By Brian Cantor, MD
Before being considered for the surgery, you must first meet a few conditions:
- Your body mass index (BMI) must be 40 or above, or your BMI is 35-plus and you have a serious medical problem related to excess weight, such as type 2 diabetes, high blood pressure, or sleep apnea.
- Previous attempts to lose weight through diet and exercise haven’t worked.
- Your weight affects your health, according to a physician.
- You must be over 18.
Once it’s confirmed that you’re a candidate, you’ll attend a nutrition consultation, where a provider will discuss what you’ll need to do for the lifelong journey that is weight loss. Leading up to the surgery, you’ll complete six months of nutritionist-guided weight loss and lifestyle modifications, mostly involving dietary adjustment and exercise. By making these practices habits before you undergo surgery, you’ll be more likely to maintain your short-term weight loss in the long term. Think of surgery as a tool that helps you achieve your goal, not the solution.
You’ll also go on a liquid diet for two weeks before a procedure. During this period, you can expect to drop between 11 and 15 pounds.
Examples of Surgical Options
There are a few common techniques to choose from with help from your provider. All have the goals of decreasing feelings of hunger and improving satiety, or fullness. Most procedures are performed laparoscopically, or using very small incisions, which lowers the risk of complications. This results in fewer wound problems and gets patients on their feet and out of the hospital faster.
In gastric bypass surgery, also known as Roux-en-Y, the stomach is divided into a smaller upper pouch and a larger lower pouch. The small intestine is then divided and rerouted to connect to just the small pouch, bypassing the larger section. This leaves a smaller space for food to go, meaning you’ll feel full after smaller meals. It also reroutes the way that food is digested to change your gut’s hormones, reversing one of the main ways obesity causes of type 2 diabetes.
Vertical sleeve gastrectomy involves the removal of 80 percent of the stomach. As with gastric bypass, the stomach can now fill up much faster. It also improves or eliminates diabetes. This procedure is considered less risky than the gastric bypass or biliopancreatic diversion, with very similar weight loss and outcomes.
Over the years, providers have found that having patients get up and move soon after bariatric surgery has a huge impact on lowering the risk of complications. Everyone gets out of bed the night after surgery, and most people spend just one night in the hospital. For the first few weeks of recovery, you’ll feel tired and sore, though by the week three follow-up visit, many people feel good enough to return to work.
In terms of side effects, nausea, vomiting, and abdominal pain are fairly common immediately after surgery, and some people may experience hair thinning or loss over the first 12 months. If you have a fever over 101 degrees, prescribed medications do not improve pain, you have blood in your stool, you can’t urinate, or nausea and vomiting don’t subside, call your provider immediately.
Be Prepared for the Long Haul
Prospective patients should keep in mind that surgery isn’t a cure-all for obesity – after surgery, you will need to maintain your pre-surgery lifestyle changes in order to keep the weight off, particularly in the first few months after the procedure. Those who stick to their modifications can lose up to 15 to 20 pounds per month over the first six months. It’s tougher to lose weight after that because the body’s metabolism has readjusted. Weight can still be lost, but it will take an even greater effort because of the adjustments the body has made.
In terms of exercise, you should look to get at least 30 to 40 uninterrupted minutes every day. Do whatever you can – chair exercises, walking, and pool aerobics all count! And be sure to get at least 64 ounces of fluid a day. Keep a water bottle with you throughout the day and during your workouts. A nutritionist and/or your provider can offer specific diet changes.
As the saying goes, all good things require effort. Should you choose bariatric surgery, with dedication and a commitment to the long term, you can look forward to a healthier future.
For more information, visit MAPMG’s Staying Healthy pages.