Slimming tablets and a tape measure

Surgery

While it is extreme, some patients who have been unable to lose weight through diet, exercise and medications like orlistat and sibutramine have resorted to surgery. Weight loss surgery is also known as bariatric surgery and the 3 most common surgeries are:

There are however a variety of different procedures and variations to each procedure.

In the UK, parliamentary figures show that there were 3,459 bariatric surgeries done last year on the NHS, but many more are performed by private surgeries. In the U.S about 100,000 have been performed.

What does the surgery involve?

Gastric Band

A gastric band is not dissimilar to having a belt round the middle of your stomach, creating two pouches. The top pouch is the smaller one, where the food a patient consumes goes. The band is adjusted to control how fast food passes through the stomach. The reduction in size of stomach being used means that the patient feels full earlier.

Because the gastric band is adjustable, this means patients do not suffer too much discomfort or other symptoms due to the degree of restriction on their stomach. It is put into place laparoscopically, (through a small incision, a thin bendy microscope is inserted) which means it is a less traumatic surgery. Also the band can be removed should that ever become necessary.

On average, after two years patients will lose between 56 and 60% of their excess weight, and long before then will start to feel more healthy, especially if they are suffering from diabetes, high blood-pressure or similar weight-related issues.

Gastric Bypass

In this operation, medical staples are used to divide the stomach into two 'pouches'. The lower pouch is large, while the upper pouch is small. The smaller pouch is where the food enters, meaning that the stomach is effectively shrunk. The small intestine is then rearranged so food stored in the smaller pouch can pass into it.

There are various methods of performing a gastric bypass, but the most common is called Roux-en-Y. In this form of the surgery, while the original outlet for food from the stomach into the intestine from the bottom pouch remains, a new outlet from the top pouch is created from the small intestine, which joins up to the original section of the digestive tract, forming a 'Y' shape.

The reduction in size of the stomach means that the amount of food that can be consumed is correspondingly reduced. When food leaves the stomach through the newly created outlet, it bypasses most of the stomach and much of the small intestine, meaning that fewer calories are absorbed as the food passes through the body. Finally, the body deters the patient from eating too much sugar, as doing so leaves them feeling queasy and lightheaded.

The size of the top pouch and used intestine is carefully measured to ensure that both are large enough to allow the patient to eat enough to stay healthy.

Studies show patients after two years lose between 66 and 75% of their excess weight and quickly start feeling healthier and more able to lead a normal life.

Gastric Balloon

This is becoming more common in private practice, though it has not been authorised yet to be used on the NHS. The procedure is done by way of an endoscopy (through the mouth and oesophagus); a silicone balloon is passed down into the stomach and filled with liquid, which creates a feeling of fullness and partially fills the stomach.

The surgery is not a permanent solution, as the balloon can only be kept in the stomach for up to 6 months.

It is a good option for severely obese patients prior to them having more permanent surgery and for severely obese patients who are not suitable for more drastic procedures. In clinical trials, it is shown to be efficient with a low risk of side-effects. However many patients experience nausea and vomiting for the first few days and there is a risk of perforation and bleeding.

Excess weight lost is between 25 and 44%.

What are the risks?

Having surgery is by its very nature risky and so every effort should be made to avoid it. This is why exercise, healthy eating and possibly medication should be tried first. Obesity also makes any procedure more dangerous.

Laparoscopic surgery is less invasive than open surgery and has far quicker recovery rates. Even so, with both types of surgery there will be post-operative pain and the possibility of infection and hernias. Being put under anaesthetic also can pose risks.

Each different surgery has different side effects and risks; for example the gastric balloon can cause nausea while the gastric band sometimes slips or can cause leakage.

You need to research the different options thoroughly, discuss them with your doctor and prove that you are making an informed decision in order to go through with whatever procedure you have opted for.

How do I get surgery?

There are two ways of getting bariatric surgery - through the NHS or privately. In both cases your BMI should be higher than 30, indicating that you are dangerously obese. Through the NHS, not only will you be given after-care lasting the rest of your life, but you do not have to pay. However there can be long waiting lists and getting funding can be difficult depending on where you live.

If you are considering going private, then make sure you are covered not just for the operation itself, but for the full cost of the surgery (such as the time you will spend in hospital, regardless of whether this proves longer than expected), as well as comprehensive pre- and after care. You will need support to follow a lifestyle that will ensure the procedure has maximum effect. Make sure the practice you choose is reputable, experienced and will put your needs first.

Be prepared for the operation to cost thousands. Be wary of cheap options - there have been numerous cases of people who have gone abroad for cheaper surgery with no after-care in the UK provided, only to return home and suffer preventable complications.

If you are considering surgery, we strongly recommend you do as much research as possible and speak to your doctor.

An excellent resource is BOSPA, the British Obesity Surgery Patient Association. They can provide you with information on all the different types of surgery, possible complications and side effects, and advise you on what to do next, whether you want to go private or through the NHS.

Further info

Exercise

If you need to lose a significant amount of weight, you will need to increase the levels of activity in your life. Get more info

Other treatments

There are hundreds and hundreds of other weight loss treatments on the market, from pills to drinks to creams. Get more info


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