Weight loss is tricky, to say the least, and when you've tried everything under the sun, a permanent fix to your day-to-day struffle starts to look more and more appealing. This is where weight-loss surgery, or bariatric surgery, comes in.
On paper, it seems like a quick fix. But it’s not like mending your jeans or replacing a button. The surgery is a true lifestyle change that calls for even more lifestyle changes. When used as a tool instead of an answer, weight-loss surgery can reverse the comorbidities of obesity.
But is it the best choice?
Luke*, who had a gastric bypass in 2015, doesn’t think so. This is even after a lifetime of weight problems. At 33, he weighed 335 pounds and could barely make it up the stairs. It was diet after diet after diet, all to no avail.
These days, Luke is still dealing with this life-changing move. "It's nothing like I imagined, and I struggle with my decision every day."
Weight-loss surgery is a big leap. At its core, it’s not a conventional method of losing weight. Different people will make the decision in different ways. The common thread is that there were countless efforts beforehand.
Like Luke, Brianna's* choice to have surgery was driven by a lifetime of weight problems. "At age 15, I weighed 224 pounds. By age 18, I was 305," she says. "Weight issues were not anything I came across later in life."
After years of diet, exercise and Weight Watchers, she would occasionally lose 10 to 20 pounds. But even with these efforts and nutritionist consultations, she still had 80 to 100 pounds to go. In November 2015, she had gastric sleeve surgery.
Julia Holloman, blogger at Miles to Go and author of "Out of Obesity and into the Promised Land," had the gastric bypass done in 2006. Before that, she went through years of constant dieting—30 years, to be exact. Even then, she was 150 pounds overweight. "I’d lose weight, gain it back, plus a few. But I never made it a lifestyle."
What Is It?
Let’s take it back to the basics: There are three common types of bariatric surgeries, each one with pros and cons.
- Roux-en-Y Gastric Bypass: Simply known as a gastric bypass, this surgery divides the top of the stomach from the rest to create a small pouch. The small intestine is then divided and the bottom end is brought up and attached to this new pouch, while the top end is connected to the small intestine further down. It basically reroutes the food’s path while suppressing hormones that control appetite and hunger. It’s also more complex than other procedures.
- Vertical Sleeve Gastrectomy: The gastric sleeve removes about 70 to 80 percent of your stomach, making it the size and shape of a banana. Your stomach will also stop secreting hormones that promote hunger. Compared to gastric bypass, the gastric sleeve is simpler.
- Adjustable Gastric Band: Another way to make a small stomach pouch is to use an inflatable band attached to the upper portion of the stomach. This will boost satiety without the risk of malabsorption. However, this means that you need to keep a foreign object in your body. It’s also linked to a slower rate of weight loss.
Obviously, weight-loss surgery isn’t for everyone. According to Dr. Seun Sowemimo, medical director at Prime Surgicare, co-medical director of Central Jersey Bariatrics and a board-certified bariatric and gastrointestinal surgeon, a patient must fall into one of the following categories to consider surgery:
- A body mass index of 35 or greater with health problems and comorbidities related to obesity
- A body mass index greater than 40 or 100 pounds over their ideal weight
Dr. Sowemimo also notes that in very obese people dealing with medical problems related to weight, surgery can improve diabetes, hypertension, high cholesterol, sleep apnea and chronic joint pain. And considering the comorbidities that come with obesity, the operation is considered to be extremely safe.
Beyond the numbers, there’s an even bigger qualification: motivation. Lots of it.
"Someone who may be a good candidate medically must also be very motivated to change," shares Sarah Matharoo, R.D. If there is no determination, the odds of success are slim.
"Surgery is only a tool," adds Denise Roden, a bariatric health coach at Bariatric Center for Success, who got the gastric bypass herself in 2004. "Without lifestyle change, the weight will most certainly come back on."
The Pre-Surgery Prep Work
Much like buying a house or planning a vacation, bariatric surgery needs major preparation. You need to learn about the ins and outs and everything in between. Now is the time to buy a new notebook.
But it’s more than just a crash course. It can take up to a year before surgery happens. After her initial seminar, for example, it took Brianna 11 months to get ready for her operation.
"[Pre-surgery] seminars and consultations will explain options. Your medical history should be discussed, along with a multi-pronged, long-term strategy," says Dr. Sowemimo. "The operation is only one aspect of this strategy."
Aside from education, your body needs to get ready. Matharoo explains that most patients are required to lose some weight before hitting the operating table to enhance the chances of a stellar outcome. This is where a registered dietitian provides guidance on pre-surgery portion control and nutritional requirements.
Post-Surgery Life
So, the operation is under your belt—literally. What next?
Dr. Sowemimo explains that the few days after operation can be uncomfortable, as with any surgery. It shouldn’t be markedly painful, though. On average, the hospital stay is one to two days. Your doctor will see you at least twice daily during this time. He’ll also have you come in for an in-office follow-up one week after you leave.
The days that follow are crucial. As your body heals, you’ll need to meet specific protein, fluid and vitamin requirements. This can be done with the help of a registered dietitian or nutritionist, who will guide you through liquid diets, protein shakes, portion control and temporary elimination of certain foods.
The goal? Staying healthy while losing weight rapidly. It will also prevent post-surgery complications like protein-calorie malnourishment and vitamin deficiencies.
It’s also the first step in warding off long-term problems. According to The Journal of Clinical Endocrinology & Metabolism, it’s possible to develop nutritional deficiencies after surgery. Unsurprisingly, the best way to prevent this is to follow your registered dietitian's guidance. Your future self will thank you.
As time goes on, you’ll shed a ton of pounds, which means that your work here is done—right? Not quite.
Roden refers to the first year after surgery as the "honeymoon phase." During this time, you can’t help but lose the weight because of the size of your stomach. But when the weight loss slows down, there’s more room for old habits.
Cue the health coach. "The surgery might have taken care of the weight loss, but it doesn’t take care of maintaining it," explains Roden. "After that 'honeymoon phase,' it would be a good time to hire a coach to help you change the way you think and feel about food and exercise."
Your surgeon won’t be out of touch, though. Dr. Sowemimo says he’ll see a patient every three months in the first year and every six months in the second. After that, appointments continue yearly. More frequent appointments can be made if there are issues.
Seeking out a therapist is another option that many surgery recipients find beneficial. Due to your reduced capacity to eat, it’s not uncommon to develop anxiety around social events and food. For some, dealing with the adjusted lifestyle can be overwhelming. A therapist can help you through these psychological complications of weight-loss surgery.
As for the most important member of the post-op team? That would be you.
It’s Just the Beginning
From now on, everything you do will make a huge difference. Sure, you already made a life-changing choice, but it won’t be the only one you make. With the drastic change of surgery comes the drastic change of lifelong habits.
"You think when you have the surgery that you will never have to think about dieting again, but that's not true," says Roden. "If you eat poorly—even in small portions—the weight will slowly start to creep up. Without lifestyle changes, the weight will most certainly come back on."
Let’s say it again, friends: lifestyle changes. The importance doesn’t change after surgery, emphasizing again its role as a tool.
Holloman adds, "It is a life-changing surgery, but it isn’t an easy way out. You have to work to make sure you don’t fall back into old habits."
Take a tip from Brianna, who lives a busy lifestyle like many of us. Despite working two jobs, spending time with her husband, caring for her pup and maintaining a social life, she treats healthy habits as a non-negotiable component.
"[All of] this makes meal prep very important. Eating fast food can’t be my go-to anymore, so I have to have snacks and meals with me when I leave the house," she explains. "I use my 30-minute lunch break to take a walk, and have worked the gym into my regular routine." Reevaluating those old habits that led to your weight gain in the first place is paramount in refocusing and realigning your life for post-surgery success. Without a shift in your mindset and daily routine, you're no better off than you were before the surgery.
How to Set Yourself up for Success
A support team is essential, but it starts with yourself.
Asking questions is right up there with support. It doesn’t matter if you’re in the pre- or post-op stage—just ask questions.
Luke, who is still coming to terms with his procedure, understands this concept well. "Now, I see that I needed more counseling before surgery. The team was great, don’t get me wrong. It was me. I never really asked questions or expressed concerns, and I’ve been struggling with compliance for the past two years [since surgery]", he says. "I constantly don’t feel well, but I know it’s on me to focus on habits. Sometimes, I wonder if I should have just waited first."
Once you decide to have surgery, you’ll have to work harder than ever before. And as long as you put in the work, it can be a life-saving tool in the face of the comorbidities of obesity.
"Long-term weight loss for any of us will only come from changing our habits and the way we think about food and exercise," explains Roden. "Eat to live, not live to eat!"
Brianna echoes a similar thought. "Having a smaller stomach won't keep your car from driving to a fast food restaurant or eating absolute junk. It won't wake you up at 5:45 a.m. to go to the gym, and it won't portion out your food for you." That’s all on you.
* Names changes for privacy
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