Dear Mayo Clinic: For years I have battled obesity and tried to lose weight through healthy eating and exercise. My doctor recently told me that I could be an ideal candidate for bariatric surgery. What is Bariatric Surgery? Are there different types of programs available?
answer:
Obesity is a disease, and overcoming it is often not easy. The Centers for Disease Control and Prevention defines overweight or obesity as “weighing above a healthy weight for a given height.” We assess the severity of obesity by body mass index, or BMI, which is weight divided by height squared. The higher the BMI, the more severe the obesity.
Obesity is a complex disease with many predisposing factors and causes. While eating unhealthy foods and not getting enough physical activity can lead to obesity, other factors including psychological, behavioral and genetic causes also play a role. Certain medications can also increase weight and cause overweight.
Due to the complex reasons behind obesity, managing this disease is not simple and requires a multidisciplinary team to treat and heal. While healthy eating and exercise are encouraged, these often need to be supplemented with other treatments to reduce weight and treat severe obesity. For example, your healthcare team may include a weight loss drug that has recently shown great promise in reducing weight into your treatment plan. However, weight gain after stopping diet pills is quite common. Endoscopic therapy is also an option for patients whose BMI falls into the low- or intermediate-risk obesity category. While these options are effective in some patients, weight recurrence is a problem, especially if used in high-risk obese patients.
The most effective treatment for obesity is bariatric surgery, also called bariatric surgery. Bariatric surgery not only results in significant weight loss, but also offers the longest lasting method of losing weight. Bariatric surgery can result in a 30% to 40% weight loss. In addition, weight loss usually lasts for many years, and the risk of weight recurrence is low. Bariatric surgery can also address or treat many other obesity-related conditions. These include high blood pressure, elevated cholesterol levels, sleep apnea, and diabetes.
Bariatric surgery is often recommended for patients with a BMI of at least 40 or higher than 35 if obesity is related to other conditions such as high blood pressure, reflux, diabetes, sleep apnea, joint problems, or other conditions. Patients with a BMI of 30 to 35 may be eligible for surgery if certain conditions occur.
The four most common types of bariatric surgery include sleeve gastrectomy; gastric bypass; modified duodenal switch, or SADI-S; and traditional duodenal switch.
A sleeve gastrectomy involves removing or suturing about 80% of the stomach and leaving a tube-like stomach the size and shape of a banana. This surgery limits the amount of food you can eat and also prompts hormonal changes that reduce hunger.
The second most common surgery is gastric bypass surgery, also known as Roux-en-Y gastric bypass surgery. Gastric bypass involves creating a pouch from the stomach and connecting the pouch directly to the small intestine. Bypass surgery also changes certain hormone levels, which can help you feel less hungry and lose weight.
For patients with higher BMI, modified duodenal diversion and biliopancreatic diversion with duodenal diversion are recommended. Both procedures are very effective, especially in people with diabetes. However, you must strictly follow nutritional recommendations.
At the Mayo Clinic, bariatric surgery is performed using minimally invasive techniques, either laparoscopic or robotic. Patients will have only a few half-inch incisions and will be able to walk and drink within hours of the procedure. Often, patients only need to spend one night in the hospital before going home. Mayo Clinic's multidisciplinary team includes endocrinologists, nutritionists, psychologists, and bariatric surgeons who develop a treatment plan based on each patient's individual needs and characteristics and provide support through all stages of the weight loss journey. — Dr. Omar Ghanem
Surgery, Mayo Clinic, Rochester, MN
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