There are many different procedures that have been or are currently in use to achieve weight loss. We will just deal with the main four procedures as the others either have already been put to one side or are still seeking a place in the sun. The first procedure, Intragastric Balloon is an endoscopic rather than surgical procedure. The three surgical procedures are laparoscopic adjustable gastric banding which we will refer to as the Lap-Band, the sleeve gastrectomy, commonly referred to as the Sleeve and the gastric bypass which we will refer to as the Bypass. These four procedures are available at CBS.
The shared features of the three surgical procedures are more important than their differences. The most important features that they have in common are that they are all very effective in getting substantial weight loss, they are all effective in controlling the diseases that obesity causes and they all improve your quality of life.
All can have outstanding successes and all can have failures. But, on average, they are all very effective. They are all much better than any non-surgical weight loss method. They have achieved substantial weight loss and that weight loss is proving to be durable. Figure 1 below shows the expected weight loss for each of the three surgical procedures.
The most important observation from this figure is that they are all very good. Each of the three procedures helps you achieve excellent weight loss, sufficient enough to change your health, your quality of life and your length of life. And that weight loss lasts for many years, beyond ten years for the Lap-Band and the bypass and approaching ten years for the sleeve.
The pattern of weight loss varies between procedures. Both of the stapling procedures, sleeve and bypass, will allow you to lose weight more quickly than the band. Note the rapid weight loss during the first year. On average you will have lost around 30 kg by the anniversary of your stapling procedure. But, as they are non-adjustable, there tends to be a weight regain from there on. This is more prominent with the sleeve than for the bypass. Meanwhile the Lap-Band is slower but steadier, taking two years to get to the peak on average of about 26 kg and, we know from our research data, it holds that level for more than fifteen years. There are good published data on the bypass to ten years but we do not yet have good data on the durability of the sleeve.
The three weight loss procedures share a common mechanism – the control of appetite. Whether you have a sleeve or a band or a bypass, you will immediately notice that you are not hungry. Food is no longer central to your life. Whereas before the procedure you were very food-focused – What will I have for lunch? What about a snack? What food should I buy? What will we have for dinner? After the procedure you really don’t care that much about food and can focus on more important matters.
You are now no longer so focused on food. You will notice that you can skip breakfast easily, a very good thing to do in spite of all the chatter that it is important. You simply have a cup of tea or coffee and get on with your day. You don’t even think about a mid-morning snack. You forget it is lunchtime. You are not so tempted by a spread of colourful and tasty foods. Chocolate is no longer so attractive. When you do eat, you are quite satisfied by a small amount and are happy to stop, leaving food on the plate.
This control of appetite is the key to success with these procedures. It allows you to follow the rules, to eat less and so lose weight. Typically, you will eat about 1000-1200 calories per day. Your weight will come down but eventually the weight loss will stop and you will remain stable at this new level. You are now in balance. You are eating the correct amount, probably for the first time in your life. So, if you now watch your friends and family eating you will realise just how much excess food you had been taking.
On the negative side, these procedures are major surgery and, like all surgical procedures, they carry risks of complications and even death. But for most, that risk is less than the risks of death and complications that go with continuing to be obese and to suffer the diseases of obesity. And they are costly, particularly if you do not have cover by health insurance. And they involve a major surgical procedure under general anaesthesia requiring some time in hospital.
And all three procedures carry the risk of needing some revisional surgery in the future. Obesity is a chronic disease. It is just not realistic to believe that you can have a procedure for obesity and all will be fixed forever for all people. Something may change, break, leak, expand, loosen or whatever. We then have to fix it up. Almost all problems can be fixed but there can be that need for further surgery. Overall, there is about a 10% chance of needing something revised during the first 10 years.