Everything You've Ever Wanted to Know About Bariatric Surgery
Bariatric surgery is a term used to describe weight loss surgeries like gastric bypass and gastric sleeve. These surgeries work to treat obesity by altering the structure of your digestive tract. These changes help limit the amount of food you can comfortably eat. They can also influence hunger hormones and appetite.
Bariatric surgery can be a good option for people with obesity who’ve struggled to lose weight with diet and exercise alone, including people who repeatedly regain the weight they do lose. Bariatric surgery can also be a good option for people experiencing obesity-related health conditions, such as type 2 diabetes.
But this approach isn’t right for everyone, and there are risks to consider in the short and long term.
In this article, you’ll learn more about the different types of bariatric surgeries, who qualifies for them, and how much they cost. You’ll also learn about how you prepare for the procedure and what the recovery process is like.
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What are the types of bariatric surgery?
When you’re considering bariatric surgery, a doctor will likely recommend a specific type that will work best for you.
According to the
- gastric bypass
- sleeve gastrectomy
- gastric band surgery
Duodenal switch surgery is less common but may also be recommended.
Gastric bypass
Also known as Roux-en-Y gastric bypass (RYBG), this surgery is designed to decrease the size of your stomach, according to the Endocrine Society. In response, your body may absorb fewer calories and nutrients, such as carbohydrates. This can lead to hormonal changes that may influence your hunger signals.
Gastric bypass may result in the most significant weight loss when compared to other bariatric surgeries. But it’s also the most complex of all the types of bariatric procedures.
- stapling of the stomach
- dividing up the small intestine
- relocating the upper small intestine
Sleeve gastrectomy
Also called a vertical sleeve gastrectomy (VSG), gastric sleeve surgery is the most common type of bariatric surgery performed in the United States. It’s used to decrease the size of your stomach and reduce the amount of food you can eat at one time.
VSG may also reduce the production of intestinal hormones that influence hunger and metabolism. One of these hormones is called GLP1. This hormone can reduce hunger signals and better regulate blood glucose (sugar) levels.
The results of a VSG surgery are permanent, according to
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Gastric band
An adjustable gastric band (AGB), or simply gastric band, surgery involves the surgical placement of a band around the top part of your stomach. This creates a pouch at the top of your stomach that holds a smaller amount of food, decreasing your overall calories and nutrient intake.
The adjustable part of this surgery means that your doctor can change the size of the opening of the band to create a smaller or larger pouch.
This is one of the least invasives of the major types of bariatric surgery. But gastric band surgery doesn’t typically lead to significant weight loss when compared with gastric bypass surgery or sleeve gastrectomy, according to 2017 research.
Your body may not be able to tolerate the band’s presence, leading to inflammation or other complications in the area where the band is placed. In these cases, a doctor will need to remove the gastric band. This is why gastric bypass or sleeve gastrectomy is often preferred over a gastric band, according to
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Duodenal switch
A duodenal switch is the least common type of bariatric surgery. Also known as a biliopancreatic diversion with a duodenal switch, this procedure involves two separate surgeries:
- A surgeon will perform traditional gastric sleeve surgery.
- The surgeon will divide the small intestine into two parts.
The goal of a duodenal switch is to reduce calorie intake and lead to more rapid weight loss. But this type of bariatric surgery also involves the most risks.
One risk is a deficiency in protein or other vitamins and nutrients. This is due to the body’s reduced ability to absorb them after the surgery.
Who’s a good candidate for bariatric surgery?
Bariatric surgery is only an option for people with obesity. This type of surgery is not intended for people who are overweight, but not obese.
You may be an ideal candidate for bariatric surgery if:
- you have a body mass index (BMI) of
35 or higher - your obesity hasn’t responded to other treatment methods
A doctor may especially want you to consider this procedure if you also have serious related health concerns, such as:
- type 2 diabetes
- high blood pressure
- metabolic syndrome
Bariatric surgery may also not be appropriate if you currently have low blood sugar (hypoglycemia) or a history of it. In some cases, hypoglycemia may worsen after weight loss surgery, according to the Endocrine Society.
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Costs, insurance, and getting cleared for surgery
Once you’ve qualified as a candidate for bariatric surgery, you’ll need to take numerous additional steps before you’re cleared to have surgery. This includes steps that your insurance company may require you to take before they agree to cover some or all of the costs of surgery.
Bariatric surgery can be expensive, even with insurance. Depending on your procedure and where it’s done, prices can range from
- Attend a seminar or consultation with a surgeon: You will learn about the different procedures and risks associated with them.
- Follow a specific diet for several months: Your insurance company may require you to undergo a medically monitored diet for 3 to 6 months before your surgery.
- Consult with a therapist or psychologist: They will assess whether you’re ready for the lifestyle changes that come along with bariatric surgery.
- Receive laboratory tests to clear you for surgery: This includes evaluations of your heart and GI tract health.
- Get clearance from a medical team: They may be involved in preparing you for and performing the surgery.
- Get authorization from your insurance provider: This is to make sure your insurance will cover some or all of the cost of surgery.
- Schedule the surgery appointment: You can do this after receiving insurance approval.
- Attend classes with medical professionals: They will discuss what to expect before, during, and after surgery.
- Meet with your surgeon: This will happen a few weeks before the surgery and is a good time for you to ask questions.
- Receive another series of laboratory tests: These will check your overall health before going into surgery.
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How to prepare
Before bariatric surgery, you may meet with different healthcare professionals to help prepare you for the procedure and results. Per
- Nutritionist: will help you plan a healthy diet and manage any restrictions shortly after your surgery
- Mental health professional: will help you cope with the challenges and changes related to weight loss surgery
Before surgery, you’ll be asked to follow a liquid diet to help keep your stomach from expanding too much. Some options for a liquid diet include:
- coffee and tea without caffeine
- nonfat milk
- broth or soup without additional ingredients
- juice with no added sugars or preservatives
- gelatin without sugar or additives
- sugar-free ice pops
If you currently smoke, you will need to stop doing so for at least
What are the risks?
Bariatric surgery is designed to help promote weight loss in people with obesity. But this is an invasive procedure that carries risks.
According to
- bleeding
- infections
- blood clots
- leaking from sections of the small intestine, stomach, or both
- diarrhea
More long-term risks are associated with the changes made to your stomach. According to the Endocrine Society, these may include:
- nutritional deficiencies
- hernias
- scar tissue
- severe hypoglycemia, which can develop 1 to 3 hours after eating
- weakened bones and subsequent bone loss (osteoporosis)
- peripheral neuropathy that can cause nerve damage in your legs, feet, and hands
- risk of an alcohol use disorder, especially with gastric bypass
It’s important to be aware of these risks — not just immediately after bariatric surgery, but also in the long term. Some of these risks are preventable, such as by taking multivitamins to help prevent nutritional deficiencies.
Research from 2020 also shows that some people may experience social and psychological difficulties after bariatric surgery as they try to cope with a new “normal.” You may consider talking with a mental health professional about extended care, including possible support groups.
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What is the recovery like?
The first few days of recovery right after bariatric surgery typically consist of resting and slowly easing into physical activity.
You may also need to start with a liquid diet before gradually eating solid foods again. After a week or so, the doctor will likely clear you to begin transitioning off of your liquid diet.
When you’re moving on from your liquid diet, eat soft or puréed foods that are slightly thicker but not solid or difficult to digest. These can include:
- Soft or blended fruits: applesauce, bananas, pineapple, melon, or canned fruit
- Blended or juiced vegetables: spinach, carrots, or squash
- Soft forms of protein: yogurt, scrambled eggs, cottage cheese, or puréed chicken, turkey, or fish
You’ll likely need to follow this puréed food diet for a few weeks until the doctor clears you to begin incorporating more solid foods into your diet. At this point, you can introduce some new soft foods into your diet, including:
- boiled eggs with runny yolks
- ground beef or turkey and shredded chicken
- steamed fish
Once the doctor assesses how your body is responding to the introduction of softer solid foods, they’ll recommend introducing solid foods again slowly and carefully.
During this stage, try one new type of solid food every few days to see how your body responds. Be sure to cut up or dice your food into smaller pieces and stick to limited serving sizes to help reduce the risk of blockages. You’ll usually be able to return to a typical diet 3 to 4 months after surgery.
As you figure out what foods your body can digest well, continue to explore solid food options and find a diet that is sustainable for you — one that lets you still enjoy your favorite foods, desserts, and drinks in moderation without resulting in pain, nausea, digestive discomfort, or vomiting.
In most cases, you may be able to go back to work within 1 to 2 weeks of having bariatric surgery.
After your initial recovery, follow the doctor’s recommendations for diet, exercise, and lifestyle changes to help you maintain your results while decreasing the risk of complications. For example, your doctor may recommend that you:
- Take a daily multivitamin: to help make up for your body’s reduced ability to process nutrients
- Reduce your intake of fat and sugar: to avoid unwanted weight gain over time
- Increase your protein intake: to make sure your body is still getting the recommended amount of protein each day
- Exercise daily: to maintain your overall health and sustain a healthy weight in the long term
- Avoid or limit alcohol: especially during the early stages of postsurgery weight loss
- Try to manage daily stress: to reduce the risk of GI symptoms like stomach pain that can happen along with anxiety or stress reactions
How much weight loss can I realistically expect?
The exact amount of weight loss associated with bariatric surgery varies between individuals. The type of procedure used can also affect your results.
Research has found that people who have bariatric surgery may lose between
Weight loss from bariatric surgery may also result in the following related benefits, per the Endocrine Society:
- reduced risk of cardiovascular disease
decreased risk of liver and kidney diseases- improvements in high blood pressure (hypertension)
- more balanced blood cholesterol levels, including lower triglycerides
- decreased blood glucose in type 2 diabetes and a subsequently decreased dependence on related medications
- improvements in polycystic ovary syndrome that can also lead to improved fertility
- increased testosterone in men
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The takeaway
If you have obese and your condition hasn’t responded well to treatment, a doctor may recommend bariatric surgery to reduce your risk of health complications related to obesity.
But there are different types of bariatric surgery to consider, with each one offering different benefits, results, and possible risks. Talk with a doctor to see if bariatric surgery may be a fit for you as well as your health and weight loss goals.
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