What Is Weight Loss Surgery?
For some people, being overweight is about more than just looks. People who are 100 or more pounds over their ideal body weight are more likely to develop medical problems. These problems include diabetes, heart disease, sleep apnea, and joint trouble.
Lots of very overweight people turn their weight around by sticking to a doctor-approved diet and exercise plan. But some people just can't make these plans work. Doctors may do weight loss surgery if someone has tried but failed to lose weight and faces serious medical problems.
Weight loss surgery (also called bariatric surgery) can help very obese people lose weight. But it's not a quick fix. People need to put in a lot of hard work before and after the operation. That's why doctors don't do the surgery just to change the way someone looks.
Doctors only do surgery when they think patients can put in the effort needed to stay on track for the rest of their lives. People also need to be healthy enough to get the surgery. Doctors can't operate if a patient isn't well enough to handle surgery.
There are three main kinds of surgery for weight loss:
1. Gastric Bypass Surgery
In a gastric bypass, a surgeon creates a small pouch at the top of the stomach. This pouch becomes the new stomach. Surgeons then connect the pouch to the middle part of the small intestine.
After the surgery, the stomach pouch holds a lot less food: about 1 cup instead of the 4 or more cups that a normal-sized stomach holds. Food also gets diverted around (bypasses) the larger part of the stomach and the upper part of the small intestine. Since the food doesn't travel the full length of the digestive system, the body does not take in as many calories.
2. Gastric Sleeve
With this operation, the surgeon removes part of the stomach. He or she makes a tube or "sleeve" out of the rest of the stomach. The new, banana-shaped stomach is much smaller than the original stomach.
After the operation, a person will eat less, feel full sooner, and be less hungry. Unlike gastric bypass, a gastric sleeve operation only changes the stomach. This kind of surgery doesn't divert food around part of the small intestine.
3. Gastric Banding
Like the other kinds of surgery, gastric banding makes the stomach smaller. But instead of permanently closing off part of the stomach, the surgeon puts a band around the top part to create a small stomach pouch. The band is linked to a port that is placed under the person's skin. The doctor uses the port to adjust the size of the pouch by tightening or loosening the band.
How Are the Surgeries Different?
All three surgeries can be successful in teens. But they have different pros and cons.
Gastric bypass surgery can help people lose the most weight right away. It's a bigger operation than gastric banding or a gastric sleeve, though:
- Patients may take longer to get back to normal after surgery.
- The surgery is complicated, so there's more chance of problems.
- People might not get the nutrition they need after bypass surgery. That's because the new digestive system absorbs fewer vitamins and minerals.
- Most important, gastric bypass surgery is final. Doctors cannot reverse the operation. The person will always have a smaller stomach and shorter intestines.
The gastric sleeve surgery is a simpler operation:
- Unlike gastric bypass surgery, gastric sleeve surgery only affects the stomach. The digestive system can still absorb many of the vitamins and minerals in food. Patients still need to take vitamin and mineral supplements, though.
- A gastric sleeve operation is final. The person's stomach will always be smaller because doctors take out the cut-off part of the stomach during the operation.
Gastric banding is the only surgery that's not permanent:
- The gastric band doesn't bypass part of the intestine. The body can still absorb the nutrients in food.
- Gastric bands can be adjusted or taken out completely. If a person needs to have the band taken out, the stomach will go back to its normal size over time.
- Gastric banding is the simplest of the three weight loss surgeries. People who get it might not lose as much weight as they do with bypass surgery, though.
- A gastric band might not keep working for a person's lifetime. If doctors need to replace or take out the band, it means another operation.
- Gastric bands aren't approved for people younger than 18. That means most teens can't get gastric banding surgery.
Are There Any Risks and Side Effects?
Like any operation, weight loss surgery has risks:
- People who've had weight loss surgery may have pain after eating. They might throw up, get diarrhea, or have acid reflux (heartburn) after eating — especially if they eat too much or too fast.
- After surgery, people need to get used to eating very small amounts. They need to chew their food more than they used to and space meals out during the day. If they don't, they might feel sick. They might even start gaining weight again.
- Food can move too fast through the stomach and intestines after weight loss surgery (especially gastric bypass). Doctors call this "dumping syndrome." It can cause nausea, weakness, sweating, cramping, and diarrhea. Eating high-sugar or high-fat foods can make dumping worse. Patients need to be careful about what they eat as their bodies get used to a different way of digesting food.
- People who have had weight loss surgery might not get all the nutrition they need. One reason is they are eating less. Also, when food doesn't move through the entire digestive system, the body can't absorb as many vitamins and minerals. After surgery, most people take vitamin and mineral supplements.
In rare cases, some people have serious problems after weight loss surgery, such as:
- a bad reaction to anesthesia
- infection near the cuts used for the surgery
- a leaky stomach or intestine that can lead to an infection of the area around the stomach and other organs
- a blood clot in the legs or lungs
- blockage in the intestines
People also can have emotional side effects after weight loss surgery:
- People with a history of emotional eating might struggle to figure out new ways to cope with stress without overeating.
- People who lose weight after surgery might have trouble adjusting to their thinner bodies. Some have high expectations and think that the surgery will bring them popularity or solve all their problems. They're often disappointed to find that the problems they had before surgery don't go away when they're a smaller size.
Weight loss surgery is no magic fix. There's a lot of hard work and self-discipline involved. People who get any kind of weight loss surgery have to learn new ways of eating — it's not that different from being on a diet.
But for people who face serious weight-related medical problems and who are willing to put the effort into a new way of life, weight loss surgery can be worth it.
Reviewed by: Mary L. Gavin, MD
Date reviewed: April 2015