It's normal to be conscious of how you look in the mirror. Losing weight isn't just healthy, but it can also boost confidence in powerful ways.
The CDC estimates that half of adults try to lose weight in any given year, with younger adults most likely to make the effort, followed by middle-aged adults, and older adults. Common ways of shedding extra pounds include healthy eating, exercising, and intermittent fasting.
But for some, there is another path that many may consider a last resort: weight loss surgery.
Spencer Kroll, MD, PhD, an internal medicine specialist in New Jersey, says, "People typically opt for weight loss surgery after failing several diet programs and sometimes medication therapy."
Jeannie Boyer, a licensed dietitian in Mount Pleasant, SC, says others chose surgery to help resolve or improve diabetes, high blood pressure, and sleep apnea.
"Some of these conditions, like diabetes and insulin treatment, make losing weight through diet and exercise very difficult, which is why surgery might be ideal," she says.
When Should You Consider Surgery?
Kroll is a cholesterol and lipid disease expert who specializes in metabolic disease.
Even though it seems that people opt for surgeries out of frustration, he says, "This should be considered only after exhausting other options, such as significant and sustainable dietary modification."
Also, he urges people to "review various weight loss strategies with a nutritionist, change their lifestyle, and increase physical activity to increase their metabolism and encourage weight loss."
Types of Weight Loss Surgery
In a situation where you may have tried all other alternatives to losing weight, surgery might be your best bet. But which is it going to be?
A recent study conducted by the University of Michigan examines the two common types of weight loss surgery: sleeve gastrectomy and gastric bypass.
"Sleeve gastrectomy is an easier surgery [because] only the stomach itself is reduced in size," Kroll says. Basically, a portion of the stomach is removed, making it smaller.
"Gastric bypass, which [involves] several surgical techniques, involves bypassing the stomach so that the esophagus is connected to the small intestine directly," Kroll says.
In other words, the stomach no longer has food entering it, but is separately attached to the intestine in order to provide digestive secretions.
Sleeve Gastrectomy vs. Gastric Bypass: Which Is Safer?
Before finding out which is safer, Ryan Howard, MD, author of the University of Michigan study, says, "It's really important for patients to understand the risk of issues like death, complications, and hospitalization after these two procedures."
Howard, a general surgeon, tells patients that understanding what they're in for helps inform the decision about which type of bariatric surgery to choose.
He considers the sleeve gastrectomy to be safer, though it "doesn't confer as much weight loss."
However, just because it is safer doesn't mean you shouldn't consider other factors.
"If a patient has a lot of comorbidities and a bypass is going to afford a better clinical benefit, maybe that risk is worth it," he says.
A recent study that followed bariatric surgery patients for 5 years discovered that sleeve gastrectomy has a lower long-term risk of mortality, complications, and reinterventions but a higher long-term rate of surgical revision.
Complications from bariatric surgery are usually rare. The American Society for Metabolic and Bariatric Surgery reports the risk of dying from weight loss surgery is less than that of gallbladder removal or hip replacement.
Kroll says the 30-day mortality rate for sleeve gastrectomy patients is 0.08% while that of gastric bypass patients is 0.14%.
Although these complications are rare, Kroll says there are risks of blockages due to scar tissue and of infection.
Outlook and Recovery
"After having bariatric surgery, you have a new opportunity. As far as weight is concerned, you can reduce your body size," says Susan Zilberman, a mind body eating coach in New York City.
But that's not the end goal. If you fail to deal with what caused the excessive weight, then it will return in a matter of time.
Zilberman says the "core emotional concerns that created the weight are still there. In order to keep the weight off, it's crucial to come to a place of self-understanding surrounding your relationship with food."
Zilberman incorporates her coaching skills when working with bariatric surgeons, nurses, and dietitians.
She says that one way to heal is through mindful eating.
"Mindful eating helps you disengage from habitual, unsatisfying behaviors. Instead of thinking about food and eating, you free up your energy and can focus on living your optimal life."
"Healing from surgery is a process. For optimum healing, it is important to follow the guidelines of your bariatric team, to think about self-care and stress reduction, and to focus on self-acceptance in the present moment."
Ryan Howard, MD, general surgeon, University of Michigan.
Spencer Kroll, MD, PhD, internal medicine specialist, New Jersey.
Jeannie Boyer, RD, LD, Mount Pleasant, SC.
Susan Zilberman, certified mind body eating coach, New York City.
JAMA Surgery: "Comparative safety of sleeve gastrectomy and gastric bypass up to 5 years after surgery in patients with severe obesity."
CDC: "Attempts to Lose Weight Among Adults in the United States, 2013–2016."
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Cite this: How to Choose the Right Weight-Loss Surgery - Medscape - Nov 02, 2021.