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After years of dieting, exercise, and trials of medications without significant weight changes, many people with obesity and their doctors consider surgery as a potential next step. Bariatric surgery is a medical procedure that can help some qualifying higher-weight people achieve rapid and lasting weight loss. Because obesity is tied to so many other medical conditions, surgery has been found to have many long-term positive health impacts, even compared to weight loss medications.
However, all surgeries come with risks, and not everyone is a good candidate for this type of procedure. In this article, we’ll walk you through what to expect before, during, and after obesity surgery. With the help of your doctor, this guide can help you make informed decisions about your treatment options.
There is not just one type of bariatric surgery — surgeons can use one of four different techniques to achieve similar results. Each method has risks and benefits.
Gastric bypass surgery, medically known as roux-en-y, is a surgery that creates a small stomach pouch by rerouting the small intestine. This procedure, which is reversible if necessary, limits food intake, due to a smaller stomach capacity, while also reducing how many nutrients the body can absorb. As a result, many people lose up to 70 percent of their excess weight and see improvements in obesity-related conditions like type 2 diabetes, high blood pressure, heart disease, and sleep apnea.
This technique places an adjustable band around the upper stomach to create a small stomach pouch. This speeds up the feeling of fullness when you’re eating, slowing how quickly you can eat. Gastric banding is the safest choice in the short term, but you’re more likely to need another surgery later. Note that this surgery is not frequently performed anymore.
“Is there a specific weight requirement for gastric band surgery?” asked one MyObesityTeam member. Weight requirements for any bariatric surgery may vary from hospital to hospital.
According to the University of San Francisco, bariatric surgery can be offered to people with:
This technique, also referred to as a gastric sleeve, surgically removes 80 percent of the stomach, leaving a tube-shaped stomach, called a sleeve. A smaller stomach reduces hunger by reducing the levels of ghrelin — a hormone that signals hunger to your brain. This is a popular technique because it’s simple and effective. A major side effect of this surgery is acid reflux. If you have a small hiatal hernia, having it corrected during the surgery is very important. Smoking is not recommended, as it can trigger severe acid reflux as well. This surgery is not reversible.
This less common technique is a surgery with two steps: first, a sleeve gastrectomy removes most of the stomach, leaving a smaller, banana-shaped stomach. Then, the digestive tract is rerouted to bypass most of the intestine, limiting food intake and nutrient absorption. This can be done as one procedure or in combination with a gastric sleeve and an intestinal bypass. Although it’s very successful in weight loss, it has the highest risk of causing nutritional and vitamin deficiencies.
On MyObesityTeam, surgery is one of the top 10 most discussed topics. "I went to a class on obesity surgery: what to expect, and what I have to do to [prepare] and continue,” one MyObesityTeam member explained. “I have my appointment at the clinic on Thursday about [...] everything I need to do."
Preparing for bariatric surgery is a multistep process during a waiting period that may take several months. “I am currently waiting for surgery. I am in the middle of the process leading up to it,” one member anticipated. Keep reading to find out about what you can expect during this time.
When you meet with a bariatric surgeon, they will take a comprehensive history of your weight loss journey, including what you’ve tried in the past to lose weight. They will want to know about your medical history, surgeries, and hospitalizations in the past.
Your bariatric surgeon will likely do a physical exam, bloodwork, and imaging studies. You may consult with more than one doctor during these medical evaluations. The most important part of this process is to identify any pre-existing conditions that can make surgery more risky.
Before your surgery, you may have to lose weight through diet and exercise to become a candidate for the procedure. Your bariatric surgeon may recommend a preoperative diet before surgery to reduce the size of your liver and improve the surgery’s results. This may also include advice on vitamins and supplements to make sure you don’t develop any nutritional deficiencies. You’ll receive extensive counseling, likely through a registered dietitian referral, about how to adapt your diet after surgery.
Bariatric surgery is a major procedure that comes with risks. Your surgeon will likely recommend a psychological assessment to ensure that you’re mentally prepared for the surgery and life afterward. They may screen for mental health problems, including mood disorders and eating disorders.
A psychological healthcare provider may also provide support for addressing emotional eating or other behavioral tendencies. “I’m trying to get myself on track with the emotional end of my eating habits,” one member said as they prepared for surgery. Psychological assessment and counseling are different for everyone.
Before your surgery, your surgeon will recommend making major lifestyle changes. For example, if you use tobacco products, they’ll likely recommend quitting smoking. They may also discuss reducing alcohol consumption and pursuing regular exercise to the best of your ability.
Obesity surgery is usually performed under general anesthesia, meaning you’ll be asleep for the whole procedure. This usually takes a few hours and is typically minimally invasive. Almost all surgeries are done with laparoscopic techniques, meaning only small incisions will be made. New surgery techniques may involve robotic tools, controlled from across the room by the surgeon, for increased precision. This reduces the amount of time it will take to recover compared to an open surgery.
During the procedure, your anesthesiologist will monitor your vital signs, while your surgeons will make sure that your procedure is performed safely and effectively.
Potential risks during surgery, like in all surgeries, include infection, bleeding, obstruction, or blood clots. Your surgeon and anesthesiologist will talk to you before surgery about your specific risks, and answer any questions that you and your loved ones may have.
Once surgery has been completed, the recovery process begins. This recovery requires following strict medical advice and lifestyle adjustments.
When you wake up from surgery, you’ll be kept in the hospital for observation and pain management for 1 to 3 days. You will start on a liquid diet, and your healthcare team will slowly start introducing pureed foods into your diet. Your surgical team will ask about pain, diarrhea, constipation, nausea, and vomiting to make sure that your digestive system is working properly.
Over a few weeks, you’ll transition slowly from soft foods to a regular diet. You’ll receive dietary counseling from your care team, but it’s generally important to prioritize a diet of high-protein, low-sugar, low-fat foods.
A systematic review analyzes and summarizes multiple studies on a specific topic. One such review, published in the journal Nature, found that the average amount of weight loss from bariatric surgery was about 22.1 kilograms (about 47 pounds). Surgery was found to be significantly more effective than medications in reducing BMI.
Bariatric surgery has also been shown to improve overall health outcomes. This study revealed that surgery significantly reduced low-density lipoprotein cholesterol (LDL, “bad cholesterol”) compared to weight loss medications alone. Surgery was also significantly better than medications in reducing blood pressure.
In the long term, surgical risks may include nutritional deficiencies, dumping syndrome, gallstones, hernias, and acid reflux.
Common nutritional deficiencies may include a lack of iron, B vitamins, folate, vitamin D, vitamin A, copper, calcium, and zinc. In the first year, you may have levels of nutrients checked every 3 months. Recommended supplements to take after surgery are:
This complication occurs when food passes too quickly through the intestines and leads to pain, nausea, and diarrhea after eating. To reduce the chances of dumping syndrome, you’re advised to consume smaller meals that are low in sugar.
Gallstones develop in up to 30 percent of people who undergo bariatric surgery. Sometimes, weight loss surgeons recommend removing the gallbladder before bariatric surgery to prevent this risk.
Hernias occur when tissue or organs, such as the bowel, enter another weak area of tissue. After bariatric surgery and rapid weight loss, intestines may shift around, poking into spaces where they aren’t supposed to be. Up to 7 percent of people can develop internal hernias after weight loss surgery, depending on the surgical techniques used. Symptoms of an internal hernia may range from minor to severe abdominal pain.
Gastroesophageal reflux disease (GERD) happens when stomach acid enters the esophagus through the lower esophageal sphincter, causing pain and changes to the tissue. In time, acid reflux can increase the risk of esophageal cancer. Although having a BMI over 30 increases the risk of acid reflux and losing weight can improve it, one exception is gastric sleeve surgery, which can make acid reflux worse. It’s very important to discuss this issue with your healthcare provider, who can suggest an endoscopy and recommend which type of surgery is best for you.
Surgery is just the beginning of your weight loss journey, but it isn’t a cure or a quick fix. “Did you gain weight back after surgery?” one MyObesityTeam member asked. Many members admitted that their weight fluctuated after their procedure. “I had a gastric sleeve done 3 years ago. Highest weight: 390. I got down to 230 pounds, but I have put some back on,” one member explained.
Surgery may expedite the weight loss impact of diet and exercise, allowing you to try out activities that you couldn’t do before. Support groups can help you stay motivated to make lifestyle changes and adapt to life after surgery.
After surgery, you’ll need to follow up regularly with your healthcare team, including your primary care doctor. They may take your blood levels and recommend nutritional supplements of certain vitamins that you’re lacking.
One MyObesityTeam member asked, “How do I lose extra skin without surgery?” Bariatric surgery can promote rapid weight loss, which can lead to excess skin. Some people may decide to undergo a cosmetic procedure in the future to remove excess skin.
Obesity surgery is a life-changing decision that requires thoughtful consideration. It’s important to choose the right healthcare provider for surgery for your needs — a doctor who is both a skilled surgeon and a compassionate person. Look for a specialist who is an expert in bariatric surgery and is eager to provide ongoing support during every step of the process.
By understanding what to expect before, during, and after surgery, you can set yourself up for success and achieve your health goals.
MyObesityTeam is the social network for people with obesity and their loved ones. On MyObesityTeam, more than 55,000 members come together to ask questions, give advice, and share their stories with others who understand life with obesity.
Have you spoken with your doctor about weight loss surgery? What questions do you have about this procedure? Share your comments below, or start a conversation by posting on your Activities page.
Flaviu Titus Patrascanu, M.D.
is a physician specializing in endocrinology and diabetes, nutritional, and metabolic disorders.
Learn more about him here.
Scarlett Bergam, M.P.H.
is a medical student at George Washington University and a former Fulbright research scholar in Durban, South Africa.
Learn more about her here.
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I’m stuck at the same weight since my surgery two years ago I did lose weight
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