Weight Loss Surgery

Are you are thinking about having weight loss surgery in Leeds?

This page will help you to find answers to two basic questions about weight loss surgery (bariatric surgery):

  • Do I need to have weight loss surgery?
  • What are the weight loss operations and which one should I have?

1. Do I need to have weight loss surgery?

The National Institute for Health and Care Excellence (NICE) recommends that weight loss surgery is an option if your body mass index (BMI) is more than 40 kg/m2. The BMI cut-off is lowered to 35 kg/m2 if you have developed some medical condition because of obesity. But, careful thought may be given to weight loss surgery even if your BMI is between 30 and 35 kg/m2. In the USA, the FDA has approved the gastric band for people with BMI more than 30 kg/m2 if they have a medical condition linked to obesity. NICE recommends that bariatric surgery may be considered if your BMI is more than 30 kg/m2 and you have recently been diagnosed with type 2 diabetes. Asian people have increased pre-disposition to complications of obesity and lower BMI cut-offs should be applied. Ultimately, NICE guidance has to be applied in the light of your individual situation. Also, the gastric balloon is licensed for use in people with BMI more than 27 kg/m2.

To find out whether weight loss surgery is suitable for you, answer the following three questions:

Determine your BMI by using the NHS Healthy Weight Calculator.

Obesity can cause many health problems. Medical conditions that are caused or related closely to obesity are called co-morbidity. Do you have any co-morbidity?

Have you tried to change your eating habits and lifestyle? Do you try to do physical exercise? Have you ever joined any slimming clubs? Has your doctor prescribed a weight loss tablet called Orlistat (Xenical™)?

2. Which weight loss operation should you have?

There are 3 bariatric operations: gastric band, gastric bypass and gastric sleeve. All operations are done by laparoscopy (keyhole surgery). In the UK, about 1/2 of bariatric operations are gastric bypass, 1/4 are gastric band and 1/4 are gastric sleeve. If you do not want to have an operation, you can think about the gastric balloon or the Endobarrier. The gastric balloon and the Endobarrier are done by endoscopy. No cuts are made on your body.

We do not have clear-cut scientific information to recommend the choice of one operation over another. In fact, a national trial called the By-Band-Sleeve Study is ongoing in order to find out which operation might be best. Each of the operations has pros and cons. These pros and cons have to be put into the context of your own medical condition and personal circumstances.

Mr Sarela will help you to understand your individual medical requirements and the effects of the gastric bypass, gastric sleeve and gastric band. Mr Sarela may recommend one operation, based on his medical knowledge and experience, but your preference is very important in making the final decision.

Ultimately, the choice of operation will be a shared decision between Mr Sarela and you (and any significant other person that you choose to involve in the decision-making).

Compare the 3 operations by their benefits, risks and follow-up requirements so that you can form a preference.

Generally, the gastric bypass gives more weight loss than the gastric sleeve, which gives more than a gastric band. But, weight loss depends also on other factors, such as your starting BMI and gender. Generally, people with BMI less than 50 have more weight loss (weight loss from bariatric surgery is talked about as percentage excess weight loss or %EWL) than those with BMI higher than 50. Basically, the %EWL reduces as you get heavier. Also, women lose more weight than men when BMI is less than 50. Once BMI crosses over 50, the %EWL is similar for men and women.

The table compares %EWL for the gastric band, gastric sleeve and gastric bypass, according to BMI and gender:

Gastric Band Gastric Sleeve Gastric Bypass
Women with BMI less than 50
55-60% EWL 70% EWL 75% EWL
Men with BMI less than 50
45-50% EWL 60% EWL 65-70% EWL
Men or Women with BMI more than 50
40% EWL 50% EWL 60-65% EWL

With the gastric bypass and the sleeve gastrectomy, you will lose weight during the first year after the operation. With the gastric band, weight loss is slower and it happens over 2-3 years. You have now reached your new weight. This is called the plateau. It is like a weight-thermostat in your body has been set to lower level. Once you have reached your plateau, the bariatric operation will help you to maintain your new weight.

Also, you should think of the overall benefit to your health and well-being after bariatric surgery. Studies have shown improvements in health after each of the 3 bariatric operations. But, like weight loss, the health-improvements generally are maximum with gastric bypass, followed by gastric sleeve, and then the gastric band.

Basically, there are risks for two types of problems after bariatric surgery. The first type of problems are those that can happen during the operation or during the first few days or weeks after the operation. These are called early post-operative complications. The second type of problems are those that can happen many months or even years after the operation. These are called late complications. There are different types of early complications and late complications with the gastric band, gastric sleeve and gastric bypass.

The risk for serious early post-operative complications depends greatly on your pre-existing health. We estimate the risk of early post-operative complications by using the Obesity Surgery-Mortality Risk Score. You can calculate your own risk by this simple score

Answer Yes or No to each of the following five questions:

  • Are you 45 years or older?
  • Are you male?
  • Is your BMI 50 or more?
  • Do you have high blood pressure?
  • Have you had thrombosis or embolism (blood clots) in the past?

If you have answered No to all questions or Yes to only 1 question, then you fall in the lowest risk group (called class A) for weight loss surgery.

If you have answered Yes to 2 or 3 questions, then you fall in the intermediate risk group (called class B) for weight loss surgery.

If you have answered Yes to 4 or 5 questions, then you fall in the high risk group (called Class C) for weight loss surgery.

Bariatric surgery is generally very safe. The risk of death is less than 1 in 1000 if the risk score puts you in Class A or Class B. But, if you fall into class C then your risk will be much higher. The risk depends also on the type of operation that you have.

The risk for serious early post-operative complications is least for the gastric band and higher for the gastric sleeve and the gastric bypass. There is not much difference in risks between the gastric sleeve and the gastric bypass if you fall into Class A or Class B. But, if you are in Class C, then gastric bypass can carry higher risks than sleeve gastrectomy.

Also, remember the long-term risks from the gastric band, gastric sleeve and gastric bypass. There are trade-offs. For the gastric band, the risk for early complications is small but the risk of long-term problems is high. For the gastric sleeve and the gastric bypass, the early risks are higher than with banding. But, long-term risks from gastric bypass and gastric sleeve are relatively low.

You should weigh up both, early risks and long-term risks, when choosing a weight loss operation.

The follow-up for gastric band is quite different from the follow-up for gastric sleeve and gastric bypass. After the gastric band operation, you will need to have band-adjustments (band-fills) to get the right sense of fullness and less hunger. In contrast, no adjustment is needed for the gastric sleeve and the gastric bypass. The effects of the gastric sleeve and gastric bypass start immediately after the operation.

Also, there are some differences in the follow-up medicines and blood tests. After all three operations, you should take a multi-vitamin and mineral capsule daily.

With the gastric sleeve and the gastric bypass (but not with the gastric band) you will need also to take calcium-Vitamin D tablets and iron tablets daily, and Vitamin B12 injections every 3 months. Also, there are some extra blood tests that are needed after gastric sleeve and gastric bypass.

Print this page | Last updated: 14/11/2016