Best Bariatric Surgery Explained: What You Need to Know

Written by Kristen Carli, RD and medically reviewed by Dr. Stephen Boyce, MD

Bariatric surgery is a widely-used weight loss procedure. In this guide, we explore what it entails, the various types of bariatric surgery, tips for selecting the right option, its benefits and risks, common misconceptions, and the role of a multidisciplinary team in the process.

Overview of Bariatric Surgery

Bariatric surgery refers to a variety of kinds of surgical procedures that help with weight loss by making changes to the digestive system. This is for people who are severely obese or are experiencing medical complications associated with their weight. Post-surgery, patients often need to include bariatric vitamins and bariatric protein shakes to support recovery and long-term health.

To be eligible for bariatric surgery, there are a few requirements. The surgery is typically considered for individuals with a BMI over 40, or over 35 with obesity-related health conditions.

The primary goal of bariatric surgery is to reduce health risks related to obesity, including heart disease, high blood pressure, high cholesterol, type 2 diabetes, sleep apnea, and certain cancers. This is done by modifying the stomach and/or intestines in some way to reduce intake, effect absorption, or a combination of both. After the surgery, taking bariatric multivitamins and bariatric calcium chews is often essential to prevent nutrient deficiencies. 

Different Types of Bariatric Surgical Options

Sleeve Gastrectomy:

The sleeve gastrectomy is an irreversible bariatric surgery. It involves removing approximately 80% of the stomach and replacing it with a tube-like sleeve. The small intestine is not operated on or changed. The new stomach holds far less food and liquid, reducing food intake. For Post-surgery, bariatric vitamins chewable can be a good option for patients adjusting to their new digestive capacity. This surgery also reduces hunger since the portion of the stomach that produces the “hunger hormone”, ghrelin, is removed. This surgery is common and effective for weight loss, even in patients with high-risk medical conditions. 

Roux-en-Y Gastric Bypass:

Roux-en-Y gastric bypass is also an irreversible surgery that involves creating a small stomach pouch and rerouting the small intestines. The result of the small intestine is a bowel connection resembling the shape of the letter Y. This surgery both limits food intake and creates malabsorption. It is known for high success rates in improvement of obesity-related conditions, but it is also considered a higher-risk surgery as it is more complex and can result in higher rates of life-long nutritional deficiencies. 

Mini gastric Bypass:

Gastric bypass is the standard version and is often called “mini gastric bypass”. Roux-e-Y is the most common form of this surgery. Mini gastric bypass is considered more simple and less invasive than Roux-en-Y, as mini gastric bypass creates one new connection between the stomach and small intestine and Roux-en-Y creates two. Mini gastric bypass reduces the stomach size and bypasses part of the small intestine, yet it reduces the stomach size less than Roux-en-Y, allowing for slightly more holding volume. After this procedure, liquid bariatric vitamins might be recommended during the early recovery phase for easier absorption.

Biliopancreatic Diversion with Duodenal Switch (BPD-DS):

This is a more drastic procedure where a portion of the stomach is removed and the intestines are rerouted to limit food intake, digestion, and absorption. The procedure involves two steps but it is typically done in one operation: first a sleeve gastrectomy is performed and then an intestinal bypass is performed. This procedure is typically reserved for patients with very high BMI’s. Studies have shown that for patients with a BMI > 50, this procedure provides more weight loss and greater changes of weight loss maintenance than other bariatric surgeries. This procedure requires adequate follow-ups and postoperative care as it introduces a higher risk of nutritional deficiencies and complications.

Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S):

The SADI-S is a more recent variation of the duodenal switch bariatric surgery, combining a sleeve gastrectomy with duodeno-ileal diversion. It’s a simpler, quicker procedure compared to the BPD-DS, as it involves only one surgical bowel connection. While it functions similarly to the BPD-DS, SADI-S may lead to fewer complications and less nutrient malabsorption. It is considered effective for weight loss and improving obesity-related conditions, but being a newer procedure, only short-term outcomes are currently available.

How to Choose the Right Surgery?

Choosing the right bariatric surgery involves an assessment of qualification criteria, medical history, and weight loss goals.

Understanding qualification criteria is an important step in choosing a surgery. Patients’ BMI should first be assessed to determine if they qualify. Additionally, a psychological evaluation can help determine if a patient is able to commit to the long-term lifestyle changes that are required after bariatric surgery. A history of unsuccessful weight loss through other means can also help determine eligibility for specific procedures.  

A complete evaluation of current and past medical history is necessary when determining the type of bariatric surgery that is best for you. Health conditions such as diabetes, hypertension, heart disease, and gastrointestinal issues can influence the type of surgery that is best for you. Specific procedures may introduce an increased risk of complications due to a certain health condition. For example, individuals with diabetes often choose gastric bypass due to the rerouting of the GI tract that may increase the chances of diabetes improvement. A sleeve gastrectomy may be a better choice for individuals who have had multiple abdominal surgeries, take medications for a psychiatric illness, or weigh more than 450 pounds. 

Determining weight loss goals can help identify what surgery is best. Some surgeries like SADI-S may result in greater weight loss but come with higher risks, while others like a sleeve gastrectomy are more suitable for moderate weight loss with fewer complications.

Benefits of Bariatric Surgery

Short-term benefits of bariatric surgery include rapid weight loss, improved metabolic health, and alleviation of obesity-related symptoms. Patients typically lose the most weight in the first 1-2 years following surgery, with weight loss peaking at 6-12 months post-surgery, and stabilizing around 18-24 months. Patients often see quick improvements in blood sugar levels, blood pressure, and cholesterol, particularly in those with type 2 diabetes and hypertension. In a meta analysis by Buchwald et al., type 2 diabetes remission rates after Roux-en-Y gastric bypass were reported to be 80%. Additionally, bariatric surgery has been shown to provide quick relief from issues such as sleep apnea, joint pain, and shortness of breath.

Long-term benefits of bariatric surgery include sustained weight loss, reduction in mortality and morbidity, and an enhanced quality of life. Sustained weight loss is possible with proper follow-up care and adherence to diet and lifestyle changes. Patients should also consider incorporating bariatric probiotics to support digestive health over time.

Compared to obese individuals who choose non-surgical therapy, bariatric surgery has been shown to provide a lower risk of developing chronic conditions, improving life expectancy. The surgery offers long-term psychological and emotional benefits such as self-esteem, decreased anxiety and depression, and improved social and physical activity skills. 

Risks and Considerations

Bariatric surgery comes with risks that should be addressed in both preoperative and postoperative care. As with any surgery there are risks of surgical complications such as infection, blood clots, and leaks in the gastrointestinal system. Some bariatric procedures can lead to nutritional deficiencies that may require lifelong supplementation with bariatric vitamins or bariatric multivitamins with iron to ensure long-term health.. It is important to consider the lifestyle commitment following bariatric surgery, which includes a change in dietary intake, regular exercise, and regular follow-up care. 

Myths About Bariatric Surgery

A common misconception about bariatric surgery is that it is the easy way out and that it is an effortless solution to obesity. Bariatric surgery requires lifelong commitment and is not an easy process. It requires dedication to follow-up care and lifestyle changes.

Bariatric surgery is not a solution for people who do not want to diet or exercise. People who are receiving bariatric surgery are individuals who have tried all other conventional weight-loss methods and have been unsuccessful at sustaining weight loss. It is a procedure that requires a life-long commitment to diet and exercise in order to keep the weight off following surgery. 

Bariatric surgery is not always successful and it does come with its risks. While it does have a good success rate, the long-term success is dependent on the individual’s adherence to post-surgery guidelines. In fact, regular intake of bariatric snacks and bariatric protein bars can help patients manage their new dietary needs post-surgery.

Some people may think that bariatric surgery is for cosmetic reasons, when in reality the primary goal is to improve health and resolve obesity-related health conditions. 

Multidisciplinary Approach

In order for patients to see a high success rate and a positive experience with this process, a multidisciplinary approach is necessary. This approach involves dietitians, psychologists, and surgeons. The team will work together to determine if the patient is a good candidate for the surgery from a nutritional, psychological, and medical viewpoint. Dietitians, physical therapists, medical doctors, and mental health professionals will work with the patient following the surgery to provide post-operative care. 

Bariatric surgery is a highly effective procedure with numerous benefits for individuals with severe obesity. It’s important to evaluate the different types of surgeries available to determine which is best suited to your physical and mental health.

Conclusion

Bariatric surgery is a highly effective solution for individuals struggling with severe obesity, offering various surgical options to aid in weight loss by modifying the digestive system. Procedures like sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion each serve different needs based on patient goals, health conditions, and BMI. 

While bariatric surgery can significantly reduce health risks such as diabetes, hypertension, and sleep apnea, it also requires lifelong commitment to dietary changes, exercise, and supplementation, like bariatric vitamins and protein shakes, to maintain success and prevent complications.

Contrary to misconceptions, bariatric surgery is not a cosmetic procedure or an easy way out—it demands a dedicated, multidisciplinary approach for both pre-and post-surgery care, involving surgeons, dietitians, and psychologists. In fact, regular intake of bariatric supplements, such as Bari Life products, supports patients’ nutritional needs and recovery. Overall, bariatric surgery offers substantial long-term benefits for both physical health and quality of life, provided patients adhere to post-operative guidelines.

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