Q&A: Weight-loss surgery

We face high levels of obesity in the U.S. What constitutes obesity, and what are some of the surgical options to assist with weight loss?

In the U.S., 69% of adults are overweight and 35.1% are obese. In adolescents, 8.4–20.5% of children under 20 suffer from obesity. Obesity is defined by using a complicated formula that takes into account your height and weight. The result of this formula is a two-digit number called a BMI, or body mass index.

Obesity is defined as having a BMI greater than 30. The most important thing for people considering weight-loss, or bariatric, surgery is to let go of the guilt and shame associated with their weight, and choose to take control of their life and health.

I often hear patients talk about how friends and family think they're taking the easy way out by choosing weight-loss surgery. Understand the physiology — the science — behind how we gain weight and how we lose weight are not simply the opposite of each other. It's much more complicated than most people realize.

The process of getting ready for surgery takes about six months and involves working with a team to make sustained changes. People start their journey at Mayo Clinic Health System by attending a free bariatric surgery information session at a location near them.

With weight-loss or bariatric surgery, how does a team approach benefit patients?

Weight-loss surgery professionals have learned over the last 10 to 15 years the importance of a team approach. Collaborating with a team of experts has become so effective that many insurance companies actually require multidisciplinary clearance. We believe in multidisciplinary clearance and in a multidisciplinary team. Working together and communicating across disciplines is the best way to support patients in making sustainable changes to their lifestyles. For example, a physical therapist will help develop an exercise program and a psychologist might help the patient overcome barriers to initiating the program. Psychologists are wonderful at helping people overcome the barriers of self-control, self-confidence and motivation. Our team of experts regularly meets, and these touchpoints provide the members of the team a chance to discuss how they can give consistent support to individual patients. Dietitians, physical therapists, psychologists and diabetes educators are able to collaborate and develop individualized strategies for patients preparing for surgery.

Certain misconceptions about bariatric surgery exist. What are some common examples?

It's the easy way out.

Prepping for bariatric surgery is time consuming and involves intense lifestyle modification. Patients often have a lifetime of habits and ideas about weight and weight loss that have to change. For example, most of these patients have the majority of their adult lives — and for some, their entire lives — thinking about how to lose weight. Unfortunately, many of these thoughts and habits we develop aren't healthy. As medical specialists, we teach patients how to maintain their weight. The surgery will get the weight off; the patients need to learn how to maintain that new weight. Thought patterns change entirely.

Everyone I know regained their weight.

Regaining weight can certainly happen, which is a key reason why a team approach has become so important. We better understand surgery works for a couple years, and then the body is able to adjust. At that time, lifestyle changes are integral to allowing patients to maintain their new weight. If you talk to someone who had surgery 10 to 15 years ago, their experience getting ready and following up after surgery is quite different from what patients do now to prepare for surgery and for long-term follow-up.

Another important distinction revolves around lap band surgery, which was popular for many years. Unfortunately, we know now that weight loss is suboptimal and long-term complications are high with lap band operations. Weight loss and the ability to keep the weight off are much better with procedures that are considered metabolic in nature, such as sleeve gastrectomy, Roux-en-Y and duodenal switch with biliopancreatic diversion.

It's too dangerous.

Bariatric surgery has become one of the safest general surgery procedures conducted. The American Society of Metabolic and Bariatric Surgery (ASMBS) has changed the focus of its accreditation from volume to quality. Surgeons are trained by doing specialized year-long fellowships under experienced surgeons who are able to teach advanced techniques. Additionally, the stapling technology we use to divide the stomach and bowel has improved tremendously, leading to safer surgeries. Mayo Clinic Health System is dedicated to the quality of care provided and has recently achieved accreditation in Mankato from the ASMBS and American College of Surgeons through a program called the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.

If someone has bariatric surgery, what should they expect in terms of weight loss?

In bariatric surgery, we talk about excess body weight and the excess body weight that's lost. The way we determine excess weight is by figuring out a patient's ideal body weight. Anything over their ideal body weight is considered excess. So, as an example, if a patient weighs 300 pounds and their ideal body weight is 200 pounds, that patient would have 100 pounds of excess weight.

We offer two procedures: the sleeve gastrectomy and the Roux-en-Y. Patients who have a Roux-en-Y can expect to lose about 70% of their excess body weight, and patients who have a sleeve gastrectomy can expect to lose about 60% of their excess body weight.

In the above example, the patient could expect to weigh 230 pounds after a Roux-en-Y procedure and 240 pounds after a sleeve gastrectomy. Keep in mind that everybody's ideal body weight is different. Many people who weigh 300 pounds could expect to lose more weight if they have a lower ideal body weight.

At your initial appointment, we're able to help calculate your expected weight loss.

By Mayo Clinic Health System staff