What are the types of weight loss surgery?

“Each type of weight loss surgery has its own benefits and drawbacks; in general, the criteria to qualify for each surgery are the same.” said Meredith C. Sweeney, M.D., a general, bariatric and laparoscopic surgeon with Norton Surgical Specialists. 

Sleeve gastrectomy

Sleeve gastrectomy, or gastric sleeve, involves a surgeon removing a large part of the stomach. The part that remains is shaped like a banana and is a fraction of the size of the original stomach. This procedure limits the amount of food you can eat at one time and is almost always done laparoscopically, meaning the surgeon makes only small incisions. After surgery, patients will find that they get full with just a very small meal. 

Gastric bypass

Gastric bypass, also called Roux-en-Y gastric bypass, is a procedure that has been used for over 60 years. In a nutshell, gastric bypass creates a small pouch from your stomach and connects it to the intestines. After surgery, when you eat, the food enters the smaller stomach pouch and then flows directly into the intestines. The surgery usually can be done laparoscopically. Gastric bypass works by limiting the amount of food you can eat and the nutrients that are actually absorbed.

Gastric band

Gastric banding  puts a silicone device around the upper part of the stomach, almost like a belt. The band is then connected via tubing to a port under the skin and can be inflated with saline inserted by the surgeon. This surgery works by limiting the amount of food you can eat at one time and by making you feel full with a small amount of food. The band can be adjusted and even removed. This surgery also is done laparoscopically.

“Each surgery comes with its own risks, side effects and results,” Dr. Sweeney said. “It’s important to talk openly with your surgeon so you can make the best choice for you.”

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“I was an active teenager, so it had never been a problem,” Ashley said.

She remained active through college, but after a torn knee ligament put an end to that and she got pregnant in 2008, her weight crept up.

A startling realization

Through her 20s, Ashley tried a few diets and various workout programs.

“I did a boot camp, and I remember one of the other participants being concerned for me because I struggled so hard,” she said.

She walked outside after that, because group workouts felt embarrassing. Ashley did several popular diets, including keto.

“I would lose a few pounds, maybe 10, and then think, ‘Oh wow, now I can go eat McDonald’s,’” she said.

The yo-yo dieting and intermittent activity continued halfheartedly until 2017, when two events had her making some serious changes.

“I went to Kentucky Kingdom with my daughter. I was too big to get on a ride,” she said. “I had to get off the ride, and I was mortified.”

Later that summer, the scale at the doctor’s office showed her weight as 278 pounds. At 5 feet, 6 inches tall, it put her body mass index (BMI) at over 40.

“I knew I had to do something,” she said.

Choosing weight loss surgery

The first step was a free weight loss seminar.

“I had already committed to doing something, and I knew it had to be permanent,” Ashley said. “Doing it all on my own, relying on willpower, it wasn’t working.”

She met with Benjamin D. Tanner, M.D., bariatric surgeon with Norton Weight Management Services.

“I was leaning toward the gastric sleeve, rather than the lap band, because it was going to be permanent,” Ashley said.

The hard part of gastric sleeve surgery

“Surgery was the easy part,” Ashley said. “There were a lot of tears after, until I got used to how things were. Knowing what might happen and actually experiencing it is different.”

Her procedure was in November, so the holidays were difficult.

“Everyone is eating cookies and turkey, and I’m having a little piece of ham and some green beans and I’m full,” she said.

There have been ups and downs over the last four years. Down times include severe hair loss and gallbladder surgery, both related to weight loss surgery. Her lowest weight was 136 pounds, but it felt unhealthy. Before surgery, Ashley recalls being fat shamed, but her new slim figure led to a different kind of shaming. “People would say, ‘You’re too skinny, you need to eat,’” she said.

Feeling and looking her best

Ashley has gotten back into activity, including running and spin classes. Her relationship with food also drastically improved.

“I don’t eat sugar; I don’t drink soda. I eat as clean and colorful as possible,” she said.

She also doesn’t restrict.

“I eat bread. I eat pasta. I can eat those things in moderation,” she said.

From 278 pounds, Ashley has lost about half of that.

“Women’s bodies fluctuate all the time, but I’m pretty consistently around 150,” she said. “I would recommend weight loss surgery to anyone who’s thinking about it.” These days, she sees her surgery this way: “Bariatric surgery gets you started, and your mindset is what keeps you going. Weight loss surgery is not something you should be ashamed of if it gives you a tool to improve your life.”

Bariatric Surgery Seminar

Led by a board-certified bariatric surgeon, this hourlong educational session includes:

• An overview of the benefits, risks and expected results of each procedure
• Detailed information on the types of surgical solutions we offer
• Details on what to expect, from preoperative preparation through ongoing follow-up care
• Qualifications for surgery and help to determine if you’re a candidate

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What to eat before and after bariatric surgery

Pre-surgery diet

Before bariatric surgery, your doctor might ask you to eat in a specific way to lose some weight — anywhere from 5 pounds to a percentage of your body weight, depending on how heavy you are.

“We want to give you the best shot at success,” said Benjamin D. Tanner, M.D., general and bariatric surgeon with Norton Weight Management Services. “This type of diet before is close to what patients will be consuming after surgery in order to ensure lifelong success anyway, so starting it before surgery only helps develop habits that can continue after surgery.”

Phase 1

For the first few weeks after surgery, you will be on a liquid diet. Fluids such as broth, water and sugar-free Popsicles or gelatin to start with, then after 24 hours, you can add in protein shakes. This continues for about two weeks.

Phase 2

At two weeks post-surgery, you will introduce soft foods including purees, hummus, scrambled eggs and finely chopped meats such as chicken. You still will supplement with protein shakes, and aim to get protein and other nutrients from food as much as possible. At five to six weeks post-surgery, you will slowly integrate tougher textures such as soft fruit and cooked soft vegetables, as well as some grains. This phase lasts through week four.

Phase 3

At five weeks after bariatric surgery, you will be able to eat what will become your “regular” diet. You still will emphasize protein at each meal, include vegetables and supplement as needed.

“There are some foods you might need to reduce or eliminate, based on how your body responds to them,” Dr. Tanner said. “Those include carbonated drinks, spicy food and caffeine. High-sugar and highly processed foods will be greatly reduced as well.”

At this point, you will be able to recognize when you feel full after eating. It will be different from before surgery, and even from the first two phases.

Complications after bariatric surgery

Many patients report experiencing at least mild symptoms of one or more of the following after bariatric surgery.

• Dumping syndrome: Though uncommon, dumping syndrome is when the stomach empties food into the small intestine faster than normal, causing symptoms such as nausea, abdominal cramping and diarrhea. It is caused by eating too much sugar.
• Constipation: Decreased or lack of physical activity, lack of fiber and dehydration contribute to constipation.
• Dehydration: Hydration changes drastically after bariatric surgery. You should not drink fluids with meals and instead should consume about 64 ounces (about 1.9 liters) of mostly water throughout the day.
• Weight gain or failure to lose weight: If you gain weight or don’t lose any weight, talk to your doctor.

“The most successful patients have a combination of tools,” Dr. Tanner said. “They follow the nutrition plan, they pay attention to their bodies’ hunger and satiety [fullness] cues and they have the right mindset. If you haven’t done the mental work, it’s going to be much harder for you.”

Dr. Tanner encourages bariatric surgery patients to have a solid emotional and social support system, as well as a change in their lifestyle to include more activity.

Norton Weight Management Services is recognized for superior care by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery. Norton Women’s & Children’s Hospital is designated as a Blue Distinction Center+ by Anthem for expertise and efficiency in bariatric surgery. These designations may be a requirement of your health insurance plan.

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Cancer and weight

Although researchers don’t know exactly why, cancer risk rises in proportion with higher body weight. Being overweight or obese can lead to more inflammation and increased levels of insulin, growth factor and sex hormones.

“We don’t understand it fully, but hormones play a role in the development of various cancers,” said Jeff W. Allen, M.D., a bariatric surgeon with Norton Surgical Specialists and Norton Weight Management Services.

Weight loss reduces cancer risks

The study published in the American Medical Association’s journal looked at more than 30,000 American adults for about 10 years. For those who had WLS, their risk of developing cancer decreased by 32%, and their chances of dying from it decreased by 48 %, compared with  those who did not have WLS. The study found that the more weight people lost, the greater reduction in cancer risk.

“This study is significant, in terms of its scope and results,” Dr. Allen said. “There is a good chance that any weight loss will result in lower cancer instances, including weight loss through medication or lifestyle modification.”

It is important to remember that being overweight does not automatically mean you will develop cancer, just that research shows a high correlation between the two. Correlation means there is a connection between two variables — such as the connection between weight and cancer.

What’s next?

“Obviously, more research will need to be conducted,” Dr. Allen said. “But this is an important step in understanding the relationship between weight and cancer.”

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There are several types of weight loss surgery. Laparoscopic sleeve gastrectomy (LSG) restricts a patient’s stomach capacity and limits the amount they can eat at one time. Other methods include the gastric bypass (also known as Roux-en-Y) and adjustable gastric banding (simply called “the band”). Recovery times, results and potential complications vary among bariatric surgeries.

A recent study, however, found next-day discharge after LSG to be safe for some patients.

Meredith C. Sweeney, M.D., is a general, bariatric and laparoscopic surgeon with Norton Surgical Specialists; she sees bariatric surgery patients at Norton Weight Management Services.

“Many bariatric surgery centers have been doing this successfully. I have seen wonderful outcomes since beginning my protocol that allows patients to go home safely the day after the surgery,” Dr. Sweeney said. “Most people don’t want to stay in the hospital any longer than they have to.”

The benefits of next-day discharge after surgery

In general, next-day discharge has many benefits, including:

1. Comfort: People sleep better, are more relaxed and can move around more easily in familiar surroundings if they are at home sooner after a procedure.
2. Faster recovery time: You get back to normal activities and daily living routines faster, which is associated with fewer complications.

Candidates for same-day release after bariatric surgery

“About 95% of my patients meet the criteria to go home safely the next day after surgery,” Dr. Sweeney said.

Although many physicians across the country are releasing patients the day after bariatric surgery, only a few in Louisville send patients home the day after gastric sleeve or gastric bypass surgery — with Dr. Sweeney being one of those who have successfully adopted this practice.

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‘Quarantine 15’

The so-called “quarantine 15” (a spin on the “freshman 15” that refers to college freshmen gaining an average of 15 pounds) is real, although the typical average gained during these COVID-19 pandemic months is closer to 29 pounds.

Reasons for weight gain during lockdown and isolation:

• Altered eating patterns
• Stress- or boredom-related snacking or bingeing
• Decreased access to gyms and other physical activities
• Hormonal changes due to stress, such as cortisol increase

Obesity is categorized as having a body mass index (BMI) of 30 or higher. Overweight is considered a BMI of 25 to 29. Although it is a ratio of weight to height and doesn’t directly measure body fat, BMI is usually a reasonable indictor of overall body fat.

Weight can make it worse

“Obesity is tied to many other conditions — such as diabetes, high blood pressure, decreased lung function and sleep apnea — that can make getting any illness worse for someone who is of a higher body weight,” said Benjamin D. Tanner, M.D., bariatric surgeon with Norton Surgical Specialists. “These other conditions often create inflammation in the body. Inflammation is the body’s natural response to infection or injury, where the body releases chemicals to signal repair of tissue. So, diseases such as COVID-19 can be worse if you are already in a state of chronic low-level inflammation.”

What to do

If you’ve gained weight during the pandemic, take comfort in the fact that there are things you can start doing today to turn things around.

“It’s important to know that you aren’t the only one,” Dr. Tanner said. “Give yourself a break and make some tweaks to your routine.”

• Get moving: Exercise makes a huge impact on mood and mental health, and even a little bit can be a benefit. Walk around the block, check YouTube for workouts or simply do some stretching.
• Mindful eating: You need to be aware of what you’re eating and how much. Tracking your meals and snacks is a good way to get the big picture. You can make dietary changes as you see your own patterns emerge.
• Prioritize sleep: Most of us don’t get enough shut-eye, and lack of sleep is connected to higher body weight. Experts recommend seven to nine hours of quality sleep per night. Work on winding down without screens, creating a good sleep environment and try to awaken the same time every day.

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Considering weight loss surgery

When her first child was born when Devin was 18, she gained around 70 pounds with the pregnancy. Then college and nursing school followed, and she never did lose the baby weight.

“I feel food was always the problem for me. I have never been diagnosed with an eating disorder, but I had some bad habits,” she said.

Those bad habits continued through her 20s.

In October 2017, Devin’s mother made some observations that kicked off her daughter’s path to more permanent weight loss.

“We were sitting at her doctor’s office, and my mom said, ‘You look miserable. You look uncomfortable,’” said Devin, who was 31 at the time. “I felt miserable and I was uncomfortable.”

Her mother’s nurse practitioner suggested she call Norton Weight Management Services.

During that call, Devin was told that her height (5 feet, 1 inch) and weight (207 pounds) very likely would qualify her for surgery. The next step was to attend a free bariatric surgery seminar.

Her surgery was scheduled for February 2018.

Gastric sleeve surgery

Weight loss surgeries can be put in two main groups: restrictive and malabsorptive. Restrictive surgeries, including gastric sleeve and lap band, limit the stomach’s capacity and leave the rest of the gastrointestinal tract intact. Some surgeries can be reversed. Malabsorptive procedures include gastric bypass — the oldest and most commonly performed bariatric surgery in the U.S. These surgeries physically limit the stomach’s size and also reroute the food so that less nutrients can be absorbed by the body.

“I knew I wanted a permanent solution,” Devin said. “I knew my mindset had to change, but I had the surgery so I could fix my brain. I don’t have to diet now; I can just … live.”

Recovery and life after weight loss surgery

Devin’s post-surgery life is all about living and eating mindfully, although she still battles “diet mentality.”

“There are times I fall off my eating plan, but now, I don’t beat myself up about it for days. I move on,” she said.

She also started lifting weights and working out on her Peloton stationary bike. She loves podcaster Kim Schlag’s show “Fitness Simplified.” She eats within her stomach’s limit and understands how her body works so she doesn’t overstretch the muscle and undo the hard work she’s put in.

Two years ago, Devin also had what is referred to as a “mommy makeover,” including a breast lift and augmentation, and a tummy tuck.

“It was almost like instant abs,” she said. “It was one of the best things I’ve ever done.”

Devin uses the resources available through Norton Weight Management Services, including the dietitians.

“They also recommended the book ‘The Obesity Code,’ which really got me going in the right direction.”

“The surgery won’t solve all your weight management problems. But for me, it helped me slow down my eating so I could focus on other issues related to my weight,” said Devin. She takes bits and pieces from many programs, books, podcasts and resources to help create a lifestyle and plan that fit her and her goals.

Choosing a weight loss surgeon

Devin didn’t have to look far to find a great care team for her weight loss journey.

“I was already working for Norton Healthcare, so it was the obvious choice,” she said.

Devin went with Meredith C. Sweeney, M.D., a general, bariatric and laparoscopic surgeon with Norton Surgical Specialists. Dr. Sweeney sees bariatric surgery patients at Norton Weight Management Services.

“The thing about Devin choosing me and the group at Norton is that she’s a medical professional. It’s one of the biggest compliments a surgeon can get, to have an insider view of the hospital and medicine, and to have me as her surgeon,” Dr. Sweeney said. “She has a deeper knowledge of surgery and medicine, and we engaged in a real partnership to help her reach her goals.”

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In questionnaires filled out before surgery, six months after and 24 months after, patients reported significantly better quality of life after gastric sleeve or gastric bypass. The study also found significant improvements in body image and self-efficacy – a psychological measure of believing in yourself.

Bariatric surgery also has been shown to improve patients’ sex lives.

“In one study, women who underwent either a sleeve gastrectomy or Roux-en-Y gastric bypass reported an increase in desire and improved sexual activity after surgery,” said Jeff W. Allen, M.D., director, bariatric surgery, Norton Weight Management Services, and a general, bariatric and laparoscopic surgeon with Norton Surgical Specialists. “They also experienced a decrease in urinary incontinence and an overall improvement in quality of life.”

Losing weight and improving obesity-related conditions such as Type 2 diabetes also contribute to improved quality of life after weight-loss surgery, according to another study. Diabetes remission is achieved at a much higher rate through bariatric surgery than any nonsurgical intervention, according to Dr. Allen.

“In other words, while bariatric surgery is not the sole existing therapy for (Type 2 diabetes), it is by far the most effective available ‘curative’ option,” the study concluded. Other conditions that could be relieved with bariatric surgery include hypertension and sleep apnea. Lung function and functional capacity also are increased.

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Prior to surgery, all patients undergo a detailed readiness assessment. They see a nurse, a licensed clinical social worker and a dietitian, who evaluate their readiness to change. The assessment is required by insurance.

We educate patients on lifestyle changes they will need to make. If a patient isn’t ready to make those changes, we’ll delay surgery because they’re not going to be successful.

Patients deemed ready for surgery are educated on the procedure they’ll be undergoing and what they can expect in terms of diet and lifestyle changes. To make the transition easier, I coach patients on how to begin moving toward the diet they’ll follow after surgery. For example, I’ll encourage them to avoid sugary drinks and to eat smaller meals throughout the day instead of a single big meal.

We want them to work on a better meal pattern. Eating once a day and snacking a lot will need to shift to multiple small meals each day after surgery. The stomach will be the size of an egg.

Read more: 8 steps on your weight loss journey

Before surgery: Making the decision

Patients considering bariatric surgery attend a free online seminar with Norton Weight Management providers. The seminar provides more detail about what to expect and the next steps in achieving your weight loss goals.

Our patient navigator is available to help with completing an information packet and to answer any additional questions while patients consider their options.

The next step is the assessment to evaluate the patient’s readiness for weight loss surgery. Patients also get more information on the specific procedure under consideration.

If the patient decides to move forward, they pay a nonrefundable $300 program fee. This fee covers lifetime follow-ups with a dietitian and licensed clinical social worker. For patients who undergo bariatric surgery, studies have shown that strong follow-up greatly increases the chance of a successful outcome.

Even if patients choose not to undergo surgery, they still can take advantage of counseling from me and the two behavioral weight management specialists at Norton Weight Management Services, Melissa Moody, LCSW, and Mary Hargadon, LCSW.

After bariatric surgery: Keeping the weight off

I’ve worked with overweight and obese patients for more than a decade, and the follow-up is probably the most important thing. We want patients to lose weight after surgery and we want them to keep it off. That means staying away from old eating habits and patterns.

Our licensed clinical social workers help them work toward making behavioral changes if they’re stress eaters. Patients typically underestimate the emotional component food plays in their lives. They don’t realize how much they use food to soothe themselves. That’s a major struggle for some people, and that’s why the follow-up is so critical after surgery.

The social workers and I meet with patients one-on-one and develop trust. Patients can also receive consultations using Norton Telehealth to meet with us via video or phone call. Email is also an option. If a patient’s primary language is not English, Norton Healthcare will provide a translator free of charge.

Staying positive with no judgments

As a dietitian, my role is education. Many people wrongly assume they’re eating a healthy diet and aren’t aware of what they’re eating during a typical day. A food diary or using a phone app can help.

A lot of these patients have been obese for years and years and have numerous medical conditions.

They’ve always been told what to do, but feel like they’ve never gotten help with their weight issues. I work with patients to find healthy foods they want to eat.

The diet is tailored to them to help them be successful. I don’t hand them a sheet of paper telling them what they can’t eat. That’s not going to work long-term.

Staying positive with patients is important. Patients feel comfortable coming to us and know we’re not here to judge them. Our role is to support them in whatever fashion they need.

Jennifer Kyser, R.D., CSOWM, L.D., is a registered dietitian with Norton Healthcare.

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“The highest weight I remember was 365 pounds,” she said, but after that, most scales couldn’t accommodate anything higher. She tried diets and fads, including an ear piercing that was supposed to curb her appetite.

“It hurt so bad I went straight to the drive-thru to get a cheeseburger to make myself feel better,” she recalled.

When a job change (and new health insurance) opened the door to bariatric surgery, Renee knew it was time. She attended a free seminar by Norton Weight Management Services and began the journey.

Keeping up with her weight loss has included much more than watching what she eats, although that is a big part of it. She treats her situation like an addiction and remains “sober” by avoiding what she refers to as “recreational sugar” in the forms of sweets and processed foods.

“Having a bite of a cookie isn’t worth the amazing life I have,” Renee said.

Renee also credits power yoga, mindfulness, intermittent fasting and the ongoing support of her Norton Weight Management Services team for helping her keep the weight off. She stresses the amount of mental and emotional work she’s done.

“If you don’t address what’s going on inside, the outside will only be temporary,” she said.

What’s changed in Renee’s life in the last six years? Besides the weight loss, of course, she has transitioned from a job as a cosmetologist into a full-time yoga instructor, sharing her story and guiding participants through a unique combination of 12-step recovery program and power yoga classes.

“My worst day now is better than my best day at 365 pounds,” Renee said.

With her new attitude and mindset, Renee’s set to have many years’ worth of good days.[templatera id=”690859″]

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