Deciding whether or not to have surgery can feel overwhelming. When a procedure is elective, like the gastric sleeve, also known as sleeve gastrectomy, it may cause one to give pause and consider if this is the right choice.  The most important thing a person can do before making a final decision about any surgery is to become educated about the pros and cons, as well as any pre- or post-operative expectations.

What is the Sleeve Gastrectomy?

The sleeve gastrectomy is a surgical procedure that induces weight loss by restricting the amount of food a person can consume.  The procedure involves the surgeon removing approximately two-thirds of the stomach.  The new shape of the stomach is that of a tube or “sleeve”.  

Originally, the sleeve gastrectomy was the first step in a two-phase duodenal switch procedure aimed at treating morbidly obese patients who had other high-risk factors, or comorbidities.  Today, however, the sleeve gastrectomy is a more common stand-alone procedure.

Considerations to keep in mind

Overall, gastric sleeve is considered a safe procedure when compared to other commonly performed surgeries.  Like many surgical procedures, the sleeve gastrectomy is irreversible.  Therefore, it is important to consider all of the facts about the surgery, including your personal reasons for choosing this method of weight loss and any other health-related factors that may affect your post surgical success.  

Despite the decrease in stomach size, bariatric surgery is a tool.  If it is not used correctly, the chance of successful weight loss and maintenance is decreased.  In fact, it is possible, especially after the first year, to experience weight regain.  Following gastric sleeve surgery, the patient must adhere to discharge teaching and instructions to achieve success.  Following a bariatric diet, exercising and taking vitamin supplements helps improve one’s success rate after gastric sleeve surgery.

If you are considering having a sleeve gastrectomy, take the time to weigh the pros and cons, as they apply to you personally.  Some things you need to consider are:

• Have you tried other diet plans, but not been successful? When you have your initial consultation about having this surgery, you will be asked what other weight loss plans/diets you have tried in the past.  Because sleeve gastrectomy is an elective procedure, many insurance companies will not approve the surgery unless other weight loss efforts have been documented and were ineffective.  Don’t worry!  Be honest and follow the process!
• Do you have any comorbidities?  Comorbidity is the presence of chronic disease related to excess weight. An example is an individual who has a diagnosis of obesity and hypertension (high blood pressure), diabetes, high cholesterol.  The presence of comorbidities means an individual is at greater risk for health-related problems.  It is one factor that many physicians look at when discussing the option of bariatric surgery with clients.
• How much weight do you need to lose?  An individual who only  wants to lose 20 or 30 lbs may not immediately consider bariatric surgery as an option.  On average, most people lose about 60% of their excess body weight in the first 12 to 18 months following sleeve gastrectomy.  If your excess weight is 100 lbs you are expected to lose between 60 to 70 lbs. Keep in mind, activity level and diet plays a big role in the rate of weight loss.  Some people may lose weight more quickly than others.  

Common Regrets and Frustrations Related to Gastric Sleeve Surgery

Sometimes considering the pros and cons can seem a little one-sided, especially if the negative things you read or hear are not what you expected.  Nevertheless, before settling in on a life-changing decision, looking at both sides really is important.  With that in mind, let’s take a look at some of the most common regrets people express postoperatively - they wish they knew that before surgery.

Having to learn the difference between head hunger and being hungry

Head hunger or emotional hunger is the desire to eat for any reason other than physical hunger. Head hunger is usually experienced because of a trigger food or the emotional need for comfort, hence the term “comfort food.”  Even after weight loss surgery, head hunger can play a significant role in a person’s success with reaching weight loss goals.  Some signs that the hunger one is experiencing is head hunger, rather than physical hunger include:

• Recently ate, but feeling the “need” to eat again:  If you have eaten within the last two hours and feel like you are hungry again, it is likely head hunger, not physical hunger.
• An emotional response, such as anger or fear.
• Craving a specific food or flavor (chocolate or salty foods):  Unlike head hunger, a person who is experiencing true physical hunger will not have a “craving”.  Rather, the need to fuel the body for energy is felt more than the need for a particular type of food.

Feeling like you’re on an emotional rollercoaster

The physical changes that occur after weight loss surgery can sometimes cause emotional changes.  With weight loss, the adrenal system seems to “slow down.”  The decrease in adrenaline production can leave some people feeling tired or depressed.

Not drinking 30 minutes before and after a meal

The gastric sleeve surgery results in a smaller stomach, which means the amount of food or fluids one can consume is much more restricted.  Drinking liquids within 30 minutes of a meal can cause the stomach to be filled with liquids, which means less room for the nutrient-rich foods your body needs.

Also, drinking while eating means more liquid mixes with the food in the stomach and the consistency of the food is thinned.  This results in food moving through your new stomach before essential nutrients can be absorbed.  It is recommended that bariatric patients concentrate on allowing the stomach to be filled with lean proteins, which will give a feeling of fullness longer, and resume drinking no sooner than 30 minutes after a meal.

“Feeling like I don’t belong at the dinner table”

Learning how much to eat and what foods are best can feel like a struggle after sleeve surgery.  Many people state that they feel out of place when eating with others, or that mealtime is no longer enjoyable.  The amount of food that the new, smaller stomach can hold is much less than the amount those who have not had surgery can take.

Because of this, sleeve patients usually feel full much faster than non-sleeve patients.  The brain does not automatically get the message that the stomach is full.  Therefore, it is important to remember to eat slowly and chew food well. This gives your brain the time to be signaled that you’ve had enough food.  Also, by doing this, you can enjoy eating with friends/loved ones without feeling like you’ve finished too soon or that you’re just sitting at the table but not eating.

Still seeing an obese person in the mirror

As odd as this may sound, many bariatric patients say that, no matter how much weight they lose, they still don’t see the new version of themselves that everyone else does.  After weight loss surgery, especially during the first 6-12 months, weight loss can be rapid.  The body changes much faster than the mind seems to be able to comprehend.  Because of this, many people still view themselves as obese or unhealthy, regardless of significant weight loss.

Addiction Transfer

Preoperative consultations and education are a must!  One thing that any good surgeon and his/her team will discuss with a client is the risk of addiction transfer.  Addiction transfer, or cross addiction, occurs when individuals trade compulsive eating for other compulsive behaviors. For these people, food is no longer a source of comfort, escape or distraction. Therefore, other behaviors or substances become a substitute for eating and can result in serious problems.  Some examples of transfer addictions include gambling, drinking alcohol in excess, using drugs or engaging in risky sexual relationships.  While not everyone experiences addiction transfer, it is important to acknowledge the fact that it can occur and be prepared if or when those urges arise.

Hair Loss

In the first 6 months following bariatric surgery, calorie intake is diminished. This may contribute to a decrease in the intake of macronutrients, particularly protein.  Because hair follicles are comprised mostly of protein, consuming adequate amounts of protein is important.  Additionally, following surgery, stress and hormonal changes occur.   All of these factors can result in hair loss.  This type of hair loss, known as telogen effluvium, is associated with bariatric surgery.  It is common in both men and women and occurs during the most rapid phase of weight loss.  Following a post-surgical diet, including consuming the recommended amount of vitamins and protein will help the body to achieve a state of balance, which will (in time) stop the hair loss.  

Weighing Your Options… No Pun Intended

If you are considering having sleeve gastrectomy surgery, take your time to research information about the surgery.  Read articles about the surgery that share both pros and cons.  Join support groups and/or social media groups that are focused on bariatric education.  Talk with your loved ones about the fact that you are considering the surgery.  Ask them to share their thoughts, in a non-judgemental way.  Most importantly, talk to your doctor.  Your primary health care provider should be able to review your medical history and discuss your health goals with you in an open manner.  He/she can advise you regarding whether the gastric sleeve is a good option for your weight loss goals.

Lastly, while educational sources and individual opinions vary, the most important voice you will listen to is your own.  Take the time to think about the choices you’ve made previously that brought you to this place in your life.  Make a list of reasons you should or should not have the surgery.  After you have weighed all of the options, you will be able to make a decision that you will be comfortable living with.