You’ve tried every diet and exercised yourself into submission — but you’re still not losing any weight. If you’re among the one-third of Americans considered to have obesity, bariatric surgery just maybe what the doctor ordered.
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The two most common weight loss procedures are Roux-en-Y gastric bypass and sleeve gastrectomy.
“For an average patient with severe obesity, both procedures are good options since they are relatively similar,” says bariatric surgeon Ali Aminian, MD. But there are some considerations that might tip the scales (pun intended) in favor of one over another.
How can you decide which weight loss surgery is best for you? Dr. Aminian breaks down the options.
Bariatric surgery options
You are eligible for bariatric surgery if your body mass index (BMI) is:
- 40 or higher.
- Between 35 and 40, and you have diabetes, high blood pressure, high cholesterol, fatty liver disease or sleep apnea.
- Between 30 and 35, and you have uncontrolled diabetes.
But finding the right procedure requires a discussion between you and your bariatric surgeon. “We consider the patient’s history, conditions and expectations. Then we come up with a plan together,” says Dr. Aminian.
Today, doctors perform almost all bariatric surgical procedures using minimally invasive techniques. That means smaller incisions (usually five or six in the abdomen) and faster recoveries. Most patients go home the day after surgery and recover in two to three weeks.
Gastric bypass surgery
The basics: Roux-en-Y gastric bypass surgery is an operation that shrinks your stomach, along with the amount of calories and fat your body absorbs.
“We disconnect the stomach on the top part and make a small pouch there. We then bring a loop of a small intestine up and connect it to that pouch, rerouting the GI (gastrointestinal) tract,” explains Dr. Aminian. “When the patient eats food, it enters the small intestine directly. We bypass 90 to 95% of the stomach.”
The benefits: “Gastric bypass is a more powerful tool than sleeve gastrectomy. Patients usually lose 10 to 20 pounds more with it. Rerouting the GI tract leads to some favorable hormonal changes, so the chance for diabetes improvement is higher as well.”
Who it’s good for:
- People with severe reflux disease: Acid reflux often improves after gastric bypass surgery.
- People with high BMIs: People lose more weight with gastric bypass.
- People with diabetes: While gastric bypass is generally better for these patients, Dr. Aminian notes: “In patients with severe diabetes, it doesn’t matter whether we do a bypass or a sleeve. Both procedures are similarly effective.”
Sleeve gastrectomy surgery
The basics: Also known as the gastric sleeve, sleeve gastrectomy surgery involves operating only on the stomach. Surgeons remove around 80 to 85% of it, leaving a smaller “sleeve” in its place.
The benefits: Dr. Aminian says the sleeve is a bit safer than gastric bypass: The risk of all complications is 3% after sleeve vs. 5% with Roux-en-Y gastric bypass.
Who it’s good for:
- People who have had multiple abdominal surgeries: “Rerouting the GI tract and operating on the small intestine would be impossible when there is severe scar tissue around it,” notes Dr. Aminian. “In sleeve gastrectomy, we only operate on the upper part of the abdomen, which is usually less affected by the scar tissues.”
- High-risk surgical patients: Sleeve gastrectomy is easier on patients than gastric bypass: The anesthesia time is shorter, and the recovery is faster. High-risk patients include people with severe heart disease or lung problems, plus transplant candidates or recipients.
- People who weigh more than 450 to 500 pounds: Too much fat can limit the amount of space inside the abdomen. Surgeons need room to reroute the GI tract. “Without space, gastric bypass isn’t possible.”
- People on multiple medications to treat psychiatric illness: Gastric bypass can affect how your body absorbs — and responds to — medications. “If a patient with severe depression or anxiety is stable on multiple psych medications, we don’t want to give them a procedure that may alter their medication’s absorption and effectiveness.”
The basics: Duodenal switch surgery is what would happen if sleeve gastrectomy and gastric bypass had a baby. During this procedure, bariatric surgeons remove part of the stomach to create the trademark sleeve. Then they do a more extensive version of gastric bypass surgery. The result? The potential for even more weight loss and greater metabolic effects.
It may seem like the best of both worlds until you consider there’s a higher risk for surgical complications because surgeons are doing more to alter your anatomy. That’s why only 1 to 2% of bariatric surgeries done in the U.S. are duodenal switches. If you want to go this route, it’s critical to find an experienced surgeon and center.
The benefits: Patients tend to lose even more weight than with Roux-en-Y gastric bypass surgery. It can conquer diabetes, too.
Who it’s good for:
- People with severe obesity: Patients can lose a significant amount of weight.
- People with severe metabolic disease: The duodenal switch procedure impacts hormonal balance in the GI tract. It’s very effective for improving related metabolic conditions like diabetes and high blood pressure.
- People who are very good at following their doctor’s orders: “It’s usually selected for patients who are very compliant to the vitamins, supplements and post-op follow up. It’s not safe for everyone. Even in patients who follow postop recommendations, there is small risk of malnutrition,” Dr. Aminian says.