Study Compares Weight Loss Surgeries
Deciding to have weight-loss surgery is tough enough, but then you have to choose between several procedures — each with different risks and potential weight loss.
So how do you decide which surgery one is best for you?
New research that compares three types of weight-loss surgery in more than 46,000 patients may help. The three types of bariatric surgery included gastric bypass, sleeve gastrectomy and adjustable gastric banding, also known as lap band.
The study found that gastric bypass surgery boasted the greatest weight loss — both short- and long-term.
But that procedure also had the highest rates of complications in the month following surgery.
“There are trade-offs. Bypass is more effective for weight loss, but has a greater risk of short-term complications. People need to consider, ‘What do I value most?’
Is safety your biggest concern? Or, is it the magnitude of the weight loss?” said Dr. David Arterburn, study lead author and senior researcher at the Kaiser Permanente Washington Health Research Institute in Seattle.
Arterburn added that it’s important to consider other weight-loss treatments, such as medication.
Three Surgeries Studied
Comparative Effectiveness and Safety of Bariatric Procedures for Weigh Loss: A PCORnet Cohort Study was published December 4, 2018 in the Annals of Internal Medicine.
Roux-en-Y Gastric Bypass
Nearly 25,000 people in the study had Roux-en-Y gastric bypass. This procedure involves making the stomach smaller and bypassing part of the small intestine, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
After this surgery, people get fuller on much less food, and the body doesn’t absorb as many calories.
Almost 19,000 people in the study had sleeve gastrectomy, which involves taking out a portion of your stomach so that you get fuller faster.
Lap Band Surgery
And finally, more than 2,500 people had adjustable lap-band surgery. A surgeon places an inflatable band around the top of your stomach, leaving only a small pouch that can be filled with food.
The rest of your stomach is filled with a balloon containing saline solution that is attached to the band.
Arterburn said this procedure has fallen out of favor in recent years.
Most Effective Weight Loss Surgery
The study found that gastric bypass appeared to be most effective for weight loss:
- Gastric bypass surgery resulted in an average 31 percent loss of total body weight in the first year and 25 percent of total body weight after five years.
- Sleeve gastrectomy led to a 25 percent loss in total body weight in the first year and 19 percent loss of total body weight after five years.
- Adjustable gastric banding led to a 14 percent total weight loss after a year and 12 percent at five years.
The average person in this study weighed 277 pounds before surgery, and for the average study participant, there was a 19-pound weight loss difference between the bypass and sleeve procedures after five years.
The 30-day rate of serious complications for gastric bypass was nearly double the risk of the sleeve procedure.
The rate of complications in the 30-day period after surgery was 5 percent for gastric bypass, 2.6 percent for sleeve gastrectomy and 2.9 percent for adjustable gastric banding.
The complications measured in the study included death, re-operation/repair procedures, clots, or failure to be discharged from the hospital within 30 days.
The 30-day rate of serious complications for gastric bypass was nearly double the risk of the sleeve procedure.
Similar Surgery Costs
Gastric bypass and sleeve gastrectomy are similar in terms of cost, according to Arterburn. Each procedure averages between $20,000 and $30,000, he estimated.
Adjustable gastric banding is less expensive and may average around $15,000, he noted.
Insurance coverage for these procedures varies quite a bit, and not all will cover weight-loss surgery.
Choosing a Procedure
Dr. Mitchell Roslin, director of the Bariatric Surgery Program at Northern Westchester Hospital in Mount Kisco, N.Y., said that people shouldn’t only focus on the total weight loss when trying to select a procedure. He says:
“There is no perfect way. The more we change the body, the higher the weight loss, but complications may be higher. There’s no one-size-fits-all weight-loss surgery.”
“The decision really requires detailed conversation and education. You need to understand your own individual medical issues and objectives,” he said.
Qualifying For Bariatric Surgery
Gastric bypass and other types of weight-loss surgery, collectively known as bariatric surgery, make surgical changes to your stomach and digestive system that limit how much food you can eat and how many nutrients you absorb, leading to weight loss.
While bariatric surgery may sound appealing, it isn’t for everyone.
Like any major procedure, it has significant health risks and side effects. In addition, the long-term success of gastric bypass surgery depends on your ability to make permanent changes in your lifestyle.
When you want to be considered for gastric bypass surgery, you must undergo a thorough evaluation to determine if it’s suitable for your situation.
Guidelines for Bariatric Surgery
Gastric bypass and other weight-loss surgeries are major, life-changing procedures. While weight-loss surgery can help reduce your risk of weight-related health problems — such as pre-diabetes, type 2 diabetes, high blood pressure, heart disease and sleep apnea — it can also pose major risks and complications.
Gastric bypass and other weight-loss surgeries are major, life-changing procedures.
You may need to meet certain medical guidelines to qualify for weight-loss surgery. You likely will have an extensive screening process to see if you qualify.
In general, gastric bypass or another weight-loss surgery could be an option for you if:
- Efforts to lose weight with diet and exercise have been unsuccessful
- Your body mass index (BMI) is 40 or higher
- Your BMI is 35 or more and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea
- You’re a teenager who’s gone through puberty, your BMI is 35 or more, and you have serious obesity-related health problems, such as type 2 diabetes or severe sleep apnea
In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems.
A Complete Evaluation
Even if you meet these general guidelines, you still may need to meet certain other medical guidelines to qualify for weight-loss surgery. You likely will have an extensive screening process to see if you qualify.
A team of health professionals — usually including a doctor, dietitian, psychologist and surgeon — evaluate whether gastric bypass or one of the other forms of weight-loss surgery is appropriate for you.
This evaluation generally determines if the health benefits of the surgery outweigh the potentially serious risks, and if you’re medically ready to undergo the procedure.
The evaluation also determines if you’re psychologically ready to undergo weight-loss surgery. The procedure may increase certain risks in people with existing mental health conditions that aren’t effectively managed.
Even if you meet all guidelines, you still may need to meet certain other parameters to qualify for weight-loss surgery.
For example, recent studies have identified an increased risk of suicide in people who have had weight-loss surgery.
This risk is greatest in those who have attempted suicide in the past. More research is needed to understand whether changes related to the surgery itself play a role in increasing suicide risk.
A history of suicidal thoughts or attempts does not necessarily mean bariatric surgery isn’t right for you, but your health care team should carefully evaluate your history and plan for close monitoring and support before and after the surgery.
Suicide risk is increased after weight loss surgery.
Pre-Surgery Health Evaluation
When conducting an evaluation for gastric bypass surgery, the health care team will consider the following criteria:
Your Nutrition and Weight History
The team reviews your weight trends, diet attempts, eating habits, exercise regimen, stress level, time constraints, motivation and other factors.
Your Medical Condition
Some health problems increase the risks associated with having surgery or may be worsened by surgery, such as blood clots, liver disease, heart problems, kidney stones and nutritional deficiencies.
The team will evaluate what medications you take, how much alcohol you drink and whether you smoke.
You will also be evaluated for sleep apnea and receive a thorough physical exam and laboratory testing. The results of these tests and exams will help determine eligibility for weight-loss surgery.
Your Psychological Status
Certain mental health conditions may contribute to obesity or make it more difficult for you to maintain the health benefits of gastric bypass surgery.
These conditions may include:
- binge-eating disorder
- substance abuse
- anxiety disorders
- major depression
- severe bipolar disorder
- issues related to childhood sexual abuse.
While these conditions may not prevent you from having gastric bypass surgery, your doctors may want to postpone surgery to ensure that any condition or significant sources of stress are appropriately treated and managed.
The team will also assess your willingness and ability to follow through with recommendations made by your health care team and to carry out prescribed changes in your diet and exercise routine.
There’s no specific age limit for gastric bypass surgery, but, until recently, the procedure was considered too risky for teenagers and older adults.
Newer studies have found gastric bypass surgery can be safe and effective for adults ages 60 and older.
Weight loss surgery is also now considered an option for some teenagers with a BMI of 35 or more and serious obesity-related health problems.
Preparing For Bariatric Surgery
If you’re approved for gastric bypass surgery, your health care team gives you instructions about how to prepare in the months or weeks before the surgery. These instructions may include restrictions on eating and drinking, undergoing lifestyle counseling to help you cope with big changes in diet and exercise, quitting smoking, and starting a supervised physical activity or exercise program.
In some cases, you may be required to lose weight before having gastric bypass surgery.
Even after gastric bypass surgery is scheduled, it can be delayed or canceled if your health care team determines that:
- You’re not psychologically or medically ready for surgery
- You haven’t made appropriate changes in your eating or exercise habits
- You gained weight during the evaluation process
If it’s determined that gastric bypass surgery is appropriate for you, you will still have financial hurdles to negotiate.
If you plan to rely on health insurance coverage for your gastric bypass surgery, you will need to get pre-approval from your health insurance company, Medicare or your state medical assistance program — whoever you have insurance through.
The pre-approval process typically requires documentation from your team of doctors that justifies your medical need for gastric bypass surgery.
Different health insurers have different requirements to prove your medical need for gastric bypass surgery. Your health insurer may not cover gastric bypass surgery at all or may cover only parts of the process.
To avoid unpleasant financial surprises, it’s a good idea to check to see what specific services are covered before starting the evaluation process. You may have to pay for some portion of the costs yourself.
Food addiction is an extremely difficult disease that is misunderstood by the general public and by many medical and mental health professionals.
Weight regain following extreme weight loss through medically supervised diet programs, fad diets, or weight loss (bariatric) surgery is all too often followed by weight regain.
Food addiction takes our brains “hostage” and makes it seem impossible for intelligent, well-meaning people who sincerely want to lose weight to avoid foods they realize will result in added pounds. Food addiction “hijacks” our rational minds and leads us to making decisions that will defy our weight loss efforts and goals.
Attempts to continue to “eat less” will fail if a person is a food addict and does not treat their addiction. The result will ultimately be weight regain, frustration and discouragement. Weight Loss Surgery Does NOT Treat Food Addiction is for people who have had bariatric surgery, are considering bariatric surgery, or for anyone who struggles with weight loss and keeping weight off.
Author Connie Stapleton, PhD. shares tips and steps to to address food addiction, as well as what it means to be in recovery from food addiction. Dr. Stapleton is a licensed psychologist specializing in addiction recovery.
Get ready to learn. Get ready to grow as a person by learning more about yourself in this educational, engaging and down-to-earth book.
How to Prepare For our Weight Loss Surgery Psychological Evaluation gives you trusted advice and support that thousands of WLS patients use for the lifelong WLS journey. Each chapter includes key subjects every WLS patient needs to know.
There are 53 worksheets covering the 15 vital areas discussed at your Psychological Evaluation. The worksheets are specifically designed to improve awareness of your patterns, design action plans, and ensure you won’t be caught unprepared by evaluation questions.
If you’re considering WLS, this book gives everything you need to achieve the best results for your WLS hopes and dreams and maintain long-term WLS accomplishment for years to come.
Gastric bypass surgery isn’t a miracle procedure — and it isn’t for everyone.
Having gastric bypass or other weight-loss surgery doesn’t guarantee that you’ll lose all your excess weight or that you’ll keep it off over the long term.
Nor is it a way to avoid making changes in your diet and exercise habits.
In fact, you can regain the weight you lose with gastric bypass surgery if you don’t stick with the lifestyle changes.
If you think gastric bypass surgery might be right for you, talk with your doctor.
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