Weighing In on Bariatric Surgery

Evaluating the benefits of bariatric surgery procedures


by Alan Wittgrove, Bariatric Surgeon

When singer Carnie Wilson appeared on the cover of People magazine after losing more than 150 pounds, she brought bariatric surgery into the spotlight and gave hope to morbidly obese people everywhere who have tried diet after diet without success.

Bariatric surgery, also known as gastric bypass surgery, alters the digestive tract to restrict the amount of food that patients can eat. However, even with this very small amount, patients feel satisfied — and that is the key to successful weight loss.

It’s important not to confuse feeling “full” with feeling “satisfied.” With fullness, you may have consumed so much that you feel uncomfortable, perhaps even bloated, but it’s not necessarily enough to make you push away from the table.

Satisfaction, by contrast, is when you truly feel like your hunger has been sated — you are no longer interested in food, and you’re ready to do something else. Bariatric surgery enables people to experience a tremendous amount of satisfaction from just a small amount of food.

Who is a candidate for bariatric surgery?

In general, candidates for surgery are about 100 pounds over their ideal body weight and have serious medical problems as a result, such as Type 2 diabetes, hypertension, heart disease or sleep apnea.

Incidentally, obesity-related diseases represent the second-highest group of preventable deaths in the United States; it is estimated that between 350,000 and 400,000 people nationwide die from complications associated with obesity.

What to expect during bariatric surgery procedures

While bariatric surgery used to require one large incision to open the abdomen, the majority of procedures are now done laparoscopically; in fact, more than 90 percent of the 250 to 300 bariatric procedures we perform each year are done via laparoscope.

In this minimally invasive procedure, surgical instruments and a tiny video camera are inserted into the abdomen through small incisions, and the surgeon views the procedure on a video monitor.

The benefits of laparoscopic surgery are numerous and include less pain, easier recovery, less of an “insult” to the patient’s immune system and a significantly reduced risk of complications.

There is a great deal of preparation involved before the actual surgery. Our patients attend a lecture where they learn all about the procedure, including the risks, possible complications and what to expect afterwards.

They also receive extensive educational materials, take a test to make sure they understand the process, complete a lengthy health questionnaire and have a psychological evaluation and internal medicine consultation.

They also submit an insurance authorization; in most cases, insurance will cover at least part of the cost.

The actual surgical procedure takes approximately 60 to 90 minutes. While patients generally stay in the hospital for two days after the surgery, most report feeling very well within a day or two.

Life after bariatric surgery

About a week after they leave the hospital, patients attend a class where they learn how to adjust to their new digestive system, including how to advance their diets, read food labels and avoid problem foods. We also cover psychosocial factors associated with recovery. Exercise, which is mandatory to the long-term success f the surgery, is addressed in another class.

As one would expect, eating habits change dramatically after surgery. However, we’ve found that 80 percent of patients adapt quite easily to their new way of eating, because they finally experience satisfaction and a sense of control over food.

Although some patients may find it more difficult to adjust, we often identify such issues during the pre-surgical preparation and are prepared to offer counseling and assistance. In addition, ongoing support groups enable patients to share experiences and help each other stay on course.

Do the results last? We’ve found about 70-75 percent of excess body weight is lost, and that loss is maintained over a five-year period when patients commit to new eating and lifestyle changes.

Common misconceptions with bariatric surgery

While bariatric surgery does require major lifestyle changes, some of the rumors about life after surgery simply are not be true. For example, it is fine for a woman to become pregnant after having the surgery.

Moreover, women are much less at risk if they get pregnant after gastric bypass than if they do so while they are morbidly obese. Obesity is often a factor in infertility, and obese women who do become pregnant have a higher risk of heart problems, diabetes and other complications. We have protocols for patients to follow while they are pregnant and help them maintain their weight loss after giving birth.

Another common misconception is that alcohol is forbidden. While it needs to be moderated, patients may enjoy a drink on special occasions. We ask them to limit their intake to one drink in a 24-hour period and to be aware that alcohol will affect them much more dramatically after surgery than it may have before.

This Scripps Health and Wellness tip was provided by Dr. Alan Wittgrove, a bariatric surgeon at Scripps Memorial Hospital La Jolla.