By Geri K. Metzger, Staff Writer, myOptumHealth

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Bariatric surgery is generally thought of as a last resort for weight loss. But it can be an important and sometimes life-saving option for some. Those who typically are candidates for bariatric surgery are severely obese. They often also have serious weight-related health problems, such as diabetes, sleep apnea or heart disease.

There are several options for bariatric surgery. They all restrict food intake. Some procedures also interfere with the body’s ability to absorb calories and nutrients. They do this by surgically bypassing part of the small intestine.

Am I a candidate for bariatric surgery?

Doctors use your body mass index (BMI) as one guide to determine whether you are a candidate for gastric bypass surgery. BMI is calculated based on your height and weight.

If you have a BMI of 40 or above, you fall in the severely obese range and you may be a candidate for surgery. A man with a BMI of 40 is about 100 pounds overweight. A woman with a BMI of 40 is about 80 pounds overweight.

You may also be a candidate if:

• You have a BMI between 35 and 40
• And you also have medical conditions that are adversely affected by weight, such as diabetes, heart failure, sleep apnea and osteoarthritis
• And you have been unable to control your weight by other means

Obesity raises the risk of medical problems, including coronary artery disease, diabetes and high blood pressure.

In addition to meeting the weight requirements, you’ll need to show that you’ve made sincere attempts to lose weight with other methods. These include structured diet programs and nutritional counseling, exercise, behavior change and support. If these methods have failed, you may be considered for surgery pending a thorough medical evaluation.

Bariatric surgical options

Two of the most common types of bariatric surgery are:

• Adjustable gastric banding. This is a technique in which a band is used to cinch off the top of the stomach to form the small pouch. Neither the stomach nor the intestine is cut. Banding limits the amount of food you can eat and slows digestion. The band can be adjusted as needed after surgery.
• Gastric bypass. A small pouch is surgically formed in the stomach. Often, the food from the pouch is then re-routed so it “bypasses” a section of the small intestine where some of it would have been absorbed.

How is bariatric surgery performed?|

• Open surgery. In this type of surgery, a traditional incision is made. The surgeon then performs the bypass or banding through this incision.
• Laparoscopic surgery. Here, small cuts are made. Very small tools are passed through the cuts and used to place the band or perform the bypass. Most bariatric surgery is now done this way. It causes less damage to the skin and tissue and there are fewer complications. But some people who are severely obese, have had other abdominal surgery or have other medical problems may not be a candidate for laparoscopic surgery.

What to expect after bariatric surgery

What to expect will depend on the type of surgery that was done.

Most often, for months after surgery, you will follow a restricted diet. For the first few weeks, you’ll gradually move from liquids to pureed foods and on to tiny bites of semi-solid foods, and so on. You will need to eat slowly, take small bites and not drink liquids during meals or snacks. These new habits may take some time to adjust to.

You will work closely with a dietitian before and after surgery for specific instruction. After a few months, you may be able to eat many regular foods. Some foods may continue to bother you for the rest of your life.

The main concern is to get enough nutrients and stay hydrated. It’s also important to progress gradually from liquids to more solid foods as your stomach heals and is able to tolerate them. It is also important to have some form of protein at each meal and take the prescribed nutritional supplements and vitamins.

Everyone has varying tolerance for different types of foods after bariatric surgery. For example, some people can’t eat bread or meat. Others can’t eat sweet foods or drink fizzy liquids (like soda).

Possible complications

You may have complications during and after bariatric surgery. Many people who have the surgery have chronic illnesses. Because of the excess weight, they often have lung and heart problems. These factors increase the risks of complications, including death, from any surgery.

Most short-term complications of bariatric surgery involve wound infections, leaks or tears around the stomach, ulcers, breathing problems or blood clots.

Dehydration, anemia, hernias, gallstones and nutritional deficiencies are common long-term problems. Gaining back the weight or not losing enough weight are also possible complications. About one in 10 people who have the surgery gain back much of the weight or don’t lose enough weight.

Possible complications of gastric banding include:

• Breakdown of the tissue beneath the band
• Stretching of the opening to the stomach
• Slipping of the band
• Problems adjusting the band to meet weight loss needs

What patients can expect

Weight loss is often dramatic for the first several months and gradually slows over time. In time, your weight should stabilize. The average amount of weight loss after surgery is about one third of the person’s initial body weight.

Exercise is an important part of life after bariatric surgery. Exercise and resistance training help maintain muscle mass and weight loss. Continued nutritional support and attention to healthy lifestyle habits is also essential. Check with your doctor to find a safe activity level and for ongoing care.

View the original Bariatric surgery for weight loss article on myOptumHealth.com 

SOURCES:

• Allen JW. Laparoscopic gastric band complications. Medical Clinics of North America. 2007;91(3):485-497. Accessed: 07/09/2008

• Weight-control Information Network. Bariatric surgery for severe obesity. Accessed: 07/09/2008