Surgery for Weight Loss: What Are the Options?
Why Consider Weight Loss Surgery?
Losing weight with diet and exercise is effective for many patients. However, some patients may fail diet and exercise and be at a high risk for disease-related complications due to obesity. In these patients, weight loss surgery may be an option. Not everyone is a candidate for weight-loss surgery. Patients should consult with a surgeon who performs bariatric surgery to discuss their options. Weight loss surgery is a permanent procedure that requires a lifetime commitment to maintaining a healthy lifestyle and a proper diet.
The advantages to weight loss surgery are many:
- Improved overall health
- Lowered risk of weight-associated diseases, such as high blood pressure, heart disease, diabetes, osteoarthritis and sleep apnea
- Decreased need for medications
- Easier mobility
- Enhanced self-esteem and quality-of-life
- Potentially a longer lifespan
In a 2012 study in diabetic patients who underwent gastric bypass surgery, 41 percent of these patients achieved remission (normal measures of glucose metabolism without taking diabetes medications at least one year after weight loss surgery). Experts state that in diabetic patients surgery plus medication works better than either treatment alone, although not all patients will achieve remission status.
Surgical Weight Loss: Who is a Candidate?
It is important to determine with your physician if you are a candidate for weight loss surgery. Most people who are candidates for weight loss surgery have tried to lose weight through traditional diet and exercise and have not had success. Candidates for weight loss surgery include those patients that have a serious, potentially life-threatening condition from obesity, a genetic propensity towards obesity, a high body mass index, and long-standing obesity.
Does Insurance Pay for Weight Loss Surgery?
Health insurance is increasingly covering many of the costs of weight loss surgery, depending upon a patient’s individual plan. However, specific requirements may need to be met. One of the requirements is that a patient be at a certain body mass index (BMI) to qualify for the surgery. In addition, some patients may need to have at least one major medical comorbidity, such as high blood pressure, diabetes, or sleep apnea. Some insurance plans also require documentation that a patient has attempted weight loss in the previous two years through traditional methods such as diet and exercise.
- Underweight = under 18.5
- Normal weight = 18.5 - 24.9
- Overweight = 25 - 29.9
- Obesity = BMI of 30 or greater
- Morbidly Obese = BMI of 40 or greater
BMI calculations can be calculated here.
To qualify for insurance coverage for weight loss surgery, patients typically must have either:
- A body mass index greater than or equal to 40
- Body mass index between 35 and 39 and at least one major medical co-morbidity, such as respiratory problems (i.e., sleep apnea), diabetes, or hypertension
Before a patient considers weight loss surgery as an option in managing obesity they should discuss this procedure with a qualified surgeon. In addition, the insurance company should be contacted to determine:
- If weight loss surgery is covered by the insurance policy
- Which local surgeons/hospitals are covered under the insurance
- If a coinsurance or deductible payment for the weight loss surgery is required by the patient
Types of Weight Loss Surgery
The three most common types of weight loss surgery are the Roux-en-Y Gastric Bypass, the Adjustable Gastric Band, and the Vertical Sleeve Gastrectomy.
Gastric Bypass Surgery
Gastric bypass surgery, the most common of which is the Roux-en-Y gastric bypass procedure, results in a portion of the stomach being stapled to reduce appetite and food intake. A small stomach pouch is formed, but no portion of the stomach is removed surgically. The top section of the stomach (called the pouch - about the size of an egg or a walnut) is where food is digested. It holds only about one ounce of food.
The pouch is then connected to the small intestine. Fewer nutrients and calories are absorbed. Hunger and food intake are reduced, and 55 to 65 percent of excess weight can be lost, usually within one year. Because absorption of food nutrients is decreased, vitamin deficiencies may occur if supplements are not taken.
Gastric bypass surgery will require one to two days stay in the hospital. General anesthesia is utilized during surgery. Gastric bypass may be performed by either a traditional incision that will leave a permanent scar, or more commonly with a laparoscopic procedure that may leave less scarring and allow a quicker recovery. Full recovery may take two to five weeks before a patient can return to normal activities.
Complications with gastric bypass surgery may include leaking, nutrient deficiencies or dumping syndrome.
Adjustable Gastric Band Surgery
Adjustable Gastric Band Surgery, often referred to as lap band or band surgery is usually performed as an outpatient procedure. In the surgery, an adjustable silicone band is placed around the upper portion of the stomach. Small incisions are made in the skin to allow the band to be placed (laparoscopic procedure). The band creates a small stomach pouch at the top of the stomach - the stomach is not surgically reduced in size. The smaller pouch that is created with the band results in smaller amount of food intake, and a feeling of fullness after eating smaller portions of food. Surgery typically takes 45 minutes to an hour during which general anesthesia is used. Patients will go home the same day. Recovery is roughly two weeks.
After surgery, the tightness of the band can be adjusted by injecting saline into a small port. The port is implanted in the skin during the surgery and is attached to the gastric band. Injection of the saline can be done in the doctor’s office. The band can be loosened or tightened to meet weight loss goals. Adjustable gastric band surgery is a reversible procedure, and is considered the least invasive of all of the weight loss surgeries. Patients who are compliant with instructions on diet can usually lose between 30 and 40 percent of excess weight with the gastric band procedure. Weight loss is slower with gastric band surgery and it may take up to five years for complete weight loss.
Complications with adjustable gastric band surgery may include band slippage, band erosion into the stomach, and port-related problems, such as bleeding or infection.
Vertical Sleeve Gastrectomy
In vertical sleeve gastrectomy, at least 85 percent of the stomach is removed during surgery. The remaining narrow portion of the stomach is attached to the intestines. The volume of the stomach is reduced, but rerouting around the intestine does not occur, thus preserving nutrient absorption. Surgery typically lasts 60 minutes and general anesthesia will be used. The vertical sleeve gastrectomy procedure is not reversible. Sleeve gastrectomies may be appropriate as an alternative to gastric banding in certain patients.
The in-hospital recovery period is about two days, with a two to three week period for full recovery. Patients will lose 40 to 55 percent of their excess weight which is generally seen one to two years after surgery.
Complications with vertical sleeve gastrectomy may include leaking and the development of strictures.
What Diet and Vitamin Changes Are Required After Surgery?
Immediately after surgery, most patients will need to be on a liquid-only diet for several weeks, then will transition to soft foods for the next six to eight weeks, and finally return to solid foods over the next nine months. Dieticians specialized in meal planning for bariatric surgery patients will consult with patients after surgery and throughout the weight loss period.
Changes in meal plans after bariatric surgery are significant. Proper eating habits must be incorporated into the daily routine. Patients will need to adjust their calorie intake to roughly 800 to 1,000 calories per day, including 40 to 60 grams of protein to help maintain muscle mass. A multivitamin with at least 18 milligrams of zinc and 400 micrograms of folic acid will be required daily. Some patients will require additional vitamins and minerals, including the fat-soluble vitamins A, D, E and K.
Risks Associated with Weight Loss Surgery
Weight loss surgical procedures require major surgery and may be associated with significant risks. It is important to discuss these risk with your surgeon.
- Complications from surgery or anesthesia
- Allergies to medicines
- Bowel obstruction
- Blood clots
- Vitamin or other nutritional deficiencies
- Risk of weight regain
- Gastroesophageal Reflux Disease (GERD)
- Dumping syndrome
- Psychological problems after surgery
Learn More About These Surgical Procedures:
- Body Mass Index (BMI): Determining Your Obesity Risk
- Can Prescription Drugs Cause Weight Gain?
- Childhood Obesity: Is a U.S. Epidemic Improving?
- Prescription Weight Loss / Diet Pills: What Are the Options?
- Side Effects of Weight Loss Drugs (Diet Pills)
- Weight Loss
- Bariatric Surgery for Severe Obesity - National Institute of Diabetes and Digestive and Kidney Diseases. Accessed Dec. 22, 2012 at http://win.niddk.nih.gov/publications/gastric.htm.
- Procedure Comparison - Duke Center for Metabolic and Weight Loss Surgery. Accessed Dec. 21, 2012 at http://www.dukehealth.org/repository/dukehealth/2010/06/02/13/44/09/4645/Surgical%20Comparison%20Chart.pdf
- Consumer Guide to Bariatric Surgery - Ceatus Media Group. Accessed Dec. 24, 2012 at http://www.yourbariatricsurgeryguide.com/
- Weight Loss Surgery (Beyond the Basics) - Up To Date. Accesed Dec 21, 2012 at http://www.uptodate.com/contents/weight-loss-surgery-beyond-the-basics?view=print
- Weight Loss Surgery - National Library of Medicine. Accessed Dec. 23, 2012 at http://www.nlm.nih.gov/medlineplus/weightlosssurgery.html.
Last updated: 2014-02-04 by Leigh Anderson, PharmD.