Bariatric surgery is the term given to surgical weight loss procedures and techniques that help overweight, obese and morbidly obese individuals lose weight by restricting the amount of food absorbed into the body. Bariatric surgery is often considered a last resort for individuals suffering a variety of weight-related health conditions and disease processes. However, consumers considering any type of bariatric surgery should know that results are not instantaneous, and those who go through bariatric surgical procedures must be prepared to commit to long term lifestyle changes for optimal success. 

Who Qualifies for Bariatric Weight Loss Surgery?
Not everyone qualifies as a good candidate for bariatric weight loss surgery. Generally, an individual is not even considered for surgery unless he or she has repeatedly tried to lose weight through diet and exercise without success.

Likely candidates are also among those diagnosed with life threatening conditions caused by weight related issues such as joint problems, diabetes, heart conditions, or severely limited mobility.

Individuals with genetic dispositions or conditions that cause obesity are considered good candidates, as are those with unusually high body mass index (30.0) or above. In addition, ideal candidates are those without a history of drug or alcohol abuse, psychiatric issues and have suffered from obesity for at least five years.

Most Common Types Of Bariatric Surgery

  • Adjustable Gastric Band
  • Roux-en-Y gastric bypass (RYGB)
  • Gastric Sleeve
  • Biliopancreatic Bypass with the Duodenal Switch
  • Incision Free

A handful of types of weight loss surgical procedures are commonly performed both domestically and abroad. Patient and physician consider which procedure is optimal for his or her condition. Eating behaviors, health, body mass index, and other medical conditions affected by weight gain are often determining factors to such decisions.

Open or Closed Bariatric Surgical Procedures
Bariatric surgery is performed through one or more small incisions in the abdominal region, known as open surgery, or through a laparoscopic approach. Laparoscopic techniques utilize instruments inserted through small 1/2-inch incisions. A laparoscope is a long, hallow tube-like instrument with a camera attached to one end that sends images to a monitor in the operating theatre. Today, most bariatric surgical procedures are performed laparoscopically in order to reduce complications, tissue damage, and encourage earlier discharge from hospital environments.
 
Adjustable gastric band (AGB) decreases food intake through the use of a band placed around the top of the stomach that creates a pouch about the size of an adult thumb. A balloon inside the band controls the outlet of this pouch and encourages or restricts intake into the digestive tract.

Gastric sleeve (GS) procedure is generally performed for patients who have a high risk of complications due to medical conditions and massive body weight. This procedure restricts food intake by removing much of the stomach.

A biliopancreatic bypass with the duodenal switch is a complex procedure that involves removal of the lower part of the stomach. The small remaining pouch is directly attached to the small intestine. While this procedure does promote optimal weight loss, it does carry complications because of decreased absorption of minerals, vitamins, as well as food in the body.

Incision free bariatric surgical procedures are relatively new, and are performed without actually cutting into the skin.  Instead, tools and bariatric equipment are often inserted in the throat to perform these incision free procedures.  While a still relatively new technique, increasing numbers of bariatric surgeons are performing this type of procedure.

The Roux-en-Y gastric bypass technique actually reduces the amount of food absorbed in the digestive tract. This procedure routes food to pass directly from a small pouch created for food intake directly into the small intestine, bypassing much of the stomach, duodenum, and upper intestine.

Consumers must be aware that any type of bariatric surgery or bypass procedure carries with it risk of infection, bleeding, and blood clots.

Lifestyle Changes after Bariatric Surgery
Bariatric surgeons warn that any type of weight loss surgery is not a quick fix, but requires determination, dedication, and adherence to strict dietary eating and exercise habits to enjoy long term success. In some cases, it may take between six months to a year to enjoy the full benefits of bariatric surgery, while others must undergo follow-up surgeries that remove excess skin and fat.

Individuals will be carefully monitored following surgery, and actively engaged in postoperative treatment and lifestyle planning that may involve nutritionists, a family doctor, follow up by the bariatric surgeon, and even psychological counseling.

Patients experience the post-operative recovery period at different rates, depending on their physical condition at the time of surgery. In most cases, individuals are able to engage in normal daily activities within eight weeks.

Perhaps the most difficult aspect of the post surgical recovery stage is learning new eating habits. The amount and type of food an individual may eat (sometimes limited to a few ounces at a time) will depend on the type of bariatric procedure performed.  Eating more slowly, chewing food thoroughly and waiting several minutes between bites is often recommended.

In addition to changing the way an individual eats, the person must also restrict foods high in sugar and fat. Such food may empty into the small intestine more quickly than desired, causing extreme discomfort or pain. Fresh fruits, vegetables and foods high in protein are recommended.

Individuals who have undergone Roux-en-Y or gastric bypass banding should ensure they take vitamin, iron and calcium supplements. However, as vitamin B12 is not easily absorbed in the body following such procedures, patients will need to discuss uptake of such nutrients with their doctors to avoid insufficiencies that may result in fatigue or other conditions that will affect long term health and wellness. 

Support and guidance for bariatric surgical patients is essential for long-term success. Nutritional counseling, psychological support, and support groups help patients remain compliant to lifestyle changes and aftercare.

Paying for Bariatric Surgery
The cost of bariatric surgery will depend upon the technique chosen by the patient and the doctor.  In most cases, weight loss surgical procedures in the United States range between $15,000 to $30,000.  These costs may or may not include laboratory and x-ray fees, use of the hospital facility, surgeon's fees, or anesthesiology. Patients are advised to ask regarding such costs, as well as costs for the hospital stay, if necessary.

In the United States, insurance providers may or may not cover all the costs of weight loss surgery. Some private insurance carriers will pay up to 80% of cost of surgical procedures, leaving the patient to bear the other 20%. Coverage may also be limited to various types or techniques of bariatric surgery specified in individual health insurance contracts.

In the United States, Roux-en-Y surgery averages around $25,000, while patients traveling to India may spend approximately $16,000 on the same procedure. Those traveling to South American destinations may pay around $10,000.

In the U.S., lap band surgical procedures may range between $15,000 and $20,000, while in locations such as Costa Rica, patients pay an average of $8,000.
 
Choosing the Right Doctor
As with any other type of surgical procedure, patients should make sure that their surgeon is trained and belongs to a surgical or medical doctor association or organization in his or her country of origin. In addition, the surgeon performing any of the above procedures should be considered a bariatric surgeon and belong to a college or association of surgeons who specializes in gastric and bariatric procedures.

A bariatric surgeon should be experienced in the specific weight-loss technique an individual is looking for, and the board certified by the American Board of surgery or the American Osteopathic Board of Surgery. Surgeons should also be a member of the American Society for Metabolic and Bariatric Surgery, or similar organizations and associations in their country of origin, and have performed at least 25 bariatric procedures as a primary surgeon.

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