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Weight-Loss Surgery Options: Which Is Right for You?

Oct. 27, 2021 - Katie McCallum

Weight-loss surgery, also called bariatric surgery, is a life-changing procedure that can help you take control of your weight and improve many obesity-related health conditions.

But it's still surgery — and you likely have a lot of pretty specific questions about it.

Maybe you've already determined that you are indeed a candidate for weight-loss surgery, but — to your surprise — there's more than one weight-loss surgery option to consider.

How do you know which is best for you?

What are the types of weight-loss surgery available today?

"There have been many types of weight-loss surgeries over the years," explains Dr. Garth Davis, bariatric surgeon at Houston Methodist. "The first surgeries were essentially malabsorption procedures, designed to shunt food to the colon as fast as possible so that a person's body wouldn't absorb all of the food they ate."

This worked since absorbing less food results in absorbing fewer calories, but there were problems with these procedures — namely, malnutrition and chronic diarrhea.

"Then we turned to restrictive surgeries," says Dr. Davis. "Instead of blocking how calories are absorbed, the idea was to limit how much food a person could eat by restricting the size of the stomach. In this case, the person takes in fewer calories simply because it takes less food for them to feel full."

While some early variations of restrictive weight-loss surgeries, such as the vertical banded gastroplasty, didn't work too well, today's procedures are very safe and effective. There are also now procedures that combine both the restrictive and malabsorptive concepts together.

The two weight-loss surgery options most widely used today are the:

  • Gastric sleeve, also called a sleeve gastrectomy, which is a restrictive procedure
  • Gastric bypass, also called the Roux-en-Y gastric bypass, which is both restrictive and malabsorptive

Gastric sleeve vs. gastric bypass: Pros and cons?

Before comparing the two procedures, it helps to understand how each works.

"During a gastric sleeve procedure, we're simply reducing the size of the stomach by removing two-thirds of it," explains Dr. Davis. "Meanwhile, food still goes from the stomach to the intestine in its normal fashion."

It's a purely restrictive weight-loss procedure that helps a person feel fuller on smaller amounts of food by reducing the size of the stomach.

"During a gastric bypass procedure, a small gastric pouch is surgically created, which is divided from the rest of the stomach and then re-routed to the middle of the small intestine," says Dr. Davis. "Since food is restricted to this small pouch and bypasses the upper intestine, where some absorption occurs, the gastric bypass is a combination of a restrictive and malabsorptive procedure."

Both procedures, Dr. Davis notes, also help reduce calorie intake since each removes the part of the stomach that secretes ghrelin. Because of the role it plays promoting hunger, ghrelin is often called "the hunger hormone."

The pros and cons of gastric sleeve for weight loss include:

  • PRO: Restricts the amount of food a person can eat
  • PRO: Lowers the level of ghrelin, "the hunger hormone"
  • PRO: Performed as a minimally invasive procedure that involves just five small incisions
  • CON: Can lead to acid reflux or worsen existing acid reflux

The pros and cons of gastric bypass for weight loss include:

  • PRO: Restricts both the amount of food a person can eat and the calories absorbed by the intestine
  • PRO: Can help manage or even cure type 2 diabetes
  • PRO: Lowers the level of ghrelin, "the hunger hormone"
  • PRO: Can almost always be performed minimally invasively
  • CON: Potential to develop nutrient and vitamin deficiencies since the upper small intestine is bypassed
  • CON: Can lead to chronic diarrhea and ulcer formation

Is there a "best" weight-loss surgery option?

The best weight-loss surgery option, says Dr. Davis, comes down to the one that's best for you, specifically.

"We have to look at each person individually and tailor the decision of which option is best to their personal weight-loss history and underlying medical conditions," Dr. Davis emphasizes. "For instance, if a person comes to me with a body mass index (BMI) of 42 and they have severe reflux and diabetes, a gastric bypass is likely their best option. Whereas a gastric sleeve might be the better option for a person with a BMI of 48 who's young and otherwise healthy."

Dr. Davis says three other factors also can affect the success of weight-loss surgery:

  • Your commitment to adopting a healthier lifestyle
  • Finding an experienced bariatric surgeon who's part of an accredited program recognized by the American College of Surgeons (ACS)
  • Choosing a weight-loss surgery team that provides long-term support

From genetics to socioeconomic issues, there are many factors that can lead a person down the path to excessive weight gain. Similarly, there are many changes that must be made to lose weight and keep it off.

"It takes adopting a new, healthier lifestyle," adds Dr. Davis. "Weight-loss surgery is a tool to help you get there, but it must be paired with lifestyle changes, such as eating healthier and exercising regularly. In addition to the highly skilled, experienced bariatric surgeons, one of the huge benefits of the weight-loss surgery team at Houston Methodist is that we have staff dedicated to supporting you beyond your surgery through monthly support groups, nutritional guidance and exercise advice."

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