Q&A: 5 points to ponder about bariatric surgery

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Before considering bariatric surgery, think about factors such as the risk of complications and whether you’re ready to change your eating habits.

Q: I’m thinking of getting bariatric surgery for weight loss. What should I consider?

A: Those with a body mass index (BMI) of 40 or higher, or a BMI of 35 with other health conditions such as diabetes, may qualify for bariatric surgery. There are several procedures to choose from, and therefore patients and providers should discuss which surgery is most appropriate,  given the patient’s health status and goals.

Generally, these procedures make the stomach smaller and restrict the amount of food and beverages that can be consumed.There are several things to consider before getting the surgery:

  1. Patients have numerous appointments to prepare for surgery.  The time from the first consultation to the surgery is typically six to nine months. Most programs ask patients to try to lose some weight before surgery (about 10 percent of total body weight) because it can make the surgery safer. To achieve this, many patients have repeated meetings with a dietitian. Most programs also require meetings with the bariatric surgeon and specialists, a psychological screening, various lab and diagnostic tests, and a sleep study.
  2. To achieve and maintain weight loss after bariatric surgery, dietary and lifestyle changes must be lifelong. Patients should maintain a low-sugar, low-fat diet, sip water and protein shakes, avoid carbonated beverages as well as breads and pastas, exercise regularly, and take vitamins to compensate for nutrient loss.
  3. There is the potential for complications and weight regain after surgery. Problems can include infection, nausea, and vomiting; malnutrition; “dumping syndrome,” which occurs when food moves from the stomach into the small bowel too quickly; and changes in mood. Also keep in mind that most patients will regain some weight (up to 10 percent) — but some will regain more.
  4. That said, for the most popular surgery types — gastric bypass and sleeve gastrectomy — patients are expected to lose 25 percent to 35 percent of their body weight in one to two years. The bypass and sleeve are also associated with improvements in other health conditions, such as type 2 diabetes, high blood pressure, and sleep apnea. In fact, patients often find that they need less medication or no medication at all to treat these conditions after surgery, and many also experience improved quality of life. A third procedure, the gastric band, is reversible, but in many cases the gastric band does not confer the health benefits seen in the other procedures.
  5. More insurance companies are covering these types of procedures. Your doctor can tell you, based on your health history, which option would be best for you, and what to expect after the procedure.

Michelle Lent, PhD. is an associate professor of clinical psychology at Philadelphia College of Osteopathic Medicine and an investigator at Geisinger’s Obesity Institute.

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