Surgical Weight Loss
Lower Weight
Almost every patient achieves a substantially lower weight for life after bariatric surgery. Surgical weight loss is dramatically greater than any medication or non-surgical program. If all types of bariatric surgery are lumped together in the long run, then about 2/3 of patients will keep off more than half of their excess weight, meaning that they will be 70-150 pounds lighter than they started.
Better Health
Lower weight leads to resolution or improvement of many medical problems. On average, patients experience dramatically better health after surgery than they had before – this is the core outcome of bariatric surgery. Read more about this on our page describing health improvements after bariatric surgery.
Weight Loss after Bariatric Surgery
Our goal is to help each patient lose a lot of weight, and to maintain the lower weight with better health for the rest of their life. That’s pretty obvious, right? Some of you are asking, “OK, but what’s the number? How many pounds should I lose? What BMI should I get to?” Let’s take a moment to discuss appropriate weight goals following bariatric surgery.
The first point is that the “Ideal Body Weight” is NOT a proper goal for a person who is currently considering bariatric surgery. This is because the body of a morbidly obese person takes on a lot of extra structure to carry/support the excess weight (bone, heart muscle, skin, etc.) and the body is not able to shed all that structure in healthy way. In other words, patients who go from a BMI = 48 to a BMI = 24 are medically too skinny; they have low energy, feel weak, look ill, and are probably not at the optimal weight for health. Most patients are at their “best” weight (best health and sense of well-being) at a BMI of 26-29.
Are all of our patients going to get to that low weight level? Unfortunately not – only about 35% of our patients will get to this “best” weight. (Check out the factors affecting weight loss below). Does that mean that patients have failed if they end up at a BMI of 37 or so? Heck no, most patients have still lost substantial weight and they are healthier as a result.
This brings us to the second point: the key goal of bariatric surgery is to make a patient healthier. Sometimes surgery is worthwhile to bring diabetes under control, or to allow better heart function or better lung function, even if a patient only loses 30 pounds.
The fact is that there is a lot of variation in weight loss results after bariatric surgery, so it is necessary to talk about some factors causing greater and lesser weight loss after bariatric surgery:
- Which procedure is done (see more about this factor below)
- Starting weight – heavier patients tend to lose more pounds, but they are not as likely to get below a BMI of 30
- Age of the patient – younger patients tend to lose more
- Diabetes – diabetics tend to lose less
- Overall health and ability to exercise – more active patients lose more
- Compliance with diet and exercise plans following surgery
- Family support and other support systems
Gastric Bypass weight loss
The Gastric Bypass helps patients achieve rapid and reliable weight loss.
In the first few months after surgery, the surgical trauma that is naturally created on the stomach “stuns” the nerves of hunger, so that patients tend to experience a profound freedom from hunger over a sustained time period. During the first 3 months after surgery, most patients lose weight rapidly. Depending on the starting point, patients can lose anywhere from 40 up to 100 pounds in the first 3 months. As healing of the stomach pouch progresses, hunger and calorie intake naturally return so that weight loss slows. Weight loss is usually steady during months 3-6, and then in the 6-8 month time period a patient begins to experience “plateaus” where the weight is stable for a week or so before continuing to drop.
For most Gastric Bypass patients, the lowest weight level is reached 10-16 months after surgery. There is a strong tendency to regain 10-15 pounds during the second year after surgery, and the weight that a patient has at the two year point after Gastric Bypass is usually one they will maintain (with an appropriate level of effort and intention) for the rest of their life.
The total weight loss depends on the other factors listed above, and it varies from a minimum of about 70 pounds lost, up to 250+ pounds lost.
Sleeve Gastrectomy weight loss
The Gastric Sleeve causes profound suppression of hunger in a way that appears similar to the Gastric Bypass. It seems that the long tubular stomach recovers a bit more quickly than after Gastric Bypass, so that average weight loss is not as dramatic as for Gastric Bypass patients. On the other hand, the reservoir section of the stomach that is removed seems to be the source of some hunger-related hormones such as ghrelin, so that removal of that stomach may help create sustained suppression of hunger.
Available literature suggests that total weight loss will be somewhat less than for Gastric Bypass, but in the same range. There is not yet any data on the weight maintenance at 5 years or more after Gastric Sleeve.
Adjustable Gastric Band weight loss
The Band helps create weight loss that is slower and more prolonged, sometimes continuing for three years after surgery.
In the first few weeks after Band surgery, most patients experience a freedom from hunger caused by the minor trauma to the nerves of the stomach. Since the trauma to the tissues is less than with the Gastric Bypass, and since the Band is placed with no fluid (wide open) on the day of surgery, hunger usually returns within the first few weeks.
During the first month, a Band patient may lose from 5-30 pounds. Weight loss will slow down as hunger and intake return, but if the patient is working with the surgical team to adjust the Band (usually filling it to make it steadily tighter until it is properly “tuned”) then the hunger will be controlled.
When a patient’s Band is working well and the patient is following the team’s diet and exercise recommendations, patients usually lose 1-2 pounds per week. It is usually possible to sustain some steady/slow weight loss for at least a year.
The total weight loss after Band surgery may bring the patient all the way down to their “best” weight in some cases. In our experience, about 30% of Band patients will lose less than 40 pounds but will have achieved better health with that modest weight loss.
Weight regain
Most people know someone who had a bariatric surgical procedure years ago, lost a lot of weight, and then “gained it all back.” There is no getting around the fact that some patients do regain substantial weight after bariatric surgery. Searching into the causes of weight regain almost always turns up one of these factors behind the problem:
- The person underwent an older surgical procedure that is prone to long term weight regain. The most common example is the Vertical Banded Gastroplasty (VBG), which was done very commonly in the 1980’s and early 90’s.
- The person has stopped visiting the surgical program in follow-up. There needs to be an understanding that obesity is a lifetime disease that requires lifetime management and support. Normal people need reminders of the proper diet and activity patterns, as well as support in sticking with the life changes that keep these patterns in place.
Of the bariatric procedures that are currently most commonly performed, adjustable gastric banding appears most likely to be associated with long term weight regain.