Weight Loss Surgery

Put simply, weight loss surgery is controversial. Traditional means of losing weight, like altering your diet and adhering to an exercise program, are seen as “safe”. No matter how bad you may feel the first few weeks of a new diet and exercise plan, it isn’t going to cause you harm. Cutting out fast food and drinking less high calorie sodas and beers may feel like a kind of death, but there is no direct risk of bodily harm from getting healthy the natural way — outside of dropping a weight on your foot or falling during a jogging session.

Not so for weight loss surgery. Lap Band and Gastric Bypass surgeries are major surgeries with the possibility of serious complications including death. Several high profile weight loss surgery deaths in recent years, including the death of rapper Kanye West’s mother following a “tummy tuck” that was most likely a gastric bypass surgery, have brought the dangers of weight loss surgery to the forefront. Though there are millions of people who have had successful weight loss surgery, including lap band and gastric bypass surgeries, it is the people who die from weight loss surgery that make these procedures seem so harmful and tragic.

Why Do People Have Weight Loss Surgery?

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Bariatric surgeons, those who perform weight loss surgeries, tell us that people have weight loss surgery only under specific conditions. A lap band or gastric bypass surgery is not something that people undergo lightly. Having a lap band procedure is nowhere near as simple and elective as, say, a breast enhancement or other cosmetic surgery. No bariatric surgeon will perform a weight loss surgery without specific conditions being met. Good candidates for weight loss surgery have attempted for many years to lose weight naturally (with diet and exercise) and still haven’t been able to shed pounds. Laziness is no excuse for weight loss surgery — unless you attempt to lose weight using natural means you’re simply not going to have weight loss surgery.

Other conditions required before weight loss surgery include cardiac checkups (to make sure your heart is healthy enough for the surgery) and other medical “musts”. Here’s a quick breakdown of various surgical requirements that must be met before weight loss surgery will be performed.

  • Age — No weight loss surgeon in America will perform a procedure on any person less than 18 years of age. There’s no way around this — it is the law.
  • BMI — Your BMI (Body Mass Index) is a number that reflects a ratio between your height and weight. The higher your BMI, the more obese you are. Most bariatric surgeons won’t perform weight loss surgery on anyone with a BMI of less than 40 or higher than 60. The few surgeons who will perform weight loss surgery on people with lower BMIs (usually cutting off at 35) require that those people have “significant co-morbid conditions” that endanger their health. Diabetes, sleep apnea, infertility, and even sleep apnea are conditions under which a person with a BMI of 35 or higher can qualify for lap band or gastric bypass surgeries.
  • Weight Loss Programs — Any weight loss surgery patient will be required to make “significant effort” (supervised by a doctor) toward weight loss. These programs must be adhered to over a specific period of time (in some cases this means multiple years) and while undergoing these programs, still fail to lose substantial amounts of weight.
  • Patient background — Different bariatric surgeons will look for different “red flags” in a patient’s background before deciding if they can have weight loss surgery. The Bariatric Surgery Center of Hackensack University (one of the leading bariatric authorities) bases its background criteria for weight loss surgery on specific guidelines which have become the national standard. These guidelines are not generally known to the public, but include factors like mental health issues and eating habits.

The National Heart, Lung, and Blood Institute in cooperation with The National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIH) adds the following recommendations to this national standard of weight loss requirements — “Weight loss surgery is an option for carefully selected patients with clinically severe obesity (Body Mass Index > 40 or > 35 with comorbid conditions) when less invasive methods of weight loss have failed and the patient is at high risk for obesity-associated morbidity or mortality.”

It is important to note that simply considering yourself “obese” or “overweight” doesn’t mean you are a candidate for weight loss surgery. The potential complications and severe side effects of these surgeries mean that you and your doctors must go into this decision carefully. Weight loss surgeries are not for cosmetic purposes, but to prevent diseases associated with so called “morbid obesity”. Patients are often required to commit to pre-weight loss surgery diet and exercise routines as well as extremely long-term (in some cases this means decades-long) postoperative health management or even medication therapy.

Gastric Bypass vs Lap Band

People who aren’t familiar with weight loss surgery may be confused about the differences between the two popular weight loss surgery procedures.

A gastric bypass procedure is designed to literally limit your food intake by “bypassing” part of your gastrointestinal system. Gastric bypass is meant to improve an overweight person’s quality of life in a few ways — by improving a patient’s physical appearance and mobility, and by reducing the severity of health problems associated with obesity. Like any major surgery, you sleep through gastric bypass surgery under general anesthesia. Depending on the surgeon and the level of obesity in the patient, the procedure can take as little as an hour or as long as five hours. Patients who undergo gastric bypass surgery are required to stay in the hospital for anywhere from a day to a week.

Gastric bypass is known among surgeons as a “malabsorptive surgery” — this is a complex term for the fact that your small intestine is bypassed to decrease the absorption of nutrients. This also means that individuals who get gastric bypass surgery have to eat even higher amounts of vitamins and minerals, often requiring supplements and pills to get the nutrition they need.

The ore popular method of gastric bypass is known as “Roux-en-Y” — this form of weight loss surgery is less complex than other methods because this type of bypass surgery does not require the removal of any part of your stomach, just the bypassing of the small intestine. The Roux-en-Y procedure is also more popular than lap banding because it causes less scarring and the recovery time is much quicker.

Lap banding, also known as gastric banding, is a “restrictive” type of weight loss surgery. This means a patient’s intake of food is literally restricted by surgical intervention. Lap banding involves a simple silicone band with an inflatable inner collar that is placed around the upper part of a patient’s stomach to limit the amount of food they eat. Lap banding basically creates a “new stomach” that consists of a tiny pouch and an extremely narrow passage to the lower part of the stomach. This pouching process causes a feeling of “fullness” even after a small meal. Lap band is popular among surgeons who like the adaptability of the procedure — the silicone band used to restrict food can be tightened or loosened over time to change the size of the passage as necessary. In gastric bypass surgery, which only takes about an hour to perform, a silicone band is connected to a tiny port in your abdominal wall. Surgeons adjust the diameter of the restrictive band by squirting saline into the port — known in the industry as a “fill”. This “fill” procedure makes lap banding a better option for most patients, as their reactions to the surgery can lead to changes in the size of the lap band.

Only about 550,000 patients have had this kind of “adjustable gastric banding” using the Lap Band System. That number may sound big, but in terms of surgical procedures, it is a small sample. That is one reason why weight loss surgery is considered dangerous — we just don’t know enough about it yet.

Procedures for Weight Loss Surgery

As a condition of your weight loss surgery, you will be required to perform certain tasks and lifestyle changes both before and after the procedure.

Be prepared to meet regularly with your doctor’s preferred dietitian. In these meetings, you will talk about your diet and what changes need to be made in the months prior to and the years after your surgery. These are in-depth meetings requiring you to keep food diaries and be really honest about your eating habits.

You will most certainly need to see a psychologist for a complete evaluation. Doctors want to make sure you aren’t going into this procedure for purely cosmetic reasons, and that you are mentally stable enough to stick to the diet and exercise regimen they require.

In the days leading up to the surgery, you will have what is called an “upper endoscopy exam” in which you swallow a substance called barium and doctors examine your body with scans to ensure you don’t have any dangerous polyps, tumors, growths, or ulcers that can cause complications during any weight loss surgery.

As far as lifestyle changes — be prepared to make plenty of them. Your lifestyle changes will need to start before surgery and continue for decades after your weight loss procedure. If you are a smoker, get ready to quit cold turkey. You must quit smoking for at least a month before and after your weight loss surgery, and you won’t be able to use medication to quit. Smoking seriously increases the risk of surgical complications, like the development of blood clots that can take your life before the surgeon has finished stitching you up. Smoking also keeps you from healing properly and can lead to pneumonia and other nasty diseases developing during your recovery. Smoking isn’t the only vice you have to give up — no drugs or drinking for at least two days before and a week after your surgery besides any medication your weight loss surgeon may prescribe for pain or discomfort.

Many people are also completely unprepared for the pace of eating post gastric surgery. You will have to eat very slowly, chewing your food thoroughly and taking time to acknowledge when your stomach is full. Overeating or eating too fast after a weight loss surgery greatly increases chances of complications and serious side effects.

How Much Does Weight Loss Surgery Cost?

This is one area in which weight loss surgery is improving rapidly. Many insurance companies are starting to cover the complete cost of bariatric surgery, noting the positive impact these procedures have on their member’s general health. Let’s face it — insurance companies are in the business of making money, and any single procedure that could reduce the cost of keeping one of their customer’s healthy over the course of their lifetime is worth it to their bottom line.

Assuming your insurance won’t cover the cost of your weight loss surgery, you can expect to spend anywhere from $17,000 to well over $40,000. Remember that weight loss surgery is complex and potentially devastating for a surgeon’s reputation — the risk of a patient dying on the table is much higher during weight loss surgery than, say, an appendectomy or tonsillectomy. The cost of your surgery will depend greatly on which specific procedure you’re having — in general, Lap Band surgery is cheaper by about $10,000.

What contributes to the high cost of gastric bypass surgery? Extensive pre-operation lab tests, general anesthesia costs, hospital fees and surgeon’s fees all add up to a massive bill. Don’t forget about the costs for post weight loss surgery — you’ll need to pay a dietitian, join a gym, pay for nutritional supplements, and many people require additional plastic surgery to get rid of excess skin. If it isn’t obvious by now, the costs associated with weight loss surgery escalate quickly and exponentially.

Weight loss surgery can mean the difference between a long life and an early death. For people who meet the requirements, weight loss surgery is a life changing and life enhancing procedure that sits somewhere in the middle of the “elective versus medically necessary” scale. If you’ve tried for years to lose weight by natural means and still can’t keep the pounds off, get in touch with a bariatric surgeon to talk about weight loss surgery. Just be prepared for the lifestyle changes, possible side effects, and high cost of gastric bypass and lap band surgeries.