The term bariatric surgery stands for a set of different surgeries any one of which may help obese people to lose weight. The surgery has been recognized to have improved the quality of life and even to have saved lives of many obese people suffering from serious diseases due to obesity.

But not all obese people are suitable for the surgery. Generally, severely obese people with Body Mass Index (BMI) 40 or above or, with BMI 35 or above and having disease/es attributable to obesity such as diabetes type 2 , sleep apnea, severe joint pain are recommended for this surgery.

To qualify for a bariatric surgery, an obese person, in addition to meeting the above criteria, should also have tried out different non-surgical options of weight loss without success and has the willingness/ commitment to adopt a new lifestyle post surgery including lifelong diet control, taking vitamin and mineral supplements, as advised and exercise.

The weight loss surgeries began in the 1950s and initially involved bypassing nearly the entire small intestine in which nutrition and calories got absorbed; But such procedure created complications such as diarrhea, dehydration, mal- nutrition etc. Later in the mid 1960s gastric bypass procedure was introduced which also had several complications. This was followed many years later in 1993 by the Roux- en-Y bypass procedure which though being difficult to perform, became quite acceptable due to less number of complications. In 1990s, the gastric banding procedure was developed by using an adjustable gastric band around the stomach and it also became popular.

The Surgical Procedures –

Laparoscopic Adjustable Gastric Banding (LAGB) Or Lap Banding-

An adjustable band is fitted around the stomach opening at the top by which food intake by the stomach is controlled each time one is eating. The band may be tightened or relaxed by injecting or removing a saline solution through a port installed below the skin and food intake is reduced or increased accordingly.

The lap banding surgery may be done laparoscopically.

With LAGB, the patient needs to be careful in selecting the right kind of food which will suit the reduced opening and will give enough nutrition as well. The patient will have to consult with a dietician, a doctor and the surgeon if necessary to achieve weight loss and yet have enough nutrition.

Weight loss of about 45% to 75% in two years is feasible after this procedure.

Gastric Bypass- Roux-en-Y gastric bypass is a well known gastric bypass procedure in which a small pouch is created by separating it out from the rest of the stomach and the pouch is attached to the small intestine bypassing the rest of the stomach, duodenum and upper intestine. The procedure can be done either by open surgery or laparoscopically which will be decided by the surgeon in consultation with the patient.

The smaller pouch working as the new stomach makes the patient feel full with less food. The pouch however may get stretched later allowing more food intake. Due to the bypass, the release of hormones are changed altering the breakdown of food and the body absorbs less calories.

Weight loss in two years may be 50% to 75% of the excess weight.

Gastric Sleeve – Also known assleeve gastrectomy, the procedure makes a narrow tube as the new stomach by separating it out from the remaining portion (banana shaped) of the stomach. The reduced stomach produces less ghrelin (a hormone that raises hunger pangs) thereby reducing appetite and need for food much less than before. This is deemed as a comparatively safer procedure as it does not alter the small intestine as in gastric bypass or involve putting any artificial object in the body as in lap banding.

The procedure reportedly allows the patient to lose about 33 % of the excess weight in the first year.

Recovery – The patient will be required to stay in the hospital post procedure usually for 2 to 3 days or as advised by the surgeon. The effect of the surgery i.e weight loss takes about 1 to 2 years to fully take place and the patient may have to get the loose skin in the body tightened surgically particularly in the abdominal areas.

The patient has to adhere to pre-designed diet including liquid, vitamin supplement intakes. These are decided in consultation with the dietician and the doctor, whom the patient needs to visit regularly to assess the health condition including weight loss and diet requirements.

After healing, the patient has to take up exercise under guidance of an expert experienced in handling bariatric surgery patients.

Adapting to a designed diet and exercise regime on long term basis and experiencing large weight loss could be stressful for which the patient may require support from the family, friends and others.

Risks – Depending on the type of surgery one has, the risks vary and one must get all the risks associated with surgery explained by the surgeon before giving consent.

Some of the common complications of bariatric surgery are bleeding, infections, blockage or damage in the bowel and further surgery. Complications like blood clots in the lung and legs, heart attacks, pneumonia may also arise in specific cases.

Alternative – A Special Medication True Diet

After bariatric surgery, one is placed on a very low calorie diet and must follow guidelines to maintain adequate nutrition from foods and supplements. This is actually very similar to A Special Medication Diets, and particularly A Special Medication True Diet. When one does this diet, they eat a nutritious very low calorie diet, eating about the same nutrition as they would after bariatric surgery. The difference is that they don’t have to undergo a surgical procedure. When done appropriately, A Special Medication True Diets can help people lose weight rapidly, and keep it off long term if they follow specific guidelines. Medical supervision is recommended when doing this diet program. To find a doctor who does this, go to A Special

[ Source: The write up has derived some information from the article “Patient information: Weight loss surgery (Beyond the Basics)” by Robert A Andrews in UpToDate 2012 ]