Obesity

Bariatric surgery, derived from the Greek word “baros” meaning weight, is designed to reduce obesity indirectly by restricting the amount of food calories a person can digest. Some bariatric operations (eg. lap band) achieve this by reducing the size of the stomach size. Other operations (eg. roux-en-Y gastric bypass) go one step further. As well as reducing stomach volume, they also reduce the length of the small intestine. This constitutes a more permanent alteration of the digestive tract and makes it more difficult for the patient to cheat.

How To Qualify For Bariatric Surgery?

According to the National Institutes of Health Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, you may be a candidate for obesity surgery only if: (1) you have a body mass index (BMI) of 40+ (about 100 pounds overweight), or (2) your BMI is 35+ and you suffer from severe weight-related health problems such as hypertension, high cholesterol, type 2 diabetes, heart disease or severe sleep apnea.

Are You a Suitable Candidate for Bariatric Surgery?

Meeting the above criteria does not guarantee your eligibility for weight loss surgery. Most bariatric clinics operate a screening policy and only approve candidates who are (a) ready to make appropriate long-term behavioral changes; and (b) committed to long-term (even lifelong) medical follow-up. This is because weight loss surgery can only be successful if you are willing to change your existing eating and exercise habits, on a permanent basis.

What Are The Main Types of Bariatric Operation?

There are two main types of obesity surgery: gastric banding and gastric bypass. These operations may be performed using traditional “open” surgical techniques, or minimally invasive laparoscopic techniques using instruments connected to video monitors, which allow the surgeon to “see inside” the patient without having to make large incisions. Patients who undergo laparascopic surgery suffer fewer perioperative and post-operative health complications, and typically remain in hospital for 2-3 days, compared to 4-5 days for open surgery. They return to work within 2-3 weeks, compared to 4-6 weeks for traditional surgeries.

Gastric banding is sometimes referred to as “restrictive surgery”. This is because it works by restricting calorie intake only. During a gastric banding operation, the surgeon shrinks the stomach from melon to egg size using special staples, or a silicone band. These procedures are more easily reversible as they do not fundamentally alter the anatomy of the digestive system. The drawback is, patients find it easier to “cheat”. Thus stomach banding is not as effective for weight reduction as stomach bypass. Examples of gastric banding procedures include: adjustable gastric banding such as lap band, and vertical banded gastroplasty.

Gastric bypass, sometimes called “malabsorptive” surgery since it restricts the absorption of calories and nutrition, is a two stage process. First, the surgeon reduces the size of the stomach. Second, the first part of the small intestine (duodenum and jejunum) is bypassed. This causes food to pass much more rapidly through the digestive tract and significantly reduces the amount of nutrients and calories that can be absorbed. So even if patients overeat, they will absorb less. As a result, weight loss after gastric bypass is typically greater than after gastric banding. Examples of stomach bypass procedures include: roux-en-Y, biliopancreatic diversion, and duodenal switch.

What Can You Eat After Bariatric Surgery?

As a bariatric patient, you must expect a drastic change of eating habits following your operation. In general, due to the small size of your new stomach pouch, you will feel full after only a very small amount of food. Over-eating or eating too fast can cause extremely unpleasant nausea, referred to as “dumping syndrome“. The typical post-operative diet regimen comprises four stages. Immediately after surgery, you may ingest clear liquids only. After 2-3 days this broadens to include any liquids. After about 2 weeks semi-solids may be consumed, leading to a low-fat solid diet after 5-6 weeks. Progress depends upon the individual circumstances of each patient.

What About The Problem of Loose Skin?

During the 12-24 months following a successful bariatric bypass or banding operation, you may lose as much as 50-80 percent of your pre-operative excess weight. As a result, you may develop a significant amount of loose skin. In addition, as your weight loss may not occur evenly throughout your body, you may suffer from unsightly pockets of excess fat. Generally speaking the only solution for these problems is plastic surgery. Common procedures include: tummy tuck, thigh-lift, panniculectomy, breast-lift, male breast reduction, arm-lift and neck lift. Liposuction is not generally considered to be a weight-related procedure as it only removes fat. It does not excise loose skin or tighten loose muscles. One point to note, is that, unlike bariatric surgery, this type of plastic surgery is not covered by medical insurance as it is deemed to be a “cosmetic” procedure.

What is The Cost of Bariatric Surgery?

The costs of bariatric surgeries vary according to the surgeon, the type of procedure performed, and the range of support services offered. Basic prices range from $25,000 to $35,000.

Is Bariatric Surgery Covered By Insurance?

Medical insurance coverage varies by state and insurance provider. Several states have passed legislation requiring insurers to offer weight loss surgery for patients, providing it meets health criteria laid down by the National Institutes of Health. However, getting insurance approval by yourself can be a time-consuming process. Ideally, work with your surgeon/doctor and get him/her to explain to your health insurance provider that the proposed surgery is not a cosmetic procedure but an operation which will help you minimize major health problems later in life. Once your insurance company understands that the surgical operation is a money-saving procedure, they often agree to provide cover. Some bariatric clinics claim an 80 percent success-rate for obtaining insurer-approval in this way.

David Johnson, LLb., is the senior researcher at http://www.bariatric-surgery.info which offers a range of information about gastric banding, stomach bypass and other weight-related surgeries to more than 2 million unique visitors per year.

Bariatric Surgery
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