Making changes to your diet and increasing exercise are traditional methods for weight loss. But for some people who are battling obesity, these solutions aren’t always practical. Mobility challenges brought on by weight gain or other medical conditions can make it difficult to exercise. And restrictive diets can be unrealistic and unsustainable.
When diet and movement methods aren’t working or have resulted in a yo-yo effect (a cycle of losing weight, then gaining it back), patients may want to talk to their physicians about surgical weight-loss options.
“Many times, folks just need a little help, a little pull out of the hole that obesity and other diseases have placed them into,” said Vanderbilt Center for Surgical Weight Loss medical director Dr. Matthew Spann.
What types of weight-loss surgeries are available?
The three main types of weight-loss surgery are: sleeve gastrectomy, gastric bypass and duodenal switch.
Sleeve gastrectomy. Your surgeon will remove a portion of your stomach to reduce its size by about 70%. The portion removed produces about 90% of the body’s hunger hormones.
Gastric bypass. This procedure bypasses about one-third of your intestines to minimize calorie absorption and to help food move faster through your digestive tract. This procedure works on hunger hormones, but it also increases hormones that tell your brain you’re full. The procedure helps with the body’s processing of blood sugar, which is important for the prevention or even reversal of type 2 diabetes.
Duodenal switch. This procedure combines elements of sleeve gastrectomy and gastric bypass. It bypasses about half to two-thirds of the intestines.
What are the benefits of weight-loss surgery?
Weight-loss surgery offers several benefits, including:
Improved health. Some people eliminate their type 2 diabetes, and some are better able to control their blood sugar using fewer medications after bariatric surgery. Patients are also likely to experience improvements in their cholesterol, with many no longer requiring cholesterol-lowering medications. Patients with joint pain often report that they found relief from pain and gained better mobility after their surgeries. Weight-loss surgery can also improve fertility.
Initial weight loss. “Patients lose between 20 to 30 pounds in the first month,” Spann said. “That rapid weight loss drastically changes a lot in your body.”
Better ability to move and walk. Some patients go from not being able to walk a complete loop on a track pre-surgery to walking up to a few miles at a time within a month or so post-surgery. Increased mobility, in turn, makes it easier to lose more weight and has many health benefits.
A change in hunger hormones. Some patients have to remind themselves to eat because they no longer have the cravings they used to. These changes in hunger and fullness can also help disrupt a person’s previous relationship with food.
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How do you know if you’re a candidate?
The National Institutes of Health recently changed the criteria for weight-loss surgery. If you answer yes to any of the following questions, you may qualify:
- Are you more than 75 pounds over your ideal body weight?
- Do you have a body mass index (BMI) of 35 or higher?
- Do you have a BMI of 30 or higher and also experience severe negative health effects related to being severely overweight? Such negative health effects include high blood pressure, high cholesterol, diabetes, sleep apnea or arthritis.
How soon will you see results after weight-loss surgery?
“Usually, folks have lost about 15% of their excess body weight around that first-month visit and around 30% of their excess body weight by the three-month visit,” Spann said. “So it starts pretty quickly.” Most excess weight will have been lost at the full-year mark.
What should you expect long term after surgery?
About 65% to 75% of patients who undergo weight-loss surgery tend to remain within 10% of their lowest body weight. You’ll continue to follow up with your doctor. If you are starting to gain weight again or are experiencing cravings, your doctor may prescribe a medication to help bolster weight loss or aid maintenance.
Although it is not uncommon to see a weight regain of 5% to 10% in the two years after surgery, most patients maintain weight loss equal to or greater than 50% of excess body weight long term, compared to 95% of individuals who gain their weight back after conventional weight-loss methods.
Some weight-loss surgeries may lead to vitamin and mineral deficiencies caused by reduced nutrient intake or reduced absorption from the intestine. However, most of these deficiencies are avoided by regular use of oral vitamin and mineral supplements. Health problems related to vitamin deficiencies are rare in patients who follow the recommended guidelines.
What are the risks of surgical weight loss?
Some people fear complications and death from surgery, even while having a strong desire to be healthier. The risk of death with the surgery is very small. There are risks with any surgery, and risks that come with obesity as well. Statistically, someone’s chance of dying from any cause goes up about 10% for every five Body Mass Index points above normal weight (a BMI below 25). Thus, having a BMI of 40 or 45 carries a greater risk of death than having weight-loss surgery.
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What are the alternatives to surgical weight loss?
For those who don’t struggle with obesity, focusing on diet, exercise, sleep and stress is a good start. Weight-loss medication is appropriate for some people. If you have obesity (a BMI of 30 or higher); or if your BMI is 27 or higher and you have a weight-related medical condition (for example, type 2 diabetes, high blood pressure, fatty liver or others), combining weight-loss medication with lifestyle changes may help. There are several FDA-approved medications available.
A common topic in medical weight loss right now is the use of glucagon-like peptide-1 receptor agonists, commonly called GLP-1 RAs and also known as peptides or injectables. GLP-1 RAs include semaglutide (under the brand names Ozempic, Rybelsus and Wegovy), tirzepatide (Monjouro and Zepbound), liraglutide (Victoza and Saxenda) and more.
Some GLP-1 RAs are only approved for treating type 2 diabetes, while others are approved for treating obesity or a combination of the two. Most GLP-1 RAs are injectables, while some are oral tablets.
If you’re concerned about your weight, a good place to start is talking to your primary care provider about the options that might be right for you.
