Is It Right for You?
Obesity is linked to more than 60 chronic diseases, including diabetes, heart disease and certain cancers. Although modifying diet and increasing exercise are among the first lines of defense towards obesity, they may not work for everyone.
Here are answers to some common questions about bariatric surgery that may help you understand if it’s the right option for you.
How can bariatric surgery improve your overall health?
Patients often become interested in bariatric surgery as an option as more medical problems develop that are related to or caused by obesity. The most common include high blood pressure, diabetes, sleep apnea, joint pain, arthritis and acid reflux. “I think the common question is does it help with those treatments, in which case the answer is yes,” says Northwestern Medicine Digestive Health Center Weight Loss Surgery Program Gastrointestinal Surgeon Ezra N. Teitelbaum, MD. There is strong medical evidence that surgery can improve and, in some cases, actually cure other medical conditions that are caused by obesity.
What the types of bariatric surgery available, and how are they different?
The two most common surgery approaches are laparoscopic sleeve gastrectomy and laparoscopic gastric bypass. Both are minimally invasive procedures, which means they are performed through very small incisions, typically leading to a faster recovery time. The procedures use different techniques to achieve a smaller stomach, but both have been shown to be very effective in terms of weight loss and improvement in medical conditions related to obesity.
During a laparoscopic sleeve gastrectomy, roughly 80 percent of the stomach is removed through five small incisions. Because you will have a much smaller stomach, you will eat less. This also removes the part of your stomach that secretes ghrelin, a hormone that is responsible for making you feel hungry. This will result in decreased hunger after surgery.
During a laparoscopic gastric bypass, the lower part of the stomach is closed off, and the upper portion is connected directly to the small intestine. This creates a smaller stomach, leading to decreased hunger, smaller meals, and absorption of fewer calories.
How do you know which one is right for you?
“We assess the patient’s reasons for pursuing surgery, and what their goals are in terms of health and weight loss. We also look at the patient’s medical conditions, and determine which surgery makes more sense,” says Dr. Teitelbaum. Gastric bypass, for example, is more effective in terms of weight loss and possible resolution of other problems, particularly type 2 diabetes and acid reflux. However, it’s more complicated and takes longer to perform. Recovery from either surgery typically takes four to six weeks.
How do you prepare for surgery?
“What’s unique is that we have a comprehensive program in place prior to surgery,” explains Dr. Teitelbaum. Patients are typically in the program for three to six months before surgery. The program itself involves a surgeon-led seminar to describe how the surgery is performed as well as the risks and benefits. An internal medicine provider ensures other medical conditions are considered and addressed.
Patients also work with a dietitian prior to surgery to review changes in diet. A psychologist then helps create a tangible plan of action to achieve success.
“People are often confused why they’re being referred to a psychologist, but we are on the team for a variety of reasons,” says Psychologist Anjali U. Pandit, PhD. “We discuss health habits, emotional health and expectations. We tend to spend a lot of time looking at what have been barriers to losing weight in the past and assist in finding the right resources so they can see the best success.”
A large role of the psychologist is to educate the patient and help make sure they make an informed decision about the procedure. “My role is also helping people to problem-solve how to change their habits,” says Dr. Pandit. “We take the recommendations and translate them into daily life, breaking down new behaviors like meal prepping, tracking protein or starting an exercise routine.”
What does life post-surgery look like?
Initially, there are some physical restrictions on exercising and lifting heavy objects. These restrictions typically are gradually lifted beginning a couple weeks after surgery with physician oversight.
Some emotional changes are common after surgery. “A lot of patients fear the feeling of being deprived of certain foods. That actually doesn’t happen so much, and if it does, it’s short-lived,” says Dr. Pandit. “The benefits of improved health and mobility generally help people to feel pretty excited and motivated in the first year after surgery. After the first year or so, mood issues can return. It’s important we help patients develop health-focused coping strategies. The surgery is a tool for weight loss, and it’s part of the process of developing a new set of habits and finding new ways of relating to stressors.”
Many patients begin a new exercise regimen to handle stress and participate in support groups.
Can you become pregnant after weight loss surgery?
“Generally, our recommendation is that patients do not become pregnant for two years following bariatric surgery, because you don’t want to have a pregnancy when you’re losing weight. That can result in low birth weight,” says Dr. Teitelbaum. At two years post-surgery, there is no evidence of negative impact on pregnancy. In fact, reducing high blood pressure and weight, and improving diabetes decreases the risk for complications in pregnancy.
Do you have more questions?
Bariatric surgery is a life-changing decision. Contact Northwestern Medicine Digestive Health Center Weight Loss Surgery Program to get your questions answered. The program offers a multidisciplinary approach in order to help you address barriers, reduce your health risks and achieve your individual goals.