Obese and tired of diets that don’t work? Weight loss surgery is another option

When you’ve carried around too much weight for too long, you might be ready for something  besides another diet. 

A weight loss surgery could be the right next step if your body mass index (BMI) is 40 or higher (at least 100 pounds overweight for most patients), or if your BMI is between 35 and 40 and you also have obesity-related conditions, such as type 2 diabetes, sleep apnea or high blood pressure. 

Such a surgery shrinks the size of your stomach and then, over time, changes your body’s metabolism, significantly reducing your hunger and leaving you full faster. You lose weight — a significant amount — and quickly.  On average, people lose 80 to 100 pounds within the first year of a bariatric surgery.

After the first year, you’ll continue to lose some weight until your body finds a healthier setpoint weight, a weight range your body will maintain. Long-term studies show that most patients keep a significant amount of weight off (25% to 30% of their weight before the surgery) for the rest of their lives.

The drastic drop in weight puts you on a healthier path. Along with getting over most of the conditions your obesity caused and eliminating medications those conditions required, your quality of life will improve dramatically. You’ll be able to play with your kids, exercise and shop for clothes at a typical retail store. 

First steps

You can start losing weight without surgery by working with the staff of dietitians, exercise physiologists, psychologists and obesity medicine specialists at The Ohio State University Comprehensive Weight Management Program. Weight loss medications and counseling could help. 

If you determine you’re interested in having a weight loss surgery, you’ll first meet with our team of psychologists and dietitians that will help you decide if it’s the right decision for you. They can provide support for an eating disorder or eating habits such as binge eating or emotional eating, which could hinder you from losing weight after surgery. 

Weight-loss surgery options

The two main weight loss surgeries performed at Ohio State, the gastric sleeve and the gastric bypass, are both performed laparoscopically. Instead of creating a large incision in your belly area, a surgeon inserts instruments through small incisions in your abdomen and performs the surgery using a camera. 

• Sleeve gastrectomy: Your stomach can stretch to about the size of a football. In a gastric sleeve surgery, a surgeon will remove about 80% of your stomach so what remains is a narrow tube of your stomach that’s the shape of a banana. The surgery lasts about one hour and requires an overnight stay in the hospital. Your recovery takes two to four weeks.
• Gastric bypass: In this operation, your stomach is divided into two parts: One portion is a small pouch the size of an egg, the other is the remaining stomach. The surgeon  connects the egg-size pouch to your small intestine so that food will go through the small pouch into the intestine. The surgery lasts one and a half to two hours and requires one or two nights in the hospital. Recovery takes two to four weeks. 

Changing your metabolism

If you receive either a gastric sleeve or a gastric bypass surgery, the size of your stomach will be made smaller so you take in less food. Why not just eat less and avoid the surgeries? Simply eating less without the surgeries won’t trigger dramatic weight loss. That’s because when you diet, whatever weight you lose, your body will fight to put back on. And it always wins. That does not happen to you after these weight loss surgeries. Instead, you will be eating far fewer calories per day because you feel full so quickly, and your body will allow itself to lose weight without your feeling hungry or deprived. These surgeries lead to changes in your gut hormones that affect hunger. That’s a big part of why the surgeries are successful in the long term, compared with diets.     

Why diets often don’t work

Do people ever lose weight and then regain it? 

While the majority of patients do maintain significant weight loss for the rest of their lives after surgery, about 10% to 15% of the people who have weight loss surgery regain a lot of their weight back years later. This is a chronic disease, and like every chronic disease, treatment is not 100% effective or lasting for everyone. There are many reasons people regain the weight they lost. It could have to do with the person’s genetics, their eating and exercise habits and their access to healthy food.  

Before any weight loss surgery, we do ask all patients to work with our staff to lose about 5% of their body weight through exercise and changing eating habits. This demonstrates a commitment to making the changes necessary for surgery to be successful.    

The surgery is not going to work magically on its own. It should be considered a tool. Weight loss does happen automatically the first few months after surgery. But maintaining that weight loss long-term requires a lot of work. Even after a surgery, you’ll need to make wise choices about food and to regularly exercise if you want to keep the weight off.

Why is it a challenge for people to start the journey to a weight-loss surgery?

By the time people come to our office, they’ve been thinking about a weight loss surgery for years. It feels to them like admitting they failed, that they couldn’t get thinner on their own.

I tell them: If you have heart disease or cancer or a hernia, would you try to treat it yourself? Of course not. You would see a doctor and expect them to treat you for that problem. Unfortunately, as a society we haven’t put obesity in the same category as other chronic diseases. There’s still a lot of bias against people who are obese and a belief that it’s always their fault, that it’s due to a lack of willpower, something they should be able to manage on their own.   

I tell my patients that having weight loss surgery doesn’t mean you’re a failure. It means you’ve taken control of your health and want the best treatment available for your condition. Because of society’s bias against obesity, many people hide the fact that they had a weight loss surgery. Instead, they can be proud of themselves for getting help and getting healthier rather than continuing to fight the uphill battle.