Bariatric surgery is an effective method that can offer lasting results in the treatment of obesity. However, this is not a simple decision. This content will discuss in detail what bariatric surgery is, who might be a suitable candidate, and what you should consider before embarking on this journey.
What is Bariatric Surgery?
Bariatric surgery is the general name for surgical procedures that change the structure of the digestive system to achieve weight loss. These operations restrict food intake and/or absorption by reducing the size of the stomach and/or bypassing a part of the intestines. As a result, patients feel full after eating less, and the body absorbs fewer calories. The primary goal of the surgery is to physically limit the patient’s daily calorie intake and, in addition, to cause metabolic changes.
These changes affect the hormones that regulate the body’s response to food and appetite, supporting weight loss. Bariatric surgery is not just a cosmetic procedure but also a metabolic surgery aimed at treating serious health problems associated with obesity, such as diabetes, high blood pressure, and heart disease. The surgeries are usually performed using a laparoscopic (minimally invasive) method, which means smaller incisions, less pain, and a faster recovery.
Who Can Benefit from Bariatric Surgery?
Bariatric surgery is not a procedure for everyone. It is generally considered for individuals who meet the following criteria:
- Those with a body mass index (BMI) of 40 or higher.
- Those with a BMI of 35 or higher who have serious health issues related to obesity, such as type 2 diabetes, high blood pressure, or sleep apnea.
- Those with chronic obesity who have failed to lose weight with previous methods (diet, exercise).
- Those who are psychologically prepared to adapt to lifestyle changes after the surgery.
Candidacy for bariatric surgery also requires an evaluation of the person’s overall health and age. The decision for surgery is made more carefully for patients under 18 or over 65. The suitability of young patients for surgery is evaluated by a multidisciplinary team, considering their growth and development. Likewise, individuals with alcohol or substance addiction, uncontrolled psychological disorders, or persistent eating disorders may not be considered suitable candidates for surgery. Bariatric surgery can be a solution not only for those who want to lose weight but also for those who want to reduce the health risks associated with obesity.
What Are the Most Common Types of Bariatric Surgery?
There are several different types of bariatric surgery. The most common ones are:
- Sleeve Gastrectomy: Approximately 80% of the stomach is removed to create a thin, sleeve-shaped stomach.
- Gastric Bypass (Roux-en-Y Gastric Bypass): A small pouch is created in the upper part of the stomach and connected to a section of the small intestine.
- Gastric Balloon: A temporary method where an inflatable balloon is placed in the stomach.
Sleeve gastrectomy is the most commonly performed type of bariatric surgery. In this procedure, a significant decrease in the patient’s appetite is observed because the part of the stomach that produces the appetite hormone (ghrelin) is removed. Gastric bypass is a more complex operation that both restricts food intake and reduces nutrient absorption. This method stands out as a strong option, especially for patients with uncontrolled type 2 diabetes.
The gastric balloon is a non-surgical option and is generally used for temporary weight loss. The balloon is placed in the stomach via endoscopy and is removed after a certain period. The decision on which surgical method to choose is made by a multidisciplinary team, taking into account factors such as the patient’s health status, existing medical conditions, lifestyle, and the surgeon’s expertise.
Advantages of Bariatric Surgery
In addition to weight loss, bariatric surgery can offer many health benefits:
- Remission or improvement of type 2 diabetes.
- A decrease in high blood pressure and cholesterol levels.
- Improvement of respiratory problems such as sleep apnea.
- Reduction of joint pain.
- Improvement in overall quality of life and psychological well-being.
One of the most significant advantages of bariatric surgery is its success in treating comorbidities associated with obesity. A rapid and lasting improvement in blood sugar levels can be observed within the first few weeks after surgery, especially in patients with type 2 diabetes. This is related to metabolic regulations in addition to weight loss. At the same time, high blood pressure and cholesterol levels caused by obesity can also return to normal, which significantly reduces the risk of heart disease. Weight loss alleviates joint pain by reducing pressure, especially on the knee and hip joints, and increases mobility. All of these physical improvements contribute to an increase in patients’ self-confidence, more active social lives, and a higher overall quality of life.
Potential Risks and Complications of Surgery
Like any surgical procedure, bariatric surgery has its risks. These include complications such as infection, bleeding, anesthesia reactions, hernias, and rarely, leaks. Vitamin and mineral deficiencies may also occur in the post-operative period. The risk of complications varies depending on the patient’s general health, the surgeon’s experience, and the type of surgical method used.
With modern surgical techniques, the risks have been minimized but not entirely eliminated. A leak is one of the most serious and rare complications, where fluid from the stomach or intestinal suture line leaks into the abdominal cavity. This situation requires immediate intervention. Vitamin and mineral deficiencies are common, especially after bypass surgery, because the nutrient absorption areas have been altered. Therefore, patients must take vitamin and mineral supplements for life after surgery.
Pre-operative Evaluation Process
Before deciding on bariatric surgery, patients undergo a comprehensive evaluation process. This process includes:
- Physical examination and blood tests.
- Psychological evaluation.
- Consultation with a nutritionist.
- Consultation with specialists such as an endocrinologist and a cardiologist.
The pre-operative evaluation is a vital step in determining the patient’s suitability for surgery, identifying potential risks, and preparing the patient for life after the operation. The psychological evaluation aims to understand the patient’s eating habits, psychological state, and how ready they are for the change after surgery.
The nutritionist creates a nutritional plan for the patient before and after surgery and helps the patient adopt healthy eating habits. Endocrinologists evaluate the patient’s hormonal status and comorbidities such as diabetes. Cardiologists check the health of the heart and blood vessels to determine the surgical risk. This multidisciplinary team approach ensures that the patient undergoes the surgery as safely as possible and is successful in the post-operative period.
Post-operative Lifestyle Changes
Bariatric surgery is not a standalone solution. Permanent lifestyle changes after surgery are essential for success:
- Eating small portions, frequently and slowly.
- Focusing on protein and fluid intake.
- Regularly using vitamin and mineral supplements.
- Regular exercise.
To maintain the weight loss achieved after bariatric surgery and improve overall health, these changes must be adhered to for life. Due to the reduced size of the stomach after the surgery, the patient feels full even with very small amounts of food. Therefore, eating small portions frequently and slowly is important to avoid straining the stomach and to meet nutritional needs.
Adequate protein intake is vital for preserving muscle mass. In addition, patients are encouraged to drink plenty of water throughout the day to prevent dehydration. Regular physical activity speeds up metabolism, increases muscle strength, and helps with long-term weight control. The surgery is just a starting point; true success comes with the person’s effort to adapt to this new life.
Bariatric Surgery and Psychological Health
Obesity is often associated with psychological problems. Bariatric surgery can help with these problems, but getting psychological support before and after the surgery is important. Obesity can lead to depression, anxiety, low self-esteem, and social isolation in individuals. Rapid weight loss after bariatric surgery can alleviate these problems and boost the person’s self-confidence.
However, radical changes in eating habits can be psychologically challenging. Some patients may find it difficult to quit emotional eating habits or may seek comfort from food in other ways. Therefore, working with a psychologist or psychiatrist before and after surgery helps ensure a healthier emotional transition. Support groups are also a great way to connect with people who share similar experiences and to encourage each other.
Post-operative Recovery Process
The post-operative recovery varies depending on the patient’s general health and the type of operation performed. Patients usually stay in the hospital for a few days, and full recovery can take a few weeks. In the first few days immediately after the surgery, patients are fed with painkillers and a liquid diet. They are closely monitored for possible complications during their hospital stay. After being discharged from the hospital, the patient’s activity level should be gradually increased.
It is recommended to avoid heavy lifting and strenuous exercise during the first few weeks. The time to full recovery and return to normal activities can vary from person to person. Meticulously following the instructions of the surgeon and other healthcare professionals during this period is critical for a successful recovery process.
Diet and Nutritional Rules
Nutrition after surgery is of vital importance for success. Patients start with a liquid diet, transition to pureed and soft foods, and eventually return to a normal eating pattern. For the first few days, patients are fed with only clear liquids, then with protein liquids. These stages are necessary for the stomach and digestive system to adapt to the surgery.
About two weeks later, pureed foods are included in the diet. From the fourth week onwards, patients gradually return to normal, solid foods. During this transition process, it is essential to chew food thoroughly, eat slowly, and drink liquids at least 30 minutes before or after meals. Eating too quickly or consuming liquids with solid foods can cause stomach discomfort and vomiting. Adhering to these nutritional rules supports both weight loss and digestive system health.
The Role of Exercise
Regular exercise after bariatric surgery speeds up the weight loss process and improves overall health. It is recommended to start with light exercises and gradually increase the pace over time. In the first few weeks after the surgery, patients can start with low-intensity activities such as light walking. Later, with the surgeon’s approval, they can transition to more intense exercises like cardio and strength training.
Regular exercise not only increases calorie burning but also helps preserve muscle mass and speed up metabolism. Additionally, exercise contributes to psychological well-being by triggering the release of endorphins, which improve mood. Exercise also plays a significant role in reducing skin sagging that can occur due to weight loss. For a successful life after bariatric surgery, nutrition and exercise should be seen as an inseparable duo.
Long-term Effects of Bariatric Surgery
Bariatric surgery provides significant long-term weight loss and can offer lasting benefits in the management of obesity-related diseases. However, the preservation of these benefits depends on the person’s lifestyle. Most patients experience the most weight loss within the first 1-2 years after surgery. After this period, the rate of weight loss slows down, and it is considered normal to regain some weight. However, returning to the pre-operative weight is quite rare.
Long-term success of the surgery depends on the person maintaining healthy eating habits, regular exercise, and vitamin supplements. For lasting results, the patient must make a lifelong commitment. Regular doctor check-ups after surgery are of great importance for the early diagnosis of possible vitamin deficiencies or other health problems.
Frequently Asked Questions
Answers to the most frequently asked questions about bariatric surgery: Is the surgery painful? How long does it take to lose weight? Does skin sagging occur after surgery? Since the surgery is performed using a minimally invasive (laparoscopic) method, patients generally do not feel severe pain after the surgery, and the pain can be controlled with painkillers. Weight loss happens fastest in the first few months after the surgery. Within the first 6 months after the surgery, 50% of the total excess weight can be lost, and within a year, 60-80% can be lost.
Skin sagging may occur due to rapid weight loss after surgery. The degree of this condition depends on the amount of weight lost, the patient’s age, and the elasticity of their skin. In cases of severe sagging, cosmetic surgery operations may be necessary. The answers to these questions can vary depending on the patient’s overall condition, so it’s best to consult a doctor for a personal evaluation.
Bariatric Surgery and Pregnancy
It is recommended that women who are considering pregnancy after bariatric surgery wait at least 12-18 months. The first year after surgery is a period when the body loses weight rapidly and nutrient absorption changes. Getting pregnant during this period can increase the risk of vitamin and mineral deficiencies for both the mother and the baby.
Ideally, before making a decision to get pregnant, the patient’s weight should be stabilized and their nutritional status should have returned to normal levels. When pregnancy is planned, a plan should be created with an obstetrician and bariatric surgeon regarding nutritional supplements and weight management. Pregnancy after surgery can reduce the risk of pregnancy complications caused by obesity, but the follow-up process must be carefully managed.
Choosing a Surgeon and Hospital
Choosing an experienced surgeon and a well-equipped hospital is crucial for a successful surgery and a safe process. When choosing a surgeon, factors such as their experience in bariatric surgery, success rates, and patient satisfaction should be considered. It is a great advantage for the surgeon to be part of a team that also manages the post-operative follow-up process.
When choosing a hospital, it is important that the operating room conditions are hygienic and modern, that there is an intensive care unit, and that a multidisciplinary team (nutritionist, psychologist, physiotherapist) is available. This team coordinates the patient’s pre-operative preparation and post-operative follow-up. A bariatric surgery center can make the process easier by offering all of these services under one roof.
Financial Aspects
Bariatric surgery can be a high-cost procedure. Insurance coverage and financing options should be researched in advance. The cost of bariatric surgery can vary depending on the type of surgery, the location of the hospital, and the surgeon’s fee. Some private health insurance plans may cover bariatric surgery if certain criteria are met. These criteria usually include a certain BMI, obesity-related comorbidities, and a documented history of weight loss attempts. Contacting your insurance company to find out if you are covered should be one of the first steps. If it is not covered by insurance, financing options or credit opportunities offered by hospitals can also be explored. Financial planning is an important issue that should not be overlooked in the pre-operative process.
Success Stories and Realities
To understand the potential of the surgery, it is important to read the experiences of people who have had successful surgery and to set realistic expectations. Bariatric surgery can be a life-changing experience for many people. Success stories highlight the challenges of this journey and the benefits that are ultimately achieved.
However, it is also necessary to understand the realities behind these stories. Success comes not only from the surgery but also from the person’s permanent change in lifestyle. Success stories can be a source of motivation, but it is important to remember that every individual’s journey is different and that results can vary from person to person. Setting realistic expectations prevents disappointment in the post-operative period.
Reasons for Failure of Bariatric Surgery
The most common reasons for the failure of the surgery include failure to adapt to lifestyle changes and violation of post-operative nutritional rules. Bariatric surgery physically restricts a person from eating less, but it does not eliminate emotional eating or unhealthy eating habits. Therefore, consuming high-calorie, liquid, or soft foods excessively in the post-operative period can stop weight loss or lead to weight regain. Sweet and carbonated drinks, in particular, make weight control difficult because they are easily consumed. To prevent failure, it is of vital importance to complete psychological preparation before the surgery and to have regular follow-ups with a nutritionist and a psychologist after the surgery.
Support Groups and Communities
The bariatric surgery journey can be made easier with support groups and people who share similar experiences. Online or in-person support groups provide a safe environment where patients can share their experiences, challenges, and successes. These groups give individuals the feeling that they are not alone and increase their motivation. In the pre-operative process, these groups can provide valuable information about preparing for the surgery and what to expect, while in the post-operative period, they can provide practical advice on coping with nutritional, exercise, and psychological challenges. Regular participation in support groups increases adherence to lifestyle changes, contributing to long-term success.
The Process of Deciding on Bariatric Surgery
Before making a final decision, it is essential to carefully evaluate all of these factors and talk in detail with a healthcare professional. Bariatric surgery is a life-changing decision, and it must be made consciously. This process involves not only a surgery but also a lifelong commitment to a change in lifestyle. In the decision-making stage, openly share all of your concerns and questions with your surgeon and the multidisciplinary team. Honestly evaluate the potential benefits and risks of the surgery, your post-operative expectations, and how committed you can be to this process. This comprehensive preparation and conscious decision will ensure that your bariatric surgery journey progresses successfully and healthily.
This draft can be a starting point for you to understand the complexity of bariatric surgery. Remember, this is not medical advice, and you should always consult a doctor for all your questions.
