Marc Bessler, MD
Marc Bessler, MD, director of the Center for Metabolic Surgery and Weight Loss Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, in New York City.
If you are obese and want to get healthy, there’s no way around the need to make significant changes to your lifestyle habits. However, some people who need to get meaningful results faster or who are unable to lose weight any other way opt for bariatric surgery—and advancements and experience have made these procedures much safer than they used to be. For the right candidates and under the right circumstances, this type of surgery can make a dramatic, positive difference in how the rest of your life unfolds. All that said, one thing hasn’t changed about weight-loss surgery—it’s a far more serious undertaking than the hospital billboards would have us believe.
Bariatric surgery is major surgery that alters your body’s primary functions, including digestion. I spoke to Marc Bessler, MD, director of the Center for Metabolic Surgery and Weight Loss Surgery at New York-Presbyterian Hospital/Columbia University Medical Center in New York City, to get expert insight on the full impact of bariatric surgery. He told me that laparoscopic approaches have made many of these procedures safer, resulting in fewer complications and deaths, especially since patients are encouraged to participate in lifestyle-change programs before and after the surgery. Nonetheless, there is still much to consider.
If you’ve tried dieting, you know the biggest problem is keeping weight off long term. “Everybody tries to accomplish this with diet and exercise first, but the vast majority—about 90% of people—aren’t successful,” says Dr. Bessler. He explained that one obstacle for many obese individuals is that the signaling between the brain and the gut has become impaired. They feel hunger and a strong urge to eat more because their bodies continually communicate that they’re not getting enough food.
There are three different surgical procedures for weight loss that are now widely available. Dr. Bessler discussed factors that may influence which type is right for which kind of patient…
What it is: In this procedure, a large section of the stomach is stapled off. A small pouch remains that is connected to a section of the small intestine.
Why it works: Patients aren’t so hungry and therefore lose weight quickly. This is in part because the shrunken stomach can hold just a few ounces of food or liquid and also because the bypass means that hormonal signals of fullness and satiety are sped up, since the undigested food enters the intestine so soon after it is eaten.
Success rate: Just about all (more than 95%) patients lose at least half of their excess weight, making this one of the most effective types of bariatric surgery. An estimated 15% regain a significant amount, however.
Downside: Patients are less able to absorb nutrients from their foods, so those who’ve had this surgery must be vigilant about eating enough protein and will need to take vitamin and mineral supplements. Also, eating sweets or fatty foods can cause cramping, diarrhea, sweating, fatigue and light-headedness.
Best for: Because the overeating impulse gets blocked, this can be a good solution for people who binge on junk food, people who have diabetes and those who have difficulty chewing and eating slowly.
How it works: An adjustable plastic band is surgically inserted then cinched around the upper part of the stomach, limiting how much you can eat and slowing the passage of food into the stomach. Patients feel full after eating less. Since neither the stomach nor the intestine is cut, this is the least invasive weight-loss surgery.
Success rate: Two-thirds of patients meet their weight-loss goals—losing about half their excess weight on average and sometimes much more.
Best for: Since this procedure limits how much you can eat at one time, it can be a good solution for people who are big eaters.
Downsides: Since the opening to the stomach is narrowed, it becomes very hard to digest fibrous foods, pasta, rice and red meat—all foods (especially these) must be thoroughly chewed or patients suffer severe discomfort. Fluids are limited—patients cannot drink any liquids within an hour of eating. Also, in as many as half of patients, the band slips at some point afterward—this requires an additional procedure for adjustment.
How it works: Sixty percent of the stomach is surgically removed and the shape is changed to a tube (or “sleeve”), which results in a permanent restriction on how much food you can eat at one time. Also, the portion of the stomach that produces the hunger hormone ghrelin is removed, so hunger pangs are diminished.
Success rate: Success rate is slightly less than with gastric bypass—mostly because the procedure leaves a larger portion of the stomach intact so patients can still eat more than they should.
Best for: Sleeve gastrectomy doesn’t involve bypass, so patients maintain the ability to absorb vitamins and minerals at near-normal levels, making it a good option for most patients. Dr. Bessler predicts this operation will become more popular because it is more reliable for weight loss than the lap band and simpler than bypass.
Downside: It’s permanent and cannot be undone. If patients overeat, it can stretch the stomach—resulting in the need for an additional procedure.
Bariatric surgery is a big deal—all surgeries carry some risk, and these procedures are major, not minor. The likelihood of certain complications—cardiac problems and pneumonia, in particular—increases with patients’ obesity levels. Depending on the procedure, there is some risk for surgical complications (bleeding, leaks and bowel obstructions) as well.
If you’re considering a bariatric surgery, Dr. Bessler makes the following suggestions…