Bariatric surgery is a drastic weight-loss move. Specialist bariatric dietitian Zoe Wilson weighs options and outcomes.
For those who have tried almost everything and still struggle to lose weight and keep it off, bariatric surgery can seem the solution. Is it really?
When is surgery appropriate?
Being obese doesn’t in itself automatically qualify you for surgery. However, you may be a suitable candidate if:
You have a Body Mass Index (BMI) of 40 or more (this can typically translate to being overweight by 45kg or more).
You have a BMI of over 35 and are suffering from other health issues that may improve with weight loss (eg, diabetes or heart disease).
You’ve tried all appropriate non-surgical measures, but still have not achieved or maintained adequate weight loss.
You are generally fit for anaesthesia and surgery.
You’re committed to the need for long-term follow-up.
What are the benefits?
You can expect to lose between 60 to 70 per cent of your excess body weight (the weight you carry above your ideal BMI). The amount that you lose depends on a number of factors, such as your age, prior health conditions, the type of surgery being performed, your diet following surgery, your level of motivation, and social support provided afterwards.
After surgery, you may also reduce the amounts of medication you take for type 2 diabetes, high cholesterol, high blood pressure or reflux, or even come off meds altogether. Often people feel more confident, have more energy, enjoy moving again and improve their relationship with food.
Any side effects?
It’s common to experience reactions like nausea, vomiting, stomach cramps and dizziness if you overeat, particularly sweet foods. Retaining large amounts of excess skin is a common complaint.
How does it change your eating habits?
After a liquids phase, most people can slowly begin eating normal, healthy foods 8–12 weeks following surgery, but in much smaller quantities.
You’ll need to spend 20–30 minutes eating a meal — taking small bites to avoid discomfort or reflux. And you’ll need daily vitamin and mineral supplements.
What’s the cost?
Each surgeon will have a different cost. You’ll generally need to either use your private health insurance or pay upfront, but in some cases, you can access your super.
Is it for you?
Only if you’re prepared to change your lifestyle and eating habits dramatically, and commit to long-term follow-up with your surgical team. Bariatric surgery involves huge physical and psychological changes, and it can be a shock to realise you’ll never eat the same way again. If you’re considering it, discuss it with your GP.
Types of surgery
A soft band is placed around the top of your stomach, dividing the stomach in two. Since the upper portion of the stomach fills up quickly, you’ll feel full faster and eat less food. This procedure is reversible, but often has the most complications.
This surgery divides your stomach in two sections. The small upper stomach is about the size of a lemon, and because food bypasses the main stomach, you can’t eat much and you also absorb less. This procedure is technically reversible, but rarely ever is.
This operation permanently removes 85 to 90 per cent of the storage capacity of your stomach, which decreases appetite and results in early satiety. This procedure is irreversible, but has less long-term risks and complications than the other surgeries.
‘I feel 10 years younger with the energy to match!’
When I finished school, my weight began to increase, due to changes in lifestyle, emotional eating and depression. This began a long 10–year cycle of losing and gaining weight. Each time I’d find myself gaining back more weight than I’d lost.
We took the kids on a holiday to Hong Kong in June 2014. It was hot, humid and I spent the entire trip sweaty and uncomfortable. What should have been an enjoyable vacation just made me realise how much my weight had affected my life.
I had gastric sleeve surgery in September 2014. I wasn’t at my biggest then (120-plus kg), but on the day of the surgery I was 104kg. I lost over 40kg due to the surgery, the majority within the first nine months. Now I try to keep my weight between 62–65kg. I don’t weigh myself all that often, but tend to go by my clothes and how tightly they fit.
I have so much more energy now to keep up with the family! I have a family history of diabetes, and had high blood pressure before the surgery, which is now back within a normal range. I was always fairly active (I believed I was fat-fit), but now I feel 10 years younger — with the energy to match! I go to the gym, do yoga, and have no problem keeping up with the kids at the park.
I still enjoy eating out with friends and family. I generally order an entrée-sized meal. I’m a bit of a ‘cheap date’ now — because my stomach is a lot smaller, I’m quickly affected by alcohol, so after two glasses of wine I’m ready to go home!
Bariatric surgery is not the easy option. I had tried so many diets, exercise programs and weight-loss shakes to get to that point. Part of my success in losing weight and keeping it off is because I always considered the surgery to be a tool, not a complete solution to weight loss. I still need to eat nutritious food, exercise, and continue a healthy lifestyle to prevent future weight gain.
I would recommend the surgery to others, but it isn’t a ‘quick fix’ for weight loss. The only thing that’s different after you wake up from surgery is that you have a smaller stomach. You still have to commit to lifestyle changes and carefully select the sorts of foods that your body needs, as your stomach can’t fit very much! The benefits to my health, self-esteem and happiness have made this journey well worth it — and I would do the surgery again in a heartbeat.