Although dieting and exercise are the traditional and safest approaches to weight loss and healthy lifestyle, some individuals require a tool that can jumpstart weight loss. Individuals with a BMI exceeding 40 and suffering from obesity-related conditions, require a fast and effective solution for successful weight loss.
For those who qualify for bariatric surgery, it is usually required to explore non-surgical bariatric weight loss procedures first. Typically, this may also be required for insurance purposes.
Bariatric surgery is considered a major surgery, so this is not something to take lightly. Most bariatric procedures make permanent modifications to your body and require strict lifestyle change after surgery in order to experience the most benefit.
To assist you in making a well-informed decision, here are the different bariatric surgery procedure types and all you need to know about them.
Understanding Your Options for Bariatric Surgery
There are many weight loss surgery options including Roux-en-Y gastric bypass, adjustable gastric band, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. These common bariatric surgeries promote weight loss by restricting the amount of food consumed, nutrient malabsorption, or a combination of both restriction and malabsorption.
All surgery options require a lifestyle change regarding diet and exercise postoperative.
Who Qualifies for Weight Loss Surgery
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 type 2 diabetes, high blood pressure, or severe sleep apnea
Qualifications for surgery may also depend on other extreme obesity-related health issues.
Types of Weight Loss Surgeries
1. Roux-en-Y Gastric Bypass
This is commonly known as the gold standard of bariatric surgeries. The idea is to cause caloric restriction by decreasing the size of the stomach, followed by, nutrient malabsorption. This surgery is complicated and requires rearrangement of the gastrointestinal tract.
A small stomach pouch is created and separated from the rest of the stomach. This small stomach pouch is reconnected to a portion of the small intestine. This causes food to bypass part of the stomach and first section of the small intestine (duodenum) for the outcome of weight loss.
People who undergo gastric bypass surgery experience an average of 70% excess weight loss. This is considered a highly effective surgery and for those who maintain lifestyle change, can see up to 80% excess weight loss within a year after surgery.
The re-routing of the intestinal tract causes changes to gut hormones. It is possible that the hormonal changes to the intestinal tract can help improve or even lead to remission of type 2 diabetes (learn more: Bariatric Surgery And Diabetes). This procedure is also considered effective in the treatment of sleep apnea, hypertension and high cholesterol.
Gastric bypass surgery is usually more complex than the adjustable gastric band and sleeve gastrectomy. As with any major surgery, there is a risk of complication. You will be required to stay in the hospital for 3-5 days, which is why it is important 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 can cause nutrient deficiencies. You will be recommended bariatric specific supplements for life to prevent this problem. It is important to be compliant with dietary recommendations, protein intake, and a vitamin/mineral regimen for the rest of your life.
Feel free to have a look at Bariatric Surgery Hospital Checklist
2. Adjustable Gastric Band (AGB)
Commonly referred to as “the band” or “lap band” procedure. This surgery relies on restriction of food.
A smaller stomach is created by utilizing an inflatable band that goes around the upper portion of the stomach. The band can be adjusted and is used to control the amount of food consumed, promoting a feeling of fullness when eating a small amount.
The band leaves a small opening that can result in food moving slowly through the stomach to help you stay fuller for longer. In this procedure, the volume of food is restricted while calories and nutrients/minerals are absorbed as they usually would be.
There are no permanent modifications with this bariatric procedure. That being said, this procedure is reversible. There are fewer complications and lower risk of malnutrition and deficiencies. However, vitamin and mineral bariatric 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. There is an average of 40% to 50% excess weight loss.
It is possible that this surgery can result in re-operation due to an increase in band size from lack of adherence to a strict diet after surgery or mechanical issues concerning slippage.
This procedure is suited for someone that is highly motivated regarding diet and lifestyle change postoperative to ensure positive weight loss results.
3. Sleeve Gastrectomy
A sleeve gastrectomy restricts the amount of food that can be eaten, resulting in weight loss similar to that of the adjustable band.
About 75% of the stomach is removed leaving a “sleeve” resembling the size and shape of a banana. This new stomach tube 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 bypass or complex re-routing of the intestinal tract resulting in a shorter hospital stay. This surgery is less complicated than other bariatric procedures and there is potential for revision if needed.
Excess weight loss rates can reach 60% to 70% within a year after surgery. This procedure is successful in treating obesity-related conditions like type 2 diabetes and sleep apnea.
Dumping syndrome, that 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 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.
An individual undergoing this surgery must be motivated and willing to make permanent lifestyle changes in regards to diet, exercise, supplemental vitamin/mineral regimen, and high protein intake.
4. Biliopancreatic Diversion With Duodenal Switch (BPD/DS)
This procedure is less common than the other surgeries listed above. It results in restriction, malabsorption of vitamins/minerals, and changes of hormones in the gastrointestinal tract. To qualify for this surgery, patients usually have a BMI greater than 50.
First, a sleeve gastrectomy is done where 70-80% of the stomach is removed resulting in a stomach the size and shape of a banana. 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 resulting in up to 80% excess weight loss within a year after surgery. BPD/DS has been considered the most effective surgery for treating diabetes and other chronic 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 and result in a hospital stay 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 deficiency with nutrients 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 deficiencies in fat-soluble vitamins (A,D,E, K).
Bariatric specific ADEK supplements will be required to prevent deficiencies that are less common in other bariatric procedures. High protein intake will also be needed to compensate for dietary intake.
Which Bariatric Surgery is the Best?
While all of the operations mentioned above are proven to achieve high success rates, they all have their own risks and complications. You will have to have a discussion with your healthcare provider on what option may be the best for your individual needs.
You and your healthcare provider should take into account BMI, obesity-related health conditions, complication rates, and willingness to lifestyle change. You will go through an extensive screening process before you even undergo surgery to ensure this is the right decision for your needs.
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**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 physician or another qualified health 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.