What are the Benefits & Risks of Weight Loss Surgery?

Weight loss can be incredibly difficult, especially if you have certain medical conditions or physical limitations. Weight loss surgery (aka bariatric surgery) can seem like a simple solution to the weight loss struggle. One procedure and you start dropping weight, wearing smaller clothes, and other health complications improve. It’s like a magic bullet! Or is it?

Bariatric surgery can be a life-saving solution and an effective means to shed pounds quickly. This is why these life-changing procedures are so appealing. However, weight loss surgery is an invasive and permanent surgery that comes with considerable risks. It is essential to weigh the pros and cons before making this life-changing decision, and that is what this blog will help you to do if you are considering weight loss surgery. It will educate you on various aspects of bariatric surgery so that you can make the best decision for yourself. As a weight loss coach, personal trainer and registered dietitian, I bring a perspective that you might not get from your doctor or weight loss surgery coordinator. 

How Weight Loss Surgery Works

To understand how weight loss surgery helps reduce obesity, it helps to first understand digestive processes and how nutrients are absorbed in the body. 

1. Mouth: Digestion begins in the mouth where enzymes are released to begin breaking down food as you mechanically break down food by chewing. 
2. Stomach: Once food is chewed and swallowed, it’s called a “bolus” and makes its way down the esophagus and to the stomach, where digestion continues with the help of strong acids.  
3. Duodenum: Then the food particles move into the duodenum, the first part of the small intestines, where the breakdown of food speeds up with the help of bile, enzymes, and pancreatic juices. The duodenum is where our body absorbs much of the iron, calcium, and magnesium in the foods we eat. We also absorb some other vitamins and minerals here.
4. Small Intestine: The final part of the digestive process takes place in the remainder of the small intestine, called the jejunum and the ileum. This is where most nutrients are absorbed – carbs, protein, lipids (fat) and vitamins and minerals. B12 is mainly absorbed in the ileum. 
5. Large Intestine: Any unused particles of food then move through the large intestine for elimination.

Weight loss procedures involve bypassing, or skipping, a part of the digestive process. They range from a simple reduction of the amount you can eat to major changes to the digestive tract. 

The Main Types of Bariatric Weight Loss Surgery

There are four main types of weight loss surgery to consider:

1. Roux-en-Y Gastric Bypass – this surgery converts the stomach into a small pouch (20-30 mL). Then the small intestine is cut and attached directly to the new pouch, bypassing the rest of the duodenum and the first part of the jejunum. This is one of the most common and effective types of bariatric surgery because it is both restrictive (restricts how much you can eat) and malabsorptive (reduced nutrient absorption). As mentioned above, much of our nutrient absorption occurs in the jejunum and duodenum, so this surgery causes malabsorption of some nutrients by bypassing a portion of the small intestine.  
2. Laparoscopic Vertical Sleeve Gastrectomy – this procedure removes the majority of your stomach, then staples the remaining portion closed, forming a smaller stomach shaped like a banana that holds about 50-150 mL. The size restricts how much you can eat at a time, thereby reducing calorie intake which leads to weight loss. The removed portion of your stomach will remain inside of your body and cannot be re-attached to the existing stomach. The intestines are not rearranged in this procedure, so it is not considered malabsorptive.
3. Duodenal Switch, biliopancreatic diversion  – this is a 2-stage surgery, starting with a vertical sleeve gastrectomy for initial weight loss and reducing complications with stage two. Stage two attaches the lower part of the small intestine to the stomach, bypassing a significant section of the small intestine. This makes it slightly restrictive and malabsorptive and allows the patient to eat larger amounts while still achieving weight loss through malabsorption. These patients require lifelong follow-ups to monitor calcium and vitamin intake. 
4. Laparoscopic Adjustable Gastric Banding – this procedure places a band around the upper part of your stomach, reducing the capacity to 3-6 oz. This limits how much food one can eat, and it is the only reversible procedure. 

Who is Eligible for Bariatric Surgery?

To qualify for weight loss surgery, a person must have a BMI (body mass index) of 40 or 35 with a coexisting condition related to obesity like type 2 diabetes, high blood pressure, or sleep apnea. Typically insurance will require a certain amount of time seeing a dietitian (usually paid for out-of-pocket) and meeting with a psychologist before approval. 

Pros and Cons of Weight Loss Surgery

Let’s start by reviewing the benefits of having one of these surgical weight loss procedures.

Pros of Weight Loss Surgery:

1. Significant Weight Loss: One of the biggest advantages of bariatric surgery is the significant weight loss. Depending on the type of surgery, you can lose up to 60-80% of excess weight in the first year. This amount of weight loss can be life-changing for most because of improved health, increased confidence, higher energy levels, and the exciting feeling of finally reaching a long-awaited goal.

2. Improved Health: Weight loss from bariatric surgery can lead to improvements in overall health, such as reduced joint pain, better sleep, and improvements in blood sugar control. Type 2 diabetics may even achieve remission. It can help decrease blood pressure and cholesterol levels which can lower the risk of heart disease. It can also help reduce the risk of developing obesity-related health issues, such as type 2 diabetes, high blood pressure, heart disease, and sleep apnea.  

3. Increased Mobility: Losing weight can lead to an increase in mobility and physical activity, which has a positive impact on mental health and quality of life. Patients may find that they can participate in activities they could not do before surgery, such as hiking or playing with their children or grandchildren.

4. Improved Food Intake: Depending on the surgery, the diet can be very restrictive during the healing process. Processed, high-sugar, and fatty foods will not be well tolerated nor provide required nutrition, so the diet promotes protein intake and whole foods like small amounts of vegetables, fruits and whole grains. This can also help a person to establish ongoing healthy eating habits which will lead to various health and even mood improvements. 

5. Reduced Hunger: One of the reasons these surgeries work so well is that the stomach is so small that you feel satiated with very little food. For the first few weeks or months, you may be eating less than 800 calories per day, but it feels easier because your stomach isn’t growling and hunger hormones are reduced.

Cons of Weight Loss Surgery

Now, let’s discuss the cons of having bariatric surgery. 

1. Surgical Risks: As with any surgical procedure, there are risks associated with bariatric surgery, including bleeding, infection, staples coming out, leaks, malnutrition and blood clots. While these complications aren’t common, they DO happen even if you have the best surgeon in the world. Make sure to discuss these risks in-depth with your healthcare provider. Many of us think we’re immune from bad things happening to us, but my time at USC seeing bariatric patients and reviewing past cases was eye-opening. Some patients went through multiple surgeries, hospital stays, tube feedings, and suffering due to complications. Death is also a possibility as a result of any of the aforementioned complications. 

2. Nutritional Deficiencies: Patients who undergo bariatric surgery may be at risk for nutritional deficiencies due to decreased food intake and malabsorption. You may not think much about protein intake, vitamin B12, iron or thiamin on a regular basis, but after surgery you must think about these because malnutrition carries serious risks. Patients must work closely with their healthcare provider to ensure they are getting the necessary nutrients and will likely need to take supplements daily for the rest of their lives. It’s important to note that not only does bypassing parts of the intestine reduce nutrient absorption, but the amount of calories you will be living on would be considered undernutrition in most non-surgical patients. For example, 4 months after a sleeve gastrectomy, your dinner might look something like this: 2-3 oz burger meat with ¾ cup green salad with light dressing – not a lot. Some patients have had complications that led to malnutrition and much lower weight than they ever wanted to achieve. 

3. Lifestyle Changes: Bariatric surgery is not a magic fix for weight loss. Just like weight loss without surgery,  you must make significant lifestyle changes in terms of diet and exercise to maintain weight loss and prevent complications. This includes following a specific diet plan, taking vitamin,  mineral, and protein supplements, and engaging in regular physical activity. Both cardio and strength training should happen weekly. This is where many patients struggle and what causes them to regain weight. If lifestyle changes never started pre-surgery, then making them post-surgery may still be difficult. 

4. Weight Regain: If a person stops exercising and starts eating a little more food here and there, weight can return. Can you imagine going through surgery, following a restrictive diet during months of recovery, losing lots of weight, and then gaining it all back? It’s very discouraging and for some people, this leads them to get another surgery. For instance, if they started with the sleeve gastrectomy, then they might undergo another surgery to turn it into a duodenal switch. Then, you must go through the entire process again. Even then weight could return if you are not careful with diet and exercise and there are only so many surgeries you can have.

5. Loose Skin: Weight loss is rapid after surgery and, depending on how much weight you lose, it is likely that you will have loose skin after the surgery. For many people this can feel embarrassing or uncomfortable and they may end up having another surgery to remove loose skin, which can be costly. 

6. Cost: Bariatric surgery can be costly and insurance coverage may vary. Patients should consider the financial implications before deciding to undergo the procedure, especially knowing that it is not a magic bullet or guarantee. 

7. Lack of Post-Op Care: Depending on where you get your surgery done, post-operative care may be minimal or lacking. Surgeons do not benefit from you succeeding at weight loss, so there is no incentive to support your efforts. If you do regain weight, the hospital and insurance get paid again if you need another surgery, so they are happy to do it. Make sure to find a good support group if you are struggling and reach out to someone as soon as you start to regain weight.

8. No Going Back: If you undergo a Roux-en-Y Gastric Bypass, sleeve gastrectomy or duodenal switch, it’s permanent. While these surgeries often have great success and safety, there is no going back if you don’t like it or complications arise. 

Other Things to Consider Before Bariatric Surgery 

Here are some final thoughts to consider and work on before you proceed with surgery.

1. Permanent Changes to Eating – after surgery, you will never be able to eat the same way again and have to be more considerate about what you consume and if you’re getting enough nutrients. Most of us love to eat, so forever restricting what you eat may be emotionally and mentally challenging. 
2. Consider Trying the Diet First– you are essentially on an extreme diet for the long-term. For the first month, all you consume are liquids in small amounts, mostly water, protein and diluted juice or broth. If a person did this without surgery, they would lose weight. So, why not try doing the bariatric diet without surgery first and see what happens?  If you followed the diet without having surgery you would likely lose the same amount of weight if you could manage the hunger pains. The difference is that your hunger hormones and stomach size are reduced after surgery, so it makes an extreme diet feel manageable. 
3. Address Emotional Eating – many of us use food as a coping mechanism. If this is you before surgery, what makes you think it will change after surgery? The only difference is that your stomach will not allow you to consume the same amount. However, one study showed that some people who had bariatric surgery had eating disorders like binge eating disorder, and the disorder remained after surgery for some. If your relationship with food is emotional, consider going to therapy and working with a registered dietitian on intuitive eating before surgery. 
4. Exercising Regularly with Intensity – some people think that reducing food is all that is necessary for weight loss and try fad diet after fad diet. Then they tell their surgeon that they’ve “tried everything and can’t lose weight.” One problem is that diets don’t work, but what about exercise? Are you doing 20-30 minutes of cardio daily? Are you strength training at least 2-3 times per week with weights or resistance bands? If not, try this first! Hire a personal trainer and a dietitian and see what progress you can make in a few months. This is a great way to lose weight while building muscle, boosting metabolism, reducing loose skin, getting adequate nutrition, and gaining confidence and strength! Remember, you will have to do this AFTER surgery anyway, so you might as well get in the habit now if you are physically able.

Final Thoughts on Weight Loss Surgery & Support for the Journey

Bariatric surgery can be an effective weight loss solution for those who have struggled with obesity and related health issues. However, it is not without risks and requires significant lifestyle changes for long-term success. Patients should consult with a healthcare professional to determine if bariatric surgery is the right choice for them. It’s important to consider both the pros and cons before making a decision and to have realistic expectations about the results of the procedure.

As a faith-based coach, I also encourage anyone who has a relationship with God to bring this to Him first and ask what He wants you to do. When we have the Holy Spirit living in us, we have the spirit of power and self-control to do things we could not do in our own strength. God may want to be your solution rather than surgery. Or, surgery may be the solution he wants to use. Talk with Him and some caring health professionals and loved ones to determine what is right for you. 

I am always here if you want a consultation or would like help trying natural weight loss first. I genuinely want the best for my clients, and if I think that is surgery, then I will tell them. If I don’t, I will them them. Weight loss is HARD, I know, and I would be happy to support you in your journey to success and health, whatever that looks like! You can set up for a free consult on my calendar. 

You can also join my Monthly Group Health Coaching for Women to get support from me and other women who are trying to lose weight, whether you are considering surgery or have already had it. We’d love to see you there!

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203132/
2. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795155
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10353499/