoing weight loss surgery.
Another meta-analysis found that excessively overweight people lost weight after surgery and also experienced the resolution of medical conditions co-morbid with it. But, as with every other type of surgery, this too comes with its share of risks.
Weight Loss For the Long Term?
It is pretty tough not to lose weight after bariatric surgical procedures. But hunger is not a physiological process alone. There are mental factors that come into play, and the role of emotional eating is essential to consider. When people are stressed out, upset or bored, they overeat. Once the six months to one year are over, the weight may be gained. A study by Journal of American Medical Association found that weight gain accompanied those who underwent sleeve gastrectomy. So weight loss surgery is not always the answer in the long run.
Rapid Gastric Emptying and Weight Loss Surgery
What is also known as dumping syndrome may occur, once the bariatric surgery is carried out! Food such as sugar goes directly to the small bowel, resulting in vomiting, diarrhea, and nausea along with painful cramps.
Other Medical Complications
Weight loss surgery also increases the chances of development of stones in the gallbladder. They result when calcium, cholesterol, and other components bind and remain stagnant in the gall bladder. Symptoms co-occurring with gallstones include back pain and indigestion. Some types of weight loss surgery such as gastric sleeve and gastric bypass lead to the transition of the gut bacteria and hormones. This can lead to not only autoimmune disorders. But also the leaky gut syndrome and diseases like heart disease, dementia, and arthritis. Aspects like fertility and long life hinge on gut bacteria and hormones, which impact long term health.
Another lethal danger of weight loss surgery is the lack of nutrients present for the body to function effectively. Patients are at high risk of malnutrition following the procedure. Most common deficiencies are B12 and iron. Malnourishment involves loss of micro or macro nutrients. These include minerals, vitamins, fats, carbs, and protein. Working with a dietician or undertaking weight loss programs may, therefore, be a better bet.
When Weight Loss Surgery Works Well (And When It Does Not!)
If you have any of the following medical conditions, weight loss surgery can lead to recovery and resolution of these:
- Extremely Severe Arthritis
- Obstructive Sleep Apnea
Close to over 95% of US citizens report enhanced quality of life following bariatric surgery. Some people have longevity following weight loss surgery, as against obese people who don’t opt for this choice.
Weight loss surgery is a real problem with a host of complications. While some of the issues are unpleasant or inconvenient, leading to pain and discomfort, others may need special operations.
So you can suffer from wound infections, nausea, vomiting, diarrhea, ab hernia or more life-threatening complications such as:
- Blood clot to the lungs
- Leaky gut syndrome
- Bleeding stomach ulcers
- Heart problems
- Stomach rupture
Even after weight loss, other problems may result such as gallstones, malnourishment or excess skin requiring body contouring. Weight loss surgery can only work well if the binge eating habit is broken and healthy foods and vitamins are ingested. Exercise on a regular basis is even more important. Keeping the weight off is simpler for those who are active and exercise. Exercise reduces disease rate, including heart disease and cancer too. Surgery is a tool for weight loss– it is not an all-encompassing solution. You still need to be active, eat right and watch out for weight gain. But for those with co-morbid medical conditions, nothing beats weight loss surgery. So, make an informed decision. Your life could depend on it.