August 14, 2019
Clinical Contributors to this Story
Alexander Abkin, M.D. contributes to topics such as Surgery.
By Sabrina Scarpa
You probably know someone with the lap band, sleeve gastrectomy or gastric bypass surgery. These are the most common bariatric surgeries for people struggling with weight loss. Yet many misconceptions about them still exist.
Below, Alexander D. Abkin, M.D., FACS, medical director of the JFK for Life Bariatric Surgery Program, discusses common misconceptions about bariatric surgery and provides insight on the realities of life postop.
Misconception 1: It doesn’t matter which type of bariatric surgery you have.
False. Each procedure is unique—as is the person having it. There are a variety of bariatric surgery options available that work differently to help patients lose weight.
Gastric Bypass Surgery– In this procedure, a small pouch is created at the top of the stomach. The small intestine is then divided into two parts. The new stomach pouch is attached to the bottom part of the small intestine, and the top part of the small intestine is connected further down so stomach acids and digestive enzymes can mix with food. The stomach pouch absorbs less food and reduces hunger, while the small intestine absorbs fewer calories and nutrients.
Sleeve Gastrectomy– This procedure removes about 80 percent of the stomach, limiting the amount of food consumed at once and effecting hormones that regulate hunger and blood sugar.
Lap Band Surgery– A band is placed around the upper stomach creating a small pouch that limits the amount of food your stomach can hold and prolongs the feeling of fullness. The band can be adjusted as needed to allow or restrict the amount of food entering the stomach.
To learn more about each of these procedures, click here.
If you’re considering weight loss surgery, discuss with your bariatric surgeon which is the best option based on your medical history. Ultimately, you will choose which procedure you feel most comfortable with.
Misconception 2: You can be too heavy for bariatric surgery.
Patients weighing over 500 pounds can pose a challenge for surgeons based on other pre-existing medical conditions, such as cardiovascular disease. However, bariatric surgery is still possible with an experienced surgeon who is knowledgeable in treating larger patients.
Generally, to qualify for bariatric surgery you need to meet certain medical guidelines including:
- Unsuccessful efforts to lose weight with diet and exercise.
- Your body mass index (BMI) is 40 or higher.
- Your BMI is 35 to 39.9 in combination with serious weight-related health problems such as high blood pressure, type 2 diabetes, obstructive sleep apnea, arthritis and PCOS
Misconception 3: Most people gain back the weight.
Continuing to lose weight and keep it off is dependent on your level of commitment to this new lifestyle. Patients that regain weight may not be following the diet and exercise routine approved by their team of physicians.
Be sure to schedule follow-up appointments with your weight loss surgery team and primary care physician to monitor weight loss and evaluate your overall health.
Misconception 4: More people die from bariatric surgery than obesity.
The chance of dying from bariatric surgery is remarkably low. According to data from the American Society for Metabolic and Bariatric Surgery, approximately 1 out of 1,000 patients are at risk of dying within 30 days following bariatric surgery.
Conversely, being obese can lead to major illnesses such as heart disease, kidney disease, type 2 diabetes and certain types of cancer. The decision to have bariatric surgery can reduce the risk of developing these health issues or eliminate them for patients who already struggle with diabetes, high blood pressure, obstructive sleep apnea, arthritis and infertility.
Misconception 5: Your insurance company won’t cover bariatric surgery.
Some insurance companies list bariatric surgeries as cosmetic, and therefore are not covered, but every insurance policy is different.
Most insurance companies follow the National Institutes of Health (NIH) guidelines to determine coverage for bariatric surgeries. People with other health conditions linked to obesity, such as high blood pressure or diabetes, are more likely to have their bariatric procedure covered, especially if your BMI is between 35 and 39.9.
To receive coverage, your insurance company may also request a letter of necessity from your surgeon or primary care physician stating your current health and medical conditions related to obesity.
Misconception 6: You’ll need plastic surgery after losing the weight.
Losing a significant amount of weight over a short period of time can leave behind loose or sagging skin. This varies from person to person based on how much weight was lost, age, amount of exercise activity, genetics and smoking history. Plastic surgery after the weight loss surgery is in most cases a personal choice rather than a medical necessity.
Rather than paying for plastic surgery, many patients choose to wear compression garments to hide any excess skin.
Misconception 7: You will develop health issues caused by vitamin and mineral deficiencies.
You will need to take a multivitamin for life, but shouldn’t you be doing that anyway? Some bariatric procedures reduce the absorption of nutrients from the intestine, which can lead to fatigue, bone and muscle loss and lower immunity.
You can avoid vitamin and mineral deficiencies by eating a balanced diet and using dietary supplements. You may also need to take iron, calcium and vitamin D.
It’s important to follow up with your surgical team or primary care physician and have appropriate lab work done to make sure you’re on the right track.
Misconception 8: Suicide risk increases after having bariatric surgery.
Any major lifestyle change can impact your mental and emotional state. Many people seeking bariatric surgery have a history of depression, anxiety and struggles with low self-esteem related to their obesity. In most cases, bariatric surgery significantly improves psychological well-being for patients. But sometimes pre-existing mental disorders go undiagnosed.
Research is still being conducted to determine the links between suicide and bariatric surgery. In the meantime, comprehensive programs require psychological evaluations prior to surgery and follow up after surgery.
Misconception 9: You can’t get pregnant after having bariatric surgery.
Bariatric surgery may positively affect your ability to conceive, carry a baby or give birth. It’s recommended you wait at least one year before trying to get pregnant for several reasons: it may interfere with weight loss or may cause a miscarriage. If you do plan to get pregnant, inform your OB/GYN of your bariatric surgery and have your vitamin levels monitored regularly.
Weight loss helps reduce the chance of experiencing gestational diabetes, eclampsia and macrosomia during pregnancy. Additionally, childbirth is safer for both mom and baby, and fewer miscarriages and stillbirths are reported when mom is at a healthy weight.
Be sure to consult your OB/GYN if you’re sexually active, but not trying to get pregnant. Birth control pills are less reliable when your weight fluctuates. Intrauterine devices (IUDs) and condoms are acceptable alternative birth control methods to use during this transition.
Misconception 10: Surgery is the “easy way out”.
Have you ever tried to lose a couple pounds? Now imagine trying to lose 50 or 70. It’s not an easy task, especially when your body is used to consuming many more calories than you allow it on a diet.
Many people that consider bariatric surgery have tried dieting and exercise without success and are seeking advanced help. Bariatric surgery makes long-term weight loss possible by eliminating food cravings and making you feel full longer.
Just as standard diet and exercise require commitment, having a bariatric procedure requires willingness to adjust your lifestyle, diet and physical activity. Bariatric surgery isn’t the “easy way out”. Think of it more as a jump start to a healthier well-being for the rest of your life.
Bariatric surgeries are meant to improve quality of life through weight loss. Discuss the available procedures with your physician to determine which fits your health needs. There is no “one-size-fits-all” approach to weight loss.
You must be willing to make permanent lifestyle changes. Bariatric surgery helps with initial weight loss, but diet and exercise are crucial to keeping the weight off.
Your body continues to adjust for years after surgery. Most patients experience significant weight loss in the first year after surgery. During this time, hunger and cravings are reduced and you’ll feel satiated longer.
Making healthy food choices is important. You don’t have to live on shakes and liquids, but you do have to watch what you eat.
Keep in contact with your primary care physician and surgeon. Schedule follow-up appointments to monitor your weight, nutrition and psychological state.
For more information about bariatric surgery, please visit: https://www.hackensackmeridianhealth.org/services/bariatrics-and-surgical-weight-loss/
The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.