Medical Treatments for Obesity – Part 5: Bariatric Surgery

April 27, 2017

Surgical treatments for obesity also known as bariatric surgery are effective, but also come with significant risks.

We all know too well the negative effects of obesity – diabetes, heart disease, high blood pressure and cancer to name a few. This is part five of a six part series on obesity.

Bariatric surgery not only results in weight loss, but can improve chronic conditions like high blood pressure, sleep apnea, type II diabetes as well as reductions in heart attack and stroke. The success of surgical therapy for weight loss accounts for the statistics that 175,000 bariatric procedures were performed in the United States in 2013.

Here is a rundown on the 3 types of bariatric surgery commonly used in the United States.

Lap band surgery consists of the surgeon placing an adjustable belt about the upper stomach, which creates a small pouch that restricts the total volume of food can be eaten. It is considered to be less effective in weight loss than the other two types and may have to be adjusted periodically. Unlike gastric bypass, the lap band can be reversed, which is a distinct advantage. The band can erode into the stomach and even slip off from its anchor point.

Surgeons perform the gastric sleeve by removing a significant portion of the stomach as shown in the diagram. Patients are left with a stomach shaped like a sausage, which reduces the volume of food that can be eaten. This procedure is permanent and alters the physiology of digestion, which can lead to malnutrition and its associated conditions. The suture line may leak postoperatively, which can result in major complications and the necessity for re-operation.

The third procedure is called Roux-en-Y. This is the classic gastric bypass surgery. Data shows that it is probably the most effective in weight loss. It is also the most complicated and most prone to postoperative complications. Like the gastric sleeve, the Roux-en-Y procedure alters the physiology of digestion. Therefore, patients must be carefully monitored long-term for the complications of malnutrition. It is considered the procedure of choice in morbidly obese individuals – those with a body mass index of 40 or greater and diabetics. The suture lines may leak postoperatively, which can result in major complications and the necessity for re-operation.

Side effects common to all procedures include chronic diarrhea, rebound weight gain, malnutrition, depression and gastroesophageal reflux.

The cost of bariatric surgery varies from center to center and may be as high as $20-$25,000. Fortunately, for patients with BMIs greater than 35 and medical complications as well as patients with body mass indices greater than 40, health insurance coverage is possible.

A strong word of caution here – you are certain to be able to locate on the Internet surgeons and ambulatory centers offering cut-rate procedures for considerably less. Bariatric surgery is not for the faint of heart and is complex. Surgical complications can be expensive, require prolonged hospitalization and devastating if not life-threatening consequences.

I strongly recommend checking out bariatric surgical centers of excellence that offer a team approach including comprehensive evaluation, pre-operative medical management, specialty trained bariatric surgeons and long-term follow-up postoperatively.

This is Dr. Jim for Be Healthy! Be Happy! hoping this message powers is your path to happiness!