Bariatric Surgery

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.

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 Vancouver, Washington, 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.

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.

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.

Like any surgery, there are some risks and side effects to consider with bariatric procedures. It's important to talk about these things with your care team so you’re fully prepared.

• You may have some pain and discomfort after surgery. You may also feel tired or weak for a little while. Your recovery plan may include medication to manage any pain or discomfort.
• Because bariatric surgery involves making cuts in your skin, there is a chance that germs can get in and cause an infection. You can lower your risk by following your provider’s instructions for keeping your incisions clean.
• You might have some trouble digesting food or absorbing nutrients after your surgery. This can lead to diarrhea, queasiness or vomiting. These symptoms are sometimes called dumping syndrome.
• You may also need to take vitamins and supplements to make sure you're getting all the nutrients you need.
• In rare cases, there can be more serious complications, like bleeding, blood clots, or leaks from the surgery site. But these complications are very rare, and your healthcare team will be monitoring you closely to make sure everything is going well.

Your care team will be there to help you through the whole process. You can talk openly with them about any concerns you have and ask any questions you need answered.

When considering bariatric surgery, it’s important to understand what costs insurance will cover and what you’ll have to pay for yourself. For costs that aren’t covered, you can explore options like payment plans, financing and financial aid.

Some people also choose to pay for bariatric surgery with money they've saved up or with help from family and friends. It's a big decision, so it's important to talk to your provider and your family to figure out what’s best for you.

The good news is that many insurance plans cover the cost of bariatric surgery. But there are certain parts of the procedure that may not be covered.

For example:

• Insurance may not cover the cost of counseling or mental health and nutrition evaluations needed before your surgery.
• Some plans may not cover the cost of certain types of bariatric surgery, such as duodenal switch.
• You may be responsible for the cost of follow-up visits with your surgeon or dietitian after your surgery.
• Insurance may not cover other expenses related to your surgery. These may include transportation to and from appointments, time off work and special equipment or dietary supplements.

No matter how you choose to pay for it, bariatric surgery can be a great way to improve your health and your quality of life. Before making any decisions, reach out to your PeaceHealth team. We’ll work with you to understand your coverage and options.

Your life will change a lot after bariatric surgery. Getting help from a registered dietitian and a mental health professional are both important ways to set you up for success.

Seeing a psychiatrist or psychologist will help you:

• Understand and cope with your feelings about the surgery. Sometimes thinking about your surgery can make you feel scared or worried.
• Develop coping strategies and gain skills to manage the life changes to come.
• Overall, talking to a mental health provider can help you feel more comfortable and confident with the bariatrics process.

Working with a dietitian will give you tools to manage your nutrition before and after surgery. They will help you:

• Learn about the foods to eat to get healthy and stay healthy for the rest of your life.
• Make a nutrition plan that includes smaller amounts of food. You’ll work together on a plan for healthy meals that are the right size for you.
• Use supplements to get the vitamins and nutrients you need since you’ll eat less.

A good place to start is with an open conversation with your primary care provider. They can see if you qualify for surgery and if it's the best option for you. Some common requirements include:

• Having a certain weight to height ratio. In general, you’ll need a body mass index (BMI) of 40 or higher to qualify for surgery. A BMI of 35 may be considered if you have other weight-related health conditions.
• Weight-related health conditions. Conditions that may make you a good candidate for surgery include high blood pressure, diabetes or sleep apnea.
• Bariatric surgery patients at PeaceHealth must be at least 18 years old.
• Difficulty losing weight with other methods. If you’ve worked with your doctor to lose weight with diet and exercise and aren’t seeing results, you could be a good candidate.

Our program requires a referral from one of your existing providers. Some insurance plans need the referral to come from your primary care provider. If that’s the case, we will let you know so you can reach out to your PCP.

Our whole-person approach to bariatric surgery includes not just the expert surgeons who do the procedures. Your team will bring together many caregivers, all dedicated to your physical and mental well-being.

The specialists who support your care include:

• Program coordinators (usually a nurse or dietitian)
• Surgeons with deep experience in bariatric procedures
• Surgical physician assistants
• Psychologists or psychiatrists
• Registered dietitians
• Physical therapists
• Family nurse practitioners
• Registered and licensed practical nurses
• Medical assistants

Our team’s contributions to your care include:

• Getting to know your needs and goals.
• Creating an individual care plan for your surgery and your life afterward.
• Helping you prepare in body and mind.
• Reviewing your options for paying for surgery.
• Working with your insurance on the necessary paperwork.
• Educating you to help you make and stick with diet and lifestyle changes.
• Following up often after surgery and offering support every year after that.
• Connecting you to other resources to help you live well after surgery.

Overall, getting ready for bariatric surgery can take six to 12 months. It's important to make sure your body is healthy enough for the surgery and that you're ready to make lifestyle changes afterwards.

Here's a general timeline for bariatric procedures:

• Meeting with a specialist. The first step is to meet with a provider who specializes in bariatric surgery. They'll talk to you about your weight and any health conditions you have. If you’re a good fit for bariatric surgery, they’ll discuss which type of procedure is the best option. This usually takes one or two appointments, which might be a few weeks apart.
• Diagnostic tests. Once your doctor decides that you're a good candidate for bariatric surgery, you'll need to have some tests. These might include blood tests, a sleep study, a heart evaluation and a psychological evaluation. These tests can take several months to schedule and complete.
• Pre-surgery diet and exercise. Before your procedure, you'll follow a diet and exercise plan to prepare your body. This might involve losing a certain amount of weight or cutting back on certain foods. You'll work with a dietitian to come up with a plan that works for you. This can take a few weeks or a few months.
• You’ll speak with a mental health provider before the surgery. They will help you prepare for the lifestyle changes you'll have after the surgery. This can take a few weeks or months, depending on the number of sessions required.
• Surgery and recovery. Finally, on the day of the surgery, you'll need to arrive at the hospital or surgery center a few hours before the procedure. The surgery itself usually takes a few hours. Depending on the type of surgery you have, you may go home soon after, or spend a few days in the hospital to recover.

Bariatric surgery takes time and preparation to make sure you have the best possible experience. PeaceHealth’s team stays with you not just through surgery. We offer support for months and years afterward.

There are a few steps you’ll take to give you the best chances of success.

1. First, talk to your primary care provider about bariatric surgery. They'll check to see if you're a good fit for the surgery. If you want to go ahead, they’ll refer you to a bariatrics provider.
2. Next, you'll meet with specialists in bariatrics, including a dietitian and a psychologist, to help you prepare for surgery. They'll explain what to expect before, during and after the surgery.
3. Depending on your health history, you may see other specialists to discuss heart health, sleep apnea, diabetes or other conditions you have. If you have sleep apnea, it may need treatment before you can go ahead with a bariatric procedure.
4. Before the surgery, your care team will recommend some changes to your lifestyle. This includes quitting smoking if you're a smoker. You may also need to lose some weight or change your diet to help prepare your body for the surgery. Your care team will share specific recommendations on what you need to do to get ready.
5. On the day of the surgery, you'll go to the hospital and meet with the surgical team. They'll review what's going to happen and answer your questions. During the surgery, you'll be asleep under anesthesia. The surgeon will make small incisions in your stomach to perform the procedure.
6. After your surgery, you'll have instructions from your care team to make sure you recover safely and successfully. This may include a special diet, exercise and medication. You'll also have regular follow-up visits to track your progress and make sure you're healing well.

Throughout the process, your PeaceHealth team will be there to answer questions and support you through this life-changing decision.

Before your surgery, your team will fully explain what to expect and will work with you to prepare, physically and mentally. Our specialists will help you build a plan for your post-surgery nutrition, activity levels and mental health. Our team will help you understand your insurance coverage and out-of-pocket expenses, too.

After surgery, you’ll have access to:

• Dietitians trained to help you learn how to eat healthier.
• Support groups for encouragement from people like you who’ve had bariatric surgery.
• Ongoing education to help you embrace your new lifestyle and support you in the healthy habits you’ve learned.

It’s important to take it easy after bariatric surgery, so your body can heal. Most people take two to four weeks to get back to their regular routine. Everyone’s recovery is slightly different, but in general:

• You’ll stay in the hospital for a couple of days to make sure everything is okay.
• When you come home, plan to rest and not do any heavy lifting or exercise for a few weeks. You may feel sore and take pain medication to ease your discomfort. You’ll also follow a post-surgery diet and drink lots of water to make sure you get enough nutrients and stay hydrated.
• After a few weeks, you can do light exercise like walking. Take care not to do anything too strenuous. You can gradually start to do more as your body gets stronger.
• Over time, you’ll feel better and be able to get back to your normal activities. It’s important to build up to this while working with your care team and going to all your follow up appointments. With time and patience, you’ll heal and be able to enjoy the benefits of your surgery.

Watch this video to see get a sense of what your recovery may be like — and when to reach out to your care team with questions or concerns.

People who are most satisfied with their experience after bariatric surgery make a commitment to change how they eat, drink and exercise.

These lifelong changes include:

• Eating smaller meals.Your new stomach will hold only a few ounces of food at a time.
• Eating slowly.It’s important to go slow and chew your food completely, until it’s mushy. If you don’t, it could cause pain or vomiting.
• Avoiding drinks with meals. Your new stomach only has room for solids or liquids, not both. Plan to avoid liquids for at least 10 minutes before meals, while you eat, and for 30 minutes afterward.
• Eating without distraction so you don’t overeat. Turn off the TV, computer or phone. Stop working, put down your book and just enjoy the food you are eating.
• Staying hydrated. Sip beverages throughout the day. Aim for 48 to 64 ounces of liquid daily. Avoid caffeinated, sugary and carbonated beverages.
• Limiting alcohol use. After bariatric surgery, it may be easier for you to feel the effects of alcohol. Drinking also can lead to stomach or intestinal ulcers.
• Taking your vitamins and supplements. Bariatric surgery means you won’t get complete nutrition from the small meals you eat. Follow the recommendations of your bariatric team to balance your diet.
• Limiting foods that are high in fat or sugar.These foods move quickly through your digestive system and can cause dumping syndrome.
• Being active at least 30 minutes a day. Research shows that exercise is important for long-term success after bariatric surgery. You don’t need to add intense workouts to your routine. Instead, plan for a half hour of moderate activity that you enjoy. This is the best way to improve your health and stay injury-free.
• Making time for rest and relaxation. Prioritize getting enough sleep and managing stress in healthy ways.

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.