Is Weight-Loss Surgery for You?

“Surgery” is a scary word. Unless they’re undergoing surgery for cosmetic purposes, most people try to avoid having surgery like the plague. Images of hospitals, scalpels, anesthesia, and long recoveries are enough to turn anyone off. However, in the arsenal of diabetes treatments, surgery is becoming more and more popular, and for some, it may put diabetes into remission.

What is weight-loss surgery?
Weight-loss surgery is also called bariatric surgery (bariatrics is the branch of medicine that deals with the causes, treatment, and prevention of overweight and obesity). We’re not talking about liposuction or tummy tucks here. Rather, weight-loss surgery involves operating on the stomach and/or intestines to help people with obesity lose weight.


What are the different kinds of weight-loss surgery?
Depending on the type of procedure, weight-loss surgery can be performed by “open” approaches (which basically mean “cutting”) or by laparoscopy. With laparoscopy, the surgeon makes a series of small cuts and inserts various instruments that are guided by camera to perform the procedure. While laparoscopic surgery is more common these days, not everyone is eligible for it, including people who are very obese and/or who have complex medical issues.

There are four types of weight-loss procedures done in the U.S.:

Roux-en-Y gastric bypass. In this procedure, the stomach is made smaller (about the size of an egg) and is connected to the middle part of the small intestine. The smaller stomach restricts how much one can eat, and the “bypass” limits how many nutrients can be absorbed at one time.

Vertical sleeve gastrectomy. In this procedure, a large portion of the stomach is removed, leaving a section that’s about the size of a banana. The smaller stomach limits how much one can eat at any one time. Also, because most of the stomach is removed, the amount of ghrelin (a hormone produced in the stomach that increases hunger) is reduced, which can help limit appetite.

Adjustable gastric band. A small band is place around the top of the stomach to create a small pouch at the top of the stomach with a narrow opening leading to the rest of the stomach. The surgeon can change the size of the band by inflating or deflating a saline-filled balloon that’s inside the band.

Biliopancreatic diversion with a duodenal switch. Also called a “duodenal switch,” this is a more complex type of surgery that involves removing a large part of the stomach and linking the remaining stomach to the lower part of the small intestine. This type of procedure affects how bile and digestive juices process and digest food and absorb calories.

Who can get weight-loss surgery?
Count surgery out if you only have a small amount of weight to lose. Obviously, any kind of surgery involves risk, and it’s generally reserved for people who are very overweight or obese and who have other medical issues. The criteria for surgery is a body-mass index (BMI) of 40 or higher, or a BMI of 35 or higher with health issues like Type 2 diabetes, heart disease, or sleep apnea. The adjustable gastric band is approved for people with a BMI of 30 or higher who also have at least one other weight-related medical condition.

Besides the medical criteria for qualifying for weight-loss surgery, most centers that perform this surgery put other criteria in place. As with any surgery, weight-loss surgery has its risks, and it’s expensive. It’s not a good fit for everyone. Is it for you? Maybe, as long as you’re willing and able to:

• Try losing weight initially by other methods (diet, exercise, medication)

• Understand the procedure and possible side effects

• Realize the risks and benefits

• Adapt to the necessary change in eating habits to be successful

• Commit to healthy eating, physical activity, and other post-surgery requirements

Weight-loss surgery may not be recommended in people with certain psychiatric illnesses and other health conditions (such as cancer); in those who are addicted to drugs or alcohol; in some people older than age 65; in people who have unrealistic expectations about the surgery; and in women who plan to become pregnant within a year. For all of these reasons, most people who seek weight-loss surgery are required to meet and work with a medical team, which generally includes a surgeon, nurse, dietitian, and mental-health professional.

More about weight-loss surgery next week!