What is bariatric surgery?
Weight loss surgery is another term for bariatric surgery. It encompasses gastric bypass and other surgical procedures associated with weight loss. These surgeries are proven effective in treating class III obesity by normalizing the metabolism. A surgeon who specializes in this surgery is known as a bariatric surgeon. Bariatric surgery may be recommended for an individual when other weight loss approaches have been unsuccessful or if obesity poses high health risks.
Bariatric surgery involves modifying the digestive system, usually the stomach or the small intestine, to aid with weight loss. These modifications control the consumption and absorption of calories. It also reduces the digestive system's hunger signals transmitted to the brain. Bariatric surgery can help treat and prevent metabolic diseases related to obesity, such as high cholesterol, diabetes, and fatty liver.
Who needs bariatric surgery?
Bariatric surgery is not just a surgical procedure suggested for overweight people. There are specific medical guidelines to qualify for this. A bariatric surgeon can help you analyze the approaches with a detailed screening process.
Bariatric surgery could be an option for an individual who is obese and if:
The body mass index (BMI) categorizes individuals with a measurement of 40 or higher as having extreme obesity. Bariatric surgery could be an option for individuals with a BMI of at least 35 who experience other severe weight-related health issues.
Bariatric surgery is an expensive procedure that requires long-term follow-ups, continuous monitoring of medical conditions, modified diet plans, and permanent lifestyle changes.
What other conditions can bariatric surgery help manage?
In addition to directly treating obesity and helping patients lose weight, bariatric surgery can be highly beneficial for managing the many health conditions that are associated with obesity. Almost all of these chronic diseases can become life-threatening, and bariatric surgery helps reduce risk factors after weight loss.
A candidate for bariatric surgery may already be at high risk of developing the following conditions:
- High cholesterol: Overweight individuals are likely to have high cholesterol; however, it may also affect individuals who are at a lower weight. A high weight also tends to increase bad cholesterol (or LDL) and lower good cholesterol ( or HDL). LDL cholesterol also rises in an individual's older age. For some, heredity might play a role. Moreover, it affects people of all ages, including children and adult men and women. Children may inherit high cholesterol, which is known as familial hypercholesterolemia. Therefore, cholesterol testing must be done for adolescents and children who are at high risk. Further, the American Heart Association also recommends that individuals aged 20 or more with a low risk of cholesterol get their cholesterol checked every four to six years.
- Obesity-induced hypertension or high blood pressure: Having more fat tissue causes many complex changes in the body, such as changes in certain hormones, changes in your sympathetic nervous system (which is a part of the body's autonomic nervous system and is responsible for the fight-or-flight response), insulin resistance, and changes to the structure of the kidneys and how they function. These changes may combine to worsen or induce hypertension.
- Insulin resistance or diabetes: Gaining weight can lead to excess body fat around your belly and organs (known as visceral fat) and raise a person's risk of developing insulin resistance. This means that the cells in your muscles, fat, and liver will not respond to insulin the way that they usually should. Since insulin plays a vital role in regulating blood sugar levels, impaired insulin sensitivity can increase blood sugar levels over a long period of time and ultimately cause prediabetes or type 2 diabetes.
- Obstructive sleep apnea or OSA: This condition is a life-threatening sleeping disorder in which a collapse in the airways significantly decreases or completely stops a person's breathing. Persons with excess body weight have more fatty deposits. These deposits then increase pressure on the upper airways. The opposite may also occur where OSA indirectly causes weight gain. Also note that while obesity can lead to OSA, it can happen to those who do not have obesity. Reduction in weight by 5-10% may potentially reduce the risk and severity of sleep apnea.
- Non-alcohol-related fatty disease: NAFLD is a condition that occurs when the body begins depositing excess fat in the liver. It can lead to non-alcohol-related steatohepatitis (NASH), chronic inflammation that may cause long-term damage to the liver.
What are the different types of bariatric procedures?
Bariatric surgery improves the body's ability to achieve a healthy weight. Over time, it has evolved and been enhanced through minimally invasive techniques like laparoscopy and robotic surgery. These advancements give patients a better overall experience, fewer complications, and faster recovery.
The American Society for Metabolic and Bariatric Surgery endorses the following different types of bariatric procedures:
- Sleeve gastrectomy: This laparoscopic procedure is relatively more uncomplicated. It removes approximately 80% of the stomach, which includes the portion that produces most of the "hunger hormone," thus making it much smaller. It helps decrease hunger, increases fullness, achieves health loss, and allows the body to maintain a healthy weight and blood sugar control.
- Gastric bypass: The most common form of bariatric procedure is gastric bypass. This procedure modifies the digestive system to limit the quantity of food one's stomach can hold, restricting the absorption of calories and nutrients.
- Gastric bands: An inflatable, adjustable silicone band is placed on the stomach's top portion to create a smaller pouch above. This procedure restricts food intake, causing patients to feel full more quickly. Over time, you can make repeated adjustments to reduce or remove the band size if necessary. This procedure is less successful against type 2 diabetes and modestly affects metabolism.
- Biliopancreatic Diversion with Duodenal Switch (BPD-DS): The surgeon creates a tube-shaped stomach pouch similar to a sleeve gastrectomy and then connects a portion of the small intestine to the outlet of the newly formed stomach. When a patient eats, the food travels through the stomach's sleeve pouch and then into the latter part of the small intestine. This modification bypasses roughly 75% of the small intestine, which can significantly decrease the absorption of calories and nutrients.
- Single Anastomosis Duodeno-Ileal Bypass with Sleeve gastrectomy (SADI-S): It is a recently introduced surgical procedure that is more straightforward and less time-consuming. Similar to sleeve gastrectomy, a small tube-shaped stomach is made. The surgeon divides the portion of the small intestine that follows the gut and forms a loop with it to connect to the stomach. When a patient eats, the food travels through the pouch and then moves to the latter portion of the small intestine. The food thus mixes well with digestive juices in the divided part of the small intestine. Therefore, it enables the absorption of vitamins and minerals, which aids in maintaining healthy nutrition levels. This surgery offers good weight loss, reduced hunger and appetite levels, more fullness, and better control over blood sugar.
While all surgical procedures generally have their fair share of risks, bariatric procedures performed at accredited centers are relatively safe and have a low complication risk. Successful bariatric surgery requires a team-based approach. The team usually comprises a surgeon, dietitian, psychologist, a nurse case manager, and an obesity medicine specialist.
Patients exhibit an excellent recovery rate when they eat healthily, engage in physical activity, keep appointments with the obesity medicine provider, and take vitamins and mineral supplements as instructed. The bariatric care team strives to provide lifelong support to succeed and maintain a healthy lifestyle.
Who can perform bariatric surgery?
A bariatrician is a specialized physician who provides treatments and management plans for patients dealing with obesity in a surgical or non-surgical manner. The training to become a bariatric physician begins with completing an undergraduate degree before an MD or DO medical degree. After graduating from medical school, the student undergoes a general surgery or internal medicine residency program. After the residency, the physician completes fellowship training in laparoscopic and bariatric surgery. Most clinical training related to bariatric medicine occurs during this fellowship program. Bariatric medical training is typically subdivided into health treatment, preventive methods, and surgical and related procedures.
The NIH, the American Society for Metabolic and Bariatric Surgery (ASMBS), and the American College of Surgeons (ACS) recommend that board-certified surgeons specialized in bariatric and metabolic surgery perform the surgery. Experts also recommend that centers with a multidisciplinary team for follow-up care conduct the surgery and treatment.
What risks does bariatric surgery carry?
Bariatric surgery carries potential health risks in both the short term and long term, as is the case with any major medical procedure. As per the National Center for Biotechnology Information, around 20% of patients undergoing bariatric surgery develop a short- or long-term complication. The surgical process can entail risks such as excessive bleeding, infection, adverse reactions to anesthesia, blood clots, lung or breathing issues, gastrointestinal system leaks, and, albeit rarely, even death.
Specific to its type, weight-loss surgery may also result in varying longer-term risks and complications. These include problems such as bowel obstruction, dumping syndrome (symptoms like diarrhea, flushing, lightheadedness, nausea, or vomiting), gallstones, hernias, hypoglycemia (low blood sugar), malnutrition, ulcers, vomiting, acid reflux, etc. Although rare, in case of any unusual symptoms or signs, it is advisable to contact a healthcare professional as soon as possible.
Understanding the potential side effects of bariatric surgery
Surgical procedures that alter the digestive system can bring about specific digestive complications, often referred to as post-gastrectomy syndromes. These potential side effects include:
- Dumping syndrome: This syndrome manifests when food moves too swiftly from the stomach into the small intestine. It affects approximately half of individuals who undergo bariatric surgery, leading to symptoms such as nausea, diarrhea, abdominal cramping, and occasional hypoglycemia. These symptoms typically diminish over time. To manage dumping syndrome during recovery, healthcare providers provide dietary guidelines aimed at preventing or minimizing its occurrence.
- Malabsorption and nutritional deficiencies: Many bariatric surgeries intentionally induce malabsorption in the small intestine to reduce calorie absorption. However, not carefully monitored can result in loose stools and nutritional deficiencies. Healthcare providers prescribe nutritional supplements post-surgery to mitigate these risks and ensure adequate nutrient intake.
- Bile reflux: Surgery that impacts the pyloric valve, responsible for regulating the flow of food from the stomach to the small intestine, may result in malfunction. A malfunctioning pyloric valve can lead to bile reflux, where bile intended for digestion in the small intestine flows back into the stomach. This reflux can potentially damage the stomach lining, causing gastritis and stomach ulcers.
- Gallstones: Rapid weight loss post-surgery triggers an increased release of cholesterol into the liver. This surplus cholesterol can accumulate in the gallbladder, forming cholesterol gallstones. While not always symptomatic, gallstones can pose risks if they obstruct bile ducts. Healthcare providers may prescribe medications to prevent gallstone formation in individuals undergoing rapid weight loss.
What can you anticipate during the surgery?
The bariatric surgeon near you performs surgery under general anesthesia, making patients unconscious. The specific details of the surgery are contingent on your circumstances, the type of weight-loss surgery chosen, and the hospital or doctor's protocols. Some weight-loss surgeries, known as open surgery, involve traditional large incisions in the abdomen.
However, surgeons perform most bariatric surgeries laparoscopically. This technique involves using a small, tube-like instrument equipped with a laparoscope camera. The laparoscope is inserted through small abdominal incisions, enabling the surgeon to view and perform procedures inside the abdomen without resorting to the conventional large incisions. While laparoscopic surgery can lead to quicker and shorter recovery times, it may not suit everyone.
The surgery typically lasts several hours. Following the procedure, you will regain consciousness in a recovery room, where medical personnel will monitor you for potential complications. Depending on the type of surgery you undergo, you may also be required to stay in the hospital for a few days.
How can you find a bariatric surgeon near you in New York, NY?
To find the best bariatric surgeon in New York, log on to Zocdoc, a free and secure online platform that helps patients connect with their ideal healthcare provider.
To search on Zocdoc, create a free account and enter details like your condition, your location, the specialist you are seeking, your preferred appointment date, and your insurance plan. A comprehensive list of bariatric surgeons based on your search criteria will appear. Each doctor on Zocdoc has a detailed profile with a brief introduction, education qualifications, practice location, visit reasons, and, most importantly, patient reviews. These patient reviews are the best way to find the top-rated bariatric surgeons in New York. If you need more clarification about your insurance plan, you can use the Zocdoc insurance detector. You can filter your results by gender, too. If your insurance plan isn't listed on Zocdoc, you have the option to upload a photo of your medical insurance card (unfortunately, this feature doesn't apply to vision or dental cards). By uploading your card, our system can scan it and identify your likely insurance plan. If you encounter difficulties uploading the image, feel free to reach out to our service team for assistance. We're here to help ensure you have a smooth experience scheduling your appointments. For more insurance-related questions, please visit Zocdoc's patient help center.
Zocdoc also provides an option for video appointments. Look for the purple video icon on the doctor's profiles or filter the video appointment selection. With Zocdoc, you can instantly schedule your appointment with the best bariatric surgeon near you.
All Zocdoc bookings are simple, secure, and free.
Statistics on bariatric surgery in the US
In agreement with the National Health and Nutrition Examination Survey, published in 2020, over the past two decades, morbid obesity rates have surpassed 40% in the US. The dramatic increase in obesity rates has made it one of the greatest public health threats worldwide. This has led to an exponential rise in bariatric surgeries performed.
The National Institute of Health analyzed the US national trends in bariatric surgery for a decade, spanning from 2006 to 2015. This study showed a gradual increase in bariatric surgery in the early years and a steady increase later. The American Society for Metabolic and Bariatric Surgery released statistics indicating that in 2020, they performed 198,651 bariatric procedures.
According to the New York State Department of Health, around 27.6% of adults are obese. In New York City, obesity has the highest prevalence in the Bronx (30.5%) and the lowest in Manhattan (19.2%).
Sources
NewYork- Presbyterian Hospital
Mayo Clinic
American Society for Metabolic and Bariatric Surgery[1]
American Society for Metabolic and Bariatric Surgery[2]
WebMD
National Institute of Diabetes and Digestive and Kidney Diseases
MD.com
National Center for Biotechnology Information[1]
National Center for Biotechnology Information[2]
Centers for Disease Control and Prevention
New York State Department of Health
NYC Health
Cleveland Clinic[1]
Cleveland Clinic[2]
Heart.org
Healthline
Obesity Medicine Association
