Weight Loss Surgery FAQs

When should weight loss surgery be considered?

Surgery should be considered for morbidly obese people, who have failed non-operative weight loss options. They should be obese for several years and not have any active drug or alcohol addictions or major psychiatric disorders. In addition, the risk and emotional cost of their obesity should exceed the risk of having an invasive operation. Potential patients should realize that while surgery provides the best chance of lasting weight loss, it comes at the cost of an invasive operation that carries risk. Additionally, surgery works by altering how you eat, thus sacrifices are mandatory and not always pleasant.

People will have different reasons for exploring surgery for their obesity. Some have serious illnesses such as diabetes, sleep apnea, hypertension or degenerative joint disease caused by excess weight. For others, the primary motivation is the psychological impact the weight is having on their lives. Whatever the reason, it is essential to realize that surgery for obesity is a major operation that can have complications. Making the decision to have surgery requires careful thought.

How can surgery make me lose weight?

There are two ways the gastrointestinal tract can be altered to cause weight loss. The stomach can be made smaller, (gastric restriction) so that a person feels full after eating less food. An analogy would be reducing the gas tank of your car from a 15 gallon tank to a 1 gallon tank.

The second mechanism is reducing the amount of intestine that the food comes in contact with. As a result, less of what is eaten is absorbed. Thus malabsorption occurs.

Different operations use these two mechanisms in various ways. Certain operations are pure gastric restrictive procedures. Many combine gastric restriction with moderate malabsorption. Pure malabsorptive procedures are rare today. It is important to realize that there is no perfect operation, therefore your surgeon will discuss the advantages and disadvantages of all potential procedures, be it gastric bypass surgery, or another procedure.

Why can I expect surgery to work, when I failed so many other weight loss remedies?

Surgery provides a control mechanism that goes everywhere that you go. While it is still important to make good decisions and exercise on a regular basis, surgery makes these goals realistic for patients. Bariatric surgery forces you to change your eating habits, or you can experience unpleasant side effects. As a result, on average, patients lose between 50 to 70% of their excess weight and keep the majority off for an extended period. The ability to eat as you once did is traded for the probability that you can lose weight and live a more active lifestyle. In fact, 35% of patients following obesity surgery can adhere to a regular exercise program. In comparison, very few can do so with medical therapy.

What are my options besides weight loss surgery?

Surgery should be considered when you feel you have explored all other options, or your condition is so severe that it requires rapid, urgent treatment. Nutritional counseling, exercise and group programs should all be considered prior to surgery. Most insurance companies require at least two substantial attempts at non-operative weight loss be documented prior to certifying surgery. Stated differently, if you can lose weight without an operation you are better off. If you cannot and obesity is affecting your health or quality of life, then surgery should be considered.

How much weight can I expect to lose?

The amount of weight a patient will lose depends on a wide range of variables and cannot be predicted. It depends on your genetic makeup, how active you’ve become, what operation you select and numerous other factors. It’s difficult to accurately know how much you eat before surgery, how much you will be able to eat after, how much exercise you will do and what your metabolic rate is, thus no accurate prediction can be done.

On average, people lose approximately 70% of their excess weight after one year following a gastric bypass. Patient results show that after 10 years, most will maintain 60% of the initial weight loss. With the Adjustable Gastric Band, weight loss is 55%to 60% of excess weight.

Patients should be reminded that an operation does not replace the need to make good decisions. Patients who adhere to a vigorous exercise routine frequently can reach a weight close to their ideal body weight and maintain it. Those that only rely on surgery and do not change their behavior and become more active will not have the same result.

What is the worst thing that can happen after obesity surgery?

The worst thing that can happen is that someone can die. This is unusual, and the chance that it can happen is reduced by selecting physicians that specialize in bariatric surgical procedures and are experienced in handling complications that can arise during obesity surgery. Potential complications include, but are not limited to, the risk of anesthesia, infection, bleeding, blood clots, hernias and wound complications. This is not stated to frighten you, but to remind you that this is a big decision and not without risk.

How do patients do after surgery?

It is recommend that you attend a support group and speak with patients. That is probably the best way to get insight. Most are extremely happy. Losing a substantial amount of weight has changed many parts of their lives. They report having more energy and many are able to do things that they were unable to do prior to surgery. Some feel that they have gotten parts of their lives back. There is an adjustment, but a substantial majority feel that the sacrifice is well worth it.

It is important to remember that certain people have a very difficult time after surgery. For some, food was their drug of choice and obesity surgery makes it unpleasant to eat. They become frustrated and depression can occur. Unfortunately, there is no medical test that can accurately predict how an individual will adjust. It is best to surround yourself with a good support system.

What are the risks of surgery?

All bariatric surgery operations are major procedures and have serious risk. The national average mortality for gastric bypass surgery is .5%. Major early complications include leakage of intestinal attachments causing infection and requiring additional surgery, bleeding, blood clots, and any other complications that may occur after major gastric surgery. Wound complications, infections, and hernias can occur. Additionally, there is the risk of malnutrition and vitamin deficiency. This list is far from exhaustive.

While most of these issues rarely arise, the major point is that these procedures should only be done when necessary and by doctors that have experience in this area.

When can I return to work?

There is no specific time limit when a post-operative patient can return to work. Certain patients, who have jobs that are not physically strenuous, have returned to work or school in one week. This is uncommon, and in general, it takes at least two to three weeks and occasionally more. The reason for delay is not pain, but lack of strength and difficulty making the adjustment to a different way of eating. Obviously, any medical complication can cause delay.

For patients with strenuous physical jobs, 6 weeks is necessary to allow for adequate healing. If arrangements can be made, you can return to light duty earlier.

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