An estimated one in every three adults in the U.S. is obese (Harvard, 2020). If you are obese, losing weight is one of the best things you can do to improve your overall health and feel better. Many individuals who suffer from obesity have significant medical problems because of their weight, including sleep apnea, diabetes, and high blood pressure, and take multiple medications to manage these conditions.
It can be difficult to shed this much weight with diet and exercise alone. Bariatric surgery, also known as weight loss surgery, has become an increasingly popular and safe alternative for individuals who have not had success with traditional methods.
“The patients who come to me have typically tried to lose weight with diet and exercise multiple times, so I encourage them to explore bariatric surgery,” says Collin Creange, MD, a general surgeon with specialty training in minimally invasive and bariatric surgery at Summit Health. “I think a lot of people see it as a failure that they need to turn to an option like surgery. However, I view it as courageous to admit that you need help to take control of your health in a different way.”
Obesity has been on the rise for decades, affecting some 42 percent of adults in the U.S. today according to the Centers for Disease Control and Prevention (CDC). Dr. Creange has also seen an increase in the number of patients who have gained a significant amount of weight throughout the COVID-19 pandemic. And while bariatric surgery has become more common, there are still only 250,000 to 300,000 procedures performed each year.
“There are many more people who could benefit from surgery,” says Dr. Creange. “While the number of bariatric surgeries has increased, it is not as common as you would expect given the epidemic of obesity in our country. We are probably only reaching 1 to 2 percent of patients who would qualify for weight loss surgery. I want this population to know bariatric surgery could be a helpful option.”
Bariatric surgery includes a variety of procedures done to the stomach or small intestines to help people lose large amounts of weight. People generally turn to bariatric surgery when they have not been successful in losing weight with conventional methods like diet and exercise or medication.
An individual is eligible for bariatric surgery based on their body mass index (BMI). Most insurance companies will cover the operation if you have either a BMI over 40, or a BMI over 35 with medical comorbidities like sleep apnea and diabetes.
Bariatric surgery works in several ways, depending on the type of surgery performed. First, the stomach becomes physically smaller. As a result, you become full much faster and are unable to consume as many calories. In addition, removing part of the stomach helps reduce the amount of “hunger hormones” that trigger appetite and slow down the metabolism. Weight loss surgeries such as the gastric bypass and duodenal switch also cause less food to be absorbed by “bypassing” a portion of the intestines.
“When I talk to patients, I focus on more than just how they will feel and look physically after losing the weight, but also how it will make them healthier. Most of the people I see have medical problems that are not going to improve over time unless they make a significant change,” says Dr. Creange.
There are numerous weight loss procedures. The two most common are gastric sleeve surgery and gastric bypass. Dr. Creange says both options have similar long-term outcomes. Gastric bypass is generally recommended over the sleeve gastrectomy in patients who have insulin-dependent diabetes or severe acid reflux.
- In gastric sleeve surgery, nearly 80 percent of the stomach is removed. The remaining section is narrowed and shaped into a small sleeve. Dr. Creange says patients typically lose about 70 percent of their excess body weight. For example, if you weigh 250 pounds, and your normal baseline weight should be 150 pounds, you can expect to lose approximately 70 pounds. This may not get you to your target weight, but it is a great improvement for your overall health.
- Gastric bypass is a type of surgery that changes how the stomach and intestines absorb the food you eat. During the procedure, a part of the stomach, about the size of an egg, is sectioned off and made into a small pouch. The new stomach is then connected to a portion of the small intestine. This allows the food to bypass a large part of the stomach and intestine so less of it is absorbed. Dr. Creange explains most individuals lose between 70 and 80 percent of their excess body weight after gastric bypass surgery.
Weight loss surgeries are safe, and the mortality risk is comparable to an everyday procedure like gallbladder removal. Most individuals spend one night in the hospital and are pain-free after about two weeks.
People who have surgery see results fairly quickly, explains Dr. Creange. Most patients lose about 15 pounds two weeks after surgery and drop another 40 to 50 pounds within three months of the procedure.
It is important that individuals who have weight loss surgery follow a specific diet afterwards. “It is a complete lifestyle change,” says Dr. Creange. “The first two years after surgery you are relearning how to eat and what is an appropriate amount of food. You may have a few bites, feel full, and not want to eat anymore.”
Individuals who have bariatric surgery also need to make lifestyle changes to sustain their weight loss. Revisional bariatric surgery is rapidly becoming more and more common in the United States. A variety of procedures are used for patients who have had bariatric surgery in the past but then gained back weight or plateaued in their progress.
“Surgery is the first step, but it is not a permanent step. It will guide you in the right direction, so you lose a lot of weight. However, in the long-term, the habits that led you to put on weight — overeating and physical inactivity — have to change,” he says.