Current research suggests that one in three Americans is obese. In this country alone, about 300,000 deaths per year can be linked to obesity. Obesity is associated with serious health conditions, including high blood pressure, heart disease, sleep apnea (serious sleep disorder), heartburn or reflux, cerebral artery disease (stroke), diabetes mellitus (sugar diabetes), asthma, osteoarthritis, infertility, and cancer of the breast, colon, prostate, and uterus. Usually, within the first six months after weight-loss surgery, patients will no longer need to take medications for these conditions.
Medical conditions that may be greatly improved after bariatric surgery include:
• High blood pressure. At least 70 percent of patients who have high blood pressure, and who are taking medications to control it, are able to stop all medications and have a normal blood pressure typically two to three months after surgery. When medications are still required, their dosage can often be lowered, with reduction of medication side effects.
• High cholesterol. More than 80 percent of patients will develop normal cholesterol levels two to three months after the operation.
• Heart disease. Although it can’t be said definitively that heart disease is reduced, the improvement in problems such as high blood pressure, high cholesterol and diabetes certainly suggests that improvement in risk is very likely. In one recent study, the risk of death from cardiovascular disease was profoundly reduced in diabetic patients who are particularly susceptible to this problem. It may be many years before further proof exists, since there is no easy and safe test for heart disease.
• Diabetes. More than 90 percent of Type II diabetics obtain excellent results, usually within a few weeks after surgery: normal blood sugar levels, normal Hemoglobin A1C values, and freedom from all their medications, including insulin injections. Based upon numerous studies of diabetes and the control of its complications, it is likely that the problems associated with diabetes will slow in their progression when blood sugar is maintained at normal values. There is no medical treatment for diabetes that can achieve as complete and profound an effect as bariatric surgery — which has led some physicians to suggest that bariatric surgery may be the best treatment for diabetes in the seriously obese patient. Abnormal glucose tolerance, or “borderline diabetes,” is even more reliably reversed by gastric bypass. Since this condition becomes diabetes in many cases, the operation can frequently prevent diabetes as well.
• Asthma. Most asthmatics find that they have fewer and less severe attacks, or sometimes none at all. When asthma is associated with gastroesophageal reflux disease, it is particularly benefited by gastric bypass.
• Respiratory insufficiency. Improvement of exercise tolerance and breathing ability usually occur within the first few months after gastric bypass surgery. Often, patients who have barely been able to walk find that they are able to participate in family activities — even sports.
• Sleep apnea syndrome. Dramatic relief of sleep apnea occurs as patients lose weight. Many report that within a year of bariatric surgery, their symptoms were completely gone, and they had even stopped snoring completely — even their spouses agreed. Many patients who require an accessory breathing apparatus to treat sleep apnea no longer need it after a surgical weight-loss procedure.
• Gastroesophageal reflux disease. Relief of all symptoms of reflux usually occurs within a few days of gastric bypass surgery for nearly all patients.
• Gallbladder disease. When gallbladder disease is present at the time of the surgery, it is “cured” by removing the gallbladder during the surgical weight-loss procedure. If the gallbladder is not removed, there is some increase in risk of developing gallstones after the surgery, and occasionally, removal of the gallbladder may be necessary at a later time.
• Stress urinary incontinence. This condition responds dramatically to surgical weight loss and usually becomes completely controlled. A person who is still troubled by incontinence can choose to have specific corrective surgery later, with much greater chance of a successful outcome with a reduced body weight.
• Low back pain, degenerative disk disease and degenerative joint disease. Patients usually experience considerable relief of pain and disability from degenerative arthritis and disk disease and from pain in the weight-bearing joints. This tends to occur early, with the first 25 to 30 pounds lost, usually within a month after bariatric surgery. If there is nerve irritation or structural damage already present, it may not be reversed by weight loss, and some pain may persist.
A person may be a candidate for bariatric surgery if he or she is at least 100 pounds overweight and traditional weight-loss methods have failed.
Roux-en-Y gastric bypass is the most commonly performed bariatric procedure. This method makes the stomach smaller and alters digestion. It is referred to as a combined restrictive and malabsorptive procedure because less food can be eaten and fewer calories can be absorbed.
Most patients recover from surgery without complications. Patients are encouraged to get out of bed and start walking by the next day. The hospital stay for patients who undergo the Roux-en-Y procedure is usually two to four days. Most individuals return to work in two to three weeks.
Weight-loss surgery is considered successful when a person loses 50 percent of his or her excess weight. Although few people lose all of their excess weight, they do gain numerous health benefits, which may be lifesaving. It’s important to remember that there are no guarantees with any method of weight loss, even surgery. Success hinges on your ability to become part of the plan to support the surgical tool you’ve chosen and make lifestyle changes with exercise and dietary adjustments.
Yes, strenuous activity should be avoided until you are healed. Walking, however, is a required activity at this stage of recovery. You are advised not to drive if you are taking pain medication other than Tylenol. At your first follow-up visit, your doctor will determine when you can return to work, but most people return to work three to six weeks after surgery.
Many insurance companies now recognize obesity as a substantial health risk and are paying for bariatric surgery.
Following surgery, you will need to follow specific eating guidelines. Registered dietitians work directly with bariatric surgery patients to provide dietary education before and after surgery.
Light exercise, such as walking, should begin immediately after surgery. Vigorous exercise will be gradually introduced in six to eight weeks. Exercise will not only keep you feeling well and energized, but it also helps burn fat and calories. For many people, returning to physical exercise is an important step toward feeling better.
Excess weight loss begins right after surgery and continues for 18-24 months after surgery.
Bariatric surgery has an excellent long-term track record for helping morbidly obese individuals maintain weight loss. If you are committed to making permanent dietary and lifestyle changes, your chance of weight re-gain is minimized.
Roux-en-Y gastric bypass surgery is considered a permanent weight-loss measure. However, it is potentially reversible. Reversal requires another operation of the same, or greater, magnitude with the same, or greater, risks. Reversal of this operation is very uncommon and rarely occurs beyond six weeks from the time of surgery.
In general, the more extensive the operation, the greater the risk for complications and nutritional deficiencies. Furthermore, patients with bypasses of the normal digestive process require close monitoring and a lifelong addition of vitamins and minerals. Bariatric surgery risks include abdominal hernias, which are the most common complication requiring surgery, but are much more common with “open” surgery where an incision is made. Uncommon bariatric surgery risks can include rare complications of leakage through staples or sutures, ulcers in the stomach or small intestine, blood clots in the lungs or legs, stretching of the pouch or esophagus, persistent vomiting and abdominal pain, inflammation of the gallbladder, and failure to lose weight (very rare). More than one-third of obese patients who have weight-loss surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss, a person’s risk of developing gallstones increases. Gallstone formation can be lessened with medication taken for the first six months after surgery.
Among other bariatric surgery risks, nearly 30 percent of patients who have weight loss surgery develop nutritional deficiencies such as anemia, osteoporosis and metabolic bone disease. These deficiencies can be avoided if vitamin and mineral supplements are maintained as recommended on a life-long basis. Women of childbearing age should avoid pregnancy for 18 months to two years after surgery, until their weight becomes stable, because rapid weight loss and nutritional deficiencies can harm a developing fetus. Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and many arthritis drugs that contain aspirin may not be taken after this surgery. Smoking after weight-loss surgery may cause ulcers in addition to other known health risks. Though gastric bypass can be reversed if medically necessary, patients should carefully consider all of the bariatric surgery risks and benefits before electing to have this surgery. Results of surgical weight loss Most weight-loss surgery patients will lose about 60 to 80 percent of their excess body weight with the gastric bypass procedure. Substantial weight loss occurs 18 to 24 months after surgery; some weight regain is normal and can be expected two to five years after surgery. In addition to weight loss, surgery has been found to have a beneficial effect on many medical conditions such as: diabetes, hypertension, acid reflux, sleep apnea, polycystic ovary syndrome (PCOS), urinary stress incontinence, low back pain and many others.
Cleveland Clinic research has shown that 80 percent of their diabetic patients had remission from their diabetes (patients’ blood sugar levels were normal without medication). In addition, many patients report an improvement in mood and other aspects of psychosocial functioning after surgery. After bariatric surgery, your overall quality of life is improved. Many weight-loss surgery patients express elation on being able to do things that may seem trivial to the non-obese person, such as going to the store, playing with their children, getting in and out of a car, riding a roller coaster, shopping for regular-sized clothes … the list is endless. Typically, weight-loss surgery is performed laparoscopically (minimal invasive surgery). Patients will often experience shorter hospital stays, smaller incisions and quicker recovery periods.