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Surgical Options

talking to your doctor about weight loss surgery

Weight loss surgery is typically reserved for individuals that are severely obese, and only when their diet and exercise routines have failed. In cases like these, weight loss surgery can literally be lifesaving. Approximately 220,000 individuals underwent some form of weight loss surgery last year in the United States.

Depending on the specific type of weight loss surgery chosen, patients typically lose between 30% and 50% of their excess body weight within 6 months of the operation. However, weight loss surgery is considered major surgery and has a few potentially serious risks. It is highly recommended that an individual take the time to learn all aspects of the weight loss process prior to going forward with surgery.

Approaches to Weight Loss Surgery

Weight loss surgeries can be broken down into two primary approaches:

  • Restriction: Weight loss surgeries performed under the restriction approach work by restricting the stomach from stretching to its full size. The average stomach can hold six cups of food. However, after a restrictive weight loss surgery has been performed on a patient, their stomach will only be able to hold approximately one cup of food. This type of surgery results in the patient feeling full faster, consuming less food, and hence losing weight.

  • Malabsorption: The second approach to weight loss surgery is called malabsorption, and the intent of the surgery is to divert food from being processed through a section of the intestines. By having food bypass a section of the intestines, fewer calories will be absorbed. This allows the individual to consume foods without absorbing their full calorie contents, thereby producing weight loss.

Today, most weight loss surgeries are performed using the laparoscopic technique. In laparoscopic surgery, 5 to 6-inch incisions are made in the belly wall. The surgeon inserts a camera and their tools through these incisions and operates while watching a video screen.

In open surgery (laparotomy), the surgeon makes a large incision along the middle of the belly. This approach is necessary when the surgery cannot be performed laparoscopically (i.e. with a video screen).

Types of Weight Loss Surgery

Roux-en-Y Gastric Bypass Surgery

roux-en-y gastric bypass

Roux-en-Y gastric bypass surgery is the most common type of weight loss surgery performed today. Approximately 140,000 roux-en-Y gastric bypass surgeries will be performed this year in the United States alone. This figure accounts for nearly 80% of all weight loss surgeries in the United States.

The roux-en-Y gastric bypass surgery consists of two primary processes:

  1. First, the surgeon divides the stomach into two sections: a large portion and a much smaller portion. The smaller stomach portion is then stapled into a small pouch.

  2. The smaller stomach pouch is then disconnected from the first part of the small intestine (the duodenum) and reconnected to the second part of the small intestine (the jejunum).

Once the roux-en-Y gastric bypass surgery has been completed, the patient will lose weight through two methods. First, the patient will consume less food since the portion of the stomach where the food is stored is smaller. This results in the patient feeling full even though they consumed less food. The second method of weight loss produced by the roux-en-Y gastric bypass surgery is a result of the fact that during the digestive process, the food bypasses a small part of the intestine. Since the food spends less time being digested in the intestine, a lower number of calories are absorbed into the body.

Laparoscopic Adjustable Gastric Banding Surgery

Laparoscopic adjustable gastric banding is the second most common type of weight loss surgery performed today. The laparoscopic adjustable gastric banding procedure is performed as follows:

  1. Using laparoscopic tools (a camera and video screen), the surgeon attaches an inflatable silicone band around the upper stomach.

  2. The band is then tightened so that the size of the stomach is reduced to a smaller pouch with a narrow outlet.

The result of the laparoscopic adjustable gastric banding procedure is that the patient feels full faster, consumes less food, and hence loses weight. The gastric band is adjustable and can be tightened or loosened. This allows for the minimization of side effects and the ability to adjust the rate of weight loss.

Gastric banding is considered the least invasive weight loss surgery technique, and the procedure is reversible if desired or necessary.

Biliopancreatic Diversion Surgery

Biliopancreatic diversion surgery is similar to roux-en-Y gastric bypass surgery and is performed as follows:

  1. Similar to roux-en-Y gastric bypass surgery, the surgeon divides the stomach into two sections - a large portion and a much smaller portion. The smaller stomach portion is then stapled into a small pouch.

  2. The surgeon then connects the smaller stomach portion to a section of the intestine that is further down in the digestive process than that of the roux-en-Y gastric bypass surgery.

The result of the biliopancreatic diversion surgery is that the portion of the stomach that processes food is smaller and the food consumed bypasses a large portion of intestine. The patient will consume less food and absorb fewer calories from the foods that they do consume, resulting in weight loss.

There are only a few weight loss surgery centers that perform biliopancreatic diversion surgery. The reason for this is that the surgery, while highly effective, is difficult to perform. In addition, the biliopancreatic diversion surgery often leads to nutritional deficiencies. This requires that the patient take vitamin and mineral supplements on a daily basis. Biliopancreatic diversion surgery accounts for less than 5% of all weight loss surgeries performed today.

Vertical Banded Gastroplasty

Vertical banded gastroplasty surgery creates a small stomach pouch using staples and a plastic band. While vertical banded gastroplasty surgery can be an effective weight loss approach, it generally produces lower rates of weight loss than the previously mentioned surgeries. Roux-en-Y gastric bypass surgery and adjustable gastric banding surgery have predominantly replaced vertical banded gastroplasty surgery. Currently, only 5% of bariatric surgeons still perform the vertical banded gastroplasty surgery.

Expectations from Weight Loss Surgery

doctor weight loss surgery

For most individuals, weight loss surgery produces a significant amount of weight loss. Roux-en-Y gastric bypass surgery and biliopancreatic diversion surgery produce the greatest amount of weight loss – approximately 60% of excess body weight. In theory, this would mean that an individual who is 200 pounds overweight would lose 120 pounds. It will typically take a patient anywhere from several months to a few years to achieve these types of weight loss results.

Laparoscopic gastric banding surgery leads to the loss of approximately 40% excess body weight. This means that an individual who is 200 pounds overweight would lose 80 pounds of excess weight.  Again, the timeframe associated with this amount of weight loss is typically several months to a few years.

The weight loss assumptions previously stated assume that the patient makes changes to their lifestyle, including consuming smaller meals and exercising regularly.

Weight Loss Surgery Risks & Recovery

Whether performed open or laparoscopically (with a video camera), weight loss surgery is considered major surgery. As with any surgery, the benefits of the surgery come with some risks as well:

  • Approximately 10% of patients will have minor complications associated with weight loss surgery. These minor complications include wound infections, minor bleeding, ulcers or hernias.

  • Approximately 1% to 3% of patients have major or life-threatening complications. These include blood clots, leaks in the new connections made via the weight loss surgery, major bleeding or infections.

  • Between 0.2% and 0.5% of patients (less than 1 in 200) die from complications of weight loss surgery within the first month.

The risks listed above may be higher at surgical centers that do not perform a large number of weight loss surgeries. In addition, the risk of death is higher for patients over the age of 65.

Assuming that the patient has no complications, the typical recovery times are as follows:

  • Two to three days in the hospital after the weight loss surgery

  • Two to three weeks to return to work and to perform normal activities


liposuction process

The total number of fat cells within the body is established by the time an individual reaches puberty. When an individual gains weight, the fat cells act like balloons and increase in size. This is due to the fact that each fat cell is storing more fat.

Conversely, when an individual loses weight, the fat cells tend to reduce in size because the amount of fat stored in each cell decreases. They may increase or decrease in size depending on several factors associated with the individual's lifestyle and hereditary disposition.

Liposuction is a medical procedure that can reshape the various areas of the body by removing fat cells from those areas. Once the fat cells have been removed from an area of the body, they will never come back.

Liposuction is the most commonly requested cosmetic surgery in the world, and can be performed at virtually any age and on any part of the body.

Typical areas where liposuction is generally performed include the neck, cheeks, jowls, abdomen, buttocks, thighs, hips, knees, ankles, calves and arms.

Liposuction can also be performed to correct enlarged male breasts, a condition known as gynecomastia. Liposuction can be performed as a standalone procedure or in conjunction with virtually any other plastic surgery procedure.

The area where liposuction is to be performed is injected with a special fluid/anesthesia combination prior to suctioning. The intent of the fluid is to constrict the surrounding blood vessels, making the procedure nearly bloodless, while at the same time reducing the level of pain and acting as an anesthetic.

To begin the procedure, a thin, hollow tube known as a cannula is inserted through one or more tiny incisions near the designated area. The cannula is attached to a machine that creates a strong vacuum. The cannula is strategically manipulated to remove fat cells and contour and sculpt the area. Typical procedure times range from 1 to 2.5 hours depending on the number of areas treated.

Liposuction Recovery Procedure 

Liposuction procedures are performed on an outpatient basis. Most patients state that they feel slightly bruised and sore following the procedure (similar to muscle soreness from exercising). Minimal swelling is expected and generally peaks within 3 to 4 days, and completely disappears within 4 to 6 weeks.

Depending on the areas treated, many individuals return to work the next day. However, some patients prefer to wait two to three days, or until the swelling is gone, before returning to work. It is important to promote blood circulation after the liposuction procedure, so normal activity is recommended as soon as possible. It is also recommended that the patient begin massage therapy the day after the operation.


considering your options

While several of these weight loss surgery approaches are highly effective, it is important to understand the risks that are associated with each beforehand as virtually all types of weight loss surgery have set of associated side effects. In general, weight loss surgery should only be considered by individuals that are severely overweight or obese, or are at serious risk of illness or death. 

After surgery, patients must completely transform their dietary intake and activity levels to optimize their weight loss. In addition, since several different weight loss surgeries reduce the time that foods are processed in the intestine, it is important that the individual begin a nutritional supplement program to ensure that they are receiving the appropriate amount of nutrition.

The intent of the various weight loss surgeries is to physically force the individual to consume less food and to absorb fewer calories from the food they consume. Likewise, an individual could mentally force himself to consume less food as well. This being said, weight loss surgery can be viewed as a physical approach to weight loss, while dieting and lifestyle changes can be considered mental approaches to weight loss.