Disclaimer: It is important to talk with your healthcare provider before making or starting any treatment decision. This blog post does not reflect the views of the OAC, the National Board of Directors or staff. Information contained in this blog post is not based on scientific research and has not been validated. The OAC does not endorse any merchandise mentioned in this blog post.
The struggle with obesity can go on for a long time. Over the years, you may try all kinds of diets to try to control your weight. They may work in the short term, if at all. However, you may be looking into other possible weight-loss options if the pounds just refuse to come off and stay off.
Bariatric surgery may be worth considering if diet and exercise haven’t worked for you. It is a big step, however, and you are certainly not alone if you are having trouble deciding whether it is right for you. The questions below are some that you might want to ask yourself before deciding on whether to have bariatric surgery.
Who Gets Bariatric Surgery?
Bariatric surgery is an increasingly popular choice. The American Society for Metabolic and Bariatric Surgery (ASMBS) estimates that in the U.S., 158,000 patients received bariatric surgery in 2011, and 196,000 received it in the year 2015. That is an increase of 24 percent in just four years!
The gastric sleeve, or vertical sleeve gastrectomy, has become the most popular type of surgery. It has jumped from 17.8 percent of surgeries in 2011 to 53.8 percent four years later. The Roux-en-Y gastric bypass is still relatively popular, accounting for 23.1 percent of surgeries in 2015. The gastric band comes in third at 5.7 percent of bariatric surgeries in 2015.
Do I Qualify for Bariatric Surgery?
The standard criteria for bariatric surgery includes the following:
- BMI over 40 OR
- BMI over 35 with serious obesity-related health conditions or risk, such as type 2 diabetes
- Previous unsuccessful attempts at controlling your weight with diet and exercise programs
- No drug or alcohol addiction
- Cause of obesity unrelated to endocrine conditions
If your health insurance covers bariatric surgery, you will almost certainly need to meet the above criteria and possibly some others. For example, you may need to document a six-month weight-loss diet.
If you are paying out of pocket, you may be able to find a surgeon who will accept you as a patient even if you do not meet all of the strict criteria listed above. For example, some surgeons will perform surgery if your BMI is over 30 if they believe that you have health risks related to extra weight.
What Are the Risks and Benefits?
Good news — study after study shows that bariatric surgery can lead to significant weight-loss! There are also likely health benefits. You may have much better management of type 2 diabetes, along with improvements in other obesity-related conditions such as sleep apnea, high blood pressure and high cholesterol. When you lose a significant amount of weight, your joints may even feel much better and some aches and pains may disappear.
Some patients lost 80 to 100 pounds in the first year after gastric bypass or gastric sleeve surgery. Gastric band patients may lose weight a little slower to start with. According to the ASMBS, the majority of bariatric surgery patients lose and maintain a loss of 50 percent or more of their excess body weight.
You can expect to lose more weight after bariatric surgery compared to diet and exercise alone. On average, patients keep off the weight for longer after bariatric surgery.
Every smart potential bariatric surgery patient wonders about risks. There are risks associated with any surgery, and the risks of bariatric surgery are relatively low. You are less likely to die from bariatric surgery than from a hip replacement or gallbladder surgery, and fewer than 1 in 20 patients has a major complication. Compared to the risks of morbid obesity, the risks of bariatric surgery are lower.
Have I Given Other Weight-loss Options an Honest Effort?
Bariatric surgery should not be the first option you turn to when fighting obesity. It is meant to be a choice when all other options have failed. Usually, this means trying multiple diets and exercise programs to lose weight.
If you cannot lose weight with diet and exercise, or you cannot keep it off for long, it may be time to look into bariatric surgery. Success will still depend on you following the strict program, but you will have the help of permanent changes to your stomach from the surgery.
How Can Bariatric Surgery Help Me Lose Weight?
That is a great question! If other diets did not work, why would bariatric surgery? Just like with a “regular” diet, you will need to follow your bariatric surgery diet for life if you want to lose weight and keep it off. However, there is more to bariatric surgery than a “diet.”
No matter which type of surgery you choose, you will have a smaller stomach — whether you have a small sleeve from the gastric sleeve, a small pouch from the gastric bypass or a small stomach from the gastric band. A smaller stomach means that you will have restriction, which means you will become full faster. You will be physically unable to fit as much food into your smaller stomach as you could do before surgery. The restriction helps you eat less, and it is no secret that eating less can lead to weight-loss.
Bariatric surgery can also help you lose weight by fighting hunger. The diet your surgeon or nutritionist will recommend is high in protein, which is a hunger-fighting nutrient because it is slow to digest. Your high-protein, low-carb diet can also help fight hunger and cravings by keeping blood sugar levels more stable.
The gastric band is only restrictive, but the gastric bypass and gastric sleeve have other weight-loss benefits. They can lower levels of your hunger hormones so that you feel less hungry than you did before surgery. They can also reduce the absorption of nutrients so that you absorb fewer calories from your food.
Am I Ready to Commit to the Diet and Lifestyle?
There is no reason to get bariatric surgery unless you are ready to commit to the diet. In the short term, you will follow a liquid diet and then progress to pureed foods and soft foods before you can add solid foods back in. The focus in these first months and weeks is on getting plenty of protein.
In the long term, as you eat solids, you will continue to focus on lean proteins such as fish, chicken, beans, yogurt, cheese, nuts and cottage cheese. After proteins, your next priority is to get in your vegetables and fruits. Finally, you will include small portions of healthy fats (think avocados and olive oil) and nutritious starches (think whole grains such as oatmeal, brown rice, whole-wheat bread and cereal, as well as starchy vegetables such as sweet potatoes and winter squash).
There are plenty of other rules to follow. For example:
- Keep portions small.
- Only drink fluids between meals and snacks, not while you are eating solid foods.
- No alcohol or caffeine for as long as your surgeon recommends.
- Take all of your recommended nutritional supplements, which may include a multivitamin along with others such as calcium, iron, vitamin D and B vitamins.
- Limit or avoid sugary foods and drinks such as candies, baked goods and soft drinks.
- Minimize fast food and fried foods.
The “diet” seems strict, and it is. However, it is largely a question of habit. For example, you may be surprised at how little you miss the drive-through when you choose a healthy breakfast of yogurt and fruit instead; how much you enjoy your new lunch of lettuce and turkey roll-ups instead of a burger; and how satisfying you find your new snack of bell pepper strips and blue cheese instead of potato chips.
What Will You Tell People?
Bariatric surgery may be a personal decision, but you need to consider other people as you make your decision. Some bariatric surgery patients are happy to be open about their surgeries and tell everyone they’ve had it. Other patients may be worried about being judged for their choice, or they simply want to keep their health decisions private.
If you do want to keep your surgery a secret, you will need to figure out what you will tell people on certain occasions. You may need to give your boss a reason why you are planning to skip work around the time of your surgery. Coworkers may wonder why you no longer order in lunch when the rest of the office does. Friends may feel hurt or worried about you when you stop joining them at the bar on Friday nights. It is a good idea to think ahead to decide what you will tell people if you do not want to tell them about your surgery.
How Will I Handle Setbacks?
No bariatric surgery patient escapes without a few (or a lot) of setbacks! Before opting for surgery, take a hard look at which challenges you may face and how you handle them when they come up. These are some of the challenges almost everyone faces, and these are some common ways of facing them.
- Plateaus, or stalls, when your weight stops dropping for a while — You can wait it out by sticking to your diet plan and focusing on other progress than the scale, such as your fitness.
- Getting off track when you stop eating right — You can forgive yourself and identify what you need to change to get back on track, such as going back to measuring portions or eliminating dessert.
- Losing motivation during the long journey — You can prepare for this by making a list of all the reasons you got bariatric surgery and want to lose weight. Then check the list when you are feeling unmotivated.
Bariatric surgery is not for everyone, but it is an option that can help a lot of people lose weight. If you are thinking about bariatric surgery, these are some questions you might want to ask yourself to help make your decision about where to get more information.
About the Author:
Alex Brecher is not only successful at weight-loss — Alex is also the man behind the success of Bariatric Pal. BariatricPal is an online social network for the bariatric surgery community, where patients support each other before and after weight-loss. BariatricPal grew out of a desire from Alex Brecher to give back to bariatric surgery patients. He strives to help people write their own successful weight-loss stories.