It’s definitely not a decision that’s entered into lightly. After all, having a procedure that helps regulate your weight is a life altering choice. There are numerous thoughts that may cross your mind, varying from positive and negative emotions to feelings that may be rooted in fear. Of course, all of these thoughts are completely natural. In fact, it would be somewhat unusual if these conflicting feelings weren’t racing through your mind at some point.
With that being said, this also isn’t a decision that your doctor, specialist, or family can make for you. Just because bariatric surgery may be presented as an option, doesn’t mean that it’s necessarily the best choice.
This week, we’ll talk more about bariatric surgery, how it works, and some of the risks and benefits.
Full disclosure: the three of us work in an outpatient clinic that supports people before and after bariatric surgery. Having said that, this post is not intended to “sell” you on surgery; only to highlight some of the important factors to think about when trying to decide if surgery is right for you.
What Is Bariatric Surgery?
Bariatric surgery refers to a number of similar surgical procedures that are designed to assist with weight loss. Bariatric surgery has been around for more than 50 years, but has become much more prominent in the last 20 years. While there have been numerous versions of the surgeries over the years, the most common bariatric procedures performed today are:
Roux-en-y Gastric Bypass (aka RNY or gastric bypass)
Sleeve Gastrectomy (aka sleeve)
Laparoscopic Adjustable Band (aka lap-band)
Duodenal Switch (aka DS)
Who Qualifies for Bariatric Surgery?
The criteria for bariatric surgery have been in place since the early 1990’s, and are unfortunately still based on the outdated Body Mass Index (BMI). We’ll certainly write a post on why we hate BMI in the future! While there are many other factors that can determine eligibility for surgery, the main criteria are as follows:
Having a BMI over 40, or
Having a BMI over 35 and having one or more weight-related health conditions like diabetes, high blood pressure or sleep apnea.
This website can help you calculate your BMI - but remember, BMI might tell you if you qualify for surgery, but it doesn’t tell you how healthy you are!
How Does Bariatric Surgery Work?
Experts used to think they knew the answer to that question! For years, people assumed surgery worked by forcing people to eat smaller portions and/or by causing the body to absorb fewer calories. It turns out to be much more complicated than that. While the exact mechanisms of surgery are not fully understood, it is believed that bariatric surgery actually causes metabolic and hormonal changes that cause people to feel fuller faster, as well as to suppress hunger and food cravings. Furthermore, these changes help to counteract the body’s defence mechanism against weight loss. Using the spring analogy from our previous post, you could say that bariatric surgery helps to loosen the tension on the spring slightly - meaning your body doesn’t fight back quite as hard to regain weight.
How Effective is Bariatric Surgery?
Regular readers of our blog will know that we sincerely believe that health is about so much more than just body weight. With that in mind, “success” can mean a lot of different things to our clients, particularly when it comes to improvements in diabetes, blood pressure, joint pain or quality of life. Still, let us say this as clearly as we can: bariatric surgery is without question the most effective long-term treatment for obesity and its related health conditions. While the vast majority of people regain weight after dieting, the vast majority of people are able to maintain significant weight loss after surgery. More importantly, bariatric surgery can have a dramatic effect on diabetes and high blood pressure, with many patients seeing improvement or full remission after surgery.
How Safe is Bariatric Surgery?
While bariatric surgery has a significant upside as noted above, there are certainly more risks involved when compared to making lifestyle changes or taking a medication to manage weight. Having said that, a very common belief is that bariatric surgery is very dangerous, and should only be reserved for extreme cases or when used as a last resort. In fact, the safety of bariatric surgery has improved dramatically as the procedures have become more common. The 30-day mortality rate of bariatric surgery in North America is around 0.13%, which is actually lower than the risk for having your gallbladder out. Your individual risks would need to be determined by your healthcare team, and can vary quite a bit based on age and other health conditions.
What Other Risks Are There?
While the surgical risk associated with bariatric surgery is quite low, there are a number of other issues worth mentioning. Nutritional deficiencies are a real concern due to reduced intake and reduced absorption of vitamins and minerals. To prevent this, people need to take vitamin and mineral supplements every day for life after surgery. Side effects like dumping syndrome and hypoglycemia (low blood sugar) can become a problem for some patients. People are at higher risk for gallstones and kidney stones after surgery as well. There can also be psychosocial concerns like changes in relationships and friendships, changes in mental health and higher risk for alcohol abuse all being associated with bariatric surgery.
So now you’ve learned more details about bariatric surgery. Next week, we’ll help you figure out if surgery is the right choice for you.
If you’re preparing for bariatric surgery, or have previously had it and are looking for some support, check out our services page! We’d be more than happy to talk to you about how we can help you out.
Thanks for reading,
Adam
Sarah
Stephanie