The In’s & Out’s of Bariatric Surgery

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I’ve been debating about writing this post for the past 3 weeks.  I kinda feel like it’s a cop-out on my part – considering I really don’t need to do any outside research to write this up.  Being a bariatric dietitian and working for a weight loss surgery practice, makes writing this post a cinch!  But I can’t deny the continuous rise in the amount of new patients we see in our office in addition to those across the country.  Weight loss surgery is becoming a very popular method to successfully lose weight.

bariatric-resolutionofcomorbidities The number of weight loss surgeries performed in this country has slowly risen over the past few years.  I know our surgeons performed over 700 surgeries last year – and that was through only ONE of their offices (we have 3).  Obviously people are interested in this surgery so I thought I’d share my knowledge on the subject, review the different surgeries and talk a little bit about the long-term nutrition guidelines.

To begin, let’s review the 2 ways bariatric surgery helps you lose weight:  by restriction or malabsorption.   Restrictive surgeries only restrict how much food you can eat by decreasing the size of the stomach.  Malabsorptive procedures change the way your body absorbs nutrients consumed contributing to additional weight loss.  The 3 major types of weight loss surgery performed include (note – all surgeries are usually performed laparoscopically):


  1. Gastric Banding – you may be familiar with the brand name for the actual band used in this surgery – Lap Band.  This is purely a restrictive procedure.  The surgeon wraps a band around the top portion of the stomach to create a small pouch.  It’s secured in place with sutures so the band does not slip out of place.  After the surgery is complete and the body has healed, the surgeon will fill the band with saline solution to create the restriction and inability to consume large volumes of food.  This procedure is the simplest to do, its reversible and adjustable.  The weight loss is slower and generally not as high compared to the following two procedures.

sleeve gastrectomy

  1. Sleeve Gastrectomy – this is a step up from the band procedure.  It’s more invasive, it’s not reversible, takes a bit longer to do and to recover from.  This is purely restrictive as with the banding procedure.  About 70-85% of the stomach is removed to create a long “sleeve” that will hold significantly less food than previously able.  There are slightly more risks with this surgery, however the average weight loss is much higher than the band and this has an overall higher success rate. gastric-bypass_large
  2. Gastric Bypass (Roux-En-Y) – this is the most invasive procedure, it takes the longest to perform and the longest to recover from.  This is a restrictive AND malabsorptive procedure, however it is reversible.  The surgeon creates a small pouch from the top of the stomach – about the size of an egg – creating the restriction.  Then the new pouch is attached to an area further down on the small intestine which creates the malabsorptive part of this surgery.  This procedure sees the most weight loss, reduction in co-morbidities and overall success rate.  Also noteworthy, is that this is the most popular type of weight loss surgery in this country.

All of the above procedures come with their own unique risks during the actual surgery and afterwards as well.  Generally, the risks are incredibly small and patients do very well regardless of the type of surgery preformed.  I will say that our particular office has seen a huge drop in the number of band procedures done.  Not only that, but many band patients are coming back because they are not satisfied with their weight loss (some have gained the weight back) and are desiring another procedure (like the sleeve or bypass).

The nutrition aspect of these surgeries has to do with lifestyle changes – specifically eating habits.  The amount of food you will be able to consume after surgery is considerably smaller than what you’re used to – progressing from 1/4 cup right after surgery up to 1 cup about a year post op.  You will have to take several supplements (like a multivitamin and calcium) daily.  In addition, carbonated beverages, caffeine, fatty and greasy foods, high sugar foods and beverages, and bread/rice/pasta will be (or let’s say should be) restricted permanently.  All hard things to give up or severely restrict.

Lastly, it’s important to realize that weight loss surgery (bariatric surgery) is not an easy way out.  Many people think this type of surgery is a magic cure.  But, in fact it’s incredibly difficult – physically, emotionally, mentally and financially too.   Bariatric surgery only provides patient’s with a tool that, more or less, forces them to make some serious and long-term lifestyle changes.  It takes a lot of time, effort, motivation and dedication on the part of the patient.  If you think bariatric surgery may help you, I encourage you to do some research and speak with a local practice or hospital for more information.  Also, our website has some cool videos, patient testimonials and more in-depth information – click here.  And as usual, you can always contact me!

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