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Weight Loss Surgery Options

Is Weight Loss Surgery Right for Me?

Here are some yardsticks to help you determine how much WLS can help you. People who match these tend to have greater success following weight loss surgery.


  • Body Mass Index (BMI) 35 to 40 or above (BMI measures fat on the body) or,
  • BMI of 30 or above, and an obesity-related condition such as diabetes or high blood pressure and,
  • Already attempted weight loss through diet, exercise and lifestyle changes, and
  • Good understanding of surgical procedure, with realistic expectations for probable weight loss, and
  • Readiness to make lifelong changes in healthy behaviors, diet, and physical activity

Classification of Overweight and Obesity Developed by the National Institutes of Health (NIH)1


BMI

Classification

25-29.9

Overweight

30-34.9

Class I Obesity

35-39.9

Class II Obesity

Over 40

Class III Obesity


1 NHLBI/NIDDKD, NIH. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. The Evidence Report. NIH Publication No. 98-4083, Sept 1998

Three Surgery Options

On this website, we focus on the three most common surgeries:

  • Gastric Bypass (also called “RNY”, short for Roux-en-Y)
  • Gastric Sleeve
  • Adjustable Gastric Band (This surgery is sometimes called lap-band*)

These are by far the most common weight loss surgeries. This does not mean that a different surgery isn’t right for you. Rather, we focused on the surgery types which are of interest to the most people.

*This surgery involves the placement of a silicone band around the stomach. The brand name of the original band is "Lap-Band”, and sometimes the Adjustable Gastric Band is called a lap-band, just as a copying machine is sometimes called a Xerox machine. Another brand of band is called the Realize Band.

More About Deciding

You know Weight Loss Surgery is a big decision. So the first important step is to get good information.

Get information from several sources

To decide whether to have the surgery, you can learn more here at BariBest.com. However, in the end, you will want to get the opinion of the surgeon on whether bariatric surgery is right for you, and which surgery choice or choices are right for you.

It is ok to ask the surgeon all of your questions. To help make sure you do that, it is good to have a written list, and take along a family member or friend who can help you listen and take notes.


Here are some things to ask about:

  • Statistics that show the results for that surgeon’s patients
  • The plusses and minuses of each of the surgeries for you personally
  • The steps you will go through if you decide to go ahead
  • Will you have to lose weight before surgery
  • What tests are required before hand

  • If you have made the decision to have bariatric surgery, there is more information that is important. You want to know about the hospital, the surgeon, and the nurses and dietitians who work with the surgeon and hospital.

    • Consider choosing a practice that is a Center of Excellence. Bariatric Centers of Excellence have met certain standards that help insure that the surgeon and the hospital/surgical facility have a good level of experience, that they report their results to a central database, and are inspected periodically.
    • You want to learn about the surgeon’s results and statistics, including:
      • How many bariatric surgeries the surgeon has done (by type)
      • Statistics that show the results for that surgeon’s patients
    • Attend the surgeon’s support group. Talk with patients.
    • Learn about insurance coverage, and how the practice can assist in getting costs covered.

Which Surgery Fits You

There are several weight loss surgery options. Three of the most common surgeries include:

  • Gastric Bypass (also called “RNY”, which is short for Roux-en-Y)
  • Gastric Sleeve (the full name is Vertical Gastric Sleeve)
  • Gastric Band (also called Adjustable Gastric Band. Two of the brands of bands are the Lap-Band™ and the Realize™ Band)
  • Each surgery helps you lose weight in a different way, and the average results vary as well.

    It is important to understand the differences between each surgery in order to decide which surgery is best for you. Learning more about types of weight loss surgery will prepare you to work with your surgeon in choosing the best procedure for you and your health goals.

How Much Weight Might I Lose with Gastric Bypass, Gastric Sleeve and Gastric Band

Weight loss surgeries have been shown to result in long-term weight loss.

As you would imagine, the amount of weight lost by any one patient depends on which surgery, as well as the individual patient’s commitment to healthy lifestyle changes. You can read more about how to get the best results from your weight loss surgery in Long Term Success.

How much weight will I lose?

There are a number of medical research studies looking at how much weight the average patient loses, by surgery type, during the first year after surgery.

Before we share the results of the research, we need to first mention that most of the research uses a term called Excess Weight. A simple way to think of that is: the amount you are overweight.

Excess Weight Calculator

To calculate your Excess Weighti , as used in the research, simply enter:

  Your Height
 ft -  in
Your Weight
Your Gender
Male  Female

Then press the Calculate button.


Your Estimated Excess Weight is ...


 

PROJECTED WEIGHT LOSS CALCULATOR FOR EACH WEIGHT LOSS SURGERY

Results from each of the kinds of weight loss surgery vary widely from person to person. Some patients closely follow the recommendations for protein, vitamins and general nutrition for the rest of their lives. They often do better than the averages which are used in this calculator.

Did you use the Excess Weight Calculator above? If not, please use that calculator first.

Again, please remember these results are the estimated average for patients with your Excess Weight. Results vary by individual.

If you have questions, please email AsktheRD@BariBest.com.


i. This calculation uses the mid-point of the Metropolitan Life tables, for “medium frame” – consistent with the methodology of many of the studies of weight loss surgery weight loss outcomes.

ii. Shi, et al. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010 Aug;20(8):1171-7.


Gastric Bypass (RNY)


WHAT IS GASTRIC BYPASS SURGERY

Gastric bypass is a procedure where the stomach is made smaller and some of the small intestines are bypassed.

The first step makes your stomach smaller. Your surgeon will use staples to divide your stomach into a small upper section and a larger bottom section. The top section of your stomach (called the pouch) is where the food you eat will go. The pouch is about the size of a golf ball. It holds only about 1 or 2 ounces of food.

The second step is the bypass. In effect, the surgeon reconnects the pouch farther along your small intestine, bypassing the rest of the stomach and the upper part of your small intestine. (See diagram)

The food you eat will now travel from the pouch into this new opening into your small intestine. Because of this, your body will absorb fewer calories.

Research is identifying other hormonal effects of gastric bypass surgery, although it seems likely that there is still more to be understood. The research indicates that gastric bypass sharply reduces an appetite-stimulating hormone, ghrelin.


Weight Loss Surgery Effect on Diabetes

  • Improvement in diabetes can occur within days of the surgery, even before significant weight loss occurs
  • Many individuals no longer require insulin or hypoglycemic medication after weight loss surgery
  • Symptoms of Diabetes appear to improve the most after gastric bypass, followed by vertical sleeve gastrectomy, then gastric banding.

For more information about Diabetes and the management of symptoms, click here


Gastric Sleeve


WHAT IS GASTRIC SLEEVE SURGERY

The Gastric Sleeve Surgery results in weight loss by decreasing the volume the stomach can hold. In this procedure part of the stomach is removed and a ‘vertical sleeve’ or tube is created (from the remaining stomach). Removing a portion of the stomach decreases the amount of food that can be consumed so you become full more quickly and eat less.

Gastric sleeve surgery reduces the size of the stomach so it does not take as much food to become full; as a result you will naturally eat less.

The gastric sleeve surgery is usually performed laparoscopically. This means that small incisions are made in the abdomen. These incisions allow for the surgeon to perform the procedure using a camera and instruments. Using small incisions results in less tissue damage, and decreases the risk for complications.

During the procedure, part of the stomach is removed and a 'vertical sleeve' or tube is created (from the remaining stomach). The food continues to move from the mouth, to the esophagus, into the stomach and through the small intestine.The intestines remain in place in this procedure.

Gastric sleeve surgery reduces the size of the stomach so it does not take as much food to become full; as a result you will naturally eat less.

In addition to reducing the amount of food you eat, gastric sleeve surgery also reduces the amount of ghrelin that is produced. Ghrelin is a hormone (produced in your stomach) that your body releases to make you feel hungry.


After a portion of the stomach is removed, your body will create less ghrelin. As a result, you will not feel as hungry.

Research is identifying other hormonal effects of vertical sleeve gastrectomy surgery, although it seems likely that there is still more to be understood. The research indicates that the gastric sleeve sharply reduces an appetite-stimulating hormone, ghrelin.

Weight Loss Surgery Effect on Diabetes

  • Improvement in diabetes can occur within days of the surgery, even before significant weight loss occurs
  • Many individuals no longer require insulin or hypoglycemic medication after weight loss surgery
  • Symptoms of Diabetes appear to improve the most after gastric bypass, followed by vertical sleeve gastrectomy, then gastric banding.

For more information about Diabetes and the management of symptoms, click here.


Gastric Band


WHAT IS GASTRIC BAND SURGERY

The gastric band surgery results in weight loss by limiting the amount the stomach can physically hold.

This procedure is usually done laparoscopically through small incisions in the abdomen. During this procedure a silicone band is placed around the upper portion of the stomach, creating a small pouch. The pouch can only hold a small amount of food, so it does not take as much food to become full. As a result, you will naturally eat less.

The silicone band is hollow. It can be made tighter or looser by adding or removing saline. Adjustments to the band are made to meet each patients’ weight loss goals. Typically adjustments are made to the band every 4 to 6 weeks.

For more information about Diabetes and the management of symptoms, click here.


BariBest BMI Calculator


Enter your height and weight below to calculate your BMI.

Your height:

ft in Feet/Inches Centimeters

Your weight:

lb

BMI results:  


BMI:

Your optimal weight is between and


Classification of Overweight and Obesity Developed by the National Institutes of Health (NIH)1


BMI

Classification

25-29.9

Overweight

30-34.9

Class I Obesity

35-39.9

Class II Obesity

Over 40

Class III Obesity


1 NHLBI/NIDDKD, NIH. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. The Evidence Report. NIH Publication No. 98-4083, Sept 1998


What is Diabetes?


Diabetes is a group of diseases characterized by high blood sugar (glucose).

When you consume food, your body breaks much of it down into glucose for energy. The glucose passes into the bloodstream. For glucose to get from the bloodstream into the cells where it is needed, a hormone called insulin must be present.

In people with diabetes, there is insufficient insulin, or problems making good use of it.

Usually diabetes is called Type 1 or Type 2.

Type 1 diabetes: This occurs when the immune system attacks the cells that make insulin. It is less common, and often develops in children or young adults.

In Type 2 diabetes: the body is initially producing enough insulin, but for unknown reasons the body can’t use the insulin well. This is called insulin resistance. Production of insulin decreases over time so the result is the same as for type 1 diabetes—glucose builds up in the blood and the body cannot make good use of its main source of fuel.

Type 2 diabetes is the most common type of diabetes and it is often associated with obesity, older age, family history of diabetes. Type 2 diabetes (and pre-diabetes) is the focus of the rest of this section.

Diabetes is common. If you have been told you have Type 2 Diabetes, you are not alone. An estimated 26 million Americans have diabetes. About 27% of those are undiagnosed.

Usually before people develop diabetes, they have pre-diabetes. About 80 million people in the United States are estimated to have pre-diabetes. In pre-diabetes, the blood sugar is elevated, but not elevated enough to be called diabetes. There are things that can be done to help prevent or delay the development of diabetes.

Impact Weight Loss Surgery on Diabetes

With gastric bypass and gastric sleeve, improvement in diabetes may occur within days of the surgery. The improvement is sometimes sufficient for some patients to eliminate the need for insulin or oral diabetes medication after weight loss surgery.

Managing Diabetes After Surgery

  • Improvement in diabetes symptoms may vary.
  • If you do not have symptoms of diabetes after surgery, it can return, especially with significant weight regain. Therefore, it continues to be important to manage your weight in the years after the surgery, even after you have reached your goal. Follow the recommendations in the Long Term Success section of this website.
  • Be sure to consistently follow-up with your bariatric practice, primary care physician, and endocrinologist.