Have you tried conventional weight loss methods such as diet changes, exercise, and assistance from a dietitian, but are still struggling with severe obesity? When all else has failed, metabolic and bariatric surgery (MBS) is considered an option to jumpstart weight loss. However, MBS does require a life-long commitment, which is important to recognize upfront.
Weight is not the only factor that qualifies you for MBS. If you are also battling obesity-related health conditions, such as high blood pressure, you may qualify for laparoscopic metabolic and bariatric surgery.
For those who qualify for MBS, insurance requires you to explore non-surgical options first.
MBS is considered major surgery. Most metabolic and bariatric procedures make permanent modifications to your body and require strict lifestyle changes after surgery.
To assist you in making a well-informed decision, we discuss the different metabolic and bariatric surgery procedure types below.
Who Qualifies for MBS?
Surgically induced weight loss may become an option for someone that continues to see negative outcomes with traditional weight loss methods. Qualifications include, but are not limited to:
- More than 100 lbs over your calculated ideal body weight
- Body mass index (BMI) of 40 or higher
- BMI of 35-39.9 followed by obesity-related conditions, such as type 2 diabetes, high blood pressure, or severe sleep apnea
Qualifications for surgery may also depend on additional obesity-related health issues.
Types of Weight Loss Procedures
There are many laparoscopic surgery weight loss options. The most common ASMBS-endorsed procedures include:
- Roux-en-Y gastric bypass
- Adjustable gastric band (AGB)
- Sleeve gastrectomy
Biliopancreatic diversion with duodenal switch (BPD/DS)
These common bariatric surgeries support weight loss by restricting the amount of food you can eat, which induces nutrient malabsorption, or a combination of both restriction and malabsorption.
All surgery options require a lifestyle change regarding diet and exercise postoperatively to support healthy weight management.
Now that you have a general overview, let’s discuss each type of metabolic and bariatric surgery (MBS).
Roux-en-Y Gastric Bypass
This is known as the gold standard of metabolic and bariatric surgery. However, it is a complicated surgery requiring gastrointestinal tract rearrangement.
Gastric bypass surgery causes restriction by decreasing stomach size so that you consume fewer calories. This food restriction is accompanied by nutrient malabsorption.
A small stomach pouch is created and separated from the rest of the stomach. This small pouch is reconnected to a portion of the small intestine. This causes food to bypass part of the stomach and the first section of the small intestine (duodenum) to support weight loss.
According to the LABS study, patients lost almost 30% of their body weight after gastric bypass surgery. (1) This is considered a highly effective surgery, especially when lifestyle changes are maintained.
The intestinal rerouting that occurs during gastric bypass surgery influences weight loss and glucose metabolism, improving or leading to the remission of type 2 diabetes after surgery. Research confirms that diabetes remission rates range between 50% and 70% post-op gastric bypass. (2) This procedure is also considered effective in the treatment of sleep apnea, hypertension, and high cholesterol.
Gastric bypass surgery is more complex than the adjustable gastric band and sleeve gastrectomy. As with any major surgery, there is a risk of complications. You will be required to stay in the hospital for 3-5 days, so it is essential to bring everything on your bariatric surgery hospital checklist.
Since stomach contents empty more quickly into the intestine after this procedure, dumping syndrome is likely to occur, causing diarrhea and nausea.
The rearrangement of the intestinal tract increases the risk of nutritional deficiencies. You will be recommended bariatric-specific supplements for dietary support. To support a healthy weight loss journey, patients are required to follow dietary recommendations, prioritize protein intake, and take vitamin and mineral supplements for life.*
Adjustable Gastric Band (AGB)
Adjustable gastric band is commonly referred to as “the band” or “lap band” procedure. This surgery relies solely on the restriction of food to support weight loss.
A smaller stomach pouch is created by utilizing an inflatable band that goes around the upper portion of the stomach. The band can be adjusted by your MBS surgeon to control the amount of food consumed, supporting satiety when eating a small amount.
The band leaves a small opening resulting in the slow movement of food through the stomach to help you stay fuller longer. This procedure restricts the volume of food while calories and nutrients are absorbed as they usually would be. (3)
There are no permanent modifications with this procedure, meaning it is reversible. There are fewer complications and a lower risk of malnutrition and nutritional deficiencies. However, bariatric-specific vitamin and mineral supplements are still recommended to compensate for decreased nutrient intake from food sources.*
This procedure results in less weight loss when compared to the other procedures. Research showed that patients undergoing gastric bypass lost 16.9% more of their baseline weight than patients with a gastric band. As a result, patients with a gastric band lost an estimated 13% of baseline weight loss a year after surgery. (4)
A follow-up operation may be required due to increased band size from not following lifestyle changes after surgery or mechanical issues, such as slippage.
This procedure is suited for someone that is highly motivated to follow diet and lifestyle changes postoperative to support weight loss.
A sleeve gastrectomy restricts the amount of food that can be eaten by removing a large portion of the stomach to support weight loss.
About 75% of the stomach is removed leaving a “sleeve” resembling the size and shape of a banana. This new stomach pouch holds a smaller amount of food compared to the normal stomach size.
Reducing the size of the stomach can result in changes to gut hormones that stimulate appetite. The goal is that you feel satiated faster with a smaller amount of food.
This procedure does not include bypassing or rerouting the intestinal tract resulting in a shorter hospital stay. This surgery is less complicated than other metabolic and bariatric procedures and there is potential for revision if needed.
The research found that patients lost almost 24% of their baseline weight 1 year after surgery. (4) This procedure is successful in treating obesity-related conditions like type 2 diabetes and sleep apnea.
Dumping syndrome, which may occur after gastric bypass surgery, is less likely to occur after a gastric sleeve.
The sleeve gastrectomy procedure is irreversible. It cannot be undone if there are complications, but instead revised to a different metabolic and bariatric procedure.
Sleeve gastrectomy and other restrictive procedures have been found to provoke reflux symptoms, especially if you had acid reflux prior to bariatric surgery. (5)
An individual undergoing this surgery must be motivated and willing to make permanent lifestyle changes involving diet, exercise, supplemental vitamin and mineral supplements, and high protein intake.*
Biliopancreatic Diversion With Duodenal Switch (BPD/DS)
This duodenal switch is less common than the other surgeries discussed above. It results in restriction, malabsorption of vitamins and minerals, and changes to hormones in the gastrointestinal tract.
First, a sleeve gastrectomy is performed where 70-80% of the stomach is removed. Next, the intestine is divided further down than in gastric bypass surgery, resulting in a larger amount of the small intestine being bypassed.
This surgery is highly effective with an average of 80% excess weight loss within a year after surgery. (6) BPD/DS has been considered the most effective surgery for type 2 diabetes and other obesity-related health problems.
Unlike gastric bypass, BPD/DS preserves the stomach muscle (pylorus) that controls the emptying of the stomach into the intestine. This means that dumping syndrome is less likely to occur.
The difficulty of this surgery can result in a hospital stay of up to 7 days.
Due to a larger portion of the small intestine being bypassed and a small window for digestive enzymes to mix with food, there is a high risk of nutrient deficiency that may not be a problem in other surgeries. For example, there is a decrease in the absorption of protein as well as fat, which can cause a higher risk of fat-soluble vitamin (A, D, E, & K) deficiency.
A bariatric-specific ADEK multivitamin supplement may be required to support vitamin and mineral levels within normal limits. High protein intake will also be needed to compensate for dietary intake.*
Which Metabolic and Bariatric Surgery is Best?
While all of the operations mentioned above are proven to achieve high success rates, they all have their own risks and complications. In order to determine the right path, consult with your healthcare provider based on your individual needs.
Factors that will be taken into account include BMI, obesity-related health conditions, complication rates, and willingness to undertake a permanent lifestyle change. There is an extensive screening process before undergoing surgery to ensure this is the right decision for your needs.
Metabolic and bariatric surgery (MBS) supports quality of life, healthy weight loss, and maintenance of obesity-related medical conditions. However, these are major surgeries, and you should fully explore all options before deciding with your healthcare provider what MBS surgery is right for you.
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Ready to start upping your protein to help you on your bariatric journey? Consider these tasty shakes and soups:
- Bariatric Meal Replacement Shakes
- High Protein Meal Replacement
- Chicken Soup Protein
- Chocolate Peanut Butter Meal Replacement Shake
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 2020
- The Journal of Clinical Endocrinology & Metabolism. 2021; 106(3)
- American Society for Metabolic and Bariatric Surgery (ASMBS). 2021
- JAMA Surg. 2016; 151(11)
- Mini-invasive Surg. 2022; 6(9)
- Annals of Surgical Innovation and Research. 2016; 10(1)
This blog is for information and education purposes only. This information is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your bariatric surgeon or another qualified healthcare provider with any questions in regards to a medical condition. A qualified healthcare professional can best assist you in deciding whether a dietary supplement is suitable based on your individual needs.
*These statements have not been evaluated by the Food and Drug Administration (FDA). These products are not intended to diagnose, treat, cure, or prevent any disease.