What is Bariatric Surgery?

Bariatric surgery, derived from the Greek word “baros” meaning
weight, is designed to reduce obesity indirectly by restricting
the amount of food calories a person can digest. Some bariatric
operations (eg. lap band) achieve this by reducing the size of
the stomach size. Other operations (eg. roux-en-Y gastric
bypass) go one step further. As well as reducing stomach volume,
they also reduce the length of the small intestine. This
constitutes a more permanent alteration of the digestive tract
and makes it more difficult for the patient to cheat.

How To Qualify For Bariatric Surgery?

According to the National Institutes of Health Clinical
Guidelines on the Identification, Evaluation, and Treatment of
Overweight and Obesity in Adults, you may be a candidate for
obesity surgery only if: (1) you have a body mass index (BMI) of
40+ (about 100 pounds overweight), or (2) your BMI is 35+ and
you suffer from severe weight-related health problems such as
hypertension, high cholesterol, type 2 diabetes, heart disease
or severe sleep apnea.

Are You a Suitable Candidate for Bariatric Surgery?

Meeting the above criteria does not guarantee your eligibility
for weight loss surgery. Most bariatric clinics operate a
screening policy and only approve candidates who are (a) ready
to make appropriate long-term behavioral changes; and (b)
committed to long-term (even lifelong) medical follow-up. This
is because weight loss surgery can only be successful if you are
willing to change your existing eating and exercise habits, on a
permanent basis.

What Are The Main Types of Bariatric Operation?

There are two main types of obesity surgery: gastric banding
and gastric bypass. These operations may be performed using
traditional “open” surgical techniques, or minimally invasive
laparoscopic techniques using instruments connected to video
monitors, which allow the surgeon to “see inside” the patient
without having to make large incisions. Patients who undergo
laparascopic surgery suffer fewer perioperative and
post-operative health complications, and typically remain in
hospital for 2-3 days, compared to 4-5 days for open surgery.
They return to work within 2-3 weeks, compared to 4-6 weeks for
traditional surgeries.

Gastric banding is sometimes referred to as “restrictive
surgery”. This is because it works by restricting calorie intake
only. During a gastric banding operation, the surgeon shrinks
the stomach from melon to egg size using special staples, or a
silicone band. These procedures are more easily reversible as
they do not fundamentally alter the anatomy of the digestive
system. The drawback is, patients find it easier to “cheat”.
Thus stomach banding is not as effective for weight reduction as
stomach bypass. Examples of gastric banding procedures include:
adjustable gastric banding such as lap band, and vertical banded
gastroplasty.

Gastric bypass, sometimes called “malabsorptive” surgery since
it restricts the absorption of calories and nutrition, is a two
stage process. First, the surgeon reduces the size of the
stomach. Second, the first part of the small intestine (duodenum
and jejunum) is bypassed. This causes food to pass much more
rapidly through the digestive tract and significantly reduces
the amount of nutrients and calories that can be absorbed. So
even if patients overeat, they will absorb less. As a result,
weight loss after gastric bypass is typically greater than after
gastric banding. Examples of stomach bypass procedures include:
roux-en-Y, biliopancreatic diversion, and duodenal switch.

What Can You Eat After Bariatric Surgery?

As a bariatric patient, you must expect a drastic change of
eating habits following your operation. In general, due to the
small size of your new stomach pouch, you will feel full after
only a very small amount of food. Over-eating or eating too fast
can cause extremely unpleasant nausea, referred to as “dumping
syndrome”. The typical post-operative diet regimen comprises
four stages. Immediately after surgery, you may ingest clear
liquids only. After 2-3 days this broadens to include any
liquids. After about 2 weeks semi-solids may be consumed,
leading to a low-fat solid diet after 5-6 weeks. Progress
depends upon the individual circumstances of each patient.

What About The Problem of Loose Skin?

During the 12-24 months following a successful bariatric bypass
or banding operation, you may lose as much as 50-80 percent of
your pre-operative excess weight. As a result, you may develop a
significant amount of loose skin. In addition, as your weight
loss may not occur evenly throughout your body, you may suffer
from unsightly pockets of excess fat. Generally speaking the
only solution for these problems is plastic surgery. Common
procedures include: tummy tuck, thigh-lift, panniculectomy,
breast-lift, male breast reduction, arm-lift and neck lift.
Liposuction is not generally considered to be a weight-related
procedure as it only removes fat. It does not excise loose skin
or tighten loose muscles. One point to note, is that, unlike
bariatric surgery, this type of plastic surgery is not covered
by medical insurance as it is deemed to be a “cosmetic”
procedure.

What is The Cost of Bariatric Surgery?

The costs of bariatric surgeries vary according to the surgeon,
the type of procedure performed, and the range of support
services offered. Basic prices range from $25,000 to $35,000.

Is Bariatric Surgery Covered By Insurance?

Medical insurance coverage varies by state and insurance
provider. Several states have passed legislation requiring
insurers to offer weight loss surgery for patients, providing it
meets health criteria laid down by the National Institutes of
Health. However, getting insurance approval by yourself can be a
time-consuming process. Ideally, work with your surgeon/doctor
and get him/her to explain to your health insurance provider
that the proposed surgery is not a cosmetic procedure but an
operation which will help you minimize major health problems
later in life. Once your insurance company understands that the
surgical operation is a money-saving procedure, they often agree
to provide cover. Some bariatric clinics claim an 80 percent
success-rate for obtaining insurer-approval in this way.

More Information

Bariatric
Surgery

Gastric Weight Loss Surgey

1. Prev:The need to change our behaviour
2. Next:Is Bariatric Surgery The Answer To Obesity?