For some people who are obese, diet changes or increased exercise just do not result in enough weight loss to make a difference to their health or sense of well-being.
But bariatric surgery, which surgeons began performing approximately 20 years ago, has been a game-changer. Now, a solution to obesity—as well as related health problems such as diabetes—is possible.
Though there are several kinds of bariatric surgery, they all work by making a person’s stomach smaller so that he or she will become full more quickly after eating.
Today this surgery is much less invasive—it is done with laparoscopy, a small instrument inserted through the abdomen—and more likely to result in lifelong weight loss than ever before.
“It has been refined so that is it a common operation with very little complication,” says Dr. Sami Hamamji, MD, a board-certified general surgeon and bariatric surgeon at St. Joseph Hospital, Orange. But it’s not for everyone.
Who should consider gastric surgery?
The first number that doctors look is a patient’s BMI – body mass index. This is a measurement of body fat using height and weight. (To find out your BMI, visit nhlbi.nih.gov/health/educational/lose_wt/BMI/index and click on ‘Check your BMI online’.) A normal-weight BMI is 18.5 to 24.9. A BMI of 25 to 29.9 means a person is overweight. Anyone with a BMI of 30 and above is considered obese.
Patients with a BMI of 40 and above are usually good candidates for gastric surgery, says Dr. Hamamji, adding that this is the recommendation from the National Institutes of Health and one that insurance companies use as well. A person with a BMI between 30 and 40 can also be a candidate for surgery if they are also experiencing serious health problems associated with their weight.
Other factors that doctors consider are patients’ failures with other weight-loss efforts, a realistic outlook, motivation, and family support.
Health problems that often accompany obesity make bariatric surgery a critical treatment. “Diabetes, high blood pressure and sleep apnea are the three most serious health problems that develop with obesity,” says Dr. Hamamji. And these problems can resolve after patients undergo bariatric surgery.
Type 2 diabetes can disappear immediately, says Dr. Hamamji. This is because the patient will eat almost nothing right after the surgery, and will tend to eat less after recovering from the procedure.
There are several different kinds of surgeries. “Gastric bypass is oldest of the operations,” says Dr. Hamamji. This involves stapling the stomach, thus making it smaller, and then attaching the lower part of the small intestines to the stomach pouch so that the digestive system absorbs fewer calories.
Gastric band surgery is another kind: a band is placed around the stomach—essentially cinching it—to make it smaller.
A third surgery is called gastric sleeve, where the surgeon removes a large portion of the stomach, making it into a small pouch. “With this surgery, there is no long-term deficiency of vitamins,” says Dr. Hamamji, explaining that when intestines are bypassed, vitamin and nutrient deficiencies can result.
Patients receive general anesthesia and usually stay overnight in the hospital, says Dr. Hamamji. Full recovery takes about two weeks.
As with any surgery, there are risks, including wound infection and bleeding. Some patients may develop gallstones, according to a review from the Cleveland Clinic. In rare cases, patients experience leakage, which can be dangerous, says Dr. Hamamji. “Some people do get heart burn or reflux,” he adds.
Finding a reputable surgeon is key—the best way is to get a referral from a family doctor, or another patients who has had a good experience, and to make sure the surgery center has been approved by the American College of Surgeons.
How successful is the surgery? “One of my colleagues says one third of the patients lose the weight and keep it off, a third lose the weight but gain a little bit back, and a third of them gain it all back,” says Hamamji.
But patients who are committed to adopting new, healthier eating and exercise habits have the best chance of long-term weight loss after surgery, says Dr. Hamamji, and they don’t have to do this alone. He offers patients support in making lifestyle changes. “We use psychologists and nutritionists to help them navigate through this,” he says. “They cannot do this without a whole program–including support groups. It all has to go together.”