Ask Your Doctor Discussion Guide
Best for: primary
care physician appointment or weight loss surgery seminar
What is weight loss or “bariatric” surgery, and why do I need surgery to
lose weight?
“Bariatrics” is a branch of medicine that relates to
obesity and its associated diseases. Bariatric surgery, or weight loss surgery,
is a common term used to describe a variety of operations for treating severe
obesity. These operations are performed to make physical changes to the stomach
and/or the small intestine in order to help you decrease the amount of food you
eat.
- It is a proven method for long-term weight reduction and portion control
among people who are exceedingly obese.
- It facilitates significant and sustained weight loss.
- It was shown to result in complete remission of diabetes in up to 86%
severely obese patients with diabetes.
- It was shown to reduce the risk of death by nearly 30% in patients with
severe obesity (BMI >40).
- It is not a simple, “quick fix” solution to a serious long-term weight
problem.
- It requires commitment and lifestyle changes for successful weight loss and
improved health.
- It is not a form of cosmetic surgery.
What are the benefits of weight loss surgery?
Most people who
undergo bariatric surgery lose a significant amount of weight. After they lose
the weight, they are also more likely to keep it off, provided they continue to
observe the amount of food they eat.
Serious health concerns related to obesity often improve or disappear
following surgery and weight loss. Some of these health concerns include:
- Heart disease
- Type 2 diabetes
- Arthritis
- Some forms of cancer
- Hypertension
- Stroke
- Sleep apnea
- Asthma
Obesity is also associated with pregnancy complications and menstrual
problems, and it often leads to psychological and behavioral conditions such as
depression.
Quality of life also improves for many people after weight loss surgery, as
they experience improvement in their physical, behavioral and social well-being.
What types of weight loss surgeries are currently available?
There
are several types of bariatric surgery, which fall into two categories:
- Restrictive procedures: These surgeries significantly reduce the size of the
stomach, making you feel satisfied after eating less food, and you stay full
longer.
- Restrictive/malabsorptive procedures: These surgeries reduce the size of the
stomach and shorten the small intestine, which are permanent changes to your
anatomy. The smaller stomach also makes you feel satisfied and full after eating
less food. In addition, the changes to the intestine reduce the amount of
calories the body can absorb.
The two most widely selected restrictive and
restrictive/malabsorptive procedures include adjustable gastric banding
(restrictive) and gastric bypass (restrictive/malabsorptive).
Am I a good candidate for weight loss surgery?
You and your
doctors—your primary care provider (PCP) and your weight loss surgeon—need to
consider many factors prior to determining if weight loss surgery is right for
you. As you go through the decision process, ask yourself if you are up to the
challenges you will face.
- First of all, you will be required to have a full medical examination. Your
doctors will also consider other factors that are unrelated to your weight by
performing a comprehensive psychological and behavioral assessment. Significant
psychological issues (major depression, alcohol or drug abuse or bulimia, for
example) that may affect your ability to care for yourself after surgery would
make it too risky to undergo surgery.
- Bariatric surgery will require you to visit your doctor regularly for
follow-up appointments. If you choose the adjustable gastric band procedure, the
surgeon will make any necessary adjustments to your band during these
appointments. Because the surgery creates physical changes to your stomach (and
intestine, if you elect to have a gastric bypass), the routine visits will
ensure long-term weight loss success.
- Weight loss surgery is usually reserved for people who are seriously
overweight, and therefore at a higher level of medical risk, and those who
continue to have a longstanding weight problem despite making numerous attempts
to lose weight.
Weight loss surgery may be suitable if:
- Your BMI is 40 or higher or your BMI is at least 35 and you have other
serious medical conditions related to obesity. Body mass index (BMI) is a method
doctors use to estimate how much excess weight a person has in relation to their
height. It is an accurate and easy way to determine if you are within an
acceptable range, overweight, or obese.
- You are over 18 years of age.
- You were not successful in losing and maintaining your weight by other
means, despite making many attempts through diet, exercise and medications.
- You are committed to making permanent lifestyle changes, and you are
psychologically and behaviorally prepared to care for yourself after surgery
Your weight loss surgeon will ultimately determine if bariatric surgery is
right for you, so be sure to ask your surgeon about your individual case.
How do I calculate my BMI?
To calculate your BMI, enter your
height and weight into the BMI calculator at the National Heart, Lung, and
Blood Institute Web site. A BMI of 30 or above is considered obese. Once you
determine your BMI, use the table below to identify your weight category.
| Body Mass Index (BMI) |
Weight Category |
| Less than 18.5 |
Underweight |
| 18.5 – 24.9 |
Acceptable |
| 25 – 29.9/T |
Overweight |
| 30 – 39.9 |
Obese
(Surgery may be suitable for those with BMI of at least 35 with at
least one weight-related health condition) |
| 40 and over |
Excessively obese
(Suitable for
surgery) |
Your weight loss surgeon will ultimately determine if bariatric surgery is
right for you, so be sure to ask your surgeon about your individual case.
How much weight will I lose?
Weight loss surgery should not to be
mistaken for a cosmetic procedure, and it is not a simple, “quick-fix” solution
to an excessive, long-term weight problem. However, studies do show that surgery
leads to significant weight loss that can be maintained long-term. Surgery also
leads to substantial improvements or complete remission of many health-related
problems, such as diabetes, hypertension and hyperlipidemia. Your weight loss
results will depend on your choice of procedure, your commitment to the
necessary lifestyle changes, and your individual situation.
- Weight loss may occur fairly rapidly or may be more gradual and steady,
averaging 5-10 pounds per month, depending on the type of weight loss procedure
you choose.
- Your success is dependent on your motivation and commitment to lifestyle
changes. Keep in mind that in some cases after weight loss surgery, some people
do not lose as much weight as they would have liked, or as quickly as they had
anticipated.
What other lifestyle changes would I need to make?
Weight loss
surgery is only the first step in a series of lifestyle changes that you will
need to adopt in order to lose weight and stay healthy. Many surgeons and
insurance providers require surgery candidates to enroll in and successfully
complete nutritional counseling programs in order to learn and practice the
healthy eating and exercise habits that will be necessary after surgery.
- Check with your insurance company to understand your coverage and determine
whether a medically supervised weight loss program is required prior to weight
loss surgery.
- Your eating habits will have to change for you to lose weight and maintain
your health. This will involve choosing healthy foods to eat, eating smaller
portions and taking daily nutritional supplements.
- Regular exercise (30 minutes a day, 3–4 times a week) is strongly encouraged
for achieving and sustaining weight loss. Exercise preserves lean muscle tissue
when losing weight rapidly after surgery and may also help reduce appetite.
Exercise may also help reduce surgical complications, promote healing and
enhance recovery after surgery.
What are the risks of weight loss surgery?
Weight loss
surgeries are major surgeries that involve risks and may lead to significant
short-term and long-term health complications. The risks and complications vary
according to the types of surgical procedure you elect to have and often depend
on your age, level of excess weight, other existing health conditions, and how
well you manage your health and your lifestyle.
Problems associated with bariatric surgery can range from minor to
life-threatening. Complications may occur during, immediately after or within
weeks or several months after surgery. Additional surgery, re-admission to the
hospital, medication or nutritional supplements may be required. Health
insurance may not cover some or any of the costs related to these unanticipated
circumstances.
If you choose to have the surgery, your surgeon will carefully explain the
risks that are unique to you and specific to the type of operation you decide
upon. Be sure to ask your surgeon all the questions you may have about risks and
benefits of weight loss surgery before undergoing your procedure.
How can I find a reputable weight loss surgeon?
Finding a
reputable weight loss surgeon can increase your chance of having a successful
operation, a good recovery, and satisfactory progress toward your weight loss
goal. You may choose to work with your PCP to find an experienced weight loss
surgeon. Some factors to consider in your selecting a surgeon include: the
surgeon’s qualifications and number of successful operations he or she has
performed, where you live, what type of health insurance you have and your
current physical condition.
The American
Society for Metabolic and Bariatric Surgery
(ASMBS) can help you and your
PCP locate a weight-loss surgeon. The ASMBS promotes the practice and
improvement of bariatric surgery through research and education. A member of the
ASMBS is board-certified in weight loss surgery and has been the lead surgeon in
at least 25 bariatric operations in the previous two years.
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