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How bariatric surgery works and how to know if it's for you

Main Line Health August 15, 2014 Nutrition and Weight Management
Last Updated on March 5, 2019

For some people, diet and exercise simply don’t work—but it’s not for lack of trying.

Obesity is a complex issue that’s now classified as a chronic disease, according to the American Medical Association. It turns out that being overweight or obese isn’t just about what you eat or whether you’re active enough, but how your body is uniquely influenced by environmental and genetic factors as well as lifestyle.

Now consider the cumulative effects of these influences over a lifetime. For many who have tried to lose weight and keep it off—but continue to end up in an endless cycle of weight loss and gain—it can feel like a hopeless endeavor.

The benefits of weight loss surgery

While bariatric surgery or weight loss surgery is not for everyone, it can be an effective solution for long-term weight loss in people who meet certain criteria, such as body mass index (BMI) over 40, or lower body mass but with certain comorbidities (multiple health conditions), such as diabetes and sleep apnea. It can be especially helpful for people who have “tried everything” and simply can’t lose the weight.

“The main reason patients undergo bariatric surgery today is less related to losing weight and more related to resolving previously chronic, incurable, life-long health issues such as type 2 diabetes, obstructive sleep apnea, hypertension and dyslipidemia among many other conditions,” explains Richard Ing, MD, bariatric surgeon and medical director of the Bariatric Center at Bryn Mawr Hospital. “Bariatric surgery has also been shown to decrease the incidence of future heart attacks and strokes, and reduces the future incidence of multiple types of cancer such as breast cancer, colorectal cancer, prostate cancer, endometrial cancer.”

Bariatric surgery as menopause weight gain treatment?

As just about any woman in her menopausal years knows, it gets more difficult to maintain a healthy weight. Fluctuating hormone levels, loss of lean muscle mass and a corresponding slowdown in metabolism all contribute to the prevalence of American women ages 40 to 59 who are overweight or “affected by obesity,” according to The National Health and Nutrition Examination Survey (NHANES).

Much of a woman’s midlife weight gain happens around the middle where visceral fat, the deep, subcutaneous fat, builds up and surrounds the body’s organs. This type of fat is dangerous because it contributes to inflammatory disease and insulin resistance, among other conditions.

While there are many different approaches to losing weight, from keto diets to Whole30, few women who struggle with obesity find long-term success from these programs. The condition of obesity requires a whole-person approach that touches on psychological and emotional aspects as well as attitudes about food, self, and body, not to mention lifelong dietary and lifestyle changes.

“This is the type of work that we do through our bariatric program,” explains Dr. Ing, referring to the range of services provided by his bariatric team. “If you are a candidate for weight loss surgery and decide to have the procedure, our team is here to support you in the months leading up to surgery to the months and years following surgery and really for the rest of your life. We’re all committed to your long-term success.” Many patients also continue to benefit from the bariatric support group that meets every month in Newtown Square.

Types of bariatric treatments

There are several approaches to bariatric surgery:

  • Malabsorptive – Procedures that change the way the digestive system works, such as laparoscopic gastric bypass, in which food is rerouted past a large portion of the stomach and part of the small intestine which absorbs some calories and nutrients from food. With a smaller stomach you’ll feel full on a smaller amount of food. 
  • Restrictive – Procedures that severely reduce the size of the stomach to hold less food, such as laparoscopic gastric sleeve. The digestive functions remain intact.
  • A combination of the two – Procedures that involve reduction of stomach size without severe food restriction while also reducing the body’s ability to absorb calories and nutrients.

Typically, malabsorptive procedures result in more weight loss than restrictive procedures. At Main Line Health, Dr. Ing performs several different types of insurance-approved bariatric procedures.

Keep in mind that weight loss doesn’t end with surgery, he adds. “Having bariatric surgery means a long-term commitment to regular exercise, specific eating patterns, and other lifestyle changes. Ultimately, surgery and its related weight loss has been shown to reverse the premature mortality associated with obesity and can extend a person’s longevity to a long and productive life. Patients regain their mobility and can reengage socially with their family and friends.”

Wondering if you're a candidate for bariatric surgery? Register for an upcoming seminar or watch an online video to see if it’s right for you.

Editor's note: This post was originally published in August 2014 and has been completely revamped and updated for accuracy and comprehensiveness.