Ask Your Doctor Discussion Guide
Best for: primary care physician appointment or weight loss surgery seminar
What is weight loss or "bariatric" surgery, and why do I need surgery to lose weight?
"Bariatrics" is a branch of medicine that relates to obesity and its associated diseases. Bariatric surgery, or weight loss surgery, is a common term used to describe a variety of operations for treating severe obesity. These operations are performed to make physical changes to the stomach and/or the small intestine in order to help you decrease the amount of food you eat.
- It is a proven method for long-term weight reduction and portion control among people who are exceedingly obese.
- It facilitates significant and sustained weight loss.
- It was shown to result in complete remission of diabetes in up to 86% severely obese patients with diabetes.
- It was shown to reduce the risk of death by nearly 30% in patients with severe obesity (BMI >40).
- It is not a simple, "quick fix" solution to a serious long-term weight problem.
- It requires commitment and lifestyle changes for successful weight loss and improved health.
- It is not a form of cosmetic surgery.
What are the benefits of weight loss surgery?
Most people who undergo bariatric surgery lose a significant amount of weight. After they lose the weight, they are also more likely to keep it off, provided they continue to observe the amount of food they eat.
Serious health concerns related to obesity often improve or disappear following surgery and weight loss. Some of these health concerns include:
- Heart disease
- Type 2 diabetes
- Arthritis
- Some forms of cancer
- Hypertension
- Stroke
- Sleep apnea
- Asthma
Obesity is also associated with pregnancy complications and menstrual problems, and it often leads to psychological and behavioral conditions such as depression.
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Quality of life also improves for many people after weight loss surgery, as they experience improvement in their physical, behavioral and social well-being.
What types of weight loss surgeries are currently available?
There are several types of bariatric surgery, which fall into two categories:
- Restrictive procedures: These surgeries significantly reduce the size of the stomach, making you feel satisfied after eating less food, and you stay full longer.
- Restrictive/malabsorptive procedures: These surgeries reduce the size of the stomach and shorten the small intestine, which are permanent changes to your anatomy. The smaller stomach also makes you feel satisfied and full after eating less food. In addition, the changes to the intestine reduce the amount of calories the body can absorb.
The two most widely selected restrictive and restrictive/malabsorptive procedures include adjustable gastric banding (restrictive) and gastric bypass (restrictive/malabsorptive).
Am I a good candidate for weight loss surgery?
You and your doctors—your primary care provider (PCP) and your weight loss surgeon—need to consider many factors prior to determining if weight loss surgery is right for you. As you go through the decision process, ask yourself if you are up to the challenges you will face.
- First of all, you will be required to have a full medical examination. Your doctors will also consider other factors that are unrelated to your weight by performing a comprehensive psychological and behavioral assessment. Significant psychological issues (major depression, alcohol or drug abuse or bulimia, for example) that may affect your ability to care for yourself after surgery would make it too risky to undergo surgery.
- Bariatric surgery will require you to visit your doctor regularly for follow-up appointments. If you choose the adjustable gastric band procedure, the surgeon will make any necessary adjustments to your band during these appointments. Because the surgery creates physical changes to your stomach (and intestine, if you elect to have a gastric bypass), the routine visits will ensure long-term weight loss success.
- Weight loss surgery is usually reserved for people who are seriously overweight, and therefore at a higher level of medical risk, and those who continue to have a longstanding weight problem despite making numerous attempts to lose weight.
Weight loss surgery may be suitable if:
- Your BMI is 40 or higher or your BMI is at least 35 and you have other serious medical conditions related to obesity. Body mass index (BMI) is a method doctors use to estimate how much excess weight a person has in relation to their height. It is an accurate and easy way to determine if you are within an acceptable range, overweight, or obese.
- You are over 18 years of age.
- You were not successful in losing and maintaining your weight by other means, despite making many attempts through diet, exercise and medications.
- You are committed to making permanent lifestyle changes, and you are psychologically and behaviorally prepared to care for yourself after surgery
Your weight loss surgeon will ultimately determine if bariatric surgery is right for you, so be sure to ask your surgeon about your individual case.
How do I calculate my BMI?
To calculate your BMI, enter your height and weight into the BMI calculator at the National Heart, Lung, and Blood Institute Web site. A BMI of 30 or above is considered obese. Once you determine your BMI, use the table below to identify your weight category.
| Body Mass Index (BMI) | Weight Category |
|---|---|
| Less than 18.5 | Underweight |
| 18.5 – 24.9 | Acceptable |
| 25 – 29.9/T | Overweight |
| 30 – 39.9 | Obese (Surgery may be suitable for those with BMI of at least 35 with at least one weight-related health condition) |
| 40 and over | Excessively obese (Suitable for surgery) |
Your weight loss surgeon will ultimately determine if bariatric surgery is right for you, so be sure to ask your surgeon about your individual case.
How much weight will I lose?
Weight loss surgery should not to be mistaken for a cosmetic procedure, and it is not a simple, "quick-fix" solution to an excessive, long-term weight problem. However, studies do show that surgery leads to significant weight loss that can be maintained long-term. Surgery also leads to substantial improvements or complete remission of many health-related problems, such as diabetes, hypertension and hyperlipidemia. Your weight loss results will depend on your choice of procedure, your commitment to the necessary lifestyle changes, and your individual situation.
- Weight loss may occur fairly rapidly or may be more gradual and steady, averaging 5-10 pounds per month, depending on the type of weight loss procedure you choose.
- Your success is dependent on your motivation and commitment to lifestyle changes. Keep in mind that in some cases after weight loss surgery, some people do not lose as much weight as they would have liked, or as quickly as they had anticipated.
What other lifestyle changes would I need to make?
Weight loss surgery is only the first step in a series of lifestyle changes that you will need to adopt in order to lose weight and stay healthy. Many surgeons and insurance providers require surgery candidates to enroll in and successfully complete nutritional counseling programs in order to learn and practice the healthy eating and exercise habits that will be necessary after surgery.
- Check with your insurance company to understand your coverage and determine whether a medically supervised weight loss program is required prior to weight loss surgery.
- Your eating habits will have to change for you to lose weight and maintain your health. This will involve choosing healthy foods to eat, eating smaller portions and taking daily nutritional supplements.
- Regular exercise (30 minutes a day, 3–4 times a week) is strongly encouraged for achieving and sustaining weight loss. Exercise preserves lean muscle tissue when losing weight rapidly after surgery and may also help reduce appetite. Exercise may also help reduce surgical complications, promote healing and enhance recovery after surgery.
What are the risks of weight loss surgery?
Weight loss surgeries are major surgeries that involve risks and may lead to significant short-term and long-term health complications. The risks and complications vary according to the types of surgical procedure you elect to have and often depend on your age, level of excess weight, other existing health conditions, and how well you manage your health and your lifestyle.
Problems associated with bariatric surgery can range from minor to life-threatening. Complications may occur during, immediately after or within weeks or several months after surgery. Additional surgery, re-admission to the hospital, medication or nutritional supplements may be required. Health insurance may not cover some or any of the costs related to these unanticipated circumstances.
If you choose to have the surgery, your surgeon will carefully explain the risks that are unique to you and specific to the type of operation you decide upon. Be sure to ask your surgeon all the questions you may have about risks and benefits of weight loss surgery before undergoing your procedure.
How can I find a reputable weight loss surgeon?
Finding a reputable weight loss surgeon can increase your chance of having a successful operation, a good recovery, and satisfactory progress toward your weight loss goal. You may choose to work with your PCP to find an experienced weight loss surgeon. Some factors to consider in your selecting a surgeon include: the surgeon's qualifications and number of successful operations he or she has performed, where you live, what type of health insurance you have and your current physical condition.
The American Society for Metabolic and Bariatric Surgery (ASMBS) can help you and your PCP locate a weight-loss surgeon. The ASMBS promotes the practice and improvement of bariatric surgery through research and education. A member of the ASMBS is board-certified in weight loss surgery and has been the lead surgeon in at least 25 bariatric operations in the previous two years.
Supported through an educational grant from Allergan Inc.
