Bariatric surgery
Bariatric surgery remains the most effective treatment for helping people lose weight and to maintain that weight loss in the long term. It is available on the NHS to people who meet the criteria below:
- They have a BMI of 40 kg/m2 or more, or between 35 kg/m2 and 40 kg/m2 and other significant diseases that could be improved if they lost weight, for example type 2 diabetes or high blood pressure.
- All appropriate non-surgical measures have been tried but the person has not achieved or maintained adequate, clinically beneficial weight loss.
- The person has been receiving or will receive intensive support from a specialist weight management service.
- The person is generally fit for anaesthesia and surgery.
- The person commits to the need for long-term follow-up.
Types of surgery
All surgery is performed as key-hole surgery and people usually remain in hospital for one or two nights afterwards.
Click below to learn more about the different types of surgery:
A silicone band is placed around the top part of the stomach and an adjustment port is put just under the skin. Fluid can be added or removed from the band via the port which reduces the size of the stomach, making people feel fuller quicker.
Typically, people lose around 15% of starting body weight with a gastric band
With this operation, a small stomach pouch is created (about the size of an egg), which is then attached to the small bowel, meaning that food by-passes the stomach and the first part of the bowel. This means people feel fuller quicker, are able to eat less and will absorb fewer calories. There are also beneficial changes to hormones within the body, with more appetite suppressing hormones produced (e.g GLP-1).
Average weight loss is around a quarter of starting body weight.
The stomach is made into a narrow tube by removing around three quarters of it. This again means people can eat less as they feel fuller quicker, and will also absorb fewer calories. Similar beneficial changes with appetite suppressing hormones are seen as with the by-pass operation.
Average weight loss is around a fifth to a quarter of starting body weight.
Dietary changes
It is important that people are able to make adjustments to the way they eat in order to be successful with weight loss through bariatric surgery.
After an operation, people will only be able to have fluids for a week, before slowly progressing to
- sloppy pureed food
- then thicker pureed food
- then mashed food
- then normal solid food after 7-8 weeks.
20:20:20:20 rule
People are advised to eat smaller portions; similar to a child’s portion. It is also important to slow the pace of eating using the “20:20:20:20 rule”:
Take small bites; about the size of a 20 pence piece of food
Chew it 20 times
Put your knife and fork down for 20 seconds between mouthfuls
Take 20 minutes to eat the meal
Complications
Although the surgery itself is low risk; it is less risky than having a gall bladder removed, there are important complications to consider.
Having a general anaesthetic always carries some risk of complications as does having any abdominal surgery itself.
The main risks include infection, bleeding and abdominal pain. Other recognised complications are nutritional deficiencies, low blood sugars, excess skin and thinning of the bones (osteoporosis). Some people will regain any weight lost if they haven’t been prepared adequately or are not following the weight management service’s advice.
Follow up after an operation
In addition to dietary changes, all people who have had bariatric surgery are advised to:
- take lifelong nutritional supplements: usually between 4-5 different supplements daily
- have regular blood tests to monitor for any nutritional deficiencies. Nutritional deficiencies can be very serious, even life-threatening, if untreated but easily avoided with supplements
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