For a country obsessed with losing weight, spending more than $60 billion a year trying to shed pounds, Americans are failing miserably. Even though we know the health risks that come with being too overweight, almost 78 million adults and 13 million children are obese — that’s one in three adults. (1, 2) It’s obvious that people are trying, but what happens when all the diets, food plans and exercise don’t seem to make a difference? For many people, the answer is bariatric surgery.
What Is Bariatric Surgery?
So what is bariatric surgery? For starters, bariatric surgery isn’t a specific type. Instead, it’s an umbrella term used to describe an operation that helps people lose weight by altering their digestive systems in some way. Most people who are obese are likely eligible candidates, and the procedure is becoming more common. In 2011, 158,000 adults had a type of bariatric surgery. In 2015, that number swelled to 196,000. (3)
There are actually four types of bariatric surgery, but only three are widely used. They include laparoscopic adjustable gastric band, usually referred to as just gastric band; gastric sleeve surgery, also known as sleeve gastrectomy; and gastric bypass, or Roux-en-Y. (4)
With gastric band surgery, a ring with an inner inflatable band is place around the top of a patient’s stomach, creating a small pouch. In effect, this reduces the size of the stomach, so less food is required to feel full. Inside the band is a balloon filled with a saline solution. A surgeon can increase or decrease the size of the pouch’s opening by either injecting or removing solution.
In gastric sleeve surgery, most of the stomach is actually removed, making it easier to feel full after eating as well. What’s left behind is a small, banana-shaped section.
Gastric bypass surgery is more complex, because it actually makes your stomach smaller while rerouting digestion. How it works is that a surgeon staples the stomach, creating a pouch in the upper section that effectively works as your stomach — you eat less because you’re satiated more quickly.
Next, a surgeon will cut the small intestine, attaching it directly to the stomach pouch. When you eat, food ends up actually skipping most of the stomach and the upper small intestine. This move means your body absorbs fewer calories from food since it’s not digesting as much.
The part of the stomach that’s been skipped will then be connected to the lower part of the small intestine. This bypassed section remains attached to the main part of your stomach, allowing digestive juices to still reach it.
Pros and Cons of Bariatric Surgery Types
Gastric Band: Using a band, the stomach’s size is reduced so you’ll feel full with less food
- The band can be adjusted or removed.
- There’s no change to your intestines.
- It’s a short hospital stay.
- You have the lowest risk of vitamin and nutrient shortage.
- You might lose less weight than with other types of surgery.
- Follow-up visits to adjust the band happen frequently. There’s also a chance your body won’t adapt to the band.
- Eventually, you might have to replace or remove the band. In fact, a recent study showed that 1 in 5 older gastric band patients will require further operations.
- You’ll lose more than the gastric band.
- There’s no change to your intestines.
- No bands or foreign objects in the body.
- Short hospital stay.
- Can’t be reversed.
- Higher risk of surgery-related problems than gastric band.
- There’s a chance of vitamin shortage.
- More weight loss than with the gastric band.
- No foreign objects in the body.
- Difficult to reverse.
- Highest chance of vitamin shortage.
- Higher risk of surgery-related problems than gastric band.
Who Is Bariatric Surgery For?
Clearly, bariatric surgery is not a low-maintenance, temporary fix. It’s a major procedure and intrusion on the body, with both physical and emotional effects. So who can undergo it?
The general guidelines for being a candidate for bariatric surgery are that you have tried to lose weight through diet and exercise, including a medically supervised program, and haven’t been successful, and also fall into one of the following categories:
- Your body mass index, or BMI, is 40 or higher, which denotes extreme obesity.
- You have a BMI in the 35 to 39.9 range, which is considered obese, but you have at least one more health problem that’s related to your weight and could be improved with weight loss, such as type 2 diabetes or high blood pressure.
- You’re at least 100 pounds over your ideal body weight. (5)
These are the basic things a doctor would consider, but just meeting one of those criteria doesn’t mean you’ll automatically find yourself on an operating table. There are other things to consider, such as the following:
Medical condition: Your medical condition pre-surgery plays a role on whether you’re a good candidate for bariatric surgery. A medical team will evaluate what risks are involved, whether you’re on medications, if you drink or smoke, and your overall physical health.
Mental health: Issues like substance abuse, binge eating and anxiety could have an effect on how well you can maintain the health benefits of surgery.
Age: There is no age limit for bariatric surgery, but the risks increase with age. For people under 18, the procedure remains controversial. (6)
Does Bariatric Surgery Work?
If nearly 200,000 people are operated on annually, surely bariatric surgery works, right? It’d be nice to just say “yes” and leave it at that, but the answer is a little more complicated.
First, let’s look at the positives. For morbidly obese candidates, weight-loss surgery has been shown to significantly decrease overall mortality along with the development of new health-related conditions. (7)
Another recent study of nearly 49,000 obese patients found that, five years later, those who’d undergone bariatric surgery were much less likely to die from any cause than those who hadn’t. In the group of patients who hadn’t had surgery, cardiovascular disease was the most common cause of death. (8)
And a review of 136 separate studies found that morbidly obese patients successfully lost weight after surgery and a majority of patients experienced total resolution of health problems like diabetes and hypertension. (9)
But bariatric surgery doesn’t come without its risks.
Risks of Bariatric Surgery
Weight Gain After the Honeymoon Period
It’s pretty hard not to lose weight after bariatric surgery, particularly in the beginning. But hunger isn’t just a biological process — it’s also an emotional one as well. That’s why people eat when they’re bored, stressed out or upset. If you’re someone with underlying issues surrounding food, surgery won’t fix that. In fact, after the “honeymoon period,” you might actually gain weight.
A study published in JAMA: The Journal of the American Medical Association found that there was a significant amount of weight gain in patients who underwent gastric sleeve surgery. (10) That’s why making lifestyle changes is critical.
This condition, also known as rapid gastric emptying, can develop after bariatric surgery. When food, particularly sugar, goes from the stomach to the small bowel too quickly, “dumping” symptoms like cramps, nausea, vomiting and diarrhea occur.
Bariatric surgery can increase the risk of gallstones, small “stones” found in the gallbladder. They’re formed when cholesterol, calcium and other particles bind together and get stuck in the gallbladder, causing pain and problems like indigestion and back pain.
Changes in Gut Bacteria and Metabolism
Two types of bariatric surgery, gastric bypass and gastric sleeve, can actually change gut bacteria and hormones, since the procedures remove part of your stomach. Messing with the human microbiome can lead to things like leaky gut syndrome and autoimmune diseases and disorders like arthritis, dementia and heart disease. Fertility and longevity also rely on the right balance of bacteria in our guts.
Bariatric surgery decreases the amount of food a person can eat while also limiting how many nutrients the body can absorb from the food. That’s why patients are at high risk of malnutrition after their procedures. (11) Malnutrition happens when there’s a lack of micronutrients, like vitamins and minerals, or macronutrients, like fats, carbs and protein. The most common deficiencies are B12 and iron. (12)
A recent study published in JAMA Surgery found that 1 in 5 older gastric band patients needed further gastric band surgery within five years of their original surgery. Researchers studied the Medicare claims data of 25,000 adults who had gastric band surgery from 2006 to 2013. They found that during an average follow-up of 4.5 years, 19 percent of patients required further gastric band surgeries, with an average of four surgeries per patient. (13)
Better Natural Options
For some people, bariatric surgery might be the best — or even last — option to transform their lives, lose weight and address the other health issues that go hand-in-hand with obesity. For other people, however, there might be other options.
Work with a professional. A nutritionist who focuses on whole foods and natural healing can help design a weight-loss menu and plan of attack that can help you lose pounds safely. While my healing foods diet is an excellent start, a nutritionist can design specific menus and recipes to keep you on track.
Working with a psychologist can be extremely helpful as well. Because many problems with food are actually rooted in other psychological issues, working with a therapist can assist in getting to the cause of the problem and make your weight loss efforts more successful.
Try a low-carb diet. The American Diabetes Association and 45 international medical and scientific societies have called for bariatric surgery to be a standard treatment option for diabetes. But as noted in a New York Times piece, there’s another option that’s seen significant success in treating or even reversing diabetes: the low-carb diet. (14) Until pharmaceutical insulin became available in the 1920s, reducing carbohydrates was actually standard treatment for diabetes.
A two-week study of 10 obese patients with type 2 diabetes had impressive results after a low-carb diet. Their glucose levels were normalized while their sensitivity to insulin improved by 75 percent. (15)
Final Thoughts on Bariatric Surgery
For some people, bariatric surgery might really be the only way to a healthier lifestyle. It’s important to remember, however, that surgery is simply a tool — it will not cure all problems.
Patients still need to be active participants in reforming their own lifestyles; a procedure alone won’t cure all. Additionally, bariatric surgery is a major procedure that should be examined with a medical professional to ensure it’s the best option, but for everyone, an improved diet combined with exercise is the best route for maintaining a healthy weight and healthy body.