Bariatric Surgery

Bariatric surgery (weight loss surgery, or metabolic surgery) is an obesity treatment. Your healthcare provider may recommend it if other weight loss methods haven’t worked for you. They may also suggest it if you have a high risk of obesity-related complications.

Bariatric surgery works by making changes to your digestive system. These changes restrict how many calories your body can consume and absorb. The surgery also reduces the hunger signals that travel from your digestive system to your brain. Together, these changes allow your body to maintain weight loss by eating healthy and getting regular physical activity.

Weight loss surgery isn’t a “quick fix” — you’ll need to prepare beforehand and make long-term changes afterward for it to be successful. But if you’ve tried everything else and your provider recommends it, bariatric surgery may be just what you need.

What are the requirements for bariatric surgery?

Bariatric surgery requirements begin with a diagnosis of class III obesity. That means you either:

• Have a BMI of 40 or higher: Body mass index (BMI) is a way of estimating how much body fat you have based on your height-to-weight ratio. A score of 40 or higher means you have a high risk of obesity-related health conditions, like diabetes or heart disease.
• Have a BMI of at least 35 and at least one obesity-related health condition: A BMI of 35 without an obesity-related health condition is considered class II obesity.

Healthcare providers can easily measure your BMI. It isn’t perfect, but it’s currently the best way to predict weight-related complications. You may need medical tests to diagnose any obesity-related health conditions.

What health conditions can bariatric surgery treat?

Obesity is linked to many long-term (chronic) diseases. The symptoms of these conditions may greatly improve after surgery and weight loss. If you’re a candidate for bariatric surgery, you may have or be at risk of developing:

• High cholesterol
• High blood pressure
• High blood sugar/diabetes
• Heart disease
• Kidney disease
• Obstructive sleep apnea
• Osteoarthritis
• Metabolic dysfunction-associated steatotic liver disease (MASLD)

How should I prepare for bariatric surgery?

Before scheduling surgery, your healthcare provider will want to ensure that you’re healthy enough for surgery. You’ll meet with a team of specialists. You may also need to:

• Take medical screening tests
• Quit using tobacco or recreational drugs, or drinking alcohol
• Follow a presurgery eating plan for a few weeks to reduce fat in your belly, which will help your body get ready for surgery

Your healthcare provider will usually perform weight loss surgery through a minimally invasive method. That means they’ll make small cuts (incisions) instead of one long cut (open surgery). With this technique, you’ll have:

• A faster healing time
• Less pain during recovery
• Minimal scarring

What are the different types of bariatric surgery?

There are several types of bariatric surgery. Your surgeon will recommend the best type for you. They’ll use factors like your BMI, other health conditions and risks of each type to decide.

Bariatric surgery options include:

Sleeve gastrectomy

Sleeve gastrectomy (gastric sleeve) is the most common type providers use. Your surgeon removes about 75% of your stomach. That leaves behind a narrow tube, or sleeve, about the size of a banana. This restricts how much food your stomach can hold.

Roux-en-Y gastric bypass

Roux-en-Y gastric bypass is another common type providers use. Your surgeon creates a small pouch in your stomach. Then, they connect it to the lower part of your small intestine. Food will bypass the rest of your stomach and go straight to your intestine. This makes you feel full faster.

Biliopancreatic diversion with duodenal switch (BPD/DS)

Biliopancreatic diversion with duodenal switch (duodenal switch) combines a sleeve gastrectomy with an intestinal bypass. It goes around most of your small intestine. That reduces hunger hormones and limits the amount of food your stomach can hold. It also restricts how much nutrition your small intestine can take in.

Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S)

Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a modified version of the duodenal switch. It begins with a sleeve gastrectomy. But then, it bypasses only about half of your small intestine. That allows your intestine to absorb more nutrients.

What happens after bariatric surgery?

After surgery, you’ll likely spend a few days recovering in the hospital. For at least the next year, you’ll see your healthcare provider regularly for follow-up visits and testing. They’ll order blood tests to monitor your health. They’ll also screen you for any nutritional deficiencies.

How successful is this treatment?

Healthcare providers consider weight loss surgery successful if you lose 50% of any excess weight and maintain a healthy target weight. By this standard, the success rate is more than 90%. Many people experience steady weight loss for the first two years. Then, they stall or regain some weight after that. Usually, the weight regain is less than 25%.

What are the benefits of bariatric surgery?

Bariatric surgery has many potential benefits. These include:

• Significant, long-term weight loss: Surgery is the only treatment proven to be effective for class III obesity over the long term.
• Reduced hunger hormones and improved metabolism: Surgery is the only obesity treatment that rewires your body’s metabolic programming. This helps prevent weight regain.
• Cholesterol and blood sugar management: Weight loss surgery often reduces diabetes symptoms. You may be able to stop using your medications.

Is bariatric surgery safe?

Your healthcare provider will help you weigh the pros and cons of surgery. You’ll want to consider the risks of the operation and possible side effects that may occur afterward.

Risks of bariatric surgery

All surgeries involve certain risks. Longer and more complex operations may involve more. Risks may include:

• Bleeding
• Infection
• Blood clots
• Hernias
• Small bowel obstruction
• Anastomotic leaks

Bariatric surgery side effects

Surgeries that change your digestive system can cause digestive complications. These are sometimes called post-gastrectomy syndromes. Possible side effects may include:

• Dumping syndrome
• Malabsorption
• Malnutrition
• Bile reflux
• Gallstones

Bariatric surgery recovery time

After surgery, you’ll spend a few weeks recovering at home. You may need to avoid intense physical activity for up to six weeks. It may take up to 12 weeks before you can start eating regularly again. Your healthcare provider will tell you what to expect during your recovery.

After a year, you may want to talk to your surgeon about body contouring. Body contouring can help remove excess skin folds and tighten loose tissues. This can be an option if you’ve achieved your target weight and haven’t had any complications.

How fast is weight loss after bariatric surgery?

You may experience rapid weight loss between 12 and 15 months after surgery. You’ll likely reach your lowest weight between one and three years after surgery.