If you are considering obesity surgery, you should find out precisely what type of surgery you are going to have and do some research about it. Similarly, it will be important for you to speak to patients who have had this surgery. In general, if your surgeon has been doing the surgery for more than a few years, there should be a case series of results of obesity surgery that you can look at.

Screening for surgery candidates

Every surgery has risks associated with it, including surgery to treat obesity. You should understand the surgery that you are considering and agree to its relative balance of risks and benefits. There are certain internationally recognized guidelines to select people who may be candidates for obesity surgery. These include the following:

  1. Your BMI must be greater than or equal to 40; or greater than or equal to 35 with other obesity-related conditions such as high blood pressure, type 2 diabetes, or heart disease.
  2. You must have no hormonal cause for your obesity, such as hypothyroidism or Cushing's syndrome, which has not been treated.
  3. You cannot have any psychiatric disorder, which requires long-term medications because after many surgeries for obesity, these medications will not be absorbed.
  4. You must have no illnesses that would make the surgery dangerous. For example, some surgeries cause kidney stones to be formed more frequently so if you already have a history of kidney stones, you should not have the surgery because you are likely to get many kidney stones after the surgery.

In addition, you should be  older than 18 years old. Surgeries are not performed for people under the age of 18, because the individual may not have gained their full adult height.

Types of obesity surgery

There are two types of surgery to remove fat. Firstly there are local surgeries to remove fat such as lipectomies or lipo-suction. These surgeries do not remove large amounts of fat from around your body, but rather they only remove localized areas of fat. Therefore, if you have one particular area of fat which is very prominent, this is the type of surgery that you might consider having done by a plastic surgeon.

Most people who want surgery for obesity want to lose weight from all over their body. If this is the case, you should be considering obesity surgery. There are 3 types of obesity surgery. The first type involves reducing the size of the stomach so that you can eat less food at any time. The second type involves the part of your bowel called the small bowel where food is absorbed. The third type is a combination of reducing the amount of food you can eat and affecting your absorption in the small bowel. There are many kinds of obesity surgery done in the world and many surgeons have slight variations on the type of surgery that they do.

Surgeries such as gastric banding, gastric stapling, and even the gastric balloon, which is the temporary insertion of a balloon into the stomach, reduce the size of the stomach. The main benefit of this type of surgery is that overall the complications relating to bowel function are less, however, in general about half the people that have surgery on their stomach regain all the weight they lose.

Surgery such as the ileogastrostomy and the biliopancreatic bypass affect the small bowel. This type of surgery is generally more effective at weight loss and you are less likely to regain weight afterwards. On the other hand, there is a greater chance of post-surgical complications. Complications such as diarrhea, deficiencies of vitamins and minerals, and formation of kidney stones can frequently occur.

The final type of surgery involves both restricting the amount of food you can eat, and malabsorbing food. The classic type of surgery here is the gastric bypass. The gastric bypass involves reducing the size of the stomach and making a bypass of food from the stomach further down in the bowel. This surgery has significant complications including diarrhea, bloating, gas, and deficiencies, however, it does work better than simply reducing the size of the stomach.

 
C. Laird Birmingham, MD, 
in association with the MediResource Clinical Team