What is bariatric surgery?

Bariatric surgery is a type of surgery to help you lose weight. There are several different bariatric procedures. This surgery is a choice for some people who are obese and have not been able to lose weight with other methods, such as diet and exercise. Your healthcare provider might discuss bariatric surgery with you if you are obese. Or they may discuss it if you are overweight and have a health problem, such as diabetes. Diabetes and certain other health problems may get better with weight loss.

What are the benefits of bariatric surgery?

Bariatric surgery may help you lose a large amount of excess weight and keep it off if you continue with diet and lifestyle changes. Excess weight can cause health problems, such as:

• Diabetes

• Osteoarthritis

• High blood pressure

• Heart disease

• Stroke

• Sleep apnea

• Liver disease

• Gastrointestinal problems

• Infertility

• Certain lung diseases, such as asthma

• Certain cancers

• Psychological problems

Weight loss will reduce your risk of some of these health conditions. If you already have 1 or more of these health problems, weight loss may lessen symptoms and improve your overall health. In some cases, a health problem linked to excessive weight may go away after weight loss.

Healthcare providers most often advise bariatric surgery to people with a body mass index (BMI) of 40 or greater, which is called morbid obesity. BMI is a method of screening for a weight category using a person's height and weight for calculation. A BMI of 25 to 29.9 means overweight. A BMI of 30 or higher means obese. Your healthcare provider might also suggest bariatric surgery if your BMI is between 35 and 40 and you have a medical problem that may get better with weight loss, such as diabetes, sleep apnea, high blood pressure, or osteoarthritis.

People who get surgery tend to lose much more weight than people who get medical therapy for their weight loss. This means that surgery is more likely to help with medical conditions linked to obesity, such as diabetes or sleep apnea. But the results do vary. Some people can have large weight loss with medical therapy alone. And some people do not lose as much weight as they want after surgery.

What are the risks of bariatric surgery?

All surgery has risks. Your risks may vary according to your general health, your age, the type of surgery you choose, and the amount of weight you need to lose. Talk with your healthcare provider about the risks that most apply to you. Risks of bariatric surgery include:

• Bleeding

• Wound infection

• Leaks from the staple lines or connections

• Pneumonia 

• Blockage of your bowels (intestinal obstruction)

• Blood clots in your legs or lungs 

• Heart attack

• Need for follow-up surgery

• Gallstones (a later complication)

• Nutritional deficiencies (a later complication)

• Psychological difficulties after the procedure

Who evaluates me for bariatric surgery?

Bariatric surgery is not the only treatment for obesity. Your healthcare provider may want you to try other treatments first. These may include working with a dietitian or using a prescribed weight loss medicine.

Your medical team will only do the surgery if they know it will give you health benefits. For the surgery to be a success, you will need to make lifelong changes to your diet and lifestyle. Your medical team will want to know that you are ready and committed to make these lifestyle changes so that surgery is successful.

You will need to go through an in-depth screening process to be approved for bariatric surgery. This is done to find out if you are ready for the surgery and if it will help you. You'll also want to find out if your health insurance plan will cover the costs of the surgery. As part of your evaluation, you'll need to give some details about your weight and diet history.

To be approved for the surgery, you'll need to meet with healthcare providers, such as:

• Your surgeon, who must confirm that you are a good candidate for surgery

• A mental health professional, who can assess your psychological health and readiness for the surgery

• A registered dietitian, who will look at your diet and eating habits and help you begin to make the needed changes

• A primary care provider, who can assess your general health and readiness for surgery

• A heart healthcare provider, who can make sure your heart is healthy for surgery

• A lung healthcare provider, who can make sure your lungs are healthy for surgery

You may need to work with these healthcare providers for several months before you can get approval. They need to make sure you are in good mental and physical shape for the surgery. You may need to work with your primary healthcare provider and a dietitian to lose some weight and stop smoking in the months before your surgery. This helps reduce your risk of complications after the surgery. You might need to work with more healthcare providers if you have other medical or social problems. Your team of healthcare providers must agree that the surgery is safe and would be beneficial for you.

Checking your mental readiness is a vital part of the approval process. Bariatric surgery is a big personal commitment. The surgery will permanently change your eating habits. To get approved for the surgery, you'll need to show that you fully understand the risks and benefits. Support from your partner, family, and friends can also be important for your mental readiness for the surgery.

What tests do I need for bariatric surgery approval?

As part of the approval process, you'll need physical exams and testing. This is to make sure you are healthy enough for the surgery and recovery. You may need tests, such as:

• Blood tests to check for anemia, infection, hormone levels, kidney function, and more

• Screening for nutrient deficiencies

• Chest X-ray, to help evaluate your heart and lungs

• Echocardiogram, if more information about your heart is necessary

• Electrocardiogram, to evaluate your heart rhythm

• Pulmonary function tests, to evaluate your lungs

• A sleep study, to see if you have sleep apnea

• An upper GI or an upper endoscopy, to examine your stomach

• An upper abdominal ultrasound, to examine your liver and gallbladder 

Your healthcare providers may ask you to lose weight before surgery. If you smoke, your surgeon will likely need you to stop smoking to go ahead with surgery. These lifestyle changes help to make the surgery and recovery safer for you. 

What are realistic weight loss goals?

It's important to have realistic weight loss goals going into the surgery. Most people don't lose all of their excess weight after surgery. Depending on the type of surgery you have, you may lose one-half to two-thirds of your excess body weight. Your healthcare provider can give you a more exact idea of what you can expect. Are you hoping to lose 50 to 100 pounds, or over 100 pounds? You should tell your surgical team how much weight you are hoping to lose as a result of the surgical procedure. It can help you select a procedure that can help you reach your goals. 

Losing this amount of weight may help any health conditions you have, even if you still carry some excess weight. You may be able to reduce or stop some of the medicines that you take. You may also have more energy and a more positive self-image. Having a realistic weight loss goal can help keep you motivated. It can help keep you on track with your good eating habits. During your evaluation, your healthcare providers will give you a realistic idea of how much you can expect to lose after your surgery, depending on which bariatric surgical procedure you will have done.