Obesity Surgery

When it comes to losing weight and achieving a healthy body, among the most commonly chosen methods are stomach-reduction (bariatric) surgeries. These procedures come in various approaches but collectively fall under the umbrella of obesity surgery.

What Is Obesity Surgery?

Obesity surgery (also referred to as “bariatric surgery”) is a set of surgical procedures designed to help individuals who are significantly overweight, typically those with a Body Mass Index (BMI) above a specific threshold. Once a patient’s BMI exceeds a certain level, surgical intervention often becomes inevitable.

People with obesity experience the burden of excess weight in nearly all aspects of their daily lives: they may have difficulty climbing stairs, rising from a chair, finding clothes that fit, and maintaining self-confidence. Besides these everyday discomforts, obesity can lead to serious health issues such as respiratory difficulties, fatty liver, type 2 diabetes, or heart disease. Thus, timely treatment is essential.

For those uncertain about starting treatment, it helps to know “Which department performs obesity surgery?” Generally, these procedures are carried out by general surgeons, especially those specializing in metabolic and bariatric surgery. Depending on your health profile, your doctor may recommend non-surgical solutions (e.g., intragastric balloon, gastric Botox) if surgery is deemed unsuitable. Patients are often initially advised to attempt weight loss through diet and exercise; when these conservative methods fail, bariatric surgery may be considered.

Types of Obesity Surgery

Bariatric (obesity) surgery employs various techniques, typically aiming to reduce stomach volume and help patients feel full on smaller food portions. In certain procedures, both the stomach and intestines are modified.

Sleeve Gastrectomy

Among the most frequently performed operations in obesity surgery is the sleeve gastrectomy, in which 80–90% of the stomach is removed. The resulting stomach is shaped like a narrow tube or “sleeve.” A significantly smaller stomach capacity helps the patient feel full quickly on less food. Additionally, because the portion of the stomach that secretes ghrelin (the “hunger hormone”) is removed, appetite decreases dramatically.

After surgery, patients must follow a structured diet under the guidance of a dietitian, progressing from liquids to pureed foods and then to solid foods. Research suggests that within a year, most sleeve gastrectomy patients lose about 60–80% of their excess weight, provided they maintain a healthy lifestyle.

Gastric Bypass

Another common bariatric approach is gastric bypass. Here, the stomach is divided into two segments (one smaller and one larger), and part of the small intestine is rerouted so that food bypasses the duodenum. This setup restricts calorie intake and decreases nutrient absorption. Gastric bypass patients often need lifelong vitamin supplementation, and closely following dietary recommendations is crucial for sustained success.

Duodenal Switch

The duodenal switch procedure is typically reserved for patients with a BMI over 50. It reduces the stomach’s size and bypasses a large portion of the small intestine, significantly limiting how much food the patient can consume and absorb. This surgery can be highly effective for individuals who eat a diet high in fatty foods.

Mini Gastric Bypass

Mini gastric bypass is another bariatric surgery variant, entailing a partial bypass of the small intestine and division of the stomach into sections. Like other bypass methods, it targets both reduced portion sizes and decreased nutrient absorption.

Who Qualifies for Obesity Surgery?

Not every overweight individual is a candidate for bariatric surgery. Common criteria include:

1. BMI ≥ 40: Surgery is typically advised for those with morbid obesity.
2. BMI 35–40 with Comorbidities: If the patient has coexisting conditions like type 2 diabetes, sleep apnea, hypertension, or infertility, they may be eligible.
3. Failure of Non-Surgical Methods: The patient must have attempted diet, exercise, and other methods without adequate success.
4. Absence of Substance Dependence: No active alcohol or drug addiction.
5. Mental Fitness: No severe psychiatric condition that impedes understanding or compliance with treatment.

Risks in Obesity & Metabolic Surgery

Like all surgeries, bariatric procedures bear short- and long-term risks. However, such risks are generally minimized when an experienced surgeon operates in a modern, sterile facility with appropriate post-op care. Technological innovations—like robotic assistance—have further reduced complications. Some notable potential risks include:

• Intraoperative Complications
  – Infection: Addressed by proper sterilization and antibiotics, if needed.
  – Anesthesia Issues: Monitored and managed by the anesthesiologist.
  – Bleeding or Clotting: Venous thromboembolism risk is lowered with early mobilization and blood-thinning medication.
  – Gastrointestinal Leaks: Surgical connections in the digestive tract sometimes fail to heal fully, causing leaks.
• Long-Term Complications
  – Bowel Obstructions
  – Dumping Syndrome (if high-sugar or high-fat foods are consumed)
  – Gallstone or Kidney Stone Formation
  – Hernias
  – Hypoglycemia (low blood sugar)
  – Revision Surgery: In some cases, a secondary (revision) operation may be required.

Strict adherence to medical guidance—especially regarding diet, follow-up visits, exercise, and supplement intake—helps patients avoid most complications and comfortably adjust to their new anatomy.

Other Common Risk Factors

Bleeding

• Stomach, intestines, and neighboring organs such as the liver and spleen are highly vascular. While most bleeding self-resolves, persistent hemorrhage may require surgical intervention.

Venous Thromboembolism

• Prolonged immobility around surgery increases the risk of blood clots in leg veins, which could travel to the lungs (embolism). Hospitals use blood thinners and encourage early ambulation to mitigate this risk.

Leaks

• Sutured areas in the gastrointestinal tract may develop small gaps if healing is incomplete, causing internal leaks. If high fever or severe pain emerges in the first two weeks post-op, immediate evaluation is critical. Leaks can be managed through endoscopic or revision surgeries; typically, the risk stands at 1% in obesity operations.

What Is the Process of Obesity Surgery?

1. Patient Acceptance: Recognizing the severity of obesity and seeking expert evaluation.
2. Medical Assessment: If your BMI ≥ 35, you may undergo lab tests, imaging, and a detailed health review.
3. Choosing a Technique: Based on your exam results, lifestyle, and comorbidities, the surgical team recommends an appropriate bariatric procedure.
4. Operation: Frequently done using robotic or laparoscopic approaches, needing only small incisions, thus speeding recovery.
5. Hospital Stay: Varies by method; laparoscopic patients typically need a shorter stay.
6. Recovery: Over time, the patient transitions from liquid to pureed to solid foods. Regular check-ups ensure smooth adaptation.

Recovery After Obesity Surgery

During post-op recovery, the patient must follow a nutritional plan set by a dietitian, beginning with liquid foods and progressing to solids over several weeks. The multi-stage diet approach is essential to allow the gastrointestinal system to adapt. Some guidelines:

1. Clear Liquids (first 2–3 days): Water, herbal tea, thin broths.
2. Liquid Diet (~2 weeks): Fat-free milk, light yogurt, protein shakes, and other easy-to-digest liquids.
3. Pureed Diet (weeks 3–4): Blended veggies, soft cheeses, pureed meats, and fruits.
4. Soft Foods (~week 4 onward): Gentle transition to solid foods, monitoring tolerance.
5. Full Solids (~week 9): Gradually resume normal diets, but with limited portions of healthy foods.

High-quality protein, fiber, vitamins, and adequate hydration are crucial. To preserve lean muscle and expedite healing, patients are urged to adhere to medical advice regarding supplements and exercise. Light workouts (e.g., a half-hour walk) generally start once the doctor approves.

Postoperative Exercise

Because many bariatric procedures are minimally invasive (laparoscopic) and require only small incisions, patients typically recover faster:

1. Begin Slowly: Start with gentle walks to enhance weight loss and blood circulation.
2. Increase Intensity Gradually: As your recovery improves, diversify your routine.
3. Benefits: Exercise boosts metabolic rate, preserves muscle mass, and supports healthy bones and joints.

Pregnancy After Obesity Surgery

Obesity can negatively affect fertility and pregnancy. However, many women find that procedures like a sleeve gastrectomy improve their chances of conceiving and lead to safer pregnancies. Nonetheless, waiting 12–18 months post-surgery before attempting pregnancy is advisable, ensuring the body has adapted and nutrient deficiencies have been addressed.

The Importance of Protein Post-Surgery

Reduced stomach size often limits protein intake. Insufficient protein can slow wound healing and compromise bodily functions. Guidelines from the World Health Organization (WHO) suggest approximately 0.8–1 g of protein per kilogram of body weight. If regular meals do not meet this requirement, additional protein supplements may be recommended. Protein should ideally come from natural food sources.

Hair Loss After Bariatric Surgery

Hair thinning or loss can occur postoperatively, typically because of insufficient protein, vitamins, or minerals—and especially during rapid weight loss. Such hair loss is frequently most prominent within the first 6–8 months. Proper nutrient intake often helps hair regrowth to stabilize by around the eighth month.

Vitamin Use After Bariatric Surgery

Different procedures impose varying requirements for vitamin and mineral supplementation. Gastric bypass patients typically need lifelong supplements due to malabsorption, while sleeve gastrectomy patients generally do not face malabsorption issues. However, because smaller meals may reduce overall nutrient intake, regular blood tests can detect deficiencies of calcium, B12, iron, vitamin D, folic acid, and other essential micronutrients.

Revision Surgery in Obesity Treatment

Revision surgeries might be needed when a prior bariatric procedure fails to achieve goals or the patient experiences complications such as significant reflux, insufficient weight loss, or weight regain. Examples include switching from sleeve gastrectomy to gastric bypass or repeating a sleeve procedure. Although each additional operation involves some risk, skilled surgical teams aim to minimize complications while optimizing weight outcomes.

Cost of Obesity Surgery (2024)

The cost of bariatric procedures varies widely based on:

• Hospital/Clinic
• Surgeon’s Experience
• Surgical Technique
• Additional Treatments or required resources

Many countries’ public insurance (like SGK in Turkey) and private health plans may cover part or all expenses if the patient meets specific conditions (e.g., BMI ≥ 40, or 35–40 with comorbidities). Confirm coverage details with your insurer.

Frequently Asked Questions

1. How much does obesity surgery cost?
   Costs vary by hospital, surgeon, and procedure type.
2. What does obesity surgery accomplish?
   It aims to help patients lose significant weight and improve overall health.
3. At what weight does obesity surgery start?
   BMI is more important than absolute weight; typically, surgery is considered at BMI ≥ 35, especially if comorbidities are present.
4. Who qualifies for obesity surgery?
   • BMI 35–40 with comorbidities
   • BMI ≥ 40 without comorbidities
5. Which doctor handles obesity surgery?
   These operations are typically performed by a general surgeon specialized in bariatric/metabolic surgery, often in consultation with dietitians and other specialists.

6. Does public insurance (SGK) cover obesity surgery?

   • Usually yes, if BMI ≥ 40
   • If BMI 35–40 and serious health issues exist, coverage can apply as well.