A basic guide to bariatric surgery & understanding the different terms connected with different bariatric procedures.
There’s no getting away from the fact that obesity has become an epidemic worldwide. Some countries have a bigger problem than others, with Australia being considered one of the ‘heaviest’ of all countries. Nearly 2 out of 3 Australians are overweight, while 1 in 3 are considered obese.
- Almost 2 in 3 Australian adults were overweight or obese in 2014–15
- 22,700 weight loss surgery separations were recorded in 2014–15, an increase from 9,300 separations in 2005–06
- 28% of Australian adults were obese in 2014–15, an increase from 19% in 1995
- 1 in 4 Australian children (aged 2–17) were overweight or obese in 2014–15
Obesity has enormous impacts on productivity and healthcare costs. Across the globe, the dieting and exercise industries are worth billions. No matter how many people try health and fitness diets and fads, the vast majority simply re-gain the lost weight.
Part of the reason for this is that the body has a defense mechanism in place when weight drops too quickly. From age-old conditioning, we’ve have been programmed to conserve weight in times of famine, and other extreme conditions, so losing fat can be seen as a threat to the body. As a consequence, most people who have been on successful diets find that their metabolism actually slows down. Meaning, they invariably gain back the original weight they lost – and in some cases even more to boot!
The rise of bariatric surgery
With obesity causing such an onslaught of illness and unhappiness, finding a solution is key for many countries. Bariatric surgery is one such answer to finding a sustainable way for people to lose weight. Just to give an indication of its popularity, there were less than 9,500 bariatric surgeries performed 10 years ago. Now, the number has spiraled to 22,700 over double than 10 years ago.
In fact, bariatric surgery has become so successful and effective that many of these procedures are now covered by private health insurance. This type of insurance is cost effective for them. Once people lose weight and become healthier their medical costs drastically reduce, making it cheaper in the long run to offer cover.
What are the different types of bariatric surgeries?
There are numerous procedures that a person can undergo. You’ll find there is a lot to learn before making a decision. All procedures are considered successful in promoting weight loss but some are significantly better than others depending on your personal circumstances.
The first thing to know is that bariatric surgery is not about removing fat tissue – in other words, it’s not liposuction. It’s a procedure that treats obesity by changing the gastronomic system. In other words, surgeons change the stomach and intestines. When they have done this a person feels ‘full’ more quickly after eating. This means that they naturally restrict the amount of food they take in, absorbing fewer calories and losing weight.
Here are 4 of the most common Bariatric surgery procedures:
How weight loss is achieved by bariatric surgery
In essence, bariatric surgery reduces the size of the stomach. This can be done by means of a gastric band, or through removal of a portion of the stomach (such as through sleeve gastrectomy or the duodenal switch). Gastric bypass surgery involves re-routing the small intestine to a smaller stomach pouch.
Here are more details of each of these procedures:
1. Gastric banding surgery
A small incision is made in the belly, and an adjustable silicone band is placed around the upper part of the stomach. The band squeezes the stomach and its size can be controlled by a plastic tube attached to a devise placed just under your skin. For example, if you’ve eaten too much and feel nauseous, you would be able to loosen the band.
Good weight loss is achieved by this method, and it’s been popular because it’s not particularly invasive. The procedure can also be reversed by removal of the band. However, once this happens and the stomach returns to its old size, the vast majority of patients start gaining weight.
2. Gastric sleeve
With gastric sleeve surgery, more than half of your stomach is removed! The small part left behind is about the size of a banana – hence the procedure being referred to as a gastric sleeve. The surgery can be done laparoscopically (with a small incision and a camera). As the stomach is actually removed, the procedure isn’t reversible. However, this type of surgery is becoming the most popular of the bariatric procedures because it’s so successful with respect to weight loss.
This procedure not only means that less food can be tolerated, but actually helps people feel less hungry.
3. Gastric by-pass
In this procedure, the stomach is first divided into two pouches – a small upper pouch and a larger lower pouch. The pouches are created by a process known as ‘stomach stapling’. A new connection is made from the smaller pouch to the small intestine. The smaller pouch can hold very little food – no more than about a cup. As a result, people eat far less, and are literally restricted by the size of the new stomach (the same as with the gastric sleeve).
This surgery normally requires a 2 to 3-day stay in hospital. Recovery can be affected by digestive problems, bleeding, and sometimes by infections and ulcers. Another problem, due to the nature of the surgery, is that there could be a leak in the intestines if the connections aren’t perfectly closed.
4. Duodenal switch
This is similar to a gastric bypass but here the surgeon will disconnect the new, small stomach pouch from the majority of the stomach and from the first part of the small intestine. This pouch will then be connected to a part of the small intestine further down. The effect is that food bypasses the duodenum, which is where many calories and nutrients are absorbed. By minimising the number of calories absorbed, weight loss is achieved.
Problems experienced are similar to a gastric bypass. However, because nutrients are no longer absorbed as well as previously (due to where the new connection is routed to the small intestine), there is the risk of deficiency of iron and calcium. When you’ve had this type of procedure, it’s important to take nutritional supplements.
The gastric balloon is also sometimes listed under bariatric surgery, even though the procedure doesn’t involve any incisions. A soft, silicone balloon is inserted into your stomach in a deflated state through the mouth and esophagus. The balloon partially fills the stomach which leads to your feeling ‘full’. This is a temporary procedure, and the balloon is normally removed after 6 months.
The difference between a gastric bypass and a duodenal switch
A duodenal switch is a newer procedure, and has definite benefits. At present, gastric bypass surgery is the most popular procedure, but it doesn’t provide the highest expected weight loss. Duodenal switch allows for higher weight loss, but does have some risks and complications that should be considered.
As both involve attaching the stomach to the small intestines lower down than usual, it means that both are restrictive (you can’t eat too much) as calories and nutrients are not absorbed as readily in this part of the intestines. With a duodenal switch, a new stomach is created, while the gastric bypass reduces the size of the stomach. The major difference is the new stomach is ‘switched’ to the last 6 feet of the small intestines. The gastric bypass also allows for a bypass of a large portion of intestines, but doesn’t usually connect the smaller stomach pouch as far down as the last 6 feet.
The surgery time of the duodenal switch is normally 4 hours – double that of a gastric bypass. The stay in hospital is similar at 2 – 3 days, as is the estimated time off work, which is 2 – 3 weeks. The big difference is recovery time – 3 weeks for a duodenal switch compared to 3 months for a gastric bypass!
These days it’s becoming clear that diet and exercise alone are rarely successful in helping people lose weight and keep it off. Many years ago, one of the most successful solutions was to wire people’s jaws shut! Fortunately, we’ve come a long way since then.
As you can see, there are many different procedures associated with bariatric surgery. The best idea is to keep researching and learning about the different types and which one is best suited to your needs and your lifestyle.
About 75% of bariatric patients have not only lost vast amounts of weight, but have kept it off for years. It’s not a way of preventing obesity, but it’s certainly becoming a way to treat it. Most people are delighted with the results they’ve achieved, so talk to your surgeon and explore your options.
Some common abbreviations
ANZGOSA – Australia and New Zealand Gastro-Oesophageal Surgery Association
BB – Before Band or Before Bypass or Before Balloon
BMI – Body Mass Index
BOLD – Bariatric Outcomes Longitudinal Database
BPD/DS – Bilio-Pancreatic Device with Duodenal Switch
BS – Before Sleeve
BSR – Bariatric Surgery Registry
DOS – Day Of Surgery
ICU – Intensive Care Unit
GI – Gastrointestinal
LAGB – Laparoscopic Adjustable Gastric Banding
LSG – Laparoscopic Sleeve Gastrectomy
OECD – The Organisation for Economic Co-Operation and Development The
OSSANZ – Obesity Surgery Society of Australia and New Zealand Queensland
RACS – Royal Australasian College of Surgeons
RYGB – Roux-Y Gastric Bypass
SAGB – Single Anastomosis Gastric Bypass
SG – Sleeve Gastrectomy
WLS – Weight Loss Surgery
Weight loss is a journey, and we can help, from treating obesity to excess weight gain or massive weight loss.
Get YOUR body feeling and looking its best by accessing some of Australia’s most caring, helpful and skilled Nutritionists, Dieticians and Surgeons.