Key Takeaways

• For those who are significantly overweight, weight loss greatly reduces the risk of many chronic conditions.

• Options for weight loss include lifestyle changes, medications, and weight loss surgery, also known as bariatric surgery.

• There are several different types of bariatric surgery.

• In general, gastric bypass surgery leads to the greatest amount of weight loss, but also carries a higher risk of complications.

• Other options include sleeve gastrectomy (also known as gastric sleeve surgery), gastric banding, and gastric balloon placement.

• Different options may be best for different patients. Talk with a qualified healthcare provider about your options for weight loss surgery.

What is weight loss surgery?

For people who are significantly overweight, losing weight is an important step to protect your long-term health. Weight loss reduces the risk of many chronic conditions, including type 2 diabetes, high blood pressure, high cholesterol, sleep apnea, and even asthma. 

Some people are able to achieve significant weight loss through lifestyle changes alone, including exercise and a healthier diet. However, this can be very challenging for many, especially those who are genetically predisposed to be at a heavier body weight.

For those who are finding that lifestyle changes aren’t enough, there are a few different ways to achieve significant weight loss. 

One of the options is weight loss surgery, also known as bariatric surgery. This involves having a surgical procedure to reduce the amount of food that your stomach can hold, and in some cases to reduce the amount that your intestines can absorb. 

Weight loss surgery can help people to lose a significant amount of weight. However, it does carry some risks and side effects, and it’s important to be aware of these.

When might you need weight loss surgery?

Not everyone is considered a potential candidate for weight loss surgery. People who may be eligible include those who:

• Have a body mass index (BMI) of 40 or above (severely obese)

• Have a BMI of 35 or above (moderately obese), along with one or more health problems that are linked to obesity (such as type 2 diabetes, sleep apnea, or severe arthritis)

• Have a BMI of 30 or above (obese), along with type 2 diabetes that has been difficult to control with medications and lifestyle changes

People who meet these criteria can consider weight loss surgery as an option. Those who are less overweight, or who are not having serious health problems related to their body weight, should consider other options for losing weight.

There are also some minimally-invasive procedures that can be used for weight loss. These are not technically considered to be bariatric surgery, because they don’t involve any incisions in the skin. Because these procedures carry a lower risk, more people are eligible for them. Those with a BMI of 30 or above (obese) can consider a minimally-invasive weight loss procedure, whether or not they’re currently having health problems related to obesity.

Weight loss medications

Another option to consider is weight loss medications. These most effective are the GLP-1 receptor agonists (GLP-1 RAs). These medications promote weight loss by keeping the stomach full for longer after a meal and by altering activity in the nervous system to reduce cravings and appetite. They also help to control blood sugar, and can be used for treating diabetes as well as for weight loss. 

Finally, it’s important to consider lifestyle modifications as a method of weight loss. Many people have tried this and have not had success, but they often didn’t have support during their journey. Having support from professionals like health coaches can make a huge difference, and some people may find that they’re able to have more success this way. If you haven’t yet tried lifestyle changes as a method of weight loss, consider giving this a try. 

Even if you choose another method of weight loss, it’s still important to take steps towards creating a healthy lifestyle that’s sustainable and works for you. This will help you to keep off the weight that you lose, and will also help to protect your long-term health.

Types of Bariatric Surgery

There are a few different surgical procedures that can be used for weight loss. Some of the options include gastric bypass, sleeve gastrectomy, and gastric banding. 

Often, these procedures are done laparoscopically. This involves making only a few small incisions in the abdominal wall, rather than one larger incision. Instead of seeing directly into the body to perform the procedure, the surgeon inserts a light and a camera into the abdomen, and sees what’s happening on a screen. Specially designed surgical instruments allow the procedure to be done through the tiny incisions.

There are several different bariatric procedures available. Different procedures may be best for different people. If you’re considering one of these procedures, you’ll need to talk with a qualified healthcare provider about your options for weight loss surgery, so you can get personalized advice about which procedure they recommend for you based on your medical history, your weight loss goals, and your lifestyle.

Gastric Bypass Surgery

Gastric bypass surgery involves rerouting the digestive tract so that it can’t absorb as much food. The most common type is the roux-en-y gastric bypass. First, the surgeon makes the stomach much smaller, by separating off a small pouch at the top. This is where your food will now go after you swallow it. The rest of the stomach remains in the body, but will no longer receive food.

This new small stomach pouch is then connected to a point far along the small intestine. The small intestine is where your body absorbs nutrients, including calories, from your food. During the procedure, most of the small intestine is bypassed, leaving only a very short portion that food will pass through. This greatly reduces the number of calories that your small intestine can absorb.

The entire procedure takes about two hours. Afterwards, you’ll need to stay in the hospital for about two to three days. You’ll then need to take two to four weeks off from work or other obligations for your recovery. At first, you’ll be eating a liquid diet, followed by soft foods only. It takes about six to eight weeks before you’re able to eat a regular diet again.

Because the stomach is very small after the procedure, you won’t be able to eat very much. In addition, because most of the small intestine is bypassed, your body won’t absorb most of what you eat. This leaves your body with many fewer calories, resulting in significant weight loss. More than 70% of patients lose at least 20% of their starting body weight, and nearly 40% of them lose at least 30% of their body weight.

Gastric bypass reduces the amount of calories that your intestine can absorb, but it also reduces their absorption of nutrients. This creates a risk of vitamin and mineral deficiencies. People who have had this procedure will need to take supplements to ensure that they don’t become deficient in important nutrients. There’s also a risk of protein deficiency, so it’s important to ensure that you’re consuming plenty of protein. This may involve taking protein shakes or other types of protein supplements.

There is also a risk of dumping syndrome. In this condition, large amounts of poorly digested food move too quickly into the intestine from the stomach, which causes uncomfortable symptoms after eating. This can also lead to issues with blood sugar control, because large amounts of sugar can move into the intestine all at once.

The gastric bypass procedure is designed to be reversible. This is why the bypassed parts of the stomach and small intestine are left in the body, rather than being removed. If there are severe complications from the procedure, it can be reversed. However, this will require another surgical procedure.

Sleeve gastrectomy surgery

The sleeve gastrectomy, also known as the gastric sleeve, only alters the stomach. During the procedure, the surgeon removes about three-quarters of the stomach. This leaves a narrower tube, or “sleeve,” to hold food. As a result, you’ll feel full when eating smaller meals. In addition, the removal of part of the stomach significantly reduces the body’s production of ghrelin, a hormone that signals hunger. With lower ghrelin levels, people generally have a smaller appetite.

Research has shown that weight loss after sleeve gastrectomy is slightly less than after gastric bypass, although the difference is small. Similarly, people who have a gastric bypass are somewhat more likely to have improvements in health-related markers, such as cholesterol levels. Still, sleeve gastrectomy leads to weight loss that’s nearly the same as for gastric bypass, without altering the body’s absorption of vitamins and minerals. In addition, this procedure doesn’t create a risk of dumping syndrome.

The procedure itself takes about an hour. After sleeve gastrectomy, you’ll need to spend two to three days in the hospital. Full recovery can take several weeks. In general, although the amount of time in the hospital is similar, the overall recovery from sleeve gastrectomy is a little quicker and easier than from gastric bypass, and the return to eating a regular diet occurs sooner.

Unlike gastric bypass, sleeve gastrectomy is not a reversible procedure. Although it does carry a lower risk of complications than gastric bypass, it’s also permanent, so it’s important to make a careful decision about undergoing this surgery.

Gastric Banding

Gastric banding involves placing a silicone band around the stomach. This creates a smaller stomach pouch, which helps you feel full after eating smaller amounts of food. 

The band contains a balloon, which can be inflated with saline (salt water). About six to eight weeks after the surgery to place it, inflation will begin. At first, a small amount of saline will be placed in the band. Over the next few months, a little more saline is added every two to four weeks. Each time more saline is added, the band becomes tighter, making your stomach pouch smaller. More saline is added until you’re achieving weight loss. If your weight loss is too rapid or you develop complications, saline can be removed.

The surgery itself takes less than an hour. People usually spend one night in the hospital before going home. Most people need to take one to three weeks off work to recover. It takes another few weeks before your body recovers enough to start filling the band. Weight loss after gastric banding is more gradual than after gastric bypass, and the total weight loss is somewhat less. People can expect to lose about 10 to 15 kg less after gastric banding than after gastric bypass. However, gastric banding still leads to significant weight loss of about 15 to 20 kg on average.

There is a risk that the band can erode into the wall of the stomach. Although this is rare, it’s very serious when it occurs, because stomach acid can then leak out into the abdomen. Another potential risk is that the band could slip off. If this happens, either it would not be effective, or it could cause damage to the stomach. The remaining small stomach pouch can also expand over time, which causes a risk for regaining the lost weight.

One advantage of gastric banding is that it’s reversible. If you’re not experiencing a benefit or if you have unwanted side effects, the band can be deflated and removed.

Gastric Balloon

The placement of a gastric balloon is often not considered to be truly a type of bariatric surgery, because it doesn’t involve any incisions in the skin. Instead, this is a minimally-invasive procedure to help people lose weight.

A gastric balloon is placed in the stomach using an endoscope. This is a long, flexible tube that’s passed from the mouth down into the stomach. A light and camera on the end allow the doctor to see what’s happening inside of the body. The empty gastric balloon is placed in the stomach and then inflated with saline (salt water).

The placement of a gastric balloon is not a surgical procedure. It takes only about 30 minutes or less, and you’re generally able to go home the same day. Many people feel some stomach pain and nausea after the balloon is placed, but this almost always goes away after a few days, as the body adjusts to the presence of the balloon. 

The purpose of a gastric balloon is to take up space in the stomach. This slows down the passage of food through the stomach, which helps you to stay full for longer after you eat. It also helps you to feel full with smaller meals. In this way, the gastric balloon trains your body to be satisfied with smaller meals.

Gastric balloons are not intended to be permanent. The balloon is left in place for about six months, and is then deflated and removed. After this, it will be crucial to maintain your new healthier habits in order to maintain weight loss. Many people benefit from health coaching in order to help them continue to eat the smaller meals that their body adjusted to while the balloon was in place.

Occasionally, the balloon may deflate inside the stomach. If this happens, then the deflated balloon can pass into the intestines, where it can potentially cause a bowel obstruction (a blockage that prevents food from passing through the digestive tract). The balloon becomes more likely to deflate if it’s left in place for longer than six months, which is why it isn’t left in the stomach permanently.

What can you expect from bariatric surgery?

In general, most people who have bariatric surgery will experience weight loss in the weeks and months following the procedure. The exact amount of weight loss can vary from person to person, and is different for different specific types of bariatric surgery. 

Some people are able to maintain this weight loss over the long term, while others find themselves regaining some or all of the weight later. Compared with the lowest weight that they achieved after the surgery, about 72% of patients have regained at least 10% of this weight after 5 years. About 37% have regained at least 25% of their lost weight after 7 years.

Although regaining some weight is common, it’s rare for people to regain all of the weight that they lost. Most people still weigh significantly less after their bariatric surgery than they weighed before it. On average, 5 years after surgery, people weigh almost 30% less than before the procedure.

One way to help keep the weight off after bariatric surgery is using a type of medication known as a GLP-1 receptor agonist, or GLP-1 RA. These medications mimic a natural hormone in the body known as GLP-1. 

It’s been shown that people with obesity have decreased levels of GLP-1 in their bodies. Taking a GLP-1 RA can help to bring GLP-1 activity back up into a more normal range, which in turn helps to support a healthier body weight. People who have had bariatric surgery can take GLP-1 RAs. Research has shown that taking these medications is an effective way for people who have regained weight after bariatric surgery to lose it again. 

In general, right after bariatric surgery, it’s best to give the body some time to adjust. Weight loss is usually rapid during the first few months after the procedure. If you’re experiencing rapid weight loss, then it’s generally best to wait and give your body some time before adding a GLP-1 RA. If you don’t quite achieve the target you were hoping for, then a GLP-1 RA may be considered. If your weight loss is slower than expected after the procedure, then adding a GLP-1 RA may also be appropriate. 

Making healthy lifestyle changes will also help to keep weight off after bariatric surgery (or a minimally-invasive bariatric procedure). This includes creating a healthy diet as well as ensuring that you get enough exercise. It’s important to ensure that you work on your lifestyle, because this will work along with your other weight loss methods to achieve the best results, and will also protect your long-term health. 

Some people are able to create and stick to a healthy lifestyle plan on their own, but most find it very helpful to have support from health coaches. Our NOVI Optimum Plus weight loss program includes this support, both in-person and through our custom-designed NOVI app. Our NOVI Optimum Plus weight loss program also includes treatment with a GLP-1 RA, if our expert physicians believe this will be safe and effective for you given your medical situation.

Find out if NOVI Optimum Plus is right for you in supporting your weight loss goals.