What is weight loss suregry? Is it good for you? what are the pro and cons of weight loss surgery? How does weight loss surgery work, and could it help you?
There are two basic types of weight loss surgery — restrictive surgeries and malabsorptive surgeries. Each helps with weight loss in different ways.
Restrictive surgeries (like adjustable gastric banding) work by physically restricting the stomach’s size, limiting the amount of solid food you can eat. Before the surgery, a normal stomach can hold about three pints of food. After surgery, the stomach may at first hold one ounce — although that may later stretch to two or three ounces. You eat less when your stomach is smaller.
Malabsorptive surgeries (like gastric bypass) work by changing the way your digestive system absorbs food. This type of weight loss surgery is more complicated. The surgeon removes parts of your digestive tract, creating a shortcut for the food to be digested. This means that fewer calories get absorbed into the body. The combined malabsorptive/restrictive surgery also creates a smaller stomach pouch, which restricts the amount of food you can eat.
This type of surgery is not for everyone. Doctors generally recommend it only for people who:
- Have a body mass index (BMI) of 40 or more — about 100 pounds overweight for men, and 80 for women.
- Have a lower BMI (35 to 40) but also have serious health problems related to obesity — heart disease, type 2 diabetes, or severe sleep apnea.
Have tried and failed to lose weight by nonsurgical means, such as diets.
Fully understand the risks and are motivated.
What are the pros and cons of these surgeries?
Gastric Banding Surgery
The Pros:
- Gastric banding is often a minimally invasive surgery — performed with small incisions, a laparoscope (a tiny camera), and special instruments.
- There is no need to cut into the stomach or intestine, and recovery is usually faster than with gastric bypass surgery.
- The surgery can be reversed by surgically removing the band.
- Tightening the band further restricts stomach size, to increase weight loss. The band can be tightened or loosened in the doctor’s office. To tighten the band, saline solution is injected into the band. To loosen it, the liquid is removed with a needle.
The adjustable band allows a nutritionist to address nutritional issues that may occur after surgery.
- Serious complications are uncommon. But gastric bands can slip out of place, become too loose, or leak. Surgery is needed to correct this.
The Cons:
- Your weight loss may be less dramatic than with gastric bypass. The average is to lose 21% of your weight after one year, and 47% of your weight after two years.
- You may regain some of the weight over the years. Ten years after surgery the average weight loss is about 13%.
Gastric Bypass Surgery
The Pros:
- Weight loss is quick and dramatic. People lose an average of 38% of their body weight in the first year, and 62% in two years.
- Because weight loss is quick, quality of life — and related health problems — improve quickly. That includes diabetes, high blood pressure, high cholesterol, arthritis, sleep apnea, and heartburn.
- Many people keep most of the weight off for 10 years or longer. After 10 years the average weight loss is 25%.
- Loss of stomach tissue results in a drop in the so-called “hunger hormone” Ghrelin, which helps control appetite.
The Cons:
- Gastric bypass surgery is riskier and results in more complications. Although the surgery is generally safe, 10% of people have minor complications. Less than 5% have serious (potentially life-threatening) complications. The risk of death is under 1%.
- The surgery may result in dumping syndrome, which occurs when food moves too quickly through the stomach and intestines. Dumping syndrome can cause shaking, sweating, dizziness, and severe diarrhea.
- Gastric bypass is irreversible. The surgery permanently changes how your body digests food.
What are typical risks after weight loss surgery?
- Vomiting may result from eating too much too quickly — and not chewing well.
- Constipation is a common problem. Mineral oil and other liquid cathartics can help. High-fiber Metamucil and psyllium can cause obstructions, and should be avoided.
- Nutritional deficiencies, such as anemia, osteoporosis, and metabolic bone disease, may develop after weight loss surgery.
- As with any surgery, wound infections can occur up to three weeks after surgery. These can be treated with antibiotics, and sometimes require further surgery.
Complications that may develop:
- Hernia
- Gallstones
- Ulcerations
- Gastric prolapse
- Severe scarring of the new stomach pouch
- Excess skin that may need to be removed in an additional surgery
Rare but serious complications include:
- Bleeding in the stool, or black stools.
- Leaks in new connections made by weight loss surgery. These usually occur within five days of surgery.
- Blood clots in the lungs, called pulmonary emboli, occur less than 1% of the time. They are the most common cause of death after weight loss surgery. Blood clots can be prevented with blood thinning medicines and frequent activity.
