Surgical approaches for shedding pounds: Different options, advantages, and pitfalls
Bariatric surgeries, also known as weight loss surgeries, are surgical procedures designed to treat obesity and help with weight loss. These procedures are typically suitable for individuals with a Body Mass Index (BMI) of 40 or higher, or those with a BMI of 35 or higher who also have obesity-related medical conditions such as diabetes, high blood pressure, sleep apnea, or heart disease [1][2][3][4].
Qualifying Medical Conditions
Key qualifying medical conditions that make surgery appropriate include:
- Type 2 diabetes
- Hypertension (high blood pressure)
- Obstructive sleep apnea
- High cholesterol
- Heart disease and other obesity-related health issues [1][2][4].
Additional considerations for surgical candidacy include:
- Age (must typically be at least 18 years old) [1]
- Previous attempts at conventional weight-loss methods without sufficient success (diet, exercise, commercial programs) [1]
- Psychological and emotional readiness for surgery and lifestyle changes [1][2]
- Absence of illegal substance use in the past year [1].
Types of Bariatric Surgeries
There are several types of bariatric surgeries available, each with its own advantages and disadvantages.
Gastric Bypass
Gastric bypass is a mixed procedure that restricts the size of the stomach and limits food absorption. It involves making a small pouch at the top of the stomach and rerouting the lower part of the stomach and the small intestine to the new pouch, bypassing a significant portion of the stomach and the first part of the small intestine [3].
Sleeve Gastrectomy
Sleeve gastrectomy is a restrictive type of weight loss procedure that removes around 80% of the stomach, leaving only a banana-shaped section. This procedure restricts the amount of food that can be eaten, leading to weight loss [3].
Adjustable Gastric Band
Adjustable gastric band is another restrictive procedure that creates a pouch at the top of the stomach. A band is placed around the upper part of the stomach, creating a small pouch, and a tube extends from the band to a port just under the skin. This port can be adjusted to control the size of the pouch and, thus, the amount of food that can be eaten [3].
Biliopancreatic Diversion with Duodenal Switch
The biliopancreatic diversion with duodenal switch is a complex surgery that creates more weight loss than a gastric bypass. This procedure involves removing a large portion of the stomach and rerouting the digestive system to bypass a significant portion of the small intestine, leading to reduced food absorption [3].
Vagal Blockade (vBloc)
Vagal blockade, also known as vBloc, is a procedure implanted under laparoscopy and general anesthesia. It aims to block the hunger signals between the stomach and the brain through the vagus nerve [2].
Balloon Systems
This involves placing a deflated balloon in the stomach using a thin tube (gastroscopy) passed down the throat and inflating it with saline solution. The balloon takes up space in the stomach, helping to reduce the amount of food that can be eaten [2].
Risks and Considerations
Each type of surgery has its own risks and considerations. These include potential adverse effects such as gastric leaking, chronic malabsorption syndrome, vitamin and nutrient deficiency and related conditions such as osteoporosis and anemia, surgical risks such as bleeding, blood clots, hernia, infection, and death [3].
Since the FDA has received reports of a total of 12 deaths that occurred in patients with liquid-filled balloon systems worldwide, it's important to discuss these risks with your doctor [4].
Post-Surgery Recovery and Weight Loss
Following surgery, a person will experience the biggest weight loss during the first few months. After a few months, weight loss will gradually decrease. It's important to follow dietary guidelines and maintain a balanced diet and regular exercise to maintain weight loss [3].
Non-Surgical Approaches
As with any weight loss program, a person may be able to maintain a moderate weight by following a balanced diet and increasing physical activity. For some, this may be a more suitable option, especially for those who do not meet the criteria for bariatric surgery [4].
In conclusion, bariatric surgeries can be effective for individuals struggling with severe obesity and related health conditions. It's important to discuss the options, risks, and benefits with a healthcare provider to determine the best course of action.
[1] American Society for Metabolic and Bariatric Surgery. (2019). Bariatric Surgery: What You Need to Know. Retrieved from https://asmbs.org/patients/bariatric-surgery-what-you-need-to-know
[2] National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Bariatric Surgery: What You Need to Know. Retrieved from https://www.niddk.nih.gov/health-information/weight-management/bariatric-surgery
[3] Mayo Clinic. (2021). Bariatric Surgery: Types of Weight-Loss Surgery. Retrieved from https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394884
[4] Obesity Action Coalition. (2021). Bariatric Surgery. Retrieved from https://www.obesityaction.org/patients/weight-loss-surgery/
- Individuals seeking treatment for obesity may consider bariatric surgeries, which are designed to treat obesity and aid in weight loss, particularly for those with a BMI of 40 or higher.
- key qualifying medical conditions for bariatric surgery eligibility include Type 2 diabetes, hypertension, obstructive sleep apnea, high cholesterol, heart disease, and other obesity-related health issues.
- In addition to these medical conditions, candidates for bariatric surgeries typically must be at least 18 years old, have a history of unsuccessful attempts at conventional weight-loss methods, and be emotionally and psychologically ready for surgery and lifestyle changes.
- Gastric bypass is a mixed bariatric surgery that restricts stomach size and limits food absorption, involving the creation of a small pouch at the top of the stomach and rerouting the lower portion of the stomach and small intestine to the new pouch.
- Sleeve gastrectomy, a restrictive surgery, removes around 80% of the stomach, leaving only a banana-shaped section, thereby limiting food consumption.
- Another restrictive procedure is the adjustable gastric band, which creates a small pouch at the top of the stomach and can be adjusted to control food intake.
- The biliopancreatic diversion with duodenal switch is a complex surgery that that creates more weight loss than gastric bypass, removing a significant portion of the stomach and rerouting the digestive system to bypass a portion of the small intestine.
- Vagal blockade, or vBloc, is a procedure that aims to block hunger signals between the stomach and brain through the vagus nerve, and balloon systems involve placing a deflated balloon in the stomach to reduce food consumption, although it's important to discuss risks with a doctor as the FDA has reported deaths associated with liquid-filled balloon systems.
