Surgery for Obesity

Weight loss surgery (bariatric surgery) involves surgically reducing the size of your stomach so you aren’t able to eat as much. This means that your body absorbs less food. Common types of bariatric surgery include laparoscopic adjustable gastric banding (also called the lap band), gastric bypass, a sleeve gastrectomy, and biliopancreatic diversion with duodenal switch.

Many of these procedures are laparoscopic surgeries, also known as minimally invasive surgeries. This means they’re performed through small incisions using a laparoscope (a small, thin tube with a camera on the tip that is used to see the inside of your body). Laparoscopic surgeries lead to less pain and a quicker recovery time than more invasive surgeries.

Bariatric surgery isn’t for everyone who is overweight or even obese. Before you can qualify for surgical weight loss, you must have health conditions related to your obesity. For example, you must also have been diagnosed with sleep apnea, heart disease, type 2 diabetes, or high blood pressure. Many insurances also require certain steps are completed and that you are over a certain weight before you qualify for this surgery.

Gastric Balloon

An inflatable balloon strategically inserted into your stomach makes you feel fuller sooner. Ideal for patients with a BMI of 30–35 or 27–30 with co-morbidities.

Laparoscopic Sleeve Gastrectomy

A minimally invasive procedure involving the reduction of the stomach volume by removing up to 85% of the stomach pouch.

Gastric Bypass

Perfected by Dr. Gagner himself, this procedure uses gastric reduction and intestinal malabsorption to achieve the patient’s weight loss goals.

Single-Anastomosis Duodenal Switch

This new type of duodenal switch procedure utilizes intestinal malabsorption to achieve weight-loss, and eradicate type 2 diabetes.

Path to improved health

Maintaining healthy body weight is one of the best ways to avoid weight-related health problems. One way to determine if you are a healthy weight is by measuring your body mass index (BMI). This measurement is based on your height and weight. It’s considered to be a better measure of a health risk than just your weight in pounds. The medical terms “overweight” and “obesity” are based on BMI values. A BMI between 25 and 30 is defined as overweight. A BMI of 30 or more is considered obese. The higher your BMI, the greater your risk of developing a weight-related illness. Use this online calculator to determine your BMI.

If you want to lose weight, the first thing you should do is talk to your doctor. He or she will help you develop a healthy eating and exercise plan. This plan can help you lose weight, improve your fitness, and decrease the chances of developing heart disease, high blood pressure, or type 2 diabetes.

However, in severe cases, diet and exercise alone may not be enough to help you lose weight. If you have a BMI of more than 40 or serious weight-related health issues, your doctor may talk to you about weight-loss surgery. This surgery can help you lose large amounts of weight if you’re obese. It will reduce the amount of food you’re able to eat, reduce the amount of food your body is able to absorb, or both. It’s most successful when used as part of a long-term healthy lifestyle change, including diet and exercise. After surgery, weight loss is initially fast, and then slows over the next two years. Weight loss can be maintained over many years after surgery when lifestyle changes are continued.

There are several different types of weight-loss surgery. One type works by restricting the amount of food you can eat. It’s called laparoscopic adjustable gastric banding (also called lap band). In this surgery, your doctor will make several small incisions in your abdomen (lower belly). A laparoscope is inserted into one incision. Your doctor will place a band, like a belt, around your stomach, separating it into two pouches.

There is a small passage between the two pouches. The food you eat will slowly pass through the narrow passage on the way to the intestine. A tube is attached to the band, and at the end of the tube is a port or an access point, that is left just below the skin. This access point allows your doctor to adjust the tightness of the band by injecting saline (saltwater) into the tube. Making the band tighter will make the passageway smaller, which makes the upper pouch fill faster. This will make you feel full faster.

Other common weight-loss surgeries work by reducing the amount of food you can eat and your body can absorb.

Gastric bypass surgery: During this surgery, your doctor will make a small pouch at the top of your stomach. This reduces the amount of food you can eat before you feel full. The connection to your small intestine is then moved from the bottom of the stomach to the new pouch. When you eat, the food you swallow goes into the new pouch and then into the small intestine, “bypassing” your stomach and the upper part of your small intestine, where absorption usually takes place.
Sleeve gastrectomy: This procedure permanently reduces the size of your stomach. The “sleeve,” or tube-like structure, that’s left will be about 15% of the original size of your stomach. It is performed laparoscopically.
Biliopancreatic diversion with duodenal switch: During this surgery, your doctor will remove most of your stomach. This type of surgery is rarely used because of possible side effects, which include being unable to absorb all the vitamins and nutrients your body needs. If you do have this type of surgery, your doctor will closely monitor your progress to make sure you’re getting all the nutrients your body needs.

If you’re interested in weight-loss surgery, talk to your doctor. He or she can decide if you’re a good candidate for surgery. If you are, your doctor can explain the different procedures and decide which surgery would be best for you.

Life after surgery

After surgery, you may experience some pain or discomfort. This is normal. Your doctor will prescribe pain medicine to keep you comfortable.

Food. Your doctor will also put you on an all-liquid diet for the first two weeks following your surgery. He or she will tell you how much liquid you should drink each day. After those two weeks, you’ll be on a soft-food diet for two more weeks. When those weeks are passed, you’ll likely be able to resume eating solid foods. But remember you’ll need to adjust your eating habits. You’ll need to eat smaller portions of food, take small bites, and chew your food completely. You should also avoid foods that are high in fat and sugar.
Movement. Your doctor will want you to get out of bed and move around the day after your surgery. Walking and doing leg exercises will help you avoid developing blood clots in your legs. Try not to stay in bed for long periods of time. You should be able to resume your normal daily activities a day after surgery. However, it will take a few weeks before you’ll be able to resume exercise or any type of strenuous activity. Your doctor will tell you when you can begin these activities.
Appointments. You’ll have frequent follow-up appointments with your doctor. These likely will be every 4 to 6 weeks during the first several months after surgery. This is when you will be losing weight quickly, so your doctor will want to monitor your progress and make sure you’re doing well. Take this time to ask questions. Be honest about how often you’re going to the bathroom (probably a lot more often). Also tell your doctor how you’re feeling. It’s common to have mixed feelings about your weight loss. Some people may even feel depressed. Discuss this with your doctor. After your weight loss slows, you will see likely your doctor every 6 to 12 months. At these appointments, you’ll discuss your diet and exercise plans. Continue to share your feelings. Your doctor may order blood tests at these appointments.
Supplements. Your doctor will probably advise a regular vitamin supplement if your surgery causes your body to not absorb vitamins from food. It’s important to take this as your doctor tells you to avoid vitamin deficiencies.

Losing your weight is only half the battle. Keeping it off will require permanent healthy changes to your lifestyle. Here are some simple measures you can apply every day to make a significant difference over time.

Increase your current physical activity by adding 10 minutes a day, or by increasing the intensity from low to moderate. Limit time spent online, watching TV, and playing video games to less than two hours total per day.
Take the stairs instead of the elevator.
Park at the far end of the parking lot and walk to your destination. You can also get off the bus one stop earlier and walk the rest of the way.
Do more household chores (such as dusting, vacuuming, or weeding).
Walk or run with the dog and/or the kids.
Take “active” vacations—go hiking or ride bicycles.
Buy a pedometer or activity tracker, which measures how many steps you take each day. Gradually increase your daily number of steps. (Pedometers can be purchased at sporting goods stores.)

Watch the types of food you eat. Cutting back on unhealthy fat benefits almost everyone. Instead of eating fatty foods, try one or two of the following changes, or those suggested in our list of healthier food choices:

Rather than frying meat, bake, grill, or broil it. Take the skin off before eating chicken or turkey. Eat fish at least once a week.
Cut back on extra fat, such as butter or margarine on bread, sour cream on baked potatoes, and salad dressings. Use low-fat or nonfat versions of these condiments.
Eat plenty of fruits and vegetables with your meals and as snacks.
When eating away from home, watch out for “hidden” fats (such as those in salad dressings and desserts) and larger portion sizes.
Read nutrition labels on foods before you buy them. If you need help reading the labels, ask your doctor or a dietitian.
Drink no- or low-calorie beverages, such as water or unsweetened tea. Sugar-sweetened drinks, such as fruit juice, fruit drinks, soft drinks, sports drinks, energy drinks, sweetened or flavored milk, and sweetened iced tea can add lots of sugar and calories to your diet.

Along with a healthy diet and an exercise program you enjoy, you’ll need support. Finding support among friends, family, or a support group will be key to a successful weight-loss plan.