Weight loss surgeries: which ones exist and how they work

It is clear that obesity is, today, both an individual and a social problem. The WHO (World Health Organization) estimates that since 1975 this condition has tripled, which translates to 1.9 billion overweight adults (650 million of them obese) worldwide. Stress, a sedentary lifestyle and different emotional pathologies take their toll on the human being because, sometimes, the immediate pleasure of food seems the only escape.

Hand in hand with these worrying data, weight loss surgeries (known as bariatric surgeries) have increased exponentially. In the United States in 2011, a total of 158,000 of these procedures were estimated, while the number increased in 2017 to 228,000. The greater the problems, the more medical interventions are made available to the public.

Bariatric intervention should not be seen as an applicable wild card in any case, but, sometimes, it is the only option to save the life of the patient. Obesity is a risk factor for cardiovascular diseases, diabetes and even for appearance of certain types of cancer (such as colorectal, up to 30% more present in people obese). Therefore, weight loss surgeries are important medical issues, and not a simple cosmetic procedure. If you want to know everything about this topic, keep reading.

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What is weight loss surgery?

Weight loss surgery or bariatric surgery is a procedure used to help excessively overweight people who cannot cope with the loss of body mass using techniques conventional, such as diets and physical exercise. This generally includes patients who must lose more than 45 kilograms of weight (100 pounds) and if they do not do so quickly, their health may be compromised in the short or long term.

In general, a person is only considered a candidate for weight loss surgeries if they meet the following requirements:

• Be at least 14 years old and have gone through puberty. An age range between 18 and 65 is usually conceived.
• Have a history of obesity dating back 5 years or more.
• Having failed in previous medical, nutritional and psychological treatments.
• Not be addicted to drugs / alcohol or present decompensated psychiatric pathologies at the time of the intervention.
• A BMI greater than 40 or greater than 35 with associated diseases, such as diabetes or serious vascular diseases, among others.

As you can see, bariatric surgery is always the last option. Although a drastic loss of weight can suppose an impulse to the patient for the recovery and well-being of her, if not anxiety, education, dependencies and other problems are addressed, it is very possible that the weight will return to earn. In various experimental series it has been observed that 20 to 87% of patients undergoing surgery regain weight, generally between 3 and 6 years after the procedure.

What types of weight loss surgeries are there?

In the first place, it is necessary to note that there are two main modalities as far as intervention is concerned. The first one is based on restriction, that is, physically limiting the amount of food that the patient can eat, reducing the size of the stomach itself. The second modality is known as malabsorption, as it seeks to "avoid" or "bypass" a part of the small intestine, which reduces the amount of calories and nutrients that the body absorbs.

Each case is different, and it will be the clinical expert who decides which way to go based on the individual situation of the patient. The 3 fundamental procedures included in these currents are the following.

1. Placement of an adjustable gastric band

As its name suggests, it is an inflatable band that is placed around the upper portion of the stomach. The purpose of this procedure is to create a small reservoir for digestion, leaving a large portion of the stomach “out”. A) Yes, the patient will feel full much sooner and literally you will not be able to eat more than a very small amount of food at each feeding.

It is a process that requires general anesthesia, as the surgeon places the gastric band through various incisions, with the help of a camera and surgical material. Next, the professional will roll the ring around the upper part of the stomach. This is not inflated when inserted, as the patient must be monitored for the first 4-6 weeks before doing so. After this interval, the band is adjusted by adding or withdrawing a saline solution.

It is a fairly aggressive interventionIt is enough for us to say that, during the first two weeks, the patient only tolerates the ingestion of small amounts of liquid. Still, the effects are obvious, as a person can continue to lose weight for up to 3 years after the surgery itself.

2. Gastric sleeve

In this case, literally a portion of the stomach is removed. For this procedure, part of this organ is removed, leaving a narrow tube or "sleeve" in contact with the rest of the digestive system. The new stomach, shaped like a banana, is much smaller than the original (¾ parts of the total are removed), which is why the patient must reduce their daily caloric intake.

Unlike the adjustable gastric band (which can be modulated with saline solutions), the gastric sleeve does not it is reversible and there is no turning back: the lost portion of the stomach cannot be recovered in any way. In addition, the procedure is even more aggressive than in the previous case and the recovery period, at least as slow.

Despite the multiple drawbacks of this surgery, it is considered the most effective for patients with a body mass index greater than 40. Statistical studies show that up to 80% of the people operated on significantly improve the state of their metabolic diseases, such as diabetes mellitus, insulin resistance, sleep apnea and many others pathologies. In addition, in the absence of a bypass, the risk of nutritional deficiency decreases.

3. Gastric bypass

Gastric bypass or gastric bypass, as its name suggests, involves connecting the upper part of the stomach (a new small “stomach”) with the middle part of the small intestine. Thus, the food bypasses the entire rest of the stomach and part of the small intestine, thus reducing the absorption surface and, therefore, the amount of calories ingested in the food. As you can imagine, the procedure causes weight loss over time.

One of the greatest risks of gastric bypass that other techniques do not present is the probability of malnutrition. By skipping meals part of the normal route, the patient may experience certain vitamin or nutritional deficiencies. For this reason, all these values ​​should be monitored by a nutritionist before and after the operation.

On the other hand, and as a benefit, this intervention lends itself to an approach called laparoscopy, in which the The doctor is guided from a camera placed in the abdomen of the patient, as opposed to a totally open. As advantages of this technique, we have to recovery time is shorter, the pain is less and the scars are smaller, which means a lower risk of infections and internal bleeding. Gastric band placement can also be approached in this way.

Final thoughts

Weight loss surgery is nothing without the appropriate dietary and psychological care. It is a multidisciplinary approach, as the patient requires a restructuring of their entire routine, way of thinking and relationship with food. As you can imagine, this is not achieved by reducing the size of the stomach.

Although surgery is the first step, continued psychological care after the procedure and the help of dietitians is essential so that the patient does not relapse into old habits. In addition to this, it is always necessary to emphasize that not everyone is a good candidate for surgeries. bariatric, as it is the last possible option when all the methods have been exhausted conventional.