After Weight Loss Surgery

With obesity affecting more than sixty million American, weight loss surgery is becoming more common place. Although weight loss surgeries are certainly no fix-all or cure-all for obesity, but it can literally be a lifesaving procedure for those who are morbidly obese and who cannot lose weight by any other means. In order to be triumphant in weight loss goals following surgery, however, appropriate after care and lifestyle chances are required, and a lifelong commitment to modifications in behavior and eating is needed. Let’s look at what to expect following surgery.

Recovery

Gastric bypass weight loss surgery is done with a laparoscope, which allows for tiny incisions to be used. This reduces the amount of time that is needed for recovery. Most people who have laparoscopic weight loss surgery remain hospitalized for around three days or so and they are able to resume their traditional daily activities in as little as three weeks, on average. Weight loss surgery that is performed in a traditional manner (without the use of a laparoscope) will necessitate a longer healing and recuperative time frame.

Results

The results achieved with weight loss surgery are nothing short of fantastic. Most people will lose (with gastric bypass) around 60% of their added weight. Gastric banding surgeries have a slightly lower result with around 50% of surplus weight being lost. Most obesity-induced medical conditions are drastically improved following weight loss surgery, including diabetes, sleep apnea, high blood pressure, degenerative joint problems, gastric reflux disease, and more.

Problems Following Weight Loss Surgery

As with any type of surgery, weight loss surgery has its fair share of risks and possible complications, too. Although the majority of weight loss surgery patients experience no serious problems, around one in ten do undergo minor complications, and around one in twenty experience potentially life-threatening serious complications.

• Wound infections
• Constipation
• Bleeding in the stool
• Blood clots or pulmonary embolism
• Leakage
• Gall stones
• Dumping syndrome

Lifestyle and Nutrition Changes

Following weight loss surgery, the body’s methods of absorbing food are changed. It is harder for the body to absorb vital nutrients, like calcium, vitamins B12 and D, iron, and others. Many patients experience anemia or low blood count. Taking vitamins and supplements is required, and may be required for life.

The smaller stomach that is created during weight loss surgery requires that the person receiving the surgery eats smaller meals on a frequent basis. They must also make a commitment to nutrition to avoid serious malnutrition. Working with a dietitian can help the recent weight loss surgery patient to create a meal plan that they can stick with.

And last of all, weight loss surgery will help the person to lose the weight that needs to be lost, but it is not a magic cure-all. Exercise is needed in order to maintain the weight loss, and to help tone the body to reduce the need for plastic surgery procedures, like torso lifts and tummy tucks that are used to reduce the excess skin that is left behind following dramatic weight loss. Even with exercise, however, some people may still need to plan for and budget for these cosmetic procedures that are typically not covered by health insurance.

In sum, life after weight loss surgery is definitely an improvement for most people, especially those who are morbidly obese, but it is certainly an uphill struggle that requires commitment and determination.

Alternatives to Weight Loss Surgery

Millions of Americans  are considered morbidly obese.  Many people that suffer from this health condition may not realize there are many different treatment options that can help their condition, but in fact there are a variety of effective treatments available. Some people look into weight loss surgery only to find that it is not a good choice for them, for one reason or the other.  Because obesity is reaching near epidemic proportions it might be good to examine the causes and treatments for this very serious health condition.

Causes of Obesity

There are many different causes of obesity; certainly our modern day environment has a great deal to do with the rise of obesity.  Most of us have an extremely sedentary lifestyles, if we need to go somewhere we drive instead of walking, it is simply more convenient.  We work at our desks all day long, rarely getting a chance to exercise. 

Another factor is habits, it is very easy to get into a bad habit, and eating habits are not an exception.  It may not even be that overeating is the only culprit, but bad food choices may be just as much, if not more to blame.  Basically we have started taking in more calories, with less nutrients and are less active.  All of this adds up to major weight gain.  Another cause is genetics.  Research is still new in this area, but some people do seem to be pre-disposed to obesity.

Treatments

The good news is that this is a reversible condition.  There is myriad of treatment options that can help individuals wanting to overcome this health problem.  It is best to discuss treatment options with a physician, as they can diagnose the weight issue and give valuable advice.

One option that is becoming increasingly popular is the many commercial programs available.  Jenny Craig, Weight Watchers and Nutrisystem are all examples of these programs.  Some of these programs offer pre-packaged foods, which works very well for some.  They also offer counselors and support groups and are usually very nutritionally sound.

Physician-supervised weight loss is another approach that has helped many on the road to a healthier lifestyle.  This type of treatment usually takes place in a clinic and offers the services of medical doctors, dietitians and psychologists. 

Behavior Changes

This is basically done by making better food choices, avoiding processed and fast foods and keeping portion sizes under control.  A good place to start is to swap sugary drinks for water; often small changes made gradually can really pay off in the end.  Being more physically active is important, again start with small changes and then build from there.  It is also important to seek support; there are many different weight loss support groups that can give encouragement and advice.

Other Options

Besides nutritional changes, there are many new supplements that help to speed along the weight loss process, but it is important to have a doctor's advice on which ones are best.

Keeping the main goal in mind will help, as well.  Change is never easy but, there are many benefits to losing weight.  Health is improved and the quality of life is improved with every pound lost.

Understanding Bariatric Surgery

There is some confusion with the term bariatric surgery; it is often confused with gastric bypass, which is partially correct.  Bariatric surgery actually refers to any weight loss surgery that is performed on individuals who are considered morbidly obese, to help them lose weight.  Generally this is done by reducing the size of the stomach.  The three main types of bariatric surgery are gastric bypass surgery, gastric banding and sleeve gastrectomy.  All of these surgeries have shown to be successful at helping patients with weight loss and thereby alleviating many related health conditions.

Gastric Bypass Surgery

Gastric bypass has been the most common of bariatric surgeries performed in the United States.  There are a few different types of gastric bypass, but the one that is most often performed is the Roux-en-Y gastric bypass.  In this surgery a stomach pouch is created by stapling off part of the stomach, part of the small intestine is bypassed as well.  This procedure can be performed either as open surgery or laparoscopically.

Gastric bypass is generally a very successful surgery in regards to fast weight loss.  Most patients undergoing this surgical procedure will generally lose 50% to 70% of their excess weight in the first year.

As with all surgeries there are certain risks involved, including various complications, and the risk of death.  Other risks include a leak into the abdominal cavity from the stomach, an infection at the incision site or possible blood clot.  It is also estimated that anywhere from 5% to 15% of bypass patients develop ulcers.

Gastric Banding

Another common bariatric surgery is gastric banding.  This procedure also restricts the stomach by using a silicone band and is the second most common bariatric surgery in the United States.  This procedure is performed laparoscopically and is reversible.

This weight loss surgery is not considered as risky as gastric bypass.  While it is a very effective surgery, weight is not lost quite as quickly as with gastric bypass.  It does have risks also, but they are considered relatively low.

Sleeve Gastrectomy

Sleeve Gastrectomy is a procedure that reduces the size of the stomach to about 15% of its original size, by removing a large portion of the stomach.  The open edges are then surgically stapled together.  This procedure is also performed laparoscopically and cannot be reversed.  This surgery is generally done as a two part procedure for patients who are considered to high risk to undergo one of the other bariatric procedures.  Once the patient has lost a certain amount of weight, and then either gastric banding or gastric bypass can be performed

Candidates for Bariatric Surgery

None of these surgeries are for those who only need to lose a few pounds.  In order to be a candidate for weight loss surgery, certain guidelines must be met. They should only be considered by the morbidly obese, or individuals having a BMI of 40 or higher, and are struggling with weight related health issues.  In most cases these surgeries are very effective in helping with weight loss.  Lifestyle changes will also have to be made to ensure weight loss success, as well.

Celebrities and Weight Loss Surgery

Obesity is a major problem for many people in the United States and those in Hollywood are no exception.  If fact, there are many celebrities that have had weight loss surgery.  Some have opted for gastric banding, while others have chosen gastric bypass to help them control their weight.  Some celebrities have been very forthcoming about their surgeries, while others have preferred to keep it more private.

Celebrity Gastric Bypass Surgery

Al Roker decided to have gastric bypass in 2002, weighing in at 320 pounds when he decided to have the surgery and he did lose 100 pounds over a period of eight months.

Star Jones has also undergone gastric bypass surgery in 2003, weighing in at 307 pounds; she has lost an estimated 160 pounds.

Carnie Wilson dropped 150 pounds, after having gastric bypass, but did regain some of the weight.

Celebrity Gastric Banding

Ann Wilson underwent gastric banding in 2002 and successfully lost more than 75 pounds.

Sharon Osbourne, also, had gastric banding and lost 125 pounds.

Each celebrity has had a varying degree of success after their surgery.  For some it has been a complete success, others have had struggles and some have had their operations reversed.  While the various weight loss surgeries are an excellent tool those struggling with obesity, they should not be entered into without serious consideration.

Comparing Gastric Banding and Gastric Bypass

The two most sought after weight loss surgeries are gastric bypass and gastric banding.  Both surgeries work by limiting the amount of food that can be eaten.

Gastric bypass usually produces faster weight loss, but the surgery has carries a somewhat higher  risk.  With gastric bypass most will experience very fast weight loss usually 50% to 70% of excess weight is gone, in the first year.  Maximum weight loss results are usually achieved within 2 years. This is partly due to part of the small intestine also being bypassed as well as the stomach, so fewer calories from the food that is eaten are absorbed. 

Gastric banding participants usually lose 40% to 50%, and maximum weight loss results are usually achieved in 3 to 5 years.  Gastric banding does not bypass the small intestine, so all the calories from any food eaten are absorbed.   This can also be an advantage, since nutritional deficiencies are more common with gastric bypass.  While weight loss is not as fast, the hospital stay is shorter and there are fewer complications with gastric banding.  Gastric banding does requires more effort on the patients part.

Both surgeries require lifestyle changes.  Diet and exercise are an important part of achieving success. Yet the advantages of losing weight are many.  Not only due most individuals who undergo these surgeries end up losing large amounts of weight.  They also will have more energy and a better quality of life.  There are also numerous health benefits as well, including the reduced risk of heart disease, diabetes and high blood pressure.  If you think that weight loss surgery may be right for you, talk to your doctor to schedule an appointment with a bariatric specialist.

What is Sleeve Gastrectomy?

Sleeve gastrectomy is a type of  weight loss surgery, in which the size of the stomach is reduced to about 15% of its original size.  The procedure is performed by surgically stapling the largest part of the stomach to form a sleeve.  It is performed laparoscopically and is not reversible.  Like all weight loss surgeries, it has many benefits, but also has a number of risks as well.  The particular weight loss surgery is well suited to extremely obese and might not want to risk surgery otherwise.  Sleeve gastrectomy does not usually produce the more extreme weight loss that other surgeries, such as gastric bypass or gastric banding, will.  It also carries a lesser risk than other options.  In some cases this surgery is a prelude to the other surgeries, helping the individual to lose enough weight that the other procedures can be performed with less risk to the patient.

The procedure time varies, usually between 1.5 to 3.5 hours and the average hospital stay is 2 to 5 days.   Normal activities can be resumed in 2 to 3 weeks

Advantages for Sleeve Gastrectomy

While the size of the stomach is reduced, thus reducing the amount of food that can be eaten, the stomach will function normally.  The hormones that are produced in the stomach, which stimulate hunger are also reduced.   Problems with vitamin deficiencies and dumping syndrome, which can be experienced with gastric bypass, are avoided.  The risk of ulcers is reduced.  Because the intestine is not bypassed, the types of foods that can be eaten after this surgery are not as limited.

This may also be a good choice for individuals that have Crohn's disease or other medical conditions that make the other weight loss surgeries too risky.

Many individuals are able to lose a significant amount of weight with this procedure.  Most patients can lose as much as 55% of their excess weight.  There is also a reduction in the cravings for sweets, as well. 

There are many benefits that come with weight loss, including a lowered risk of heart disease, diabetes and high blood pressure.   Many other health benefits come from weight loss, as well.   In addition to the many health benefits, individuals will have more energy and generally experience a much better quality of life. 

Disadvantages for Sleeve Gastrectomy

The surgery does not usually produce the weight loss results of other weight loss surgeries.  There is the risk of not losing enough weight or regaining the weight.  Although it is very effective in helping the extremely obese achieve a healthier weight and then undergo a more effective surgery.  Stomach stapling can cause complications.  This procedure is not reversible.  Because it is still considered experimental it may not be covered by insurance.  This procedure is not widely available in all areas, so finding a surgeon or doctor that performs the procedure is tricky in some instances.

Risks for Sleeve Gastrectomy

As with any surgery there are risks and potential complications with this procedure.  Because this surgery involves stomach stapling there is a risk of leakage.  Other risks, though relatively low, are death, pneumonia, and pulmonary embolus.

Men and Weight Loss Surgery

While men only make up about 15% of weight loss surgery patients, as the procedures become safer and the rate of morbid obesity rises, the number of men seeking these surgeries is rising.  In general the effects of obesity are harder on men than women, so they have more to gain as far health benefits go.

Why have the amount of men, in the past, opting for surgery been so much lower than women?   It is perhaps that obesity is viewed as a women's disease and as such, a social stigma is attached to weight loss surgeries.  As more is learned about obesity and its effects on the body, this stigma is slowly changing. And more and more men are undergoing weight loss surgery.

The Adverse Effects of Obesity

Obesity negatively affects almost every system in the body.  Not only does it increase the risk of heart disease and diabetes, it shortens life expectancy, impairs breathing, can cause sleep apnea, high blood pressure and can lead to erectile dysfunction and may cause a decrease in male fertility.  Many other issues can be related to morbid obesity, as well.  The risk of developing certain stomach cancers and skin disorders are increased.  Plus back problems and joint problems are common in the morbidly obese.  It is estimated that over 400,000 people die due to obesity related issues, in the United States, alone.  Obesity is obviously, very hard on the body.  So what are the benefits to losing excess weight?

Benefits to Weight Loss

There are a multitude of health benefits experienced with losing weight.  Just a few of these benefits are, increased energy levels, improved breathing, better mobility, reduced aches and pains, reduced blood pressure and the decreased risk of developing heart disease and diabetes.  Problems with sleep apnea are often resolved with weight loss. Plus there is often an increase in emotional well-being and self-esteem. Obviously the benefits to weight loss are numerous.

Why Weight Loss Surgery?

Even though men tend to lose weight more quickly than women, there are still many men out there that have struggled to lose weight.  Years of dieting and exercise have produced little success and whatever weight was lost often comes right back.

For those who are morbidly obese (having a BMI of 40 or higher) and who struggle with the adverse effects of obesity,  gastric bypass surgery may be a good tool in losing the weight for good.

The success rate for the different weight loss surgeries is quite high.  Most people will begin to lose weight almost immediately.  Usually within one to two years 60% of the excess weight is gone

There are many different types of weight loss surgeries, gastric bypass and gastric banding are two of the most popular and effective.  Again, weight loss surgery is not a cure all, but it is a very effective tool in fast weight loss.  Lifestyle changes will have to be made in order to reap the benefits and the risks associated with the various surgeries will have to be considered.

Weight Loss Plastic Surgery

Many people find that after losing a significant amount of weight following weight loss surgery they have to deal with the issue of excess skin. When a person gains weight their skin and other tissues expand. Sometimes during the process of expanding, these tissues are damaged. So the damaged tissues do not retract with weight loss, causing excess skin. The amount of excess skin that a person has to deal with after losing weight depends on many factors. Age, skin color and the amount of weight lost all help determine how much excess skin a person has after weight loss.

Regardless of how much excess skin a person is left with, there are many cosmetic procedures that can help get rid of the excess skin. Weight loss plastic surgery should only be considered after the person has reached their weight loss goal, usually in 12 to 24 months after bariatric surgery.

Body Lift

This procedure effectively deals with excess skin and cellulite in several areas of the body, all at once. A body lift involves abdominoplasty or a tummy tuck, and a thigh and buttock lift, as well. There is quite a lengthy scar, but it is usually hidden under the bikini line.

Arm Lift

The arms are a big area of concern after weight loss; the individual may feel uncomfortable wearing tank tops or short sleeved shirts. There are several different options for improving the arm area. Just having liposuction may be an option for some, if the tone of the arms is good. For situations where the excess skin is moderate, a combination of liposuction and a modified brachioplasty, or arm lift, with a very well-concealed scar may fix the situation. For others, with more excess skin to deal with, a regular brachioplasty with liposuction can be performed. There is a longer, more noticeable scar along the inner arm with this surgery.

Face Lift

Weight loss can make the face look older, wrinkles and other lines might become more noticeable. There is also the problem of excess skin and fat in the neck. A face lift combined with a neck lift will alleviate both these problems. While a face will leave some scarring, they will not be easily detectable.

Breasts

There are several different plastic surgeries that can be performed after weight loss on the breast area. In some cases an implant may be enough to restore the desired shape. At other times a breast lift or mastopexy is needed. Depending on the desired outcome sometimes, a lift and an implant are used. The amount of scarring will depend on the operation.

Men require a somewhat different approach. Liposuction is used in the beginning to remove excess fat and tissue. A waiting period is then recommended to let the skin retract. After the waiting period is over, a mastopexy can be performed to deal with excess skin. Scarring is generally less evident in men.

Not all these procedures can be performed at one time, it is recommended to wait three months before scheduling another procedure.

Teens and Weight Loss Surgery

With more and more teens being overweight, many parents and teens are looking at weight loss surgery as a viable option that can help them lose weight and live a fuller life.  Weight loss surgery is uncommon among teens - due largely to the fact that there are a limited number of surgeons in the U.S. who will perform a weight loss procedure on individuals under the age of eighteen.  Nonetheless, there are some surgeons that offer weight loss for teens, and weight loss surgery can be a viable option in some instances. 

When a Teen Might Qualify for Weight Loss Surgery
There are valid reasons that weight loss surgery should not be performed on teens, and likewise there are good reasons that weight loss surgery is the best option.  In 2004, the American Academy of Pediatrics established guidelines that doctors and surgeons can use when determining if weight loss surgery is a good choice for obese teens.  To meet the criteria for a weight loss procedure, the teen should:

• Have previously attempted weight management in an organized program for at least six months or longer, under the assistance of their doctor. 
• Have reached skeletal maturity, which is typically considered age thirteen or older for females and age fifteen or older for males. 
• Be severely obese with a body mass index greater than 40 and have obesity-related problems that are considered serious, or have a body mass index of 50 or greater obesity-related problems that are less serious. 
• Undergo psychological evaluations prior to and following surgery.
• Commit to avoiding becoming pregnancy for at least a year following surgery to reduce risks.
• Live in a supportive family environment. 

Weight loss surgery is not an option for those teens that have a medically correctable cause behind their obesity, for teens that have undergone substance abuse in the year prior to the evaluation, or who exhibit an inability to comprehend the procedure and the consequences of the procedure. 
The two most popular types of weight loss surgery for teens are gastric banding and gastric bypass. 

Benefits of Weight Loss Surgery for Teens

There are many benefits for teens that undergo weight loss surgery. Other than the most obvious benefit, increased self-esteem, teens who suffer from diabetes, heart problems, bone and joint problems, and other obesity-related illness and disease can benefit from increased good health that accompany weight loss. 

Finding a Weight Loss Surgeon for Teens

Since there are few doctors willing to perform weight loss surgery in teens, finding a surgeon is often an obstacle that teens and their parents will face. Many times the patient will have to travel to another state to locate a surgeon who offers this procedure in their age group.  The best way to find a surgeon is to meet with a bariatric pediatrician or bariatric specialist who can refer you to the nearest qualified surgeon that will consider performing the procedure if the qualifications are met.

Weight Loss Surgery-What to Expect

Weight loss surgery requires a great deal of commitment.  Generally the decision stems from having tried various other methods to lose weight and not having had much success.  If you have been considering weight loss surgery, it is important to know what to expect.  Keep in mind the steps may vary depending the recommendations of your regular doctor and the bariatric treatment center.

Insurance Approval

Weight loss surgery can be costly; knowing whether or not your insurance will cover, at least, some of the cost is a good first step.  You will want to contact your regular doctor and have documentation sent in, chronicling your struggle with weight loss.  Often insurance companies will want proof of psychological counseling, as well. 

If you don't have insurance, there is the option of financing the procedure yourself.  Many bariatric treatment center offer payment plans or you can go through a 3rd party for financing.  After arranging financing you will have the initial consultation with your bariatric surgeon.

Initial Interview

At your first appointment, you will of course, have to fill out all the forms with your medical history and insurance information.  You will also be counseled in the different weight loss surgery procedures available and the various risks associated with the procedures.  You will meet with your surgeon and arrangements for any tests required will be made at this time.

Weight Loss Support Group Meeting

Many bariatric treatment centers will require you to attend at least one weight loss surgery support group meeting before scheduling surgery.  You will be able to learn more about the surgery and meet people who have been through the surgery.  After the necessary test results are in and you have attended a meeting, surgery can be scheduled. 

Pre-op

Generally you will have a complete physical exam a few weeks before the surgery.  You may sign consent forms and have another counseling session at this time.

Surgery

You will probably check in two hours before the surgery is scheduled to be prepared for your particular surgery.  Actual times in surgery vary depending on the procedure that is being performed.   After surgery, you will be in the recovery until you wake up.  Then you will be taken to your room unless there are complications

Recovery

Your hospital stay will also vary depending on the different operation.  In some cases you may be able to go home after a few days, other times recovery can take up to a week.  A clear liquid diet is recommended for the first two weeks.  Then you will slowly move to pureed foods and on to normal foods.  It is a good idea to slowly try new foods after having weight loss surgery. 

Long Term Results

Weight loss surgery does have definite risks, but it can also produce excellent results.  Many people are able to lose as much as sixty percent of their excess weight within the first year following their surgery.  It does take effort on your part, however.  It will be necessary to make good food choices, stick to your doctor's orders and exercise.

Incision Free Weight Loss Surgery

There may soon be other options for those struggling with morbid obesity other than traditional weight loss surgery types, such as gastric banding or gastric bypass. One of the biggest benefits to these new surgeries is that they do not require any incisions. One of the most promising of these techniques is transoral gastroplasty or TOGA.

What is TOGA?

The purpose of this new procedure is to eliminate some of the problems experienced with other bariatric surgeries. This surgery is performed with special instruments that pass through the mouth, into the stomach, without any incisions. Direct endoscopic visualization is used to allow the surgeon to see where to place the flexible stapling devices. A restrictive pouch is then created; this pouch will help the patient’s loss weight by feeling fuller on less food. The surgery is performed under general anesthesia and takes one to two hours.

Benefits

While all the long-term benefits are not yet known, there are many advantages to this surgery so far. There is less pain and a quicker recovery time and shorter hospital stay with this procedure than other weight loss surgeries. There is also the advantage of no scarring and fewer complications. In time, this may be an excellent alternative for patients who cannot go through the more invasive surgeries.

Results

So far studies have shown that patients can lose up to 40% of their excess weight in the first year. Patients undergoing the standard gastric bypass have lost more weight in the first year, but this procedure may be safer and less painful.

Who is a candidate for TOGA?

This surgery is not yet approved for widespread use by the FDA yet. There are however clinical trials going on for individuals who qualify. Some basic guidelines to qualify are having a BMI or body mass index of 35 or above and having had little success with other weight loss methods. Other restrictions may apply, as well.

Other Procedures

There are other, incision free procedures that are showing promise. EndoBarrier Gastrointestinal Liner is another new device that is inserted and removed through the mouth. This procedure takes only 30 minutes to perform and is done on an outpatient basis. The liner is removed after 3 months and removal only takes 15 minutes. This method is showing a great amount of promise in treating type 2 diabetes as well as jump starting weight loss. This may be a good prelude to another more drastic surgery.

Another method that is not yet available in the United States is the gastric balloon. In this procedure a gastric balloon is inserted through the mouth and then inflated in the stomach reducing the amount of food that can be eaten. The balloon must be removed in 2 to 6 months.

These new techniques all show promise in helping those struggling with morbid obesity. As with all methods of surgical weight loss it is important to realize that lifestyle changes will have to be made. Diet and exercise will be required to achieve good results.