Bariatric surgery is a term that includes all types of surgical procedures that facilitate weight loss through the limitation of food intake and/or malabsorption of calories. Due to the numerous medically supervised weight loss programs available to patients today, surgery is often the last report for those with a Body Mass Index higher than 40, or a BMI of 35 and an associated disease, such as high blood pressure, heart disease, diabetes, metabolic disease or sleep apnea.
There are four main types of bariatric surgery: gastric bypass, sleeve gastrectomy, adjustable gastric band (gastric banding), and biliopancreatic diversion with duodenal switch, and given the improvements and advancements to the procedures, it is now possible for surgeons to perform weight loss surgery using minimally invasive techniques. However, weight loss surgery does not cause weight loss directly; it helps in the process, which only begins with the surgery. Patients need to be fully committed to lifestyle alterations and be aware of the long-term results of the surgery.
Long-Term Results of Bariatric Surgery
Weight loss after a bariatric surgery is a long-term project, but when patients commit to a healthy diet and regular exercise, weight loss results can be achieved, as patients maintain on average 50% of their excess weight loss five years after surgery. The weight loss leads to the patient feeling better, having more mobility, and experiencing an improved quality of life. In addition, the outcome of the surgery improves or resolves more than 40 conditions related to obesity, reduces mortality from cancer by 60%, coronary artery disease by 56% and type 2 diabetes by 92%, according to the American Society for Metabolic and Bariatric Surgery (ASMBS).
The long-term benefits of bariatric surgery are not only health-related, as there are also positive economic effects as well. Health care costs for patients suffering from morbid obesity are reduced by 29% on average within five years following bariatric surgery, which is also related to the reduction or elimination of obesity-related conditions. Similarly, the individual results can cause an increase in worker productivity of $2,765 per year for U.S. employers.
Long-Term Requirements of Bariatric Surgery
The benefits are scientifically proven, but losing weight and maintaining the weight loss is not easy and requires commitment and medical attention, as explained in the study “Long-term Management of Patients After Weight Loss Surgery.” Despite the fact that patients are usually excited about the weight loss and all of the improvements it brings with it, it may be easy to go back to old habits, including overeating or being sedentary, leading to a regaining of weight.
“Long-term bariatric follow-up requires a team approach and attention to several aspects of care. Nutrition is the most important aspect of follow-up to safely maximize weight loss and prevent weight gain. Exercise helps to maintain weight loss. Complications need to be identified early and can result from improper behavior or from surgical complications. Emotional difficulties occur in many patients,” state the authors, who also stress the importance of emotional and psychological evaluation to understand the reasons for previous overweight and avoid it during long-term treatment.
Long-Term Risks of Bariatric Surgery
Despite the benefits associated with bariatric surgery, there are also risks — some of them long-term. According to the study “Risks and benefits of bariatric surgery: Current evidence,” open surgery can result in several types of side effects, including postoperative pain, slower return to normal activity, and higher rates of iatrogenic splenectomy and abdominal wall complications, as up to 20% of patients develop incisional hernias. While there are also side effects related with the laparoscopic surgical approach as well, patients often experience less postoperative pain, better postoperative pulmonary function, and significantly fewer wound complications.
Laparoscopic bariatric surgery can, however, cause anastomotic stricture, gastrointestinal bleeding, and late postoperative bowel obstruction. Other long-term effects include bowel obstruction, dumping syndrome that results in diarrhea, nausea or vomiting, the development of gallstones or hernias, low blood sugar also known as hypoglycemia, malnutrition more common when patients don’t take supplementary vitamins and minerals, iron or calcium deficiencies, stomach perforation, ulcers, vomiting, and staple-line failure in the pouch, depending on the type of procedure.