Bariatric surgery refers to a range of surgical procedures designed to help severely obese people lose weight. With some 15 million people in the United States suffering from severe obesity, the number of bariatric procedures has risen exponentially over the last two decades. According to the American Society for Metabolic and Bariatric Surgery, 220,000 people had bariatric surgery in 2009, compared to 18,000 procedures performed in the early 1990s.
These procedures can be categorized according to their modes of action. Some limit food intake, generally by decreasing the size of the stomach so that patients feel sated sooner than they did before surgery. Others restrict the body’s ability to absorb some components of food, including calories. A third category incorporates aspects of both methods.
Types of Surgery
While there are a variety of bariatric surgery options to choose from, some surgeries lose favor over time and others become more popular as technology changes and as studies are done measuring the long term success rates. The three surgery options below are more commonly performed today due to their effectiveness and overall patient outcome.
- Vertical Sleeve Gastrectomy: The stomach is divided along its vertical access and stapled, reducing its volume by up to 85 percent.
- Laparoscopic Adjustable Gastric Banding: The stomach is wrapped with a saline-filled silicone band in order to decrease its volume, and the surgeon can adjust the degree of restriction after surgery by changing the amount of saline in the band. This procedure and the Vertical Sleeve Gastrectomy are the purest examples of methods that work by limiting food intake.
- Gastric Bypass: Perhaps the best-known bariatric surgery, a gastric bypass dramatically reduces the size of the stomach. It also relocates the stomach’s connection to the small intestine so that the duodenum and jejunum are “bypassed,” a change that reduces calorie absorption.
Bariatric surgery is performed both as a traditional open procedure and as a laparoscopic procedure in which small instruments and a miniature camera are inserted through a single abdominal incision. Laparoscopic surgery can offer a faster and less painful recovery than the traditional approach.
The criteria for bariatric surgery generally revolve around an individual’s body mass index (BMI), a number obtained by dividing body weight by the square of a person’s height.
According to the National Institutes of Health, bariatric surgery is appropriate for patients with a BMI of 40 or greater and for patients with a BMI of at least 35 if there are additional obesity-related medical problems like diabetes, serious sleep apnea or hypertension. Recent research, however, has shown support for bariatric surgery when patients who are otherwise healthy have a BMI of at least 35 and when patients with additional medical issues have a BMI of at least 30.
Benefits and Risks
Regardless of the specific procedure, all types of bariatric surgery have been effective in achieving weight loss, with the majority of that loss occurring within two years of surgery. The purely restrictive procedures, like Vertical Sleeve Gastrectomy and Gastric Banding, tend to result in losses that are less dramatic than those obtained with combined procedures, but even those purely restrictive procedures result in losses that average 50 percent of excess weight.
Weight loss is only one of the surgery’s potential benefits. Almost all diabetic patients experience a significant improvement of the disease, with many obtaining a complete resolution. In more than 85 percent of patients, sleep apnea is resolved by surgery. Life expectancy increases by some 89 percent, the risk of developing heart disease is cut in half, and the risk of premature death is reduced by up to 40 percent.
Bariatric surgery is major surgery, done on an inpatient basis and requiring a hospital stay of up to two days, and, as such, it carries some degree of risk. Most of those risks are identical to those inherent in any major surgery, including infection and incisional hernia, but the medical consensus is that the benefits of bariatric surgery outweigh its risks. According to the federal government’s Agency for Healthcare Research and Quality, the risk of death is 0.1 percent and the risk of major complications is approximately four percent.
Patients should be aware that procedures that reduce absorption can result in deficiencies in vitamins and minerals, including calcium, iron and fat-soluble vitamins.
The cost of bariatric surgery ranges from $10,000 to $35,000, depending on the procedure and the patient’s location. Insurance coverage varies among insurers and among specific policy provisions.
Read more here about the cost of bariatric surgery.