Patient Education: Obesity and Bariatric Surgery

Patient Education: Obesity and Bariatric Surgery

Weight loss surgery, sometimes called bariatric surgery, is a surgery to help you lose weight. It works by making you take in fewer calories and nutrients. Doctors use a measure called “body mass index” or BMI, to decide who can have this weight loss surgery. Your BMI will tell you whether your weight is normal for your height. (See BMI Chart in my previous postings.)

Weight loss surgery is appropriate only if you have not been able to lose weight through other means and if you:

  • have a BMI above 40 and have not responded to diet, exercise, or weight loss medicines; or
  • have a BMI above 35 and also have a medical problem related to obesity, such as diabetes, heart disease, or high blood pressure; or
  • have a BMI above 30, but only if you have certain medical conditions.

Types of Surgery

Gastric Bypass: Gastric bypass is short for “Roux-en-Y Gastric Bypass,” and sometimes called “RYGB.” For this surgery, the doctor closes off part of the stomach, leaving only a small pouch for food. Then, he or she connects the stomach pouch to the middle part of the small intestine. This allows food to “bypass” or reroute around a part of the stomach and small intestine. There are other surgeries that are simlar to gastric bypass in how they cause weight loss.

Gastric Sleeve: Gastric sleeve, also known as “sleeve gastrectomy,” is a surgery that turns the stomach into something that looks like a sleeve. In other words, the doctor removes a large portion of the stomach and leaves a narrow tube.

Gastric Balloon: For this, the doctor puts a special balloon into your stomach. He or she does this using a thin tube that goes into your mouth and down your throat. The balloon stays in your stomach for up to 6 months. While it is there, your stomach has less space for food, which limits the amount you can eat at one time.

Gastric bypass and gastric sleeve can be done as “open” surgery or as a laparoscopic surgery. For open surgery, the surgeon cuts open the belly and works on the organs directly. For laparoscopic surgery, the surgeon makes a small cut and inserts a narrow tool that has a tiny camera on the end into the belly. This tool is called a laparoscope. It allows the surgeon to see inside the belly without opening it up all the way. Then, the surgeon can do the surgery using other tools that fit through small openings in the belly and that can be controlled from the outside.

Gastric balloon is a procedure, it is not actually a surgery. It does not involve cutting the skin the way the other options do.

Each type of weight loss surgery is different and each has different benefits and downsides.

  • Gastric Bypass leads to the most weight loss and works the fastest, but it involves the most serious surgery with the highest risks. It can also cause problems in how your body absorbs nutrients. As a result, it can lead to “nutritional deficiencies,” meaning your body is missing important nutrients. This can sometimes make you sick. If you have gastric bypass, your doctor will monitor your nutrient levels afterward.
  • Sleeve Gastrectomy is safer than gastric bypass because it does not involve rerouting or cutting and reattaching the intestines, and because it is less likely to cause problems with how you absorb nutrients. It might also be safer because it does not involve any plastic materials that stay in your body.
  • Gastric balloon is becoming a more popular option for weight loss. That’s because it is safe, easy-to-do, and does not involve any cutting. But, it also does not lead to as much weight loss as the other surgical options. After the balloon is removed, some (but not all) people are able to keep the weight off.

The decision about which type of surgery to have is important. Discuss your choices with your doctor. If you have different options, ask the following questions.

  • About how much weight can I expect to lose with each option?
  • How long will it take me to lose the weight?
  • What are the risks of each option for someone like me?
  • What changes will I need to make to my diet and lifestyle with each option?

Whatever you decide, make sure your surgeon is experienced with weight loss surgery. Also, check with the staff at your treatment center, or make sure it is a certified “Center of Excellence.” Those centers have a team of nurses and doctors who specialize in taking care of patients like you. If you are unsure about your decision, you can ask for an opinion from another doctor. Most hospitals that have experience with weight loss surgery offer patient education sessions where you can learn more about weight loss surgery and the options you have.

In addition to helping you lose weight, surgery can help improve or even get rid of certain health problems including:

  • diabetes
  • high blood pressure
  • high cholesterol
  • sleep apnea, a condition that causes you to stop breathing for short amounts of time while you sleep.

The risks of surgery are different depending on the following.

  • What type of weight loss surgery you have.
  • Whether your surgery is open or laparoscopic.
  • Your age and overall health.
  • How experienced your surgeon is.

In general, the risks could include:

  • Bleeding
  • Infection inside the belly or in the wounds from surgery
  • Leaks from the incisions on the stomach or intestine
  • A blockage or tear in the intestines
  • Problems with the heart or lungs
  • Gallstones
  • Nutritional problems
  • Severe diarrhea
  • Need for more surgery

As with any kind of surgery, it is possible for these procedures to lead to serious problems or even death. Death following weight loss surgery is very rare. But it’s still important to talk to your doctor about all the possible risks of each type of surgery.

You will need to eat healthy foods that “work with” your surgery. For example, you should choose foods high in protein and low in fat and calories. You should also avoid liquid foods that are high in calories, such as ice cream. If you eat the wrong things, you could hurt your chances of losing weight.

If you have weight loss surgery, you will need to avoid certain foods that could make you sick. Plus you will probably need to take special multivitamins with minerals. That’s because weight loss surgery, especially gastric bypass, can make it hard for your body to get all the nutrition it needs. You must keep taking vitamins for the rest of the life. Your body will always need them to stay healthy.

Adopted from Up-to-Date Education Basics.

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