Bariatric Weight-Loss Surgery: What to Know

Bariatric surgery involves making changes to the digestive system to promote weight loss. One way these surgeries work is by making the stomach smaller. As a result, people can't eat as much and consume fewer calories.

Weight-loss surgeries now use minimally invasive techniques. These techniques reduce incision size, shorten recovery time and lower the chance of complications.

When choosing weight loss surgery, factors such as Body Mass Index (BMI), eating habits and health issues are taken into account. “It all depends on your specific situation,” Dr. Takata says.

Bariatric surgery is often an option for people who:

• Have a BMI between 30 and 34.9 and a serious weight-related health problem, such as diabetes, sleep apnea, hypertension, high cholesterol or heart disease
• Have a BMI of 35 or higher

Patient education and careful selection of patients is critical for successful outcomes.

“If you are approved for surgery by your doctor and health plan, you’ll work closely with a medical team to make sure you’re healthy enough for surgery, identify any potential challenges and develop specific plans for you to reach and maintain your goal weight,” Dr. Takata says.

Several types of bariatric operations are available, each with its own set of techniques and considerations. The most common are:

This procedure involves removing up to 80 percent of the stomach, leaving a smaller “sleeve” or tube-shaped stomach. This limits how much food you can eat.

Gastric sleeve patients have reported losing a significant amount of weight and improvements with sleep apnea, diabetes hypertension, and high cholesterol.

This procedure involves creating a smaller stomach pouch and rerouting a portion of the small intestine. It reduces both the stomach size and the absorption of calories and nutrients. Patients who have had this procedure report losing substantial amounts of weight and improvement in medical problems. 

Lap-Band surgery, as it is also known, places an adjustable band around the stomach to create a small pouch for food. It helps people feel full sooner.

SADI combines gastric sleeve and gastric bypass to provide very aggressive weight loss. It is recommended for people with a BMI above 50 or those who have not lost enough weight with just gastric sleeve. 

Many patients can lose up to 100 pounds or more after surgery and improve their health.

Studies show that more than 90 percent of bariatric surgery patients are able to maintain long-term weight loss of 50 percent excess body weight or more, according to the American Society for Metabolic and Bariatric Surgery.

Bariatric surgery is effective at reducing the impact of or curing many obesity-related conditions, including:

• Type 2 diabetes
• Sleep apnea
• High cholesterol
• High blood pressure
• Heart disease

“Weight-loss success also depends on many other important factors, such as nutrition, exercise and lifestyle changes to prevent weight gain,” Dr. Takata adds. “This is why a comprehensive approach, such as the one offered at the Center for Weight Management and Bariatric Surgery at Scripps Clinic Del Mar, is critical for success.”

All surgeries have risks that should be considered. For bariatric surgery, risks include:

After surgery, patients must take certain supplements to prevent vitamin deficiencies. “Most patients take supplements anyway, so this requirement is not a significant change for many patients,” Dr. Takata says.

Weight-loss surgery shrinks the size of the stomach and creates a significant decrease in appetite. This puts patients at risk for dehydration in the first two to three months after the procedure. “We follow patients very closely to ensure everyone is progressing as expected without problem,” Dr. Takata says.

Patients may get blockages in their intestines, “but this is very rare,” Dr. Takata says. “Your medical team will be tracking your nutrition and progress closely.”

Many bariatric surgeries cannot be undone. So, patients must think carefully before choosing surgery and understand the procedure and its long-term effects.

“I recommend people come to an orientation session and learn about the operation before turning away from the lifesaving option of bariatric surgery.”

Certain procedures are reversible, including gastric banding.

“There are many patients with gastric bands that were implanted many years ago who want to get them removed or want a different weight-loss operation,” Dr. Takata says. “Making this type of change is something we frequently perform to help them achieve their weight-loss goals.”

Gastric bypass surgery is also a reversible operation. “But it is rare to have a patient who needs it reversed,” Dr. Takata says.

Bariatric surgery risks are low due to minimally invasive techniques and established medical standards. Scripps Clinic is a recognized center for bariatric surgery. It meets high standards set by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.

When choosing bariatric surgery, risks and benefits are carefully considered.

Weight loss and improved health can outweigh the risks for many people. “It is important to understand that the risks of remaining obese are far greater than the risks of bariatric surgery,” Dr. Takata says.

Your physician will go over what to expect after the procedure, including side effects, diet and exercise. To keep the weight off, you need to live a healthy life for a long time.

Patients who don‘t stick to healthy habits may slowly regain some weight years after the operation. Good nutrition, exercise, and lifestyle changes are important to prevent weight gain. Successful patients are motivated, well-informed and can engage in long-term care follow-up.

“This is why a comprehensive approach, like the one offered at the Center for Weight Management and Bariatric Surgery at Scripps Clinic Del Mar, is critical for success,” Dr.Takata says.

Bariatric surgery is expensive. This makes health care insurance an important issue. Coverage can vary depending on the type of insurance plan and specific criteria set by your insurance company. Medicare for example pays for some weight-loss procedures.

Check with your insurance provider to know their policy and requirements. You may also want to call the office of a local bariatric surgeon and ask for help in checking whether you have coverage.

“Most bariatric programs are happy to check and often have someone on staff that does this on a regular basis,” Dr. Takata says.