Choosing the Right Weight Loss Surgery for You

Disclaimer: This post contains content from multiple website, in addition to my opinion. This is not to be taken as an exhaustive resource, rather, it’s a starting point for you to do your own research with your medical team. Everyone is different, and no one procedure works for every individual. Do your homework and make your decision based on your findings. I post this information merely to assist you in your search.

 

From Web MD:

There are two basic types of weight loss surgery — restrictive surgeries and malabsorptive/restrictive surgeries. They help with weight loss in different ways.

  • Restrictive surgeries work by physically restricting the size of the stomach and slowing down digestion. A normal stomach can hold about 3 pints of food. After surgery, the stomach may at first hold as little as an ounce, although later that could stretch to 2 or 3 ounces. The smaller the stomach, the less you can eat. The less you eat, the more weight you lose.SBS Note – This is the surgery type I chose (Lap Band) because I did not want the rerouting of my digestive system.
  • Malabsorptive/restrictive surgeries are more invasive surgeries that work by changing how you take in food. In addition to restricting the size of the stomach, these surgeries physically remove or bypass parts of your digestive tract, which makes it harder for your body to absorb calories. Purely malabsorptive surgeries — also called intestinal bypasses — are no longer done because of the side effects.

Which Weight Loss Surgery Is Best?

The ideal weight loss surgery depends on your current health and body type. For instance, if you are very obese, or had abdominal surgery before, minimally invasive surgeries might not be possible. It really pays to talk with your doctor about the pros and cons of each procedure.

If possible, go to a medical center that specializes in weight loss surgery. Studies have shown that the risk of complications is lower when weight loss surgery is done by experts. No matter where you are, always make sure that your surgeon has had plenty of experience performing the procedure you need.

SBS Note: Take your particular situation into account when making your decision. Decide how much information you need and then get it – don’t let television commercials, well-meaning family and friends, or other advisors sway you to what THEY want. The surgery is happening to YOU – it’s YOUR body that will be changed – so you need to be comfortable with the process. Write down your questions and get them answered before making a final decision, and realize that your medical history and any co-morbidities present may also affect the decision making process.

 

Is Weight Loss Surgery Right for Me?

Weight loss surgery is not for everyone. Doctors only recommend it for people who:

  • Have a body mass index (BMI) of 40 or more. This would be about 100 pounds overweight for men or 80 pounds for women.
  • Have a lower BMI (of 35 to 40) but also have a serious health problem related to obesity, such as heart disease, type 2 diabetes, severe sleep apnea, or high cholesterol.
  • Have tried and failed to lose weight by other means.
  • Fully understand the risks.

In early 2011, the FDA approved the use of LAP-BAND surgery in those with a BMI of 30 or higher who have at least one obesity-related condition, such as diabetes.

Even if you meet these basic criteria, there’s a lot more you have to consider. Perhaps most importantly, you need to be mentally ready. Weight loss surgery can be lifesaving, but it is not a cure. Instead, it’s the first step in a lifelong commitment. For any surgery to help, you need to be dedicated to making dramatic and permanent changes to how you eat, exercise, and live.

SBS Note: Consider your personality type when choosing a surgery – are you self-directed and self-motivated? Do you foresee a future where you are active and exercising strenuously, or would you prefer to stick with a lower intensity level of movement? What’s the availability of your doctor / surgeon? Can you visit them easily? Does your health insurance plan cover after-care (like Fills or Adjustments for the Lap Band) or will that be an out-of-pocket expense for you?

Try to consider every aspect of your life both before AND after the surgery to help you make the decision on what’s right for you.

 

From the Obesity Action Coalition:

Considerations When Choosing a Surgery Type

Expected Weight-loss
In general, gastric bypass patients will lose around 70 percent of their excess weight, sleeve gastrectomy patients will lose around 60 percent, and gastric banding patients will lose around 50 percent.

All of this depends, however, on how well a patient follows up and if the patient works on all the necessary lifestyle changes that must occur to make them successful over the long-term. I think it is important to keep in mind that even though gastric banding patients tend to lose less weight, they still see significant improvement in their health and quality of life.

Reliability of Weight-loss
Gastric bypass and sleeve gastrectomy patients almost always achieve the expected weight-loss outlined above. I do not worry about these patients losing weight; I worry about them regaining it down the road. This will occur if they do not make the necessary lifestyle changes in the first year after their weight-loss operation.

Weight-loss with adjustable gastric banding is much more variable. Some patients will lose 70-90 percent of their excess weight (remember, 50 percent is expected), but some will lose almost no weight. You see, with a band, if patients are not following-up and working on lifestyle change IMMEDIATELY, they just will not lose weight. The good news is that when a gastric banding patient loses weight, they almost always keep it off because they had to make lifestyle changes to take off the weight and that is what keeps it off for ANY weight-loss operation.

Fast or Slow
Gastric bypass and sleeve patients will typically lose five to seven pounds a week early on and will reach their expected weight-loss 12-15 months after their operation. Some patients say, “I am having this operation to lose weight and I want it off NOW!” That is more of a gastric bypass/sleeve type of weight-loss.

On the other hand, gastric banding patients tend to see a slower, steadier weight-loss (losing one to two pounds per week) but will see this continue until they reach their expected weight-loss around two years after their operation.

Fear of the Unknown
There are good studies looking at the long-term effects of gastric bypass and adjustable gastric banding. It appears that both of these operations are safe, lead to significant weight-loss and improvement in weight related medical problems, and most importantly, maintenance of the weight-loss.

The same cannot be said for the sleeve gastrectomy at this point. Certainly the studies currently available show this operation to be safe and effective, but because the operation is so new, we do not yet know what is going to happen to patients 5 or 10 years after this operation. Will they see weight regain? Will there be problems due to removing so much stomach? We just do not know the answer to these questions yet.

Ability to Follow-up
In order to get an adjustable gastric band to be effective, it HAS to be adjusted. In the first year after surgery, gastric banding patients are typically seen more frequently than gastric bypass or sleeve patients, so it is important that a gastric banding patient be able to make these follow-up appointments in order to achieve maximum weight-loss.

If your employer makes it very difficult for you to get to your doctor appointments or if you live a great distance from your surgeon (more than 2 hours), you are less likely to follow-up and therefore less likely to do well with your band.

Fear of Needles
In order to “fill” the band, a needle must be used. The needle is small and fills do not really cause much pain, but if you are afraid of needles it does not matter if the needle is small.

I will never forget a patient that I inherited after he went to Mexico to have his band placed. I went to fill his band for the first-time and he said, “You have to use a needle? Dr. Stegemann, I am deathly afraid of needles!” As I put the needle into his port, he passed out. Needless to say, he really should have thought about that before he had a band.

Punishment Factor
Gastric bypass patients will very likely experience “dumping” if they eat foods containing sugars. After eating a sugary food, their heart starts racing, they start sweating and then they get severe abdominal pain, dizziness and oftentimes diarrhea. This really helps them stay away from those foods that may have caused them problems in the past.

Some patients like the idea of knowing that if they “cheat” on their operation the operation will punish them for it. There is no dumping with gastric banding and sleeve patients so they need to be more disciplined in their food choices when it comes to sweets.

Foreign Body Fear
Gastric band patients need to be VERY comfortable with having the band in you for the rest of your life. We do not take the band out when patients reach a healthy weight. Please do not be like one of my band patients who called two weeks after surgery and said, “Dr. Stegemann, you have to take this out. I can’t sleep knowing it is inside of me.”

Reversibility
Some patients choose to have a band because they believe that if the “cure” for obesity is found or they develop some other “problem,” they can have it taken out. While it is true that taking out a band is pretty straightforward, there are few reasons why a surgeon would remove a band.
And, despite what you may have heard, a gastric bypass is also reversible. Certainly it is more challenging to reverse a bypass than it is to remove a band, but it can be done. A sleeve gastrectomy, however, cannot be reversed. If a band is removed or a bypass is reversed, a patient almost always begins regaining weight as they no longer have the “tool” that controlled their hunger and portion size.

Fear Factor
Many patients fear a gastric bypass or a sleeve gastrectomy because they feel it is “more invasive” and therefore more dangerous.  While it is true that a gastric bypass and a sleeve gastrectomy are bigger operations, when we look at the complication rates of all three operations, they are the same: 10-15 percent of patients will experience a complication related to their operation at some point. I think it is also important to keep in mind that weight-loss surgery has NEVER been safer than it is today.