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The Facts About Weight-Loss Surgery: Medical Experts Debunk 6 Common Myths

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For World Obesity Day, we're looking into common misconceptions around bariatric surgery, including what BMI you really need to have to qualify for the procedure and whether you can expect to gain any weight back.
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3-10 years.

That’s the potential loss in life expectancy caused by being obese.

40%.

That’s the reduction in risk of death and heart complications for patients with diabetes and obesity who’ve undergone weight-loss surgery.

Yet only 1% of people who qualify for weight-loss surgery undergo the procedure, explains Elizabeth Dovec, M.D., FACS, FASMBS, Medical Director of the Greater Baltimore Medical Center Comprehensive Obesity Management Program and consultant to Ethicon, one of the Johnson & Johnson Medical Devices Companies. While surgery isn't the right choice for everyone, Dovec and other experts believe there are some common misconceptions that tend to deter people from discussing the option with their doctors.

So we spoke with medical experts in the field to help share the facts about bariatric surgery.

1.

Myth: Only people who have hundreds of pounds to lose can qualify for weight-loss surgery.

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"Many people think it's only for those who could be on My 600-lb Life," says Dr. Dovec. In reality, you may be a candidate if you have a body mass index (BMI) of 35 and one or more weight-related health conditions, such as type 2 diabetes, hypertension, high cholesterol/triglycerides, obstructive sleep apnea, fatty liver disease or severe arthritis. If your BMI is more than 40, you may qualify based on your weight alone.

So, for example, a woman who is 5' 4", weighs 205 pounds and has a BMI of 35, might be a candidate if she has type 2 diabetes. That same woman could be a candidate based on size alone if she weighs 240 pounds or more and has a BMI of 41.

2.

Myth: There's only one type of bariatric surgery.

There are several options, but the most common ones are laparoscopic sleeve gastrectomy (LSG) and laparoscopic roux-en-Y gastric bypass (LRYGB)

If you have LSG, approximately 75% of your stomach is removed, so you're left with a small "sleeve" of a stomach, restricting the amount of food you are able to consume. The procedure, which is non-reversible, also prompts hormonal changes that assist with weight loss. This procedure tends to lead to an average weight loss of about 50% of excess weight.

LRYGB is a more involved procedure that entails several steps. The first involves dividing the stomach so you're left with a small, egg-sized pouch, which limits the amount of food you can eat. The second step involves attaching the pouch to a different part of the small intestine to bypass some of the normal digestive process. Because the food skips part of the intestine, fewer calories are absorbed. Gastric bypass tends to result in 60-80% of excess weight loss.

"My advice on the best choice of weight-loss surgery is specific to each patient," Dr. Dovec says, "but, generally, I tend to recommend a gastric bypass if the person has more than 150 pounds of excess body weight; they have refractory acid reflux, a known hiatal hernia or Barrett’s esophagus; or they are a diabetic, especially if it is uncontrolled or requires insulin. I require them to get a gastric sleeve if they have inflammatory bowel disease, such as ulcerative colitis or Crohn's disease."

3.

Myth: Weight-loss surgery is for people who don't want to do the hard work of diet and exercise.

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"The average patient who opts for bariatric surgery has tried an average of 22 different diets and exercise programs first," Dr. Dovec says. The patient also needs to meet specific medical criteria in order to be considered for the surgery, so this is not for someone who has trouble losing that last 10 pounds.

In addition to undergoing physical tests and psychological and nutritional counseling before qualifying for the procedure, people who have surgery also have to make significant changes to their diet and exercise regimens post-procedure—which is why it is important to educate yourself about all that bariatric surgery entails.

Weight-loss surgery limits the amount of food you can eat in one sitting, and also impacts how your body processes nutrients, so you'll need to learn to eat smaller portions and take supplements.

"The goal with bariatric procedures is to assist patients in making long-term changes," says Raymond Fryrear, M.D., Raymond Fryrear, M.D., VP & Integrated Leader, PreClinical, Clinical and Medical Affairs at Johnson & Johnson VP & Integrated Leader, PreClinical, Clinical and Medical Affairs, Johnson & Johnson.

4.

Myth: Weight-loss surgery always has complications, and recovery is long and painful.

There are risks to any surgical procedure, but bariatric surgery has become a lot safer over the past few decades, explains Dr. Dovec. Not only have the techniques and equipment been refined, but most procedures are now performed laparoscopically (through a tiny incision).

"There's a misconception that the chance of dying from surgery is greater than the risk of having obesity itself, but that's not true," Dr. Fryrear says. "Obesity is associated with type 2 diabetes, hypertension, sleep apnea and other health problems that carry added risk. In general, one could say that, as body size increases, longevity can decrease."

As for recovery, everyone is different and healing can vary depending on other conditions a patient may have, but for people who undergo laparoscopic surgery, recovery tends to be expedited. "Many people will have a shorter hospital stay, and some may even have a same-day outpatient surgery," Dr. Fryrear says.

There are over 40 obesity-related comorbidities, and surgery has been shown to help resolve or improve all 40. Obesity impacts every aspect of your life.

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Recovery from bariatric surgery does involve some changes to how you eat. For example, you'll need to ease back into eating by first subsisting on liquids, and when you do move to solids, you'll need to get used to eating much smaller portions.

Your doctor can discuss this with you as well as other things you should consider, such as working with a mental health professional before and after surgery, suggests Dr. Dovec.

While many people have improved mental health after bariatric surgery, "some people can lose hundreds of pounds but still struggle with 'seeing' themselves as their new, thinner self," she explains.

5.

Myth: Weight-loss surgery is simply a cosmetic procedure that's all about vanity.

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While a desire to look more attractive may certainly play a role in someone's decision to have bariatric surgery, it's rarely the driving force.

"Most people who are good candidates have a very clear reason of why they want to have surgery," Dr. Dovec says. "Often something major happens, like a near-death experience. Or you look at your child and realize you can't play with them anymore [because of your size]."

What's more, most people who have weight-loss surgery see real results—and not just in the mirror.

Nearly 90% of people with type 2 diabetes who have bariatric surgery end up with lower blood sugar and fewer diabetes-related complications, enabling them to take less medication. And 78% have gone into remission, meaning their blood tests no longer identify them as having diabetes and they can stop taking medication.

Research has also found that people with type 2 diabetes who have bariatric surgery reduce their risk of having a major adverse cardiovascular event, such as a stroke or heart attack.

"There are over 40 obesity-related comorbidities, and surgery has been shown to help resolve or improve all 40," Dr. Dovec says. "Obesity impacts every aspect of your life."

6.

Myth: Most people who have weight-loss surgery gain all the weight back.

This is a very common belief, but it's simply not true. Results vary by individual, but most people who have bariatric surgery keep the majority of the weight off.

"The reality is that approximately 50% of patients regain a small amount of weight over a two-year period, but recurrent weight gain generally is only about 5% of their excess body weight," Dr. Fryrear says.

So how much weight can you expect to lose to begin with?

It is variable, says Dr. Fryrear, depending on your starting weight, how closely you adhere to lifestyle changes post-surgery and other factors.

According to the American Society for Metabolic and Bariatric Surgery, weight-loss surgery is officially considered "successful" if a patient loses at least 50% of their body weight.

"Many people struggle with weight and health issues," Dr. Fryrear says. "And while the procedure isn't the right choice for everyone, bariatric surgery is a powerful option for many severely overweight people who are doing their best to become healthy but are unable to achieve the results they need."

Read about the various weight-loss procedure options that are available to help patients live healthier lives.

Find safety information about bariatric surgery here.

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