Bariatric Procedures: Surgeries for Weight Management

Surgical intervention for weight management is increasingly prevalent for obese individuals who are unable to lose weight through traditional means (ie; diet and exercise). The gastric sleeve, gastric bypass, adjustable gastric band, and the biliopancreatic diversion with duodenal switch are the most common procedures performed in the United States (US). These surgical procedures typically reduce weight in patients by reducing stomach volume or by altering intestinal absorption/metabolism, but are not guaranteed to work long-term. People who receive a bariatric procedure should work with a dietitian (in addition to their doctor) to appropriately manage weight and lifestyle change(s) post-procedure.

The gastric sleeve is unique and one of the most common procedures. During the surgery, the surgeon removes part of the stomach to make it smaller. Limiting the size of the stomach reduces the amount of food that needs to be consumed to feel full. By feeling satiety sooner, the patient will typically consume less when eating; thereby, reducing body weight over time. Unlike other bariatric procedures, this one is irreversible.

The gastric bypass (AKA: Roux-en-Y Gastric Bypass) includes a similar element of the gastric sleeve in that the first part of the procedure is reducing the stomach volume to initiate early satiety. Then, the small intestine is divided into two parts. One part of the intestine is attached to the newly reduced stomach area to allow food to pass from the stomach the small intestine without appropriate time to digest and break down the nutrients. Next, the other part of the intestine is attached to a lower part of the stomach to facilitate movement of digested food and digestive juices from the stomach to the small intestine (facilitating absorption in the intestines). This procedure combines increased and early satiety with a new pathway for digestion that reduces the amount of calories/nutrients absorbed; effectively reducing the amount of calories consumed and utilized by the body. Unlike the gastric sleeve, this procedure is sometimes possible to reverse.

The adjustable gastric band is similar to the gastric sleeve and bypass in that it causes reduced food and calorie intake through early satiety through reduced stomach volume. The adjustable gastric band is an adjustable circular band fitted around the stomach to reduce its size. Unlike the other procedures, the band is adjustable. Unfortunately, this procedure does not promote as much weight loss as the other procedures and it is commonly removed due to intolerance and/or ineffectiveness.

The biliopancreatic diversion with duodenal switch is very similar to the gastric bypass; however, a majority of the small intestine is bypassed, resulting in significantly less nutrient absorption. This method is becoming increasingly less prevalent due to complications and poor health as a frequent result; however, it is still reserved for cases of extreme obesity.

Unlike traditional forms of weight management (ie; diet and exercise), gastric procedures come with significant health risks (acute and chronic). These procedures are best reserved for individuals who have already exhausted all other weight loss options and have not experienced success through traditional means. After these procedures are performed, lifestyle changes are essential in maintaining and furthering weight loss. If you have questions about gastric procedures or what care and lifestyle changes are important post-procedure, please reach out!