Weight Loss Surgery Questions and Answers
By Dietitian, Juliette Kellow BSc RD
Is surgery suitable for anyone with a weight problem?
This report outlines that bariatric surgery – surgery to help people lose weight – is only suitable for those with a Body Mass Index (BMI) of 40 or more, where all other methods such as diet and exercise have failed to reduce weight.
It’s also considered to be suitable for people with a BMI of 35 or more who have another health-related problem that could be improved by losing weight, such as type 2 diabetes or high blood pressure.
Surgery is also considered to be a suitable option as a first-line treatment for people with a BMI over 50, presuming they are suitable for surgery. This means someone who is 5ft 7in may be considered for surgery if they weigh 102kg (16st) and have another health problem (BMI of 35), 116kg (18st 3in) if other weight loss methods haven’t worked (BMI of 40) or 145kg (22st 12lb) even if they haven’t tried to lose weight in the past (BMI of 50).
How does surgery work?
There are several different types of weight loss surgery available but ultimately, they all work to reduce the number of calories available to your body.
This means, your body starts using its fat stores to provide it with the energy or calories it needs to function properly. As you lose your fat stores, you start to lose weight.
What types of surgical operations are available?
There are several procedures to choose from and people who are suitable for surgery should discuss the risks and benefits of each with a health professional.
Some surgical weight loss procedures reduce the size of the stomach so that only small amounts of food can be eaten; others bypass part of the small intestine so that the body absorbs fewer calories from food; and others combine the two.
Which surgery should I choose?
This should be a decision between you and your surgeon.
The NICE guidelines don’t recommend one particular surgical procedure over another and instead suggest that the patient and the surgeon should make the decision jointly. The decision should take into account your BMI and any other conditions that are caused by being obese, for example, type 2 diabetes or high blood pressure.
What else should I consider?
Going ahead with weight loss surgery shouldn’t be undertaken lightly and it’s important that you research and discuss all the possible options with a health professional.
You may also find it helpful to talk to other people who have received the surgery you are thinking of having to get first-hand experience of the treatment. The British Obesity Surgery Patient Association can put you in touch with other people who have received surgery to treat their obesity and can also help to locate a patient support group in your area.
It’s also crucial that you spend time with your surgeon discussing in detail the different procedures and which one will be best for you.
Once you have decided on a procedure, you need to find out who will be performing the operation, how many of these operations they have carried out before, the benefits and any immediate risks and long-term complications.
It’s also important that you have a clear idea of what you will and won’t be able to eat after surgery, both in the short and long term – and are prepared to follow the recommended diet, which will probably be very restricted and extremely different to the one you are used to.
You must also be prepared to commit to the need for regular follow up appointments.
Finally, it’s important to make sure you have realistic expectations and have set achievable goals. It will still take time to lose your excess weight – you won’t wake up after the surgery instantly slim. Plus, even the most effective surgeries will generally only help you lose up to about 75 percent of your excess weight – and that’s after one or two years.
How can I be referred for surgery?
Regardless of whether you plan to have surgery on the NHS or as a private patient, start by making an appointment with your GP. He or she will then be able to refer you to a surgeon who specialises in weight reduction surgery to treat obesity. Your GP may ask you to complete a questionnaire to help him identify whether you would benefit from surgery.
What can I expect when I’m referred to a specialist?
Your surgeon will assess you both physically and psychologically to help him decide whether you will be able to receive an anaesthetic, have the surgery and adhere and cope with a new way of eating after the operation.
You should receive information on the different procedures your surgeon may think are appropriate, including the amount of weight you can expect to lose and any health risks.
Your surgeon should also be able to tell you what follow-up appointments you will need, help to manage and monitor other health problems such as type 2 diabetes and provide psychological support before and after surgery.
He or she should also be able to provide you with information regarding access to plastic surgery to remove excess skin after weight loss if necessary.
How long will I have to wait for surgery on the NHS?
This can vary dramatically depending on where you live, but could take as long as 2-3 years.
Unfortunately, in some areas, there is no funding available for bariatric surgery. If this is the case, you may need to be prepared to lobby your Primary Care Trust. For more information on how to do this, contact the British Obesity Surgery Patient Association, www.bospa.org
How much will it cost to have surgery privately?
Prices vary considerably but expect to pay between £4,000 to £8,000 for a gastric band and £8,000 to £15,000 for a gastric bypass.
You should always check what the cost includes, for example, pre-op assessment and follow-up treatment.
Bear in mind that private practices should still follow the NICE guidelines so you should expect to receive the same quality of care and have the same facilities made available to you as if you were an NHS patient.
Are there any questions I should ask if I’m considering weight loss surgery?
There are lots of questions you should ask. According to NICE, these are some of the main ones you should consider:
- Why are you suggesting an operation for me?
- What exactly does the operation involve and what are the risks?
- How quickly will I lose weight and will I put the weight back on again?
- What will I be able to eat after the operation?
- What support will be available to help me cope after the operation?
- Does my child really need an operation for their obesity?
Will surgery help me get the perfect body?
Surgical procedures are not designed to give you the body of a supermodel and they are certainly not a miracle cure for weight loss.
The main aim of surgery is to help solve the immediate health problems that are associated with being severely obese. As a result, this means you may not even achieve a BMI of 18.5 to 25 – considered to be the healthy range. But it does mean you will get much closer to it.
It’s worth bearing in mind that if you lose large amounts of weight, you may be left with large amounts of excess skin, which some people find just as upsetting as being extremely overweight. Recent TV programs such as Embarrassing Fat Bodies have highlighted the problems associated with weight loss following surgery, and the impact that loose skin can have on an individual.
Because it doesn’t affect physical health, the NHS doesn’t routinely fund plastic surgery to remove excess skin after weight loss, with the result that you may have to have it removed privately if you can’t live with it – and that may cost between £2,000 and £4,000.
What about surgery for children?
Until recently, guidelines recommended that surgery was unsuitable for children under the age of 18 years. However, the new NICE document published in December 2006 relaxed these rules slightly.
The guidelines still say surgery is not generally recommended for children or young people but add that it may be considered for young people in exceptional circumstances if they have achieved or nearly achieved physiological maturity, in other words, if they have been through puberty.
While surgery has been performed on teenagers in America for some time now, in the UK it’s likely that only a small number of under 18s whose health is severely threatened by their weight will be likely to receive surgery to help them lose weight.
I’ve read some people are gaining weight so that they qualify for surgery. Is this to be recommended?
There have been some media reports suggesting that a few people have actively gained weight to increase their BMI to a level that helps them meet the criteria for obesity surgery. However, according to the British Obesity Surgery Patient Association, this only appears to have happened in areas of the country where Primary Care Trusts have imposed a higher BMI than that recommended in the NICE guidelines.
As part of your assessment for surgery, you must be able to prove you are willing to make changes to your lifestyle, which includes adopting a healthy diet. One of the main ways to show this is to actually lose weight, or at least maintain your weight, during the assessment period.
Weight Loss Resources provides tools and information to control your weight by getting your calorie balance right and learning what works best for you. You can access the calorie and exercise databases and keep an online diary. Try it free for 24 hours.
WLSinfo ia charity that offers information, advice and a forum
Overview of weight loss surgery NHS