Overview of Weight Loss Surgery

Weight loss surgery, also called bariatric surgery, is gaining acceptance in the medical community as a treatment for severe obesity. This page contains discussion on:

·         Why is weight loss surgery the right choice for some people?

·         Who should consider weight loss surgery?

·         What are the options in weight loss surgery?

·         If you are interested in weight loss surgery, what is the next step?

·         Will insurance pay for the surgery?

Q. Who is a candidate for weight loss surgery?

A. Weight loss surgery is indicated if your body mass index (also called BMI) places you at risk for increased health problems. BMI is calculated by dividing your weight in kilos by the square of your height in meters.

The National Institute of Health states that you should consider weight loss surgery if you have

1.    a BMI  greater than 35 with associated medical problems

2.    a BMI greater than 40 and

3.    have been unsuccessful at long-term sustained weight loss through diet and exercise programs

Diet and exercise alone rarely result in long-term sustained weight loss in people with a BMI over 35. However, weight loss surgery leads to successful long-term weight loss in the vast majority of our patients. If your BMI is over 35, you should definitely consider weight loss surgery. Some people with a BMI as low as 30 may benefit from weight loss surgery.

Q. Why have weight loss surgery?

A. Being too heavy is a major source of health problems in the United States. People who are more than 100 pounds overweight have an increased risk of having high blood pressure, diabetes, heart disease, severe arthritis, sleep apnea, and gastroesophageal reflux. This translates into a shorter life span with a lower quality of health for the overweight. As well, being more than 100 pounds overweight in our society has a tremendous social effect on people, and often results in a lower quality of life due to limitations in their activities and social discrimination. It has been demonstrated in scientific studies that if people lose this excess weight and keep it off, their health improves and they live longer.

Q. What is weight loss surgery?

A. Weight loss surgery includes many different operations that work in different ways. All bariatric surgeries can be done both "open" through a large incision, or "laparoscopically" through incisions that are less than one inch long. Bariatric surgery procedures are described as either restrictive (meaning they reduce the amount of food you can eat) or malabsorptive (meaning they let the food you eat pass through the intestine without being absorbed).

Laparoscopic Gastric Bypass is the most common procedure weight loss surgery performed in the United States. The Roux-en-Y gastric bypass (also known as RNY or proximal gastric bypass) is primarily a restrictive operation. It offers the benefit of limiting food intake with a restrictive component, the hormonal benefit of bypassing the duodenum, and the discouragement of unhealthy food choices from their effect on the Roux limb (aka dumping). The laparoscopic approach has been shown to be superior to the open approach with less pain, fewer wound problems, faster return to normal activity and smaller scars.

Laparoscopic Adjustable Gastric Banding is a purely restrictive procedure. It offers the benefit of limiting food intake with a restrictive component which is adjustable by inflating or deflating the band by injecting saline into a reservoir under the skin. There are two different bands available in the US: the LapBand and the REALIZE band.

Laparoscopic Sleeve Gastrectomy is a relatively new weight loss procedure. It offers the benefit of limiting food intake with a restrictive component plus likely has a hormonal benefit associated with partial stomach removal.

Q. Is weight loss permanent after surgery?

Weight loss after successful gastric bypass has been shown to be stable over ten years, with slight weight regain similar to the weight gain seen by other people who haven't had weight loss surgery over ten tears.

Q. I know someone who had weight loss surgery and never lost very much weight. Does that mean that most patients never lose very much?

A. Almost everyone will have successful weight loss after laparoscopic gastric bypass. On average, our bypass patients have lost 70% of their excess body weight in the first year after surgery.

All weight loss surgeries have some patients who don't lose very much weight, often because the surgery they chose wasn't right for them or because the surgery wasn't done very well. Sometimes patients fail to lose much weight because of inadequate nutritional education before surgery. And sometimes people are unhappy with their weight loss because they are given unrealistic expectations before surgery.  This doesn't mean that you can't be successful if you have the right surgery performed well.

Q. I know someone who had successful weight loss surgery but gained it all back. Does this happen to everyone?

A. No, most patients have sustained, long-term weight loss after laparoscopic gastric bypass.

There are many reasons that people regain weight after initially losing weight with the help of surgery. The traditional "stomach stapling" called Vertical Banded Gastroplasty or VBG was often successful in the first year, only to have the staple lines open up later leading to weight regain. Even with gastric bypass, there are some surgical techniques which lead to a higher incidence of anatomic breakdown after the first year, leading to weight regain.

Q. I am interested in weight loss surgery. What is the next step?

A. Telephone our offices at (425) 453-7888. If you are ready to move ahead with surgery or if you simply want to get more information, you can start with an office consultation with one of our bariatric surgeons. If you don't feel ready to move ahead with a consultation but want to gather more information about weight loss surgery, we can schedule you to attend a free informational seminar.

Q. What will happen at the consultation?

A. You will meet your surgeon face to face, have a history and physical, review the indications and outcomes for surgery, and have the opportunity to ask questions. You will be given our educational material to take home for review. You will meet our office staff who will be involved in helping with the insurance approval process. The consultation will take between 60 and 90 minutes. After the consultation we will submit a request for coverage for surgery called the Letter of Medical necessity to your insurance company.