Bariatric surgery is weight loss surgery to treat obesity or reduce weight-related health complications. These surgeries change the structure of the digestive tract, which helps reduce hunger.
As dieticians and obesity doctors, we are often asked when an adult might consider weight management surgery.
The short answer is people may be eligible for surgery if they have a body mass index (BMI) over 40 (defined as severe obesity) or if their BMI is less than 40 but they have medical complications such as diabetes .
But bariatric surgery is not for everyone with obesity. Here are some factors to consider when considering it.
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How does your weight affect your health?
The Edmonton Obesity Staging System is used to rank the physical, medical, and health impairment of people with obesity. Level zero means no impairment, while level 4—the highest category—indicates severe impairment.
People in stages three and four often have major health problems, use medications and health services more often, require longer treatment times to reach their weight-related goals, and are at higher risk of post-surgery complications.
People who are candidates for bariatric surgery are typically in stage three or four.
How does bariatric surgery work?
Bariatric surgery reduces stomach volume. Most are keyhole procedures, in which small incisions are made in the abdomen and tiny cameras are inserted to guide the operation.
Bariatric surgery makes people feel fuller. When combined with changes in dietary intake, this typically results in a long-term weight reduction of 20% to 40% of the person’s baseline weight.
This weight loss can help improve high blood pressure, type 2 diabetes, sleep apnea, and fatty liver.
However, there are risks of surgery that also need to be considered, including vomiting, constipation, increased bowel movements, as well as longer-term risks such as reflux, hernia, malnutrition, and small bowel obstruction.
Alternative approaches to weight control
Before considering surgery, it’s important to speak to a family doctor or obesity specialist about any appropriate evidence-based approaches to improving your weight-related health, including very low-energy diets.
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Specific medications approved for weight control in Australia are available but can be costly. Medications can help achieve a 5-10% weight reduction, although results and side effects vary, so regular review is necessary.
While people with moderate obesity can lose enough weight through diet alone to improve their health, for those who are severely obese, diet may not be enough.
Weight management is a lifelong journey, so a person can try numerous approaches over time and check their progress toward their goals at each stage. These include interventions to improve diet, physical activity, fitness, mental health, and/or medications to address health risk factors, appetite, and complications from carrying excess weight.
Read more: Health check: What is the best diet for losing weight?
A word on stigma
Weight stigma and bias are negative attitudes, beliefs, or discrimination based on a person’s weight. This can occur in both public and private healthcare settings and prevent people from receiving the medical care and support to improve their weight-related health.
It’s important for people to find a doctor they can work with to develop a comprehensive treatment strategy for them. This plan may or may not include bariatric surgery.
Weight stigma can also lead people to abandon health care after surgery because they feel bad or are made to feel bad about their weight or the results of the surgery.
When should bariatric surgery be considered?
Access to bariatric surgery by public hospitals in Australia is currently very limited unless you have private health insurance that covers bariatric surgery.
Other considerations are:
1) What weight-related results are you hoping to see?
From improved health to less medication, remission from type 2 diabetes, or better physical mobility, a clear understanding of the potential positive effects post-surgery helps in monitoring progress.
It also helps in deciding whether other approaches could be tried first, e.g. B. Medicines.
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2) What are the advantages and disadvantages of bariatric surgery?
Bariatric surgery has both positive and negative effects. While body dysmorphia (negative feelings about your body) may improve after surgery, this may not be the case.
Other common concerns you should be prepared for include difficulty eating out with friends, potential hair loss, excess skin, and bone and muscle loss. Special considerations may be needed for those planning a future pregnancy to ensure they are getting enough nutrients.
3) Can the person considering surgery give their full informed consent?
A “yes” means that all of the person’s questions have been answered, they fully understand that permanent weight loss is not guaranteed, and that lifelong follow-up care is required to optimize their health.
While most people lose significant amounts of weight, weight can regain depending on the type and time since surgery, the presence of emotional or disordered eating, and eating larger portions of food.
4) Can you access appropriate post-operative support?
The first year after surgery requires more intensive follow-up care involving surgeons, primary care physicians, obesity specialists, and allied health care providers. Ongoing follow-up helps monitor health improvements, nutritional status, mental health, and weight gain.
Bariatric surgery may be the right choice for people living with obesity when the benefits are clear, the time is right, and to optimize their health and well-being. But preparation and long-term care are important. It is best to talk to your family doctor.
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