A Complete Guide to Bariatric Surgery

Bariatric surgery, or weight loss surgery, refers to any operation for weight loss that alters the digestive system in people with obesity. This surgery can be effective but comes with risks and requires permanent lifestyle changes to keep the weight off.

Bariatric surgery refers to a class of surgical procedures that support weight loss in people with severe, or class 3, obesity. Doctors mainly recommend bariatric surgery to those who have yet to see results from other weight loss methods.

Although the procedures carry risks for some people, a healthcare professional will determine whether complications are more likely to result from obesity than from the surgery.

What Is Bariatric Surgery?

Each surgery type has pros and cons to discuss with your doctor. “Each provides different average weight loss results and potential side effects or risks,” says Ellen Morrow, MD, an assistant professor and surgeon at the University of Utah Health who is certified in bariatric surgery.

“In general, it seems like the risk of a procedure sort of parallels the benefits,” she adds. “A sleeve gastrectomy, for example, may have a little bit less risk in some ways but results in a little bit less weight loss, while a duodenal switch may have potentially more long-term complications but also has the most significant weight loss results.”

Gastric Bypass

A Roux-en-Y gastric bypass is also known simply as a gastric bypass. "Roux-en-Y" is French for “in the form of a Y.” This procedure is a common choice in the United States.

“My colleagues and I here at the University of Utah perform Roux-en-Y gastric bypass the most, which is kind of considered the gold standard,” says Dr. Morrow. In this procedure, the surgeon separates the stomach into a top and bottom section.

The top section — also called a pouch — is roughly the size of an egg, and the bottom section no longer digests food. The surgeon then connects a part of the small intestine called the Roux limb to the new stomach pouch.

“The Roux-en-Y gastric bypass works through malabsorption, so for this procedure there is some intestinal rearrangement as well to alter your body’s hormonal response to food, which is important,” says Morrow.

Sleeve Gastrectomy

This option is the most popular kind of bariatric surgery. “Sleeve gastrectomy is currently the most commonly performed procedure nationwide,” says Morrow.

“Bariatric procedures generally work in one of two ways, or sometimes both,” explains Morrow. “The first way is with restriction. All bariatric procedures have altered the stomach to try to make people have a smaller stomach and feel fuller,” she says.

“A sleeve gastrectomy works purely through restriction, so we’re creating a smaller stomach by removing about two-thirds of the stomach.” A sleeve gastrectomy is the simplest of the procedures and doesn’t require as much time on the operating table. “It takes approximately an hour to perform,” says Morrow.

Duodenal Switch

Biliopancreatic diversion with a duodenal switch is often called a duodenal switch. “A duodenal switch involves a bit more malabsorption [compared with the gastric bypass],” says Morrow.

While a specific diet is crucial for everyone who undergoes bariatric surgery, following eating guidelines closely is necessary for people who have a duodenal switch.

“They have to be really careful about eating enough protein, or else they can become deficient, and drinking enough water so they don’t get dehydrated. Plus, they must take vitamins daily, often more than once a day, depending on which vitamin supplements they choose,” says Morrow.

• People with a BMI of 35 or higher
• Adults who have a BMI between 30 and 34.9 and a metabolic disease, such as diabetes
• “Appropriately selected” children and adolescents

When deciding whether or not someone should have bariatric surgery, doctors will also take into account various risk factors to ensure that it’s a safe option. “We don’t want to do surgery if it’s not going to be safe for the patient,” says Morrow.

• Smoking
• Substance use
• How well the patient is managing any mental health conditions they have

Risks and side effects can be minor or something you’ll need to see your doctor for. Here are some of the potential side effects and complications of bariatric surgery.

Risks

While very uncommon, certain complications do arise after bariatric surgery.

Causes of concern in a recovering patient include an abnormal heart rate, fever, and an unusual amount of pain, says Morrow. “The rate of more serious complications — blood clots and leaks — is around 1 percent.”

• Excessive bleeding
• Infection
• Problems relating to anesthesia
• Blood clots
• Leaks in your gut
• Death

Side effects

• Bowel obstruction
• Dumping syndrome, where food moves into the small intestine too quickly and causes vomiting, nausea, diarrhea, and abdominal pain
• Gallstones
• Hernia
• Low blood sugar
• Malnutrition
• Ulcers
• Vomiting
• Acid reflux

Some people may need to have a second surgery or procedure.

• Taking steps to quit smoking permanently because nicotine can increase the risk of heart attacks, pneumonia, blood clots, and slow recovery
• Reducing or stopping alcohol because the body absorbs alcohol faster after bariatric surgery
• Avoiding pregnancy within 12 to 18 months of the procedure, which can help an individual control body weight and get enough nutrition for a healthy pregnancy

Other considerations include diet and nutrition, exercise, and mental health care.

Medications

Short-Term Postsurgery Expectations

Nutrition and Diet Progression

To prevent malnutrition or weight gain after bariatric surgery, you’ll need to follow a healthy eating plan and meet regularly with a registered dietitian.

“Patients should meet with a dietitian regularly for at least the first year, and then we ask our patients to return annually after that,” says Morrow.

• Avoid soda.
• Eat 60 to 100 grams of protein a day.

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• Drink at least 64 ounces of water a day.
• Eat frequent small meals.
• Emphasize protein-rich foods.
• Minimize refined carbohydrates.
• Avoid food and drinks with refined sugars.

The nutritional profile and quality of the foods you consume are also key. “We definitely emphasize lean protein, vegetables, and dietary fiber,” says Morrow. In addition to helping you stick to a specific eating plan, a nutritionist may offer straightforward strategies for following the diet, such as meal planning.

Take Supplements

These supplements typically include:

• A multivitamin
• Vitamin B12
• Calcium
• Vitamin D
• Iron

Exercise Guidelines

Seek Mental Health Help if Needed

• Bariatric surgery is an effective way to lose weight for people with obesity when other treatment options have not worked.
• Each type of weight loss surgery comes with potential benefits, risks, and side effects and requires a long-term commitment to making diet and other changes.
• Patients must understand the lifelong commitment to a healthier lifestyle necessary to make bariatric surgery successful.