PeaceHealth Bariatrics at Medical Center Physicians Building

Bariatric surgery, also known as weight loss surgery, helps you lose weight long term. It's done by making your stomach smaller or changing the way your small intestine absorbs food.

Surgeons who are specially trained in weight loss procedures will do your surgery. They are supported by a team of specialists in diet, mental health and patient education who help you adjust to lifestyle changes after surgery.

There are several types of bariatric surgery. No matter which you choose, evidence shows they are the most effective treatments for long-term weight loss.

Research shows that many health concerns associated with obesity can be significantly reduced through bariatric surgery.

Most people stay in the hospital for about two days for a bariatric procedure. Afterward:

• More than 8 out of 10 people no longer have to manage their diabetes.
• 9 out of 10 no longer have to treat their sleep apnea.
• More than 6 out of 10 no longer have to manage high blood pressure.

Losing weight through bariatric surgery helps improve conditions such as arthritis or heart disease, too. Many people also experience greater mobility. Everyday activities may become easier, allowing you to be more active. And long-term weight loss can help with your mental health by raising your self-esteem and improving your confidence.

Bariatric procedures are best for people who can commit to long-term lifestyle changes along with surgery. This includes adjusting when and how you eat, and how much physical activity you do each day.

It’s important to learn what you can about your options. To start, consider asking yourself these questions:

• Am I going to be healthier in the future without weight loss surgery?
• Can I lose extra weight on my own?
• What would my life be like if I were healthier?
• What would be the best type of procedure for me?
• What is the cost to my health and my pocketbook if I don’t have surgery?

Bariatric surgery may be right for you if you are:

• 18 to 74 years old
• Have a body mass index (BMI) of 40 or higher.
• Have a BMI of 35 and another condition related to your weight, such as diabetes, high blood pressure or sleep apnea.
• Don’t drink heavily.
• Don’t use nicotine, marijuana or other drugs, or are willing to quit.
• Don’t have untreated depression or other mental health conditions.
• Have tried to lose weight working with your doctor and haven’t succeeded.

Weight loss surgeries use two different techniques: Restriction and malabsorption.

• Restriction reduces how much food or calories you can take in. It does this by limiting the stomach space available for food.
• Malabsorption reduces the amount of nutrients absorbed from food you eat. It does this by changing the path of your small intestine.

PeaceHealth offers three main types of bariatric surgeries. They are done using minimally invasive techniques. We offer:

• Gastric bypass, often called Roux-en-Y (sounds like roo-en-WHY) gastric bypass.
• Vertical sleeve gastrectomy (VSG), or gastric sleeve surgery.
• Duodenal switch surgery at our Southwest location.

Here’s what you need to know about each procedure:

Gastric bypass (Roux-en-Y)

• What it is: This procedure combines restriction and malabsorption for weight loss. It creates a small stomach pouch out of part of your upper stomach. The pouch is then connected to the middle part of your small intestine. It avoids your lower stomach and upper small intestine. A smaller stomach helps you to feel full faster, and you absorb fewer calories.
• How it’s done: Your surgeon separates a small portion from the top of the stomach. This pouch is about the size of an egg. Your surgeon will seal it off with surgical staples, creating your new stomach. Next, they will cut the middle of your small intestine and attach it to the stomach pouch. This bypasses the rest of your stomach and the upper part of your small intestine. Watch an animation of how it’s done.

Bypass surgery is usually done through a minimally invasive procedure. It also can be done as traditional open surgery, but this is rare at PeaceHealth. Open surgery has a larger incision. The minimally invasive option is called laparoscopic surgery. Your surgeon uses tiny incisions and a camera called a laparoscope to do the procedure. Because the incisions are smaller, your recovery time is quicker.

• How well it works: Weight loss happens quickly in the first year after gastric bypass In the second year, you’ll continue to lose weight but at a slower pace. By the end of the second year, patients on average have lost more than 60% of their extra weight. You may lose more than this, or you may lose less.

By eight years after surgery, typical patients have lost more than 50% of their extra weight. This is usually enough to improve their long-term health.

• Other considerations: When you eat after gastric bypass surgery, you’ll feel full quickly. This is because your stomach pouch is now much smaller. You’ll have a smaller appetite and eat less, helping you lose weight.

Vertical sleeve gastrectomy

• What it is: This procedure is sometimes called VSG or gastric sleeve surgery. It creates a stomach pouch about the size of a small banana — which is about 15 percent of your stomach’s original size. Like gastric bypass surgery, it restricts the amount of food you can eat. The smaller stomach pouch helps you feel full sooner. The food you eat goes through your digestive tract as usual, so you can still absorb nutrients.
• How it’s done: In a VSG procedure, your surgeon will separate your upper stomach from the rest of your stomach. They will use surgical staples to form a small pouch, which will be your new stomach. The surgery is usually done with a laparoscope and tiny incisions. This minimally invasive approach means you can recover faster. Because part of your stomach is removed, this surgery can’t be reversed. See an illustration of sleeve gastrectomy.
• How well it works: Within two years after a sleeve gastrectomy, most people lose about 60% of their extra weight.
• Other considerations: Sleeve gastrectomy is a good option for people with conditions like Crohn’s disease or anemia. This is because people who have VSG have less malabsorption (the amount of nutrients you can absorb from your intestines into your bloodstream). They are less likely to experience a common gastric bypass side effect called dumping syndrome. With dumping syndrome, eating sugary foods can cause symptoms such as nausea, sweating, stomach cramps or diarrhea.

Duodenal switch

• What it is: This procedure is highly effective, and PeaceHealth is the only bariatrics center between Vancouver and Olympia to offer it. Duodenal switch changes the size of your stomach and the length of your small intestine. It combines two techniques for greater weight loss. One is restriction (the volume of food you can eat at one time). The other is malabsorption (the amount of nutrients you can absorb from your intestines into your bloodstream).
• How it’s done: Your surgeon will first do a simple sleeve gastrectomy. This procedure uses surgical staples to shrink your stomach to about the size of a small cucumber. This limits how much food you can eat at a meal. You'll then have an intestinal bypass procedure. It is like gastric bypass, but technically different. Intestinal bypass shortens your small intestine by 50 to 75%. Food doesn’t have to travel as far from your stomach through your intestine, so you absorb fewer nutrients. See an animation of how it’s done.
• How well it works: People who have this surgery lose about 80% of their extra weight within two years. And 9 out of 10 maintain significant long-term weight loss. It works well for people with Type 2 diabetes, many of whom can stop taking diabetes medication after their surgery.
• Other considerations: Duodenal switch is a complicated procedure, so it’s not widely available. PeaceHealth Southwest does more of these operations than any other hospital in the Portland metro area. Higher volumes generally lead to better outcomes. This means you can feel confident about your surgical team's expertise.

When you consider duodenal switch, it's important to know that insurance coverage varies. Some companies have BMI restrictions and other criteria for authorization coverage for this procedure. PeaceHealth can help you check with your health plan to see what's covered for you.

Having surgery to lose weight is a big decision. The reasons to consider surgery are different for each of us. Among them:

• Bariatric surgery helps most people lose a lot of weight and keep it off for years to come.
• Losing extra weight can make you less likely to have related health conditions. And if you have a related condition, it can get better. This is especially true for heart disease, type 2 diabetes, sleep apnea, high blood pressure and high cholesterol.
• Losing weight may help you live longer and have a better quality of life.

As you sort through your options, this tool can help you weigh the pros and cons of bariatric surgery.

When you look for a program, check to see if it is accredited. This means that outside experts in bariatric surgery have made sure the program is doing all it can to provide safe, effective care.

Accredited programs have providers who are highly trained, have a lot of experience and a track record of success. The group that grants accreditation makes sure that the program keeps up high standards from year to year.

When you choose an accredited program, you’ll get:

• Safe care tailored to your needs and goals.
• A team of experienced providers who specialize in bariatric surgery.
• Complete care, including support for mental health, nutrition and other services that help you succeed.
• A program that is committed to ongoing improvement, so you can have the best possible experience.

We recommend looking for a program accredited by national organizations like the American College of Surgeons or the American Society for Metabolic and Bariatric Surgery.

PeaceHealth is accredited by the American College of Surgeons’ Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Blue Cross Blue Shield also recognizes our program as a Blue Distinction Center of Excellence for bariatric surgery.

When you have bariatric surgery, it can help you lose weight and improve your health in many ways:

• It can help you manage or cure Type 2 diabetes, lower your blood pressure and reduce your risk of heart disease. It can also relieve sleep apnea.
• It can help you lose weight long term when you haven’t succeeded with diet and exercise alone. After surgery people often feel better and have more energy, too, because they're carrying around less weight.
• After surgery you may enjoy activities that you weren’t able to do before, like playing sports or going for a hike.
• Overall, it can help you live a longer, healthier life.

Bariatric surgery can be a great way to improve your health and feel better about yourself. But it’s best for people who can commit to long-term lifestyle changes after surgery.

Before you make any decisions, reach out to your healthcare provider. Your PeaceHealth team can review your health history and help you decide if its right for you.

Bariatric procedures take time and careful preparation to make sure you have the best possible experience.

For most people, getting ready takes several months. That’s because it’s important to make sure your body is healthy enough for surgery. You also need to get ready to make lifelong lifestyle changes.

Before you can have surgery, you’ll need to:

• Meet with a specialist to see if you qualify for surgery, and if so, which procedure would be best for you.
• Have lab tests and a mental health evaluation to learn more about your physical and emotional well-being.
• Have a nutrition assessment. It’s important to follow a diet and exercise plan to get your body ready for surgery.
• Have counseling and get nutrition education to prepare for your life after surgery.

When you choose to work with PeaceHealth’s bariatrics team, we offer support not just to get you ready for surgery. We stay with you to help you navigate the months and years to come.

Medication like Ozempic was originally created to treat type 2 diabetes. It’s getting a lot of attention right now for its weight loss potential, too.

It may be an option for some people, while others may prefer the longer-lasting effects of weight loss surgery. Here are some differences to consider:

Weight loss medication can be given as a weekly injection or a daily pill. It helps you feel full and burn fat more efficiently. It’s not invasive, so it may be a good choice if you’re not comfortable with having an operation. The results may not be as dramatic as bariatric surgery, though. They also may not last once you stop taking the medication. And insurance may not cover your prescription for weight loss alone. It might cover the medication to treat diabetes or prediabetes, however. See more details about semaglutide.

Bariatric surgery reduces the size of your stomach so you can't eat as much. It’s a more permanent solution that research shows can help you lose a large amount of weight and keep it off. But it requires more preparation and recovery time. You need to meet certain criteria to qualify for surgery, too.

Both methods can help you lose weight, and both have pros and cons. It's important to talk to your doctor about the best option for you, based on your specific health needs and goals.

Getting pregnant after bariatric surgery is generally safe. But it's important to work closely with your care team to manage any potential risks.

Here are some things to consider for yourself and the health of your baby:

• People who have bariatric surgery need to avoid becoming pregnant for at least 12 months after the procedure. Your provider may recommend waiting 18 months or more, however, so you can optimize your weight loss before pregnancy. This is because your body needs time to heal and adjust after the surgery. Your care team can help you decide when it's safe to start trying to get pregnant.
• After the surgery, it can be harder for you to get the vitamins and nutrients that your baby needs to grow. You may need to take extra vitamins to make sure the baby gets what it needs.
• Bariatric surgery can change the way your body absorbs food. You might not be able to eat as much as you used to, and you might need to eat more often to make sure your baby gets enough food. It's important to work with your doctor and a registered dietitian to make sure you eat enough and get the right nutrients for you and your baby.

Your care team can answer any questions you have and help you come up with a plan that works for you.

There are many types of support that can be helpful. You may want to consider resources such as:

• Personal connections. Your family and friends can encourage you to stick to your lifestyle changes and be there for you when you need a hand.
• Support groups. Being part of a bariatric surgery support group allows you to share your experiences and get advice from people who know what you're going PeaceHealth offers monthly in-person support groups.
• Mental health providers. After your surgery, therapy can help you work through your emotions and gain coping skills to adjust to your new lifestyle.

A strong support network can help you have a successful surgery and a healthy life afterwards. Your care team also can offer suggestions for how to find the resources you need.

You can explore PeaceHealth’s patient library for detailed information about weight loss surgery.

The American Society for Metabolic and Bariatric Surgery also has lots of material for patients. Explore FAQ, videos and more in its online Learning Center.

Our bariatrics specialists are happy to answer any questions you have.

• You can contact our team in Vancouver at 360-546-8065 or Washington_Bariatric_Clinic@peacehealth.org.