Have you tried diets and exercise programs but are having difficulty reaching your goal or keeping the weight off? There are several options - both surgical and non-surgical - available for people who need help losing weight and getting healthy. Researching and getting questions answered beforehand will help you make sure you make the choice that will be most beneficial for you.

What is Bariatric Surgery?

Bariatric surgery involves making changes to the digestive system that help promote weight loss.  Some weight loss surgery procedures reduce the size of the stomach, reducing the amount of food one can consume at each meal. In contrast, other procedures lessen the body’s ability to absorb nutrients. Some bariatric procedures reduce both stomach size and the ability to absorb nutrients.

Types of Weight Loss Surgery

Talking with your primary care provider and an experienced bariatric surgeon is the first step to learning about weight loss surgery and what options may be the most beneficial to help you reach your weight loss goals.

Sleeve Gastrectomy

Sleeve Gastrectomy - referred to as sleeve surgery, vertical sleeve gastrectomy (VSG), or gastric sleeve - is a procedure that involves reducing the stomach by approximately 2/3 its original size.  Although some dilation may occur later in life, the gastric sleeve alternative permanently reduces the stomach's capacity.

The gastric sleeve procedure is generally performed laparoscopically.  The surgery limits the size of the stomach, therefore, restricting the amount of food a person can consume.  Further, it causes hormonal changes that assist with weight loss.

Some people can go home from the hospital on the same day of surgery, depending on the surgeon’s recommendation.

Others may need to stay for 24 to 48 hours.

Roux-en-Y Gastric Bypass

Roux-en-Y Gastric Bypass is the second most common type of bariatric surgery in the US.  It involves creating a small pouch while keeping the separated stomach in place.  A small portion of the small intestine is bypassed by connecting the new stomach pouch to a lower part of the small intestine.

Typically, people who have gastric bypass surgery stay in the hospital for 1 to 3 days and can return to normal activities within 1 to 3 weeks.  Again, each surgeon has different recommendations for length of hospital stay and when activity can be increased.  Also, each person is different, which can make recovery time varied.

Gastric Band Alternative Procedure

This alternative procedure is commonly known as Lap-Band, is a type of restrictive weight loss surgery.  The lap-band alternative involves placing an inflatable band around the top portion of the stomach below the esophagus.  The band is filled with saline through a small port inserted into the skin, causing it to inflate and compress around the abdomen.

Food sits above the area of the band, giving the person a feeling of being full until food slowly moves the rest of the way through the stomach through the normal digestive process.

The Lap Band is usually adjusted the first time just a few weeks after surgery.  A surgeon generally must fill the band with saline several times until a balance of ability to eat and the restriction is achieved.

Biliopancreatic Diversion with Duodenal Switch Alternative

The Biliopancreatic Diversion with Duodenal Switch Alternative involves both malabsorption and restrictive aspects of contributing to weight loss.  It is what many people consider a “combination” of gastric sleeve and gastric bypass surgeries.  Approximately 70 percent of the stomach is surgically removed, leaving a new smaller sleeve-shaped stomach.  The new stomach is connected to the lower portion of the small intestine, which results in alterations of the digestive process.

Requirements for Bariatric Surgery

Bariatric surgery is a major procedure that can create positive life-changing effects.  Although weight loss surgery can help reduce the risk of weight-related health problems, there are also risks of complications.  To qualify for bariatric surgery, candidates must meet specific criteria.  In general, weight loss surgery can be an option under the following circumstances:

• Previous efforts to lose weight with diet and exercise alone have been unsuccessful
• Your body mass index (BMI) is 40 or higher OR
• Your BMI is 35 or more with at least one weight-related diagnosis, such as high blood pressure, type 2 diabetes, or sleep apnea that is severe

Documentation of medically supervised weight loss attempts, a physical to show that you are healthy enough for surgery, and psychological evaluation is required for surgery approval.

Risks Associated with Weight Loss Surgery

Like any surgical procedure, there are risks and possible complications associated with weight loss surgery.  If you consider weight loss surgery, it is important to schedule an appointment with a primary care provider and/or a bariatric surgeon to discuss options that may be beneficial to you.

One of the most common complications following bariatric surgery is nutrition deficiencies.  While reduced stomach size and changes in the absorption of some nutrients can help promote weight loss, individuals who choose to undergo weight loss surgery must learn what foods are important to eat, which foods to avoid, and usually require taking supplemental vitamins for life.

Other complications that may occur include:

• Blood clots
• Stomach ulcers
• Staple or suture-line leakage
• The development of hernias
• Failure to lose weight

Alternatives to Bariatric Surgery

Bariatric surgical procedures can be beneficial for weight loss and help improve overall health.  However, it’s important to acknowledge that all bariatric surgeries are major procedures that can have serious risks and side effects. If you want to lose weight and achieve improved health but are not sure if weight loss surgery is appropriate for you currently, there are non-surgical alternatives to weight loss.

• Healthy Diet and Exercise:  Even with surgical weight-loss options, adopting a healthy lifestyle that consists of a balanced diet and exercise regimen is essential for long-term success.  A consultation with a nutritionist can help determine what types of foods will boost weight loss and to learn what appropriate portion sizes are.
• Appetite Suppressants: These affect the region of the brain that regulates appetite.  Like any other medication, it is important to talk with your primary care provider before beginning the use of appetite suppressants.  Your physician will be able to determine what medication, if any, is best suited for you and your weight loss goals.  Further, he/she will monitor your progress and make changes as needed.
• Gastric Bypass Hypnosis: Gastric Bypass Hypnosis is also known as a virtual gastric bypass.  This alternative involves a patient being placed in a “suggestive state,” during which a hypnotherapist talks to the patient through a gastric bypass procedure.  The hypnotherapist makes suggestions about reduced appetite and lowered desire to eat.  The process usually involves at least three follow-up sessions that are focused on psychological blocks to weight loss, methods to cope with cravings, and eating behaviors.
• Mesotherapy: This technique involves the injection of vitamins, hormones, enzymes, and plant extracts under the skin. Mesotherapy promotes the breakdown of fatty tissues and an increase in the circulation of blood under the skin.  The result is tightened rejuvenated skin and the removal of excess fat.  Mesotherapy treatments for weight loss do not produce drastic changes.  Therefore, it is usually recommended for individuals who require a small amount of fat reduction in target-specific areas.
• Endoscopic Sleeve Gastroplasty: Also called Transoral sleeve gastroplasty, Endoscopic Sleeve Gastroplasty is a less radical alternative to gastric bypass surgery.  The procedure involves placing stitches inside the stomach to reduce the overall stomach size.  It is performed endoscopically, making the surgery less invasive than laparoscopic surgery alternatives.  
• Balloon Alternative for Weight Loss:  For individuals who are seeking an option for weight loss that is non-invasive, there are alternative medical procedures.  Balloon surgery, commonly referred to as the gastric balloon, offers a safe way to stimulate weight loss in patients who are not interested in bariatric surgery or are not candidates for bariatric surgery.
  
  With this procedure, a gastric balloon is inserted into the stomach through the mouth and creates an effect like sleeve gastrectomy or lap-band.
  
  Typically, gastric balloons remain in place for about six months.  They create a temporary and easily reversible option for weight loss.  The average weight loss with the gastric balloon is between 15 and 25 pounds.  However, results vary and can be affected by long-term dedication to proper diet and exercise.

Bariatric Surgery: A Tool to Help You Succeed

Weight loss surgery can be a useful tool to aid in the promotion of weight loss.  By following post-surgical guidelines, including eating a healthy diet and participating in a regular exercise program, it is possible to lose weight and keep it off.  Before having bariatric surgery, it is important to research different options for surgery and alternatives, as mentioned in this article.  Schedule an appointment with your primary care provider to make sure you meet the qualifications for bariatric surgery and see which option will best help reach your goals.