Weight loss surgery: Is it an option for you? 

Being overweight or obese continues to be an issue for many people. 

According to the CDC’s National Health and Nutrition Examination Survey, approximately one in three adults are overweight, more than two in five are obese and approximately one in 11 are severely obese. 

For people who cannot lose weight with routine changes of diet and regular exercise, weight loss surgery may provide a way to lose unwanted pounds. 

Surgical Options

There are several types of surgery to achieve weight loss. The primary procedures either reduce the size of the stomach or slow down the digestive process. 

Gastric banding

Also known as a lap band, gastric banding involves placing an inflatable band around the stomach to create a small top section and a larger lower section. When eating, the person eats until the top section is full, which results in them eating less. As the food breaks down, it moves into the larger lower section, where it is naturally digested. 

Biliopancreatic diversion with duodenal switch

This surgery combines two procedures. The first is similar to a gastric sleeve surgery. The second is similar to a gastric bypass in that the small intestine is divided into two sections, allowing food to bypass most of the small intestine. 

Gastric Sleeve

Also known as a vertical sleeve gastrectomy (VSG), this procedure involves removing the majority of the stomach, which reduces how much food you can eat and makes you feel full faster. 

Gastric bypass

Also known as Roux-en-Y gastric bypass, gastric bypass involves creating a small pouch in your stomach so you eat less. The procedure also involves dividing the small intestine into two sections, connecting the lower part to the small pouch in the stomach. The remaining section of the intestine is attached to a lower portion of the small intestine. This aids in full digestion of food.

How successful are weight loss surgeries?

It’s important to keep in mind that how much weight a person loses following weight loss surgery depends on the individual, the type of surgery and how committed a person is to keeping the weight off after the surgery. 

“Success rates can vary, but the majority of patients achieve significant weight loss and improvements in obesity-related conditions,” says AdventHealth Ocala Director of Bariatric Surgery Dr. Juan C. Gutierrez. “Success is often measured by the percentage of excess weight lost. On average, excess weight loss is around 60% to 80% at one year, 50% to 70% at three years, and 45% to 60% at five years. A bariatric surgeon can provide more personalized information based on the chosen procedure.”

Studies also show that many people who undergo weight loss surgery do keep the weight off. According to the Longitudinal Assessment of Bariatric Surgery funded by the National Institute of Diabetes and Digestive and Kidney Diseases, at the seven-year follow-up, LABS researchers found that participants lose an average of 28.4% of their body weight after gastric bypass surgery. Participants who underwent laparoscopic gastric band surgery lost 14.9% of their body weight. 

How do I know which weight loss surgery is right for me?

It’s important to discuss all options with your doctor before choosing a weight loss surgery. Some procedures are more common than others, but that doesn’t mean they are right for you. 

“The choice of procedure depends on various factors such as the patient’s overall health, BMI and personal preferences,” Gutierrez says. “For example, a sleeve gastrectomy may be preferable in a patient with a history of vitamin or mineral deficiencies, whereas a gastric bypass may be the best choice for a patient with acid reflux. The patient’s preferences are always taken into consideration when developing the treatment plan. Consultation with a bariatric surgeon is crucial to assess individual needs and determine the most suitable option.”

Alternative solutions to weight loss surgery 

If weight loss surgery is not an option for you or you prefer not to undergo surgery, there are other options to help you lose weight. “While there are medications and injectables for weight loss, they are typically recommended for individuals who don’t qualify for, or prefer not to, undergo surgery,” Gutierrez says. “These alternatives may have different mechanisms and potential side effects, and their efficacy varies among individuals. In addition, many of the newer injectable medications are in short supply, expensive and often not covered by insurance.”

Devices

Some weight loss devices may offer some of the same benefits as weight loss surgeries without permanently altering the stomach or small intestine. With some devices, an inflatable balloon is inserted into the stomach using endoscopy. It is then inflated into the stomach, reducing how much food it takes to help you feel full. Sometimes, more than one balloon may be inserted. They typically are removed after six to 12 months. 

With a gastric emptying device, a tube is inserted into your stomach and connected to a port on the outside of your abdomen. After eating, you attach the port to a pump and drain your stomach contents, reducing how much your body absorbs. This device can be left in for a longer period of time and removed at any time. 

Injectables

It’s a simple fact. Most people don’t drink enough water. 

Government statistics from 2015 to 2018 reveal that U.S. adults drank an average of just 44 ounces of plain water daily. In adults older than 60, that dropped to 36 ounces per day.

The absolute minimum ounces of water you should drink per day is half your body weight. (For a 150-lb. person, that translates to 75 ounces a day.)

“Here in Florida with our high humidity in the summer, or if you’re exercising, you really should add another 20 ounces to that,” says Bookman.

Because caffeine is a diuretic, she recommends replacing however many ounces of caffeinated beverages you drink with the same amount of water. (And that’s beyond the recommended minimum of half your body weight in ounces of water!)

Your body and brain can’t function properly if they aren’t hydrated.  

The percentage of water in the human body varies somewhat by age and sex, but the average adult’s body contains 60 percent water.

The brain, however, is approximately 73 percent water, which not only protects it, but promotes normal function. Because your brain can’t store water, it requires hydration throughout the day. 

Prolonged dehydration literally shrinks the size of brain cells. Even slight dehydration adds to confusion, difficulty focusing and short-term memory loss. 

There’s also a troubling link between dehydration and dementia. As we age, our bodies tend to lose the trigger that says “I’m thirsty.” An older person struggling with memory loss not only doesn’t feel thirsty but can actually forget they need to drink. 

Bookman emphasizes that by the time someone feels thirsty, they are already becoming dehydrated.

Energy drinks are very popular today, but many are high in sugar and loaded with caffeine.

“You can still get dehydrated drinking energy drinks and there’s not a lot of nutritional value,” says Bookman. “It’s a quick fix to raise your energy level, but then your body takes a deep dive. The body becomes ‘addicted’ to this rise and fall of energy.”

Not sure you’re properly hydrated? Check the toilet next time you “go.” Colorless or pale yellow urine typically indicates your fluid intake is adequate.

Move More

Wegovy

This medication uses semaglutide to stimulate insulin production, which can reduce appetite and help you feel full. Ozempic, which also contains semaglutide, is gaining considerable attention for weight-loss, but it is only approved by the U.S. Food & Drug Administration for treating Type 2 diabetes. If you stop taking the medication, you could regain any lost weight. Side effects could include constipation, vomiting, abdominal cramping, headache and fatigue. 

Pills

Prescription medications may also aid weight loss. These are typically short-term aids used in combination with exercise and a healthy, low-calorie diet to achieve weight loss. 

Phentermine

Available in capsule and tablet form, phentermine decreases appetite. A controlled substance, phentermine could be habit-forming, so it usually is prescribed for just three to six weeks. Side effects could include diarrhea, vomiting, constipation, dry mouth, dizziness, insomnia and increased blood pressure.  

Orlistat

Available in a capsule, orlistat works by blocking absorption of some fat in the intestines. It also may be prescribed following weight loss surgery to prevent regaining lost weight. Possible side effects include loose stools, stomach pain, headache, nausea and vomiting. 

Follow-Up Surgeries After Weight Loss Surgery

Many patients who lose a lot of excess weight after weight loss surgery are left with excess skin.

To remove the excess skin, they often need plastic surgery such as facelifts, armlifts or a body lift. 

“Eventually these patients have a very deflated look with a lot of extra skin and extra stretched out skin,” says Dr. Fernando Serra of Central Florida Plastic Surgery in The Villages. “This can happen all over the body, whether it’s a face and neck, breasts, arms, legs or tummy. So, ultimately, once the patient has successfully reached their goal weight after a massive weight loss, then they have a consultation with a plastic surgeon to address the excess skin issues on the areas that the patient desires improvement. Also, I think that after all that hard work, that is kind of like a reward, that the removal of all the extra skin will help someone look on the outside the way they feel on the inside.”

After her gastric bypass in 2004, Oxford resident Sue Sullivan lost 67 pounds, leaving her with a lot of excess skin. After her husband died in 2019, she decided she wanted to get in shape and remove that excess skin. In 2020, she had a chin lift to remove the “gobble” under her chin, and followed up with an arm lift in 2021. 

“The arms were always something that bothered me,” she says. 

Sullivan says the recovery was short and included using Biocorneum Advanced Scar Treatment cream to reduce scarring. Regarding both the gastric bypass and the follow-up surgeries she had, Sullivan says she is happy with the results. 

“It’s not a magic bullet,” she says. “You can still overeat and gain weight, you just can’t do it in one sitting. You still have to be careful, but it did help me when nothing else seemed to. It helped my self-esteem, and I’m healthier. I’m very glad I did it. I’ve never had anything bad happen because of it. I recommend it highly.” 

When considering follow-up surgery after weight loss surgery, Serra recommends taking some time after the weight loss surgery before undergoing any procedures. 

“We want to wait at least a year after the weight loss surgery so that their weight is stabilizing,” he says. “We also have to make sure that they’re on the proper nutrients and vitamins because, after weight loss surgery, sometimes they can be kind of malnourished and they have to take special supplements.” 

Once a person is ready for post-weight loss surgery, they should consult with a plastic surgeon regarding their options. In addition to working with a board-certified plastic surgeon with a good reputation, it’s important to find a surgeon that you connect with and makes you feel comfortable. Working with the right surgeon can lead to the results you want. It could be the finishing touch to your weight-loss journey.