Bariatric surgery is the most powerful tool to help patients lose significant amounts of weight and keep it off in the long term. Although bariatric surgery is a significant commitment, it can result in average weight loss of 25%-30% of total body weight, or 60%-80% of excess body weight. Typical weight loss is affected by the patient’s health status and mobility, but a lot of people can enjoy significant health benefits due to their bariatric surgery.
More important than the number of pounds of weight lost, bariatric surgery has been shown to significantly improve weight-related medical problems that patients already have, or significantly lower their risk of developing them in the future. These include conditions you might expect like type II diabetes, high blood pressure, obstructive sleep apnea, and heart disease. Losing weight through bariatric surgery also can improve other conditions such as asthma, chronic back and joint pain, polycystic ovarian syndrome (PCOS), and depression and anxiety.
Who Qualifies for Bariatric Surgery
Kaiser Permanente covers bariatric surgery for patients who:
- Have a body mass index (BMI) of 40 or more or have a BMI of 35 or more with a weight-related medical problem and
- Are over the age of 18 (some adolescents can also be considered on a case-by-case basis) and
- Have been recommended for bariatric surgery by a physician, such as a primary care provider and
- Have undergone evaluation by a bariatric surgeon and completed a multidisciplinary preoperative bariatric program.
How to Choose a Bariatric Surgery
There are multiple surgical options available. When you meet with your surgeon, you will discuss your goals and medical history to help determine which surgery would be best for you. In the vast majority of situations, these surgeries are performed minimally invasively, with small incisions using small instruments, which decreases complications, hospital stays, and postoperative pain.
Sleeve Gastrectomy
In a gastric sleeve surgery, the stomach is divided using a surgical stapler and a portion of the stomach is removed to reduce the size of the stomach to a banana-shaped tube, approximately 20%-30%of its original volume. This helps with weight loss, both by reducing the physical size of the stomach and by reducing appetite between meals.
Roux-en-Y Gastric Bypass
In the gastric bypass, the stomach is divided, leaving a pouch about the size of a jumbo egg. This pouch is then connected to a limb of small intestine. The digestive juices from the stomach, pancreas and liver, join up with the stream of food at a second connection further downstream. As with the sleeve, this surgery helps with weight loss by reducing the effective size of the stomach and reducing appetite, and it also has a hormonal effect due to the food bypassing the majority of the stomach and the first portion of the small intestine.
Revision Surgery and Other Procedures
There are also special situations in which patients need a different kind of surgery or who have had prior bariatric surgery may need a second surgery. These can be complex scenarios, and you and your surgeon will work together to determine if one of these surgeries may be right for you.
Bariatric Surgery: What to Expect
Before Bariatric Surgery
Every patient who is going to have bariatric surgery will complete the following as a part of their pre-surgical program:
- Screening lab studies
- Behavioral health evaluation to determine if there are any undiagnosed eating disorders or other psychiatric conditions that need to be treated prior to surgery
- Bariatric nutrition program to help build a foundation of a healthy lifestyle prior to surgery, which will continue after surgery
- Other medical diagnostic tests and clearances depending on your medical problems
At the time of Bariatric Surgery
The surgery is performed under general anesthesia and can last anywhere from under an hour to a few hours, depending on the situation. Almost all patients can go home within 24 hours of surgery, and some patients are able to go home the same day.
After Bariatric Surgery
You can expect to be very sore for a few days and mildly sore for a few weeks. Most patients will need pain medication for the first few days. You should be able to do light activity less than a day after your surgery, but you should avoid heavy lifting or more vigorous exercise.
Always remember, going through this process can be challenging at times, but you will have an entire team helping you along the way.