What is Weight Loss Surgery?
Weight loss surgery, also known as bariatric surgery, involves an operation to help a person lose weight more effectively than dieting and sustain the weight loss in the long term. Successful weight loss surgery induces the loss of up to two thirds of excess body weight over a period of two years, a goal unachievable by any other known method. Typically, patients lose 2 to 3 stone during the first 6 weeks after surgery but weight loss continues out to about 2 years.
If you’re considering weight loss surgery, please read all the facts here.
Am I Overweight?
BMI is a calculated index of how overweight a person is. A normal healthy person has a BMI of 18.5 to 24.9. If a person is a little overweight, their BMI is 25-29.9. If a person’s BMI is 50 or more they are considered to be super-obese. A BMI of more than 35 suggests that you are becoming dangerously overweight, a condition known as morbid obesity. This is because you are at risk of developing illnesses associated with being overweight – diabetes, arthritis, high blood pressure and heart disease. Breathing difficulties such as asthma and obstructive sleep apnoea can also occur. Sleep apnoea begins with snoring and eventually results in a lack of oxygen for your brain when you are asleep. People with sleep apnoea typically have to get up in the middle of the night because they feel short of breath.
Are there any guidelines for who is best suited to surgery?
In the UK, we are guided by a group called the National Institute for Clinical Excellence (NICE) for major healthcare issues. NICE has stated that if a person has a BMI of 35 and they also have some comorbidity (illness related to being overweight) or a BMI of 40 or more without comorbidity then weight loss surgery is recommended. This is because the chances of managing to lose weight by any other method are so low. Unfortunately, not everyone who fulfils NICE guidelines is approved for weight loss surgery because of funding restrictions. Talk to your family doctor to find out if funding is available for you. If you are not eligible, relatively low cost private surgery is available with Prof Lodge at Leeds Nuffield Hospital.
What weight loss surgery is right for me?
In the clinic Prof Lodge will be able to advise you about weight loss surgery options. There are restrictive options, the best of which is sleeve gastrectomy as this is a more permanent solution than a gastric band. The Roux-en-Y gastric bypass uses a combination of restriction of intake and also malabsorption – you eat less and you absorb less. There are more radical malabsorption operations but they have a lot of side effects and they are rarely recommended. For some patients, revisionary surgery after previous weight loss operations may be a possibility.
How is the surgery done?
This involves putting 4 small telescopes (called ports) into the tummy to allow special instruments to enter the abdomen to do the surgery. In addition a very small retractor is used.
For sleeve gastrectomy, a portion of the stomach is removed using special stapling instruments, which prevent leakage. Careful checks are done before the ports are removed.
In a gastric bypass, the first stage is to create a small pouch from the stomach, reducing its capacity. The second stage involves bypassing a portion of the intestine to reduce absorption. The final stage involves carefully checking all the stitch lines and joins before removing the ports. Because the joins are sewn by hand, most patients report that they can eat normally by the end of the first week after surgery, and have a full recovery after the second week.
The Scandinavian weight loss surgery techniques are technically demanding for the surgeon, but less invasive for the patient. Average surgical times are between 45 minutes and 2 hours. The result is that after successful surgery, almost all patients can go home within 24 hours of surgery.
“I feel like I have been given a second chance at life and I am thoroughly enjoying it!”
What are the risks?
Risks of surgery always have to be weighed up against the risks of not having surgery – the life time risk of remaining seriously overweight. It would not be sensible to consider an operation without thinking about the risks involved. All of these risks will be explained and written information will also be given to you to read after your consultation. Any operation carries with it a small risk of blood loss or infection. When an operation involves making joins between pieces of bowel, there is a small risk of leakage. This is the reason for staying in hospital overnight – so that you can be monitored closely to make sure everything is fine before you go home.
How long does it take to recover?
Following successful laparoscopic surgery, most people are fully recovered within 2 weeks of the operation. You may still have some trouble tolerating specific foods, but you should be back to all of your normal activities. Laparoscopic surgery doesn’t look much on the outside, but you have to remember it’s still a big operation inside so you may experience some aches and pains over the next couple of weeks while everything is healing up.
How do I prepare for weight loss surgery?
The best way to prepare for any surgery is to be as fit as possible before hand. This can be difficult if you are very overweight but there are some tips you may find useful. The liver tends to enlarge as we get fatter. This is due to an increase in the number and size of the fat cells in the liver. This can make the surgery more tricky as the liver lies directly over the part of the stomach where the operation is done. Experts in Scandanavia have worked out that if a person can lose 8% of their body weight before surgery then this makes the operation easier and speeds recovery enormously. This sounds a lot but for most patients it works out to be between 1 and 2 stone. This can usually be achieved by cutting out carbohydrate as much as possible fora few weeks – that means no bread, potatoes, rice or pasta. In the final 10 days leading up to surgery, a special “liver shrink” diet is advised and this is something we can help you with.
How rapid is the weight loss after surgery?
Successful weight loss surgery aims to result in a loss of up to two thirds of excess body weight. The degree of weight loss achieved depends to some extent on how heavy you are at the time of surgery. Most patients lose 2 to 3 stone in the first 6 weeks and a similar amount over the next 4 to 5 months. The operation is designed for a gradual loss of weight over a two year period as procedures designed for more rapid weight loss have been associated with significant side effects in the past. As you lose weight it is important to increase the amount of exercise that you do. Exercise is an important component of weight loss and will help to avoid problems with loose skin. Some patients consider plastic surgery to improve body contour but you shouldn’t make decisions about that until at least 2 years from surgery.
What will life really be like for me after this surgery?
Weight loss surgery should be regarded as the start of a new life. As mentioned above, the operation makes your stomach smaller so you will always eat smaller portions than you have been used to. Most patients don’t find this to be a problem as they feel full more quickly and also feel less hungry between meals. If you eat too much sugar or fat in a meal you may experience dumping. This is something you will learn to avoid. The majority of patients tolerate all the usual food groups in normal quantities. As your weight comes down, you will notice that your energy levels increase and you can do more exercise.