Obesity and weight loss surgery: What you should know

Being overweight (obesity) causes serious health problems, including depression, diabetes, high blood pressure, joint pain, shortness of breath and sleep apnea.

Many people can improve their health by losing weight. But what happens if the usual diet and exercise programs don't work for you? Such is the case for people who are morbidly obese.

Morbid obesity

People with morbid obesity have a body mass index of more than 40. That's at least 100 pounds overweight for men and 80 pounds for women.

When it comes to losing weight and keeping it off, traditional diet and exercise programs often fail people with morbid obesity. That’s why weight loss surgery has become a popular treatment option.

Should I have weight loss surgery?

You may be a good candidate for weight loss surgery if you…

have morbid obesity
are committed to losing weight and keeping a healthy lifestyle
understand the procedure and how it will affect your life
have tried to lose weight in more traditional ways
understand that the surgery will change how you live your life, especially how you think of food
are willing to have medical follow-up appointments throughout your life
understand that the procedure may have complications or may not work

Many health insurance companies cover weight loss surgery if the patient has a body mass index of more than 40. To find out about a specific health plan's coverage, call the plan’s customer service number.

A surgeon may recommend weight loss surgery for someone with a body mass index of 35 and obesity-related problems, such as severe arthritis, diabetes, sleep apnea, or high cholesterol and high blood pressure that doesn't improve with other medical treatments.

Different procedures and methods

Weight loss surgery is also called bariatric surgery. "Bariatric" refers to a branch of medicine that focuses on the control and treatment of obesity. The term comes from "baros," a Greek word for "weight."

Bariatric surgery helps you lose weight by changing how your body takes in the food you eat. There are three kinds of operations:

Restrictive procedures, such as adjustable gastric banding and vertical banded gastroplasty, make the stomach smaller so that you feel full sooner and eat less.
Malabsorptive procedures, also called intestinal bypasses, change the digestive process so that the body absorbs fewer calories. Because this operation also keeps the body from getting all of the nutrients it needs, it is no longer recommended.
Combined restrictive and malabsorptive procedures, such as Roux-en-Y gastric bypass surgery and biliopancreatic diversion with duodenal switch (DS), decrease the amount of food you can eat and the calories the body absorbs. They are the most common bariatric surgeries performed today.

Weight loss operations can be open or laparoscopic.

Open procedures are standard surgeries. The surgeon makes a cut of several inches, "opening" the abdomen for surgery.
Laparoscopic procedures involve making six or more small cuts into the abdomen. The surgeon places the laparoscope, a tube with a small video camera attached to the end, through the incisions. This allows the internal organs to be seen on a monitor.

If you're thinking about having weight loss surgery, you should work closely with your doctor to decide which option is best for you.

Possible problems after surgery

As with any medical procedure, weight loss surgery has risks. That’s why it's important to talk with your doctor about possible complications.

Problems from restrictive procedures, such as adjustable gastric banding and vertical banded gastroplasty, often involve the slippage, wearing away or breakage of the band, saline-filled tubing or staple line used to make the stomach smaller. Some patients experience infection and bleeding. In less than 1 percent of all cases, complications cause death.
Combined restrictive and malabsorptive procedures are more difficult to do than either kind alone. This makes complications more likely. There's a 28 percent chance that a combined procedure will cause abdominal hernia, requiring a follow-up operation to fix. The risk of death is less than 1 percent for gastric bypass patients and 2.5 to 5 percent for those with biliopancreatic diversion.

While adjusting to life after weight loss surgery, watch for problems like these:

Vomiting may happen if you eat too fast or too much. It can also happen if your now-smaller digestive passages tighten too much or become clogged with food.
Weight gain can still happen from eating high-fat foods, carbohydrates and foods with added sugars. Drinking with meals, snacking and liquid calories can also add to weight gain.
Gallstones (clumps of cholesterol and other matter that form in the gallbladder) can easily form during quick or large weight loss. If after eating you often feel a steady, severe pain on the right side of your stomach going to your back, call your doctor.
Dumping syndrome is common after combined procedures. When eating foods high in sugar, fat or grease, you may have nausea or vomiting, become lightheaded or dizzy, and have a hot flash, cramps or diarrhea.
Emotional issues come with major weight loss. As your body changes drastically, you may not recognize yourself. Your loved ones also may have a hard time adjusting to the “new you.” Trusted friends, support groups, even professional counseling, can help you go through the changes more smoothly and be more successful with your weight loss.