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Bariatric surgery





NHS Choices Syndication


Bariatric surgery

Getting ready for weight loss surgery

Weight loss surgery and adapting to life after surgery is a challenging process, requiring the input of not just the surgeon but many different medical professionals working together as a team.

This is known as a multidisciplinary team (MDT) and it may consist of:

  • a surgeon
  • an anaesthetist
  • a dietitian
  • a psychologist
  • a gastroenterologist (doctor who specialises in treating digestive conditions)
  • a specialist weight loss surgical nurse, who will usually be your first point of contact

Most MDTs operate out of specialist bariatric surgery units, which are typically based in larger hospitals.

Before your weight loss surgery can take place, you will probably be referred to your nearest specialist unit for an assessment, to see if you are a suitable candidate for surgery.

Assessment

Your assessment may consist of three main phases:

  • physical assessment
  • psychological assessment
  • nutritional assessment

Physical assessment

The purpose of the physical assessment is to check whether you have any health problems or there are other factors that could complicate your surgery.

You may receive the following tests:

  • blood tests
  • an electrocardiograph (ECG), where electrodes are used to measure the electrical activity of your heart
  • chest X-rays
  • spirometer – a machine that measures how well you can breathe in and out
  • ultrasound scan – this uses sound waves to build up a picture of the inside of your body and is useful for spotting conditions such as gallstones and non-alcoholic fatty liver disease

Psychological assessment

The psychological assessment determines whether:

  • you have any mental health conditions or emotional problems that could prevent you sticking to your lifestyle plan after surgery
  • you have developed unhealthy patterns of eating, such as binge eating, that could cause problems after surgery
  • you have realistic expectations of what life will be like after surgery

The process of assessment can differ from unit to unit, but it is likely you will be asked questions about:

  • how obesity is affecting your emotions
  • how obesity is affecting your relationships with others
  • how obesity is affecting your daily activities
  • whether you are currently taking medication or seeking treatment for a mental health condition
  • your current pattern of eating and your willingness to change the pattern after surgery
  • what benefits you expect surgery to bring you and how you feel your life will be after surgery

Having a mental health condition such as depression, or an eating disorder does not automatically mean you are not suitable for surgery. However, surgery may be delayed until it is under control.

Nutritional assessment

The nutritional assessment has two main purposes.

The first is for the dietitian to obtain a detailed history of your current diet and associated patterns of eating and how these have contributed to your obesity.

The second is to ensure that you fully understand the dietary commitments you will need to make after surgery, which may include:

  • improving the nutritional content of your meal
  • eating small amounts of food slowly rather than rushing through a meal as quickly as possible

Your dietitian may also recommend that you go on a calorie-controlled diet for several weeks or months before surgery. This is because losing even a modest amount of weight before surgery is known to reduce the risks of complications, especially if you are going to have keyhole surgery.

Published Date
2013-08-28 16:30:56Z
Last Review Date
2012-11-05 00:00:00Z
Next Review Date
2014-11-05 00:00:00Z
Classification
Obesity,Obesity surgery,Weight loss,Weight management






NHS Choices Syndication


Bariatric surgery

How weight loss surgery is performed

The two most widely used types of weight loss surgery are gastric banding, based on restriction, and gastric bypass, which uses a combination of restriction and malabsorption.

Each type of surgery is discussed in more detail below.

Gastric banding

Gastric banding is usually performed as a type of laparoscopic (keyhole) surgery, where a series of small incisions are made in the abdomen, rather than one large incision. The advantage of this type of surgery is it causes less pain afterwards and has a faster recovery time.

However, laparoscopic surgery may not always be possible in severely morbidly obese people.

Gastric banding is carried out under general anaesthetic, which means you will be asleep during surgery and will not feel any pain.

The surgeon makes the incisions in your abdomen and then inserts an instrument known as a laparoscope through one of the cuts. A laparoscope is a thin, rigid tube containing a light source and a camera. The camera relays images of the inside of your abdomen to a television monitor.

Other small instruments are placed through the cuts to place the band around your stomach, effectively dividing your stomach into two, leaving a small pouch at the top of the stomach.

It will take less food to fill the pouch, so it will take less food to make you feel full.

The band contains an access port through which saline (sterile salt water) can be passed to inflate the band. This allows the band to be adjusted as required after surgery.

The surgery usually takes around an hour to complete.

Gastric bypass

Gastric bypass is usually performed as a type of laparoscopic surgery where possible, as this causes less pain afterwards and has a faster recovery time.

However, it may not be suitable for severely morbidly obese people.

As with gastric banding, a small pouch is created at the top of your stomach. This pouch is then connected directly to a section of your small intestine, bypassing the rest of the stomach and bowel.

This means that it will take less food to make you feel full and you will also absorb fewer calories from the food you eat.

Bypass or banding?

Both types of surgery have advantages and disadvantages.

There is usually more weight loss after a gastric bypass than after a gastric band.

Most people with a gastric band will lose around half their excess body weight, whereas most people with a gastric bypass will lose around two-thirds of the excess body weight.

However, because it is more technically demanding, a gastric bypass carries a higher risk of complications, including death.

The risk of any sort of complication after a gastric band is around 1 in 10 compared to 1 in 5 for a gastric bypass.

The risk of death after a gastric band is around 1 in 200 compared to 1 in 100 for a gastric bypass.

A gastric band is reversible, so if you find it difficult to cope with the restrictions associated with life after surgery, you can have the band removed.

A gastric bypass, on the other hand, cannot be reversed. You will also be required to take nutritional supplements for the rest of your life if you have a gastric bypass.

Discuss the advantages and disadvantages of both types of surgery with your surgical team.

Other types of bariatric surgery

Other types of weight loss surgery, which are less commonly used, are outlined below.

Sleeve gastrectomy

A sleeve gastrectomy is a type of surgery used to treat extremely morbidly obese people (with a BMI of 60 or above).

Such a high level of obesity means that performing a gastric band or bypass would not be safe as both procedures carry a very high risk of causing complications in people of that weight.

During surgery, a section of the stomach is surgically removed, reducing the size of the stomach by three-quarters. The short to medium term weight loss should be around 60-70%.

Once this weight loss has been achieved, it should be possible to perform either a gastric band or bypass safely.

Bilo-pancreatic diversion

A bilo-pancreatic diversion is similar to a gastric bypass except a much larger section of the small intestine is bypassed, meaning you will absorb even fewer calories from the food you eat.

A bilo-pancreatic diversion can achieve a good level of weight loss (up to 80% of excess body weight) but it carries a high risk of complications and can cause unpleasant side effects, such as unpleasant-smelling diarrhoea.

Because of this, a bilo-pancreatic diversion is usually only recommended when it is felt that rapid weight loss is required to prevent a serious health condition, such as heart disease, from getting worse.

Intra-gastric balloon

An intra-gastric balloon is a soft silicone balloon that is surgically implanted into your stomach. The balloon is filled with air or saline solution (sterile salt water), and so takes up some of the space in your stomach. This means you do not need to eat as much before you feel full.

This procedure is only temporary, and the balloon is usually removed after six months. The procedure is useful if you do not meet the criteria for the other types of surgery, for example because you are too obese.

An intra-gastric balloon procedure can usually be done without making an incision in your abdomen. Instead, the balloon can be passed through your mouth and down into your stomach using an endoscope (a thin, flexible tube that has a light and a camera on one end). Read more information about a gastroscopy.

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Published Date
2014-01-22 14:04:29Z
Last Review Date
2012-11-05 00:00:00Z
Next Review Date
2014-11-05 00:00:00Z
Classification
Obesity,Obesity surgery,Surgery,Weight loss






NHS Choices Syndication


Bariatric surgery

How weight loss surgery works

To understand how weight loss surgery works, it is useful to know how the human digestive system functions.

The digestive system

The digestive system has three main sections:

  • the stomach
  • the small intestine
  • the large intestine

The stomach

The food you eat passes down into your stomach. The stomach releases liquids, known as gastric juices, that help break down the food into a more liquid form.

The muscle that surrounds the stomach causes the stomach to contract. The partly digested food is broken down into smaller and smaller pieces which can pass through the small intestine without any problem.

The stomach is the part of the digestive system that appears to cause feelings of hunger. It is thought that once the amount of food inside the stomach falls below a certain level, nerve endings inside the stomach transmit signals to part of the brain known as the hypothalamus, which then triggers feelings of hunger.

For reasons that are still unclear, the ‘hunger threshold’ often appears to be much lower in obese people, so they regularly fill their stomach with food to avoid being hungry.

The small intestine

The small intestine is an extremely long tube (up to 7 metres in adults) that coils around itself at the bottom of your abdomen.

The small intestine digests the various nutrients from food that your body needs, such as:

  • fats
  • proteins
  • carbohydrates

The large intestine

The large intestine is essentially the exit point of the digestive system. Its role is to transport any waste materials left behind in food out of your rectum and anus (back passage) when you pass stools.

Methods used in weight loss surgery

The various types of weight loss surgery use two main methods to achieve weight loss:

  • restriction – your stomach is effectively made smaller, so it takes less food to make you feel full
  • malabsorption – surgery alters the structure of your digestive system so any food that you eat bypasses a section of your small intestine and you digest less food

Some types of weight loss surgery, such as a gastric bypass, use a combination of both methods to achieve weight loss.

Published Date
2011-09-11 19:09:17Z
Last Review Date
2011-01-27 00:00:00Z
Next Review Date
2013-01-27 00:00:00Z
Classification
Gut,Large intestine,Obesity,Obesity surgery,Small intestine,Stomach,Weight loss




Weight loss surgery – NHS Choices






























































Weight loss surgery 

Introduction 

Understanding BMI results in adults


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Find out how to calculate your body mass index (BMI) and interpret the results correctly.

Media last reviewed: 04/03/2014

Next review due: 04/03/2016

Body mass index and obesity

The most widely used method of seeing if you are a healthy weight is to calculate your body mass index (BMI). This is your weight in kilograms divided by your height in metres squared:

  • If your BMI is 25-29.9, you are over the ideal weight for your height (overweight).
  • If your BMI is 30-39.9, you are obese.
  • If your BMI is over 40, you are very obese (known as morbidly obese).

BMI does not provide an accurate assessment of weight in all circumstances, such as in people who are very muscular or children going through a sudden growth spurt.

Vicky Finch

‘My gastric band surgery’

Vicky talks about the changes she had to make to her diet before and after weight loss surgery, and what it’s like living with a gastric band

Weight loss surgery, also called bariatric surgery, is used as a last resort to treat people who are dangerously obese (carrying an abnormally excessive amount of body fat).

This type of surgery is only available on the NHS to treat people with potentially life-threatening obesity when other treatments, such as lifestyle changes, haven’t worked.

Potentially life-threatening obesity is defined as:

  • having a body mass index (BMI) of 40 or above
  • having a BMI of 35 or above and having another serious health condition that could be improved if you lose weight, such as type 2 diabetes or high blood pressure

For people who meet the above criteria, weight loss surgery has proved to be effective in significantly and quickly reducing excess body fat. 

The National Institute for Health and Care Excellence (NICE) is currently considering lowering the threshold for weight loss surgery to a BMI of over 30 for people who have recently been diagnosed with type 2 diabetes.

However, it is always recommended that you try to lose weight through a healthy, calorie-controlled diet and increased exercise before you consider weight loss surgery, as surgery carries a risk of complications and requires a significant change in lifestyle afterwards.

Due to these associated risks, most surgeons, whether they are working privately or for the NHS, would only consider a person for surgery if there was a clinical need, and not just for cosmetic reasons.

Read more about who can use weight loss surgery.

Availability of weight loss surgery

Even if you are eligible for weight loss surgery, the demand for this surgery on the NHS is currently higher than the supply in many areas of the country. Therefore, there may be a considerable waiting list.

Weight loss surgery is also available privately. Prices are around: 

  • £5,000-8,000 for gastric banding
  • £9,500-15,000 for gastric bypass surgery

An increasing number of people are seeking treatment abroad as costs for private treatment are often cheaper in other countries, but this option should be considered carefully. For more information, see planned treatment abroad.

Types of weight loss surgery

The two most widely used types of weight loss surgery are:

  • gastric band, where a band is used to reduce the size of the stomach so a smaller amount of food is required to make you feel full
  • gastric bypass, where your digestive system is re-routed past most of your stomach so you digest less food and it takes much less food to make you feel full

Several other surgical techniques may be recommended in certain circumstances.

Read more about how weight loss surgery is performed.

Life after weight loss surgery

Weight loss surgery can achieve often impressive results in the amount of weight lost, but it should not be seen as a magic cure for obesity.

People who have had weight loss surgery will need to stick to a rigorous and lifelong plan afterwards to avoid putting weight back on or long-term complications.

This plan will include:

  • a carefully controlled diet
  • regular exercise

The rapid weight loss may cause relationship problems, for example with a partner who is also obese, and it may lead to unwanted loose folds of skin, which may need further surgery to correct.

Also, many people with mental health problems, such as depression or anxiety, find that these problems do not automatically improve because they have lost weight.

It is important to have realistic expectations about what life after weight loss surgery will be like.

Read more about life after weight loss surgery.

Risks

As with all types of surgery, weight loss surgery carries the risk of complications, some of which are serious and potentially fatal, such as:

A 2014 American review of over 157,000 patients found the overall risk of death, within 30 days of having any kind of weight loss surgery, is around 1 in 1000. The risk of death after having a gastric bypass was slightly higher.

However, certain risk factors, such as high blood pressure or a BMI of 50 or above, increase the risk of complications.

Read more about risks of weight loss surgery.

Results

As long as a person is willing and able to stick to their agreed plan afterwards, surgery can effectively reduce their weight and treat conditions associated with obesity, such as diabetes.

Recent research carried out in America found that on average:

  • people with a gastric band will lose around half their excess body weight
  • people with a gastric bypass will lose around two-thirds of their excess body weight

Both techniques also lead to a considerable improvement (and sometimes a complete cure) of obesity-related conditions, such as diabetes or high blood pressure.

Read more about the results of weight loss surgery.

Page last reviewed: 05/11/2012

Next review due: 05/11/2014

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Comments

The 15 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Lubelle81 said on 09 July 2014

I just discovered I have PCOS.. The weight started packing on when I was 19.. I’m 32 now.. I got very lucky to have one son..But this uncontrollable weight gain is too much it’s depressing, every time I travel to work I want to jump in front of a train.. I talked this over with my GP, I begged him for a gastric bypass but instead he told me to get a dietitian and enter a gym, I don’t want to be difficult but I choose to work as a cleaner to replace going to a gym.. Besides swallowing painkillers as if I was eating skittles, How else can I explain to my GP 12 years of Pain, and Depression is enough for me, I settle for a Gastric Bypass??

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Chezzybaby said on 15 March 2014

I had a gastric bypass on 23rd October 2013 and 5 months on and I am 6 stone 2llb lighter and have not looked back, providing you stick with what the hospital tell you and take ur medication and eat what they say you should be fine. Iv yoyo dieted for years battled with my weight iv researched thus operation to help me reach the right decision . The only part of the journey I didn’t really like was having to have injections in my tummy for two weeks twice a day, but it was all go after they were finished. And I do not regret it one bit. Everyone is different but this op had mentally changed my whole outlook on food and drink, I no longer crave chocolate and diet Pepsi which was my downfall before. Good luck to you all considering to have the bypass xx

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cirelondiel said on 07 January 2014

I need help.
I am 22 years old, 5”10 size 26/28 and around 25/26 stone. As a child I was always bigger than the other children in school.
I have been on a diet most of my life even when I was small. relentlessly bullied all the way through school and still even now remarks and taunts are made. exercise is hard as I had a accident a few years ago and have nerve damage in the base of my spine and a curvature in the top. manic depression and anxiety disorders and a history of self harming and several attempts on my own life. I am seriously considering surgery but I need as much help and advice as you can give me.
Any advice or words of wisdom will be greatly appreciated.

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cirelondiel said on 07 January 2014

I need help.
I am 22 years old, 5”10 size 26/28 and around 25/26 stone. As a child I was always bigger than the other children in school.
I have been on a diet most of my life even when I was small. relentlessly bullied all the way through school and still even now remarks and taunts are made. exercise is hard as I had a accident a few years ago and have nerve damage in the base of my spine and a curvature in the top. manic depression and anxiety disorders and a history of self harming and several attempts on my own life. I am seriously considering surgery but I need as much help and advice as you can give me.
Any advice or words of wisdom will be greatly appreciated.

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GastricBypassSufferer said on 10 December 2013

As someone who has to live with a mother who has had the gastric bypass operation, I think people should be made aware of what the side effects are to having this surgery and how Gastric Surgery can be detrimental to your own health because what the surgeons tell patients before hand is not a reality and the operation should be banned under some sort of misselling in my opinion.

Firstly as a result of having a cut and shut of the digestive system, the food consumed is never digested properly, you will not absorb all the nutrition you need from the food which will ultimately be bad for your own health but as the food passes through in a undigested/incorrectly digested state, what goes down the loo, stinks.

I really cant emphasis enough just how bad this smell is and over time this smell will follow you around everywhere like an unchanged nappy!

Likewise your gaseous emissions or flatulence will also smell an order of magnitude worse than before surgery and you will always be planning to be around a toilet as you have far less control over your bowels as a result. If an app existed where you can see every public toilet on the planet, gastric bypass recipients will almost certainly download it. Secondly, if you choose to have this operation, you will become very ashamed of this smell (which is a negative effect on your already fragile mental health) and will spend massive amounts on air-freshener and perfumes. This means anyone else living in the home if they have not already, will develop breathing problems including asthma as a results of the copious amounts of artificial smells deployed in the building. The smell for me is so bad it triggers massive coughing sessions and as a result I have developed permanent ringing in my ears and a hernia from the excessive coughing caused ultimately by this surgery. This excessive use of air freshener is bad for everyone’s health but the I doubt the Gastric Surgeons have thought that fair ahead!

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GastricBypassSufferer said on 10 December 2013

Part 2.

Thirdly as a taxpayer I dont see this Gastric Surgery recipient having changed what they eat contrary to the “careful eligibility checks” carried out by the NHS before hand. My mother still continues to pig out on doughnuts and other junk fund, which suggests to me obesity may be have some element of mental health issues after all what is comfort eating if its not eating in search of missing nutrients from the diet? Likewise I think its also worth pointing out most obese people are seriously deficient in Vitamin D, and studies show your weight will drop off when your get your levels up to 200nmol/L, so if you want a cheaper less invasive alternative, get your Dr to check your Vit D levels and get them up, at least to 100nmol/L, as Vit D helps your body repair itself, your taste for healthy food will increase until you crave eating healthy food and shun sugary foods. Some fatty foods are healthy because fat soluble vitamins need fat to be stored in, so when you eat some joints of meat, you will getting the fat soluble vitamins the animal has naturally built up so you will benefit from a a natural form of vitamin delivery.

So to anyone considering this surgery, its painful, and will leave you smelling and behaving like an incontinent for the rest of your life. And ask yourself do you really want that? At least check out the Vit D route for 1 year before hand as the science backs up my claims, but it also means the UK’s GDP will decline as a Vit D is a lot less expensive than questionable surgery.

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BigIsBack said on 09 November 2013

Reading the experiences of everyone else here that somehow resembles my own experience I come to the conclusion that patients are not in the heart of the NHS ethos.

I really hope that the NHS will help every patient enjoy a healthier life.

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Soul Surfer said on 10 October 2013

I am a 34 year old female. I have always suffered from weight problems and tried all the diets that are around. I managed to shed some weight when I was younger, however now is so difficult. Recently, I have been diagnosed with low thyroid function and I am taking hormone treatment to regulate that. My current BMI is 33.9 (I weigh 98 Kilos) – height 5.7. I have also been diagnosed with hypertension and I am asthmatic. I am just worried that things might just get worse as I get older. I wonder whether the NHS can make exceptions when just BMI is not 35 or above. I do certainly have the High blood pressure which is considered a serious health condition. Does anyone know if these exceptions exist?

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H from Bedford said on 27 August 2013

I had a gastric bypass last year and I would urge anybody who has had problems with their doctor to try and see another doctor perhaps even another doctor at the same practice. It is scary going to the doctors but all doctors vary and it is always worth getting a second opinion. Princess Teacake – I do understand what its like – I would stress your family history of diabetes when you see the doctor – really hope it works out.

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PrincessTeacake said on 28 May 2013

I am writing this to ask for help. I’m a female, aged 24, and currently weigh in at 21.7stone with my height being 5.8. Well I have always had an issue with my weight being a size 12/14 at school then size 16-18 at college. And now rest at a size 22-24. I am very insecure and very depressed about my weight. I have been to the doctors many of times to be told I’m not big enough. Well I’m pretty sure 21stone is more then enough! I hate the way I look so much I don’t even let my fiancé see me in the nude. I hate being like this, it’s always been a big issue. I have depression and anxiety and I’m worried I’m going to get diabetes soon as my auntie and mum currently have it. I have tried many diets, slimming tablets and even going to the gym 3 days a week but my weight barely comes off. Most I’ve lost is 1stone and a half but had a bad day and my depression got the better of me and I put it back on In a matter of a few weeks. I’m In this viscous circle and I can’t get out. What does it take for me to get a gastric bypass on the NHS??? I pay my taxes! I don’t want to be thin to be a model or just like everyone else I want to be thin to be healthy to get my confidence back to wake up everyday and not cry!

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fussie said on 25 May 2013

Dear mysticalpickle. I read your post with real compassion your frustration and desperation are so evident. I wanted GB surgery but was encouraged by my family to try other methods as we lost a family friend in the operating room having this procedure. I tried many things as you have but I persevered with Lighter Life and now I am so glad I did, some packs were OK but generally I had to think of it at nutrition. Ultimately, all I was doing was eating what I could have done after surgery and the counsellor was fantastic helping me to make the changes I wanted in both my diet and lifestyle and enabling me to start thinking about me and food differently. I know that being morbidly obese is a lonely place but the support of the group and the management group that I still attend every now and then is worth it. I am so proud that I own the responsibility of my weight loss and it is mine alone not dependant on an NHS budget or a GP opinion, Weight management isn’t about what you eat it is about how we use food for a variety of reason. I wish you all the luck in the world with weight loss but please don’t let the GP door closing stop you from doing what you need to do,

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mysticalpickle said on 21 May 2013

Hi, im a 40 yr old mum, im 5ft 7, i now weigh 20stone. I suffer with Fibromyalgia, severe depression/ migraines, i have a wheat and glutten issue( some diet foods make me worse) Ive had an acl recon, ive damaged ligamemnts in one ankle, I suffer with Achillies tendonopothy on both feet/ankles, i suffer with plantar facilitus on both feet and ganglion syst on one foot which can not be removed, its hard to breath at times, I also have ligament damage on one of the shoulders and carple tunnel damage in one of my wrists after a car accident. my sciatica is in overdrive. I do not claim disability as i am not disabled enough lol I can not walk unaided, im sick of taking pills, i can not attend a gym due to the above conditions, i have tried 5 diets( cambridge, lighter life, slimming world, weightwatchers and diet chef) i am not working , not because I am not qualified or dont have the incentive, but medical conditions stop me and companies wont epmploy insurance risks or obese( fact). I have begged for help from my gp in the past, and they suggest the normal.(gym and healthy food) I dont smoke, dont do drugs nor do i drink. My mental and emotional state are so low, its hard to see myself live the rest of my life like this. I have 2 children and want to be around for them, grandkids etc to enjoy my life and etc. i dont have a personal life, everything is sooo painful, i desperatly need some help. Having read the types of op, bypass, band etc , i read about the balloon too. which is similar to the band but can be altered to fix the need of each person. im going up and up in weight, and its hard for us over weighties to keep weight off through daily routine. I have no friends for support and family is miles away. Can anyone suggest something, im not after sympathy or a magic wand, but i just cant get me wobbly bits off. Im quite scared to go back to my GP. Would i be a good candidate for these procedures? surely having a better lif, healthier life is better than struggles

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nata1ie said on 08 May 2013

Im 32 5′ 3" and a bmi of 53 since i had my daughter when i was a size 10 ive suffered from extreme lower back pains which made me put the weight on as i can hardly walk with the amount of pain im in i dont leave the house as apart from the pain, ive gained a phobiia that everyones looking and laughing at me.
Ive tried excercise to get my weight down but because of the pain i cant do it so i asked my doctor for weight loss surgery and he refused im at a loss why did he refuse when im obviously needing the help !! I just dont know where to turn anymore, if this comment gets read then plz help me xx

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Marina3 said on 05 October 2012

I am 18 years old, 5"3 and 105kilos. My BMI is 41. I have always been big in my life due to many bad experiences during my early life. I have been to my doctor today to discuss my weight, they just told me what I have already been trying to do since I was 14. I have done every diet possibly, hypnosis (didn’t work), calorie controlled diets, non carb diets, all have not worked. I have quite an active life style. Yet I also suffer with Asthma. My weight can extremly make me depressed and stop me from doing what I want to do. I really need medical help now, Please.

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gilboandco27 said on 07 August 2012

Why can’t my 21 year old Son have the gastric band fitted when he is over 28 stones and lives in his bedroom all of the time because he is so afraid of what people think of him. Does he have to wait untill he has a heart attack, diabetes or a stroke. He fits all of the criteria and also his mental health now because of the fear of going out of the house. I had the gastric band fitted 7 years ago now and I lost 11 stones and kept it off. I wonder if anyone will respond to this letter?

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Weight loss resources to help you lose weight healthily, including the NHS 12-week diet and exercise plan

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Find out whether weight loss surgery, including gastric band and gastric bypass, is right for you, and how it would affect your diet and lifestyle










NHS Choices Syndication


Bariatric surgery

Introduction

Weight loss surgery, also called bariatric surgery, is used as a last resort to treat people who are dangerously obese (carrying an abnormally excessive amount of body fat).

This type of surgery is only available on the NHS to treat people with potentially life-threatening obesity when other treatments, such as lifestyle changes, haven’t worked.

Potentially life-threatening obesity is defined as:

  • having a body mass index (BMI) of 40 or above
  • having a BMI of 35 or above and having another serious health condition that could be improved if you lose weight, such as type 2 diabetes or high blood pressure

For people who meet the above criteria, weight loss surgery has proved to be effective in significantly and quickly reducing excess body fat. 

The National Institute for Health and Care Excellence (NICE) is currently considering lowering the threshold for weight loss surgery to a BMI of over 30 for people who have recently been diagnosed with type 2 diabetes.

However, it is always recommended that you try to lose weight through a healthy, calorie-controlled diet and increased exercise before you consider weight loss surgery, as surgery carries a risk of complications and requires a significant change in lifestyle afterwards.

Due to these associated risks, most surgeons, whether they are working privately or for the NHS, would only consider a person for surgery if there was a clinical need, and not just for cosmetic reasons.

Read more about who can use weight loss surgery.

Availability of weight loss surgery

Even if you are eligible for weight loss surgery, the demand for this surgery on the NHS is currently higher than the supply in many areas of the country. Therefore, there may be a considerable waiting list.

Weight loss surgery is also available privately. Prices are around: 

  • £5,000-8,000 for gastric banding
  • £9,500-15,000 for gastric bypass surgery

An increasing number of people are seeking treatment abroad as costs for private treatment are often cheaper in other countries, but this option should be considered carefully. For more information, see planned treatment abroad.

Types of weight loss surgery

The two most widely used types of weight loss surgery are:

  • gastric band, where a band is used to reduce the size of the stomach so a smaller amount of food is required to make you feel full
  • gastric bypass, where your digestive system is re-routed past most of your stomach so you digest less food and it takes much less food to make you feel full

Several other surgical techniques may be recommended in certain circumstances.

Read more about how weight loss surgery is performed.

Life after weight loss surgery

Weight loss surgery can achieve often impressive results in the amount of weight lost, but it should not be seen as a magic cure for obesity.

People who have had weight loss surgery will need to stick to a rigorous and lifelong plan afterwards to avoid putting weight back on or long-term complications.

This plan will include:

  • a carefully controlled diet
  • regular exercise

The rapid weight loss may cause relationship problems, for example with a partner who is also obese, and it may lead to unwanted loose folds of skin, which may need further surgery to correct.

Also, many people with mental health problems, such as depression or anxiety, find that these problems do not automatically improve because they have lost weight.

It is important to have realistic expectations about what life after weight loss surgery will be like.

Read more about life after weight loss surgery.

Risks

As with all types of surgery, weight loss surgery carries the risk of complications, some of which are serious and potentially fatal, such as:

A 2014 American review of over 157,000 patients found the overall risk of death, within 30 days of having any kind of weight loss surgery, is around 1 in 1000. The risk of death after having a gastric bypass was slightly higher.

However, certain risk factors, such as high blood pressure or a BMI of 50 or above, increase the risk of complications.

Read more about risks of weight loss surgery.

Results

As long as a person is willing and able to stick to their agreed plan afterwards, surgery can effectively reduce their weight and treat conditions associated with obesity, such as diabetes.

Recent research carried out in America found that on average:

  • people with a gastric band will lose around half their excess body weight
  • people with a gastric bypass will lose around two-thirds of their excess body weight

Both techniques also lead to a considerable improvement (and sometimes a complete cure) of obesity-related conditions, such as diabetes or high blood pressure.

Read more about the results of weight loss surgery.

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Published Date
2014-07-22 13:24:33Z
Last Review Date
2012-11-05 00:00:00Z
Next Review Date
2014-11-05 00:00:00Z
Classification
Obesity,Obesity surgery






NHS Choices Syndication


Bariatric surgery

Life after weight loss surgery

It is very important that you stick to your recommended diet plan after your surgery.

Diet plans can differ between specialist centres and depending on your individual circumstances, but most people will be given a plan similar to the ones described below.

Diet after a gastric band operation

Your diet after a gastric band operation will progress over three main stages:

  • In the first four weeks after surgery, you will only be able to drink liquids and eat small amounts of pureed food, such as mashed potato.
  • In weeks four to six, you can you have soft food, such as chicken.
  • After six weeks, gradually resume a healthy diet based on eating small amounts of nutritional food.

Each stage is discussed in more detail below.

First four weeks

It is important that any food you eat during this period is pureed. Attempting to eat solid foods at this stage could put pressure on the band and damage it.

Pureed food has the same texture and consistency as baby food. You can puree food using a food processor, hand-held blender or potato masher.

Additional fluids, such as sauces or water, may be required to soften some types of food.

Aim to eat small portions four to five times a day. A portion is around 100g or five to six tablespoons of food. Eat all your meals slowly, taking small mouthfuls.

Stop eating as soon as you feel full. Due to the position of the band, you will probably experience a feeling of fullness or tightness in your chest rather than in your stomach.

Drink around 1.5 litres (2.5 pints) of water a day. Drink small glasses, around 100-200ml, between meals but never with your meals.

If you experience repeated episodes of vomiting after eating, it may be a sign that you are eating too much or that your band needs to be adjusted. Contact your surgical unit for advice.

Weeks four to six

Continue to eat a similar diet as you did for the first four weeks, but your food no longer has to be pureed, although it should be soft.

For example, you could eat:

  • wholewheat breakfast cereals mixed with milk
  • porridge
  • mashed potatoes and melted cheese
  • soup
  • yoghurt
  • rice pudding

After six weeks

After six weeks, you will be ready to adopt a long-term diet that you will need to stick to for the rest of your life. Your band should now be adjusted correctly so you should need to eat much less to satisfy your appetite.

While weight loss is an important goal of your diet, do not neglect the nutritional content of your diet. See the box, above right, for more information on what makes a healthy, nutritional diet.

The British Obesity Surgery Patient Association (BOSPA), a charity for people who could benefit from surgery, has six golden rules you will need to follow to get the maximum benefit from your gastric band:

  • Only eat three meals a day.
  • Avoid snacking between meals. If you are following your recommended guidelines, there is no reason why you should feel hungry between meals.
  • Eat solid food. While soft foods may be easier to digest, they usually contain more carbohydrates and fat and make you feel less full than solid foods.
  • Eat slowly and stop eating as soon as you feel full. Cut your food into very small chunks, around the size of a pencil-top rubber, then chew each chunk 10-25 times before swallowing. Stop eating once you feel a sensation of fullness or tightness in your chest. Overeating or eating too fast could cause unpleasant symptoms such as pain and vomiting.
  • Do not drink during meals. This can flush food out of your stomach pouch and make you feel less full. Avoid drinking fluids 30 minutes before a meal and for an hour afterwards.
  • Avoid drinking high-calorie drinks, such as cola, alcohol, sweetened fruit juices and milkshakes. These types of drink will quickly pass out of your stomach and into your small intestine, increasing your calorie intake. Ideally, drink water or zero-calorie drinks, such as diet cola or diet lemonade.

Diet after a gastric bypass

The progression of diet stages after a gastric bypass is broadly similar to those after a gastric band:

  • In the first week after surgery, drink liquids only (this does not include pureed food).
  • In weeks two to four, you can eat pureed food in the same quantities (100g) and frequencies (four to five times a day) as described above.
  • In weeks four to six, you can eat soft food.
  • After six weeks, gradually resume eating a healthy diet.

The golden rules above also apply to your diet after a gastric bypass.

However, you need to be aware of several additional issues.

Firstly, you will need to avoid eating food that is high in sugar, such as chocolate, cakes, sweets and biscuits. This is because your bypass will affect how you digest sugar, and any sugar you eat will trigger your body to produce high levels of insulin.

The excessive amount of insulin can cause a number of unpleasant symptoms that are collectively known as dumping syndrome. Symptoms of dumping syndrome include:

  • nausea
  • abdominal (tummy) pain
  • diarrhoea
  • light-headiness

Secondly, you will need to take daily vitamin and mineral supplements, as your small intestine will no longer be able to digest all the vitamins and minerals your body needs from your diet.

The dosage and type of supplements can vary from case to case, but most people are required to take:

  • a multivitamin supplement, which contains a combination of different vitamins
  • a calcium supplement (the body requires calcium to maintain healthy bones)
  • an iron supplement

Diet after other types of weight loss surgery

The recommended diet after other types of weight loss surgery is likely to be similar to the advice above.

Your specialist centre will be able to provide more detailed advice.

Exercise after weight loss surgery

Losing weight and then maintaining a healthy weight does not simply involve reducing the amount of calories you eat. Burning calories while exercising is also important.

Regular exercise also has additional health benefits other than weight loss. These include reducing your risk of developing heart disease and some types of cancer, and boosting your self-esteem and wellbeing.

You will probably be given an exercise plan that starts gradually with low to moderate amounts of physical exercise, such as 10 minutes a day, before the amount is gradually increased.

The exercise should be intense enough to leave you feeling out of breath and getting your heart beating faster.

Recommended types of physical exercise include:

  • activities that can be incorporated into everyday life, such as brisk walking, gardening or cycling
  • supervised exercise programmes
  • activities such as swimming, walking (where you aim to walk a certain number of steps a day) and stair climbing

Chose physical activities that you enjoy as you will be more likely to continue doing them.

Further information

Read more about fitness including information on:

Published Date
2013-08-28 16:31:28Z
Last Review Date
2012-11-05 00:00:00Z
Next Review Date
2014-11-05 00:00:00Z
Classification
Carbohydrates,Drinks,Fruit and vegetables,Getting active,Healthy eating,Obesity,Obesity surgery,Physical wellbeing,Surgery,Weight loss,Weight management






NHS Choices Syndication


Bariatric surgery

Recovering from weight loss surgery

After weight loss surgery, you will need a few days to recover. It may also be several weeks or months before you can resume normal activities, depending on the type of surgery you have.

Recovering from a gastric band operation

When you wake after surgery, you will probably have some pain at the site of the surgery. This is normal and should pass within a few days.

Blood clots are an uncommon but serious complication that can occur after banding and can include:

To reduce the risk of blood clots, you may be given a blood-thinning medication, such as heparin, and compression stockings to wear.

Once you feel well enough, move around as much you can as this will further reduce your risk of blood clots.

For the first 24 hours, you will only be allowed to drink a small amount of liquids. This is because your stomach will be very swollen and sore from the effects of the surgery.

Gradually, small amounts of solid food will be introduced into your diet. Read about recommendations for weight loss surgery.

Gastric band surgery may be carried out as a day case and most people are well enough to leave hospital within 24 hours of surgery. You can resume normal activities within four to six weeks.

Four to six weeks after surgery, your stomach should have healed enough that your band can be adjusted by inflating it with saline (sterile salt water).

This is done by inserting a needle via the access point through which the saline is pumped. The band will then inflate, which will constrict the upper pouch of your stomach. The whole process takes around 15 minutes. This is sometimes done after numbing your abdomen with a local anaesthetic, using an X-ray to locate the band.

Often, this process of adjustment is a fine balancing act. For example, if the band is too loose you may not lose weight, but if the band is too tight, you may vomit after eating.

Therefore, it can take a number of sessions before the ideal adjustment for your band is reached.

Recovering from a gastric bypass

Once you wake after surgery, you will probably have a drip in your arm, to provide your body with liquids, and a tube in your bladder, known as a urinary catheter, to drain urine out of your bladder.

These tubes will be removed once you are well enough to get out of bed.

Again, you may be given blood-thinning medication and compression stockings to wear to help prevent blood clots.

You will only be allowed a liquid diet immediately after surgery, and solids will be slowly introduced into your diet.

Most people are well enough to leave hospital one to four days after surgery and resume normal activities within three to five weeks.

Recovering from other types of weight loss surgery

The recovery time for other less commonly used types of weight loss surgery are:

  • sleeve gastrectomy – one to four days to leave hospital and four to six weeks to resume normal activities
  • bilo-pancreatic diversion – one to four days to leave hospital and three to six months to resume normal activities
  • gastric balloon – fitting a gastric balloon is a non-invasive procedure (does not involve making incisions in your body), so you should be able to leave hospital on the same day and resume normal activities almost immediately

The advice about adopting a liquid diet immediately after surgery and then gradually introducing small amount of solids also applies here.

Published Date
2013-08-28 16:31:18Z
Last Review Date
2012-11-05 00:00:00Z
Next Review Date
2014-11-05 00:00:00Z
Classification
Obesity,Obesity surgery,Weight loss






NHS Choices Syndication


Bariatric surgery

Results of weight loss surgery

As long as you stick to the recommendations on diet and exercise, all types of weight loss surgery can achieve good and often impressive results.

However, rapid weight loss can cause complications. Read more information about the risks of weight loss surgery.

Gastric band

A person with a gastric band should expect to lose 50% of their excess body weight within two years.

The weight loss is a gradual process with:

  • 35% of excess weight lost within six months of surgery
  • 40% of excess weight lost by 12 months
  • 50% of excess weight lost by 24 months

Also expect to see a marked improvement in health conditions related to obesity, particularly:

Most people also report an improvement in their overall quality of life in terms of:

  • day-to-day pain and discomfort
  • general physical health
  • mental health

Gastric bypass

A person with a gastric bypass should expect to lose 70% of their excess body weight within two years.

The weight loss tends to be more rapid in the first year (60% of the excess weight lost) then slows in the second year, with only an additional 10% weight loss.

Again, expect to see a marked improvement in the health conditions above.

Published Date
2013-08-28 16:31:39Z
Last Review Date
2012-11-05 00:00:00Z
Next Review Date
2014-11-05 00:00:00Z
Classification
Obesity,Obesity surgery,Weight loss






NHS Choices Syndication


Bariatric surgery

Risks of weight loss surgery

The rapid weight loss associated with weight loss surgery can cause a number of side effects and has a number of risks.

These are outlined below.

Complications immediately after surgery

Complications that can occur during or immediately after surgery include:

  • infection – this affects around 1 in 20 people
  • blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism) – this affects around 1 in 100 people
  • internal bleeding – this affects around 1 in 100 people

Excess skin

While weight loss surgery can successfully remove the fat in the body, it cannot cause skin to revert to its pre-obesity tightness and firmness.

Therefore, if you were obese, especially for many years, you may be left with excess folds and rolls of skin, particularly around the breasts, tummy, hips and limbs.

These folds and rolls normally become most apparent 12-18 months after surgery. They can look ugly and are difficult to keep clean, so you may be vulnerable to developing rashes and infections.

Cosmetic surgery can be used to remove the excess skin. However, as this treatment is for cosmetic and not clinical reasons, it is not available on the NHS.

The price for a course of skin-removal treatment can range from £1,500 to £6,000 depending on the amount of skin that needs to be removed.

Gallstones

Around 1 in 12 people will develop gallstones after weight loss surgery, typically 10 months after surgery.

Gallstones are small stones, usually made of cholesterol, that form in the gallbladder.

In most cases, gallstones do not cause any symptoms. However, if they become trapped in a duct (an opening or channel), they can irritate and inflame the gallbladder and cause symptoms, such as:

  • a sudden intense pain in your abdomen (tummy)
  • nausea and vomiting
  • jaundice (yellowing of the skin and the whites of the eyes)

Psychosocial effects of surgery

While most people who undergo weight loss surgery report an improvement in their quality of life, several psychosocial effects may be related to rapid weight loss.

Some people have reported relationship problems with their partner as their partner begins to feel nervous, anxious or possibly jealous about their weight loss.

Additionally, social occasions that revolve around food, such as family meals, can become awkward, as it is common to feel self-conscious about your reduced capacity to eat. 

It is also common for a person to experience a worsening of mood when their weight stabilises, typically two years after surgery. This is often because many people realise that problems that existed before surgery, such as money worries or difficulties at work, are still there after surgery.

You may find it useful to discuss these issues with people who have also had weight loss surgery. The British Obesity Surgery Patient Association’s website contains a service directory of support groups in the UK along with more information.

You can also find more information and tips for dealing with psychosocial effects of surgery such as stress, anxiety or depression in the Moodzone.

Stomal stenosis

A common complication in people with a gastric bypass is that the hole (stoma) that connects their stomach pouch to their small intestine becomes blocked by a piece of food. This is known as stomal stenosis and is thought to occur in one-fifth of people with a gastric bypass.

The most common symptom of stomal stenosis is persistent vomiting.

Stomal stenosis can be treated by directing a small flexible tube, known as an endoscope, to the site of the stoma. A balloon attached to the endoscope is inflated to unblock the stoma.

The best way to prevent stomal stenosis is to always cut food into small chunks, chew the chunks thoroughly and avoid drinking during meals. Read more information about recommendations for weight loss surgery.

Gastric band slippage

Gastric band slippage is a complication that affects around 1 in 50 people with a gastric band.

As the name suggests, the band slips out of position. This means that the stomach pouch becomes bigger than it should be. This can cause symptoms such as:

  • heartburn
  • nausea
  • vomiting

Further surgery will be required to repair the band.

Food intolerance

Around 1 in 35 people with a gastric band develop a food intolerance, often many years after their surgery.

A food intolerance is when your body is unable to tolerate certain foods, such as red meat or green salad, resulting in a number of unpleasant symptoms such as:

The reason why a food intolerance can develop after surgery is unclear.

In most cases, avoiding foods that trigger a reaction should help improve symptoms, but if you have persistent symptoms associated with a number of different foods, it may be necessary to remove the band and replace it with a gastric bypass.

Death

No surgery is entirely safe and all surgical procedures carry a risk of death. However, the outlook for weight loss surgery has greatly improved with modern techniques.

A 2014 American review of over 157,000 patients  found the overall risk of death, within 30 days of having any kind of weight loss surgery, is around 1 in 1000. The risk of death after having a gastric bypass was slightly higher.

Complications of weight loss surgery which could lead to death include:

A number of risk factors have been identified that increase the risk of death during or shortly after weight loss surgery. These are:

  • being over 45 years old
  • high blood pressure
  • having a BMI of 50 or above
  • being male, as obese men tend to weigh more than obese women
  • having a known risk factor for a pulmonary embolism

Known risk factors for a pulmonary embolism include:

  • having a previous history of blood clots
  • pulmonary hypertension, when the blood pressure inside your lungs is particularly high
  • obesity hypoventilation syndrome, when you have persistent breathing difficulties related to your obesity

The risk factors above can have a significant impact on your individual risk of death. However, untreated obesity, especially morbid obesity, carries a significant risk of premature death itself.

In most cases, the benefits of surgery outweigh the risks in people who meet the National Institute for Health and Care Excellence’s criteria for weight loss surgery. Read more about who can use weight loss surgery.

Published Date
2014-07-22 13:24:22Z
Last Review Date
2012-11-05 00:00:00Z
Next Review Date
2014-11-05 00:00:00Z
Classification
Death and dying,End-of-life issues,Gallstones,Nausea,Obesity,Obesity surgery,Skin,Surgery,Vomiting,Weight loss






NHS Choices Syndication


Bariatric surgery

See what the doctor sees with Map of Medicine

The Map of Medicine is used by doctors throughout the NHS to determine the best treatment options for their patients. NHS Choices offers everyone in England exclusive and free access to this cutting-edge internet resource, which lets you see exactly what your doctor sees.

The information in the Map has been approved by the UK’s leading clinical experts, is based on the best available clinical evidence, and is continually updated. To take advantage of this unique resource go to:

Map of Medicine: obesity in adults

Map of Medicine: obesity in children

Published Date
2011-09-11 19:09:20Z
Last Review Date
0001-01-01 00:00:00Z
Next Review Date
0001-01-01 00:00:00Z
Classification






NHS Choices Syndication


Bariatric surgery

Who can use weight loss surgery?

Weight loss surgery is only recommended for people with a BMI of 40 or more, or a BMI of 35-40 and a serious health condition that could be improved if you lose weight, such as type 2 diabetes or high blood pressure.

The National Institute for Health and Care Excellence (NICE) also recommends that weight loss surgery should only be offered on the NHS if all the following conditions apply:

  • You have tried all the appropriate non-surgical methods, such as diet and exercise, but have failed to achieve or maintain a beneficial level of weight loss for at least six months.
  • You agree to commit to long-term follow-up treatment after surgery at a specialised obesity service.
  • You are fit and healthy enough to withstand the anaesthetic (painkilling medication) and surgery.

Read the full NICE guidelines on treating obesity (PDF 483Kb).

There may be slightly different criteria at your local clinical commissioning group (CCG) which could affect your access to surgery.

NICE is also currently considering lowering the threshold for weight loss surgery to a BMI of over 30 for people who have recently been diagnosed with type 2 diabetes. A final decision is expected by the end of 2014.

If you pay for private surgery, it is still likely that a surgeon will only agree to perform surgery if similar criteria are met, due to the risks associated with surgery.

When weight loss surgery isn’t suitable 

Weight loss surgery may not be recommended if you have a serious illness that would not be improved after the operation, such as:

Weight loss surgery is also unlikely to be recommended if a mental health condition or other underlying factor means you would be unable to commit to long-term follow-up and  lifestyle changes.

Examples include:

  • schizophrenia for which you are refusing to seek treatment 
  • actively abusing alcohol or drugs
  • a previous history of not complying with medical recommendations about your care

Children

Weight loss surgery would only be considered to treat obese children in exceptional circumstances, and only if the child is physically mature (this would be around the age of 13 for girls and 15 for boys).

Most experts in obesity would only recommend surgery as a treatment of last resort for children who are severely morbidly obese (a BMI of 50 of above), or who are morbidly obese (a BMI of 40 or above) and also have a serious health condition that would improve if they lost weight.

Published Date
2014-07-11 10:30:04Z
Last Review Date
2012-11-05 00:00:00Z
Next Review Date
2014-11-05 00:00:00Z
Classification
National Institute for Health and Clinical Excellence,Obesity,Obesity surgery,Weight loss






NHS Choices Syndication


Bariatric surgery

Why weight loss surgery is used

Weight loss surgery is used to treat morbid obesity that has failed to respond to non-surgical treatments. Morbid obesity is defined as having a body mass index (BMI) of 40 or above.

It is also used to treat severe (but not morbid) obesity that is associated with a potentially life-threatening condition, such as heart disease, and that has not responded to non-surgical treatments. Severe obesity means having a BMI of 35-39.

Why it is used to treat morbid obesity

Morbid obesity is a very serious health condition that can affect almost every biological system in the human body. It is thought that morbid obesity increases your risk of many different health conditions, such as diabetes and getting blood clots. These conditions are outlined below.

Cardiovascular conditions

The cardiovascular system is made up of the heart and blood vessels. It is involved in circulating oxygen-rich blood around the body.

People with morbid obesity are vulnerable to the following cardiovascular conditions:

Health conditions that affect the cardiovascular system are collectively known as cardiovascular disease.

Respiratory conditions

Respiratory conditions often seen in people with morbid obesity include:

  • asthma 
  • obstructive sleep apnoea, when a person stops breathing for brief periods of time when sleeping
  • obesity hypoventilation syndrome, where a person is unable to breathe deeply or quickly enough to meet their body’s need for oxygen, resulting in symptoms such as drowsiness, high blood pressure and headaches

Metabolic conditions

Metabolism is the term for all the chemical reactions used by the body to break down food into energy.

Metabolic conditions often seen in people with morbid obesity include:

Muscle, joint and bone conditions

The excessive weight associated with morbid obesity places extra pressure on the bones, muscles and joints. This can result in conditions such as:

  • low back pain
  • slipped disc, when one of the discs that make up the spine becomes damaged and moves out of position
  • osteoarthritis of the hips, knees, ankles and feet – osteoarthritis is when the joints become damaged, resulting in symptoms such as joint pain and stiffness

Digestive conditions

Eating a high-fat diet, especially for many years, can disrupt the normal workings of the digestive system as it is unable to digest excessive amounts of fats and carbohydrates.

Digestive conditions associated with morbid obesity include:

  • gallstones 
  • gastro-oesophageal reflux disease (GORD), where stomach acid leaks out of the stomach and into the throat
  • non-alcoholic fatty liver disease, where deposits of fat form in the tissue of the liver. In the most serious cases, this can result in scarring of the liver (cirrhosis) and loss of liver function

Cancer

Morbid obesity significant increases the risk of getting some types of cancer, such as:

Mental health conditions

People who are morbidly obese often have a poor quality of life and low self-esteem. This makes them potentially more vulnerable to developing mental health conditions such as:

Why it is used to treat severe obesity

Weight loss surgery may also be recommended to treat severely obese people (with a BMI of 35-39) who:

  • have tried all other options to lose weight without success, and 
  • have a serious health condition that would improve if they lost weight

Examples of these types of conditions include:

  • high blood pressure
  • coronary heart disease
  • type 2 diabetes
Published Date
2011-09-11 19:09:17Z
Last Review Date
2011-01-27 00:00:00Z
Next Review Date
2013-01-27 00:00:00Z
Classification
Coronary heart disease,Fats and fatty acids,Liver cirrhosis,Mental health conditions,Metabolic conditions,Obesity,Obesity surgery,Type 2 diabetes,Weight loss,Weight management




Weight loss surgery – NHS Choices






























































Weight loss surgery 

Introduction 

Understanding BMI results in adults


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Find out how to calculate your body mass index (BMI) and interpret the results correctly.

Media last reviewed: 04/03/2014

Next review due: 04/03/2016

Body mass index and obesity

The most widely used method of seeing if you are a healthy weight is to calculate your body mass index (BMI). This is your weight in kilograms divided by your height in metres squared:

  • If your BMI is 25-29.9, you are over the ideal weight for your height (overweight).
  • If your BMI is 30-39.9, you are obese.
  • If your BMI is over 40, you are very obese (known as morbidly obese).

BMI does not provide an accurate assessment of weight in all circumstances, such as in people who are very muscular or children going through a sudden growth spurt.

Vicky Finch

‘My gastric band surgery’

Vicky talks about the changes she had to make to her diet before and after weight loss surgery, and what it’s like living with a gastric band

Weight loss surgery, also called bariatric surgery, is used as a last resort to treat people who are dangerously obese (carrying an abnormally excessive amount of body fat).

This type of surgery is only available on the NHS to treat people with potentially life-threatening obesity when other treatments, such as lifestyle changes, haven’t worked.

Potentially life-threatening obesity is defined as:

  • having a body mass index (BMI) of 40 or above
  • having a BMI of 35 or above and having another serious health condition that could be improved if you lose weight, such as type 2 diabetes or high blood pressure

For people who meet the above criteria, weight loss surgery has proved to be effective in significantly and quickly reducing excess body fat. 

The National Institute for Health and Care Excellence (NICE) is currently considering lowering the threshold for weight loss surgery to a BMI of over 30 for people who have recently been diagnosed with type 2 diabetes.

However, it is always recommended that you try to lose weight through a healthy, calorie-controlled diet and increased exercise before you consider weight loss surgery, as surgery carries a risk of complications and requires a significant change in lifestyle afterwards.

Due to these associated risks, most surgeons, whether they are working privately or for the NHS, would only consider a person for surgery if there was a clinical need, and not just for cosmetic reasons.

Read more about who can use weight loss surgery.

Availability of weight loss surgery

Even if you are eligible for weight loss surgery, the demand for this surgery on the NHS is currently higher than the supply in many areas of the country. Therefore, there may be a considerable waiting list.

Weight loss surgery is also available privately. Prices are around: 

  • £5,000-8,000 for gastric banding
  • £9,500-15,000 for gastric bypass surgery

An increasing number of people are seeking treatment abroad as costs for private treatment are often cheaper in other countries, but this option should be considered carefully. For more information, see planned treatment abroad.

Types of weight loss surgery

The two most widely used types of weight loss surgery are:

  • gastric band, where a band is used to reduce the size of the stomach so a smaller amount of food is required to make you feel full
  • gastric bypass, where your digestive system is re-routed past most of your stomach so you digest less food and it takes much less food to make you feel full

Several other surgical techniques may be recommended in certain circumstances.

Read more about how weight loss surgery is performed.

Life after weight loss surgery

Weight loss surgery can achieve often impressive results in the amount of weight lost, but it should not be seen as a magic cure for obesity.

People who have had weight loss surgery will need to stick to a rigorous and lifelong plan afterwards to avoid putting weight back on or long-term complications.

This plan will include:

  • a carefully controlled diet
  • regular exercise

The rapid weight loss may cause relationship problems, for example with a partner who is also obese, and it may lead to unwanted loose folds of skin, which may need further surgery to correct.

Also, many people with mental health problems, such as depression or anxiety, find that these problems do not automatically improve because they have lost weight.

It is important to have realistic expectations about what life after weight loss surgery will be like.

Read more about life after weight loss surgery.

Risks

As with all types of surgery, weight loss surgery carries the risk of complications, some of which are serious and potentially fatal, such as:

A 2014 American review of over 157,000 patients found the overall risk of death, within 30 days of having any kind of weight loss surgery, is around 1 in 1000. The risk of death after having a gastric bypass was slightly higher.

However, certain risk factors, such as high blood pressure or a BMI of 50 or above, increase the risk of complications.

Read more about risks of weight loss surgery.

Results

As long as a person is willing and able to stick to their agreed plan afterwards, surgery can effectively reduce their weight and treat conditions associated with obesity, such as diabetes.

Recent research carried out in America found that on average:

  • people with a gastric band will lose around half their excess body weight
  • people with a gastric bypass will lose around two-thirds of their excess body weight

Both techniques also lead to a considerable improvement (and sometimes a complete cure) of obesity-related conditions, such as diabetes or high blood pressure.

Read more about the results of weight loss surgery.

Page last reviewed: 05/11/2012

Next review due: 05/11/2014

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Comments

The 15 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Lubelle81 said on 09 July 2014

I just discovered I have PCOS.. The weight started packing on when I was 19.. I’m 32 now.. I got very lucky to have one son..But this uncontrollable weight gain is too much it’s depressing, every time I travel to work I want to jump in front of a train.. I talked this over with my GP, I begged him for a gastric bypass but instead he told me to get a dietitian and enter a gym, I don’t want to be difficult but I choose to work as a cleaner to replace going to a gym.. Besides swallowing painkillers as if I was eating skittles, How else can I explain to my GP 12 years of Pain, and Depression is enough for me, I settle for a Gastric Bypass??

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Chezzybaby said on 15 March 2014

I had a gastric bypass on 23rd October 2013 and 5 months on and I am 6 stone 2llb lighter and have not looked back, providing you stick with what the hospital tell you and take ur medication and eat what they say you should be fine. Iv yoyo dieted for years battled with my weight iv researched thus operation to help me reach the right decision . The only part of the journey I didn’t really like was having to have injections in my tummy for two weeks twice a day, but it was all go after they were finished. And I do not regret it one bit. Everyone is different but this op had mentally changed my whole outlook on food and drink, I no longer crave chocolate and diet Pepsi which was my downfall before. Good luck to you all considering to have the bypass xx

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cirelondiel said on 07 January 2014

I need help.
I am 22 years old, 5”10 size 26/28 and around 25/26 stone. As a child I was always bigger than the other children in school.
I have been on a diet most of my life even when I was small. relentlessly bullied all the way through school and still even now remarks and taunts are made. exercise is hard as I had a accident a few years ago and have nerve damage in the base of my spine and a curvature in the top. manic depression and anxiety disorders and a history of self harming and several attempts on my own life. I am seriously considering surgery but I need as much help and advice as you can give me.
Any advice or words of wisdom will be greatly appreciated.

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cirelondiel said on 07 January 2014

I need help.
I am 22 years old, 5”10 size 26/28 and around 25/26 stone. As a child I was always bigger than the other children in school.
I have been on a diet most of my life even when I was small. relentlessly bullied all the way through school and still even now remarks and taunts are made. exercise is hard as I had a accident a few years ago and have nerve damage in the base of my spine and a curvature in the top. manic depression and anxiety disorders and a history of self harming and several attempts on my own life. I am seriously considering surgery but I need as much help and advice as you can give me.
Any advice or words of wisdom will be greatly appreciated.

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GastricBypassSufferer said on 10 December 2013

As someone who has to live with a mother who has had the gastric bypass operation, I think people should be made aware of what the side effects are to having this surgery and how Gastric Surgery can be detrimental to your own health because what the surgeons tell patients before hand is not a reality and the operation should be banned under some sort of misselling in my opinion.

Firstly as a result of having a cut and shut of the digestive system, the food consumed is never digested properly, you will not absorb all the nutrition you need from the food which will ultimately be bad for your own health but as the food passes through in a undigested/incorrectly digested state, what goes down the loo, stinks.

I really cant emphasis enough just how bad this smell is and over time this smell will follow you around everywhere like an unchanged nappy!

Likewise your gaseous emissions or flatulence will also smell an order of magnitude worse than before surgery and you will always be planning to be around a toilet as you have far less control over your bowels as a result. If an app existed where you can see every public toilet on the planet, gastric bypass recipients will almost certainly download it. Secondly, if you choose to have this operation, you will become very ashamed of this smell (which is a negative effect on your already fragile mental health) and will spend massive amounts on air-freshener and perfumes. This means anyone else living in the home if they have not already, will develop breathing problems including asthma as a results of the copious amounts of artificial smells deployed in the building. The smell for me is so bad it triggers massive coughing sessions and as a result I have developed permanent ringing in my ears and a hernia from the excessive coughing caused ultimately by this surgery. This excessive use of air freshener is bad for everyone’s health but the I doubt the Gastric Surgeons have thought that fair ahead!

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GastricBypassSufferer said on 10 December 2013

Part 2.

Thirdly as a taxpayer I dont see this Gastric Surgery recipient having changed what they eat contrary to the “careful eligibility checks” carried out by the NHS before hand. My mother still continues to pig out on doughnuts and other junk fund, which suggests to me obesity may be have some element of mental health issues after all what is comfort eating if its not eating in search of missing nutrients from the diet? Likewise I think its also worth pointing out most obese people are seriously deficient in Vitamin D, and studies show your weight will drop off when your get your levels up to 200nmol/L, so if you want a cheaper less invasive alternative, get your Dr to check your Vit D levels and get them up, at least to 100nmol/L, as Vit D helps your body repair itself, your taste for healthy food will increase until you crave eating healthy food and shun sugary foods. Some fatty foods are healthy because fat soluble vitamins need fat to be stored in, so when you eat some joints of meat, you will getting the fat soluble vitamins the animal has naturally built up so you will benefit from a a natural form of vitamin delivery.

So to anyone considering this surgery, its painful, and will leave you smelling and behaving like an incontinent for the rest of your life. And ask yourself do you really want that? At least check out the Vit D route for 1 year before hand as the science backs up my claims, but it also means the UK’s GDP will decline as a Vit D is a lot less expensive than questionable surgery.

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BigIsBack said on 09 November 2013

Reading the experiences of everyone else here that somehow resembles my own experience I come to the conclusion that patients are not in the heart of the NHS ethos.

I really hope that the NHS will help every patient enjoy a healthier life.

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Soul Surfer said on 10 October 2013

I am a 34 year old female. I have always suffered from weight problems and tried all the diets that are around. I managed to shed some weight when I was younger, however now is so difficult. Recently, I have been diagnosed with low thyroid function and I am taking hormone treatment to regulate that. My current BMI is 33.9 (I weigh 98 Kilos) – height 5.7. I have also been diagnosed with hypertension and I am asthmatic. I am just worried that things might just get worse as I get older. I wonder whether the NHS can make exceptions when just BMI is not 35 or above. I do certainly have the High blood pressure which is considered a serious health condition. Does anyone know if these exceptions exist?

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H from Bedford said on 27 August 2013

I had a gastric bypass last year and I would urge anybody who has had problems with their doctor to try and see another doctor perhaps even another doctor at the same practice. It is scary going to the doctors but all doctors vary and it is always worth getting a second opinion. Princess Teacake – I do understand what its like – I would stress your family history of diabetes when you see the doctor – really hope it works out.

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PrincessTeacake said on 28 May 2013

I am writing this to ask for help. I’m a female, aged 24, and currently weigh in at 21.7stone with my height being 5.8. Well I have always had an issue with my weight being a size 12/14 at school then size 16-18 at college. And now rest at a size 22-24. I am very insecure and very depressed about my weight. I have been to the doctors many of times to be told I’m not big enough. Well I’m pretty sure 21stone is more then enough! I hate the way I look so much I don’t even let my fiancé see me in the nude. I hate being like this, it’s always been a big issue. I have depression and anxiety and I’m worried I’m going to get diabetes soon as my auntie and mum currently have it. I have tried many diets, slimming tablets and even going to the gym 3 days a week but my weight barely comes off. Most I’ve lost is 1stone and a half but had a bad day and my depression got the better of me and I put it back on In a matter of a few weeks. I’m In this viscous circle and I can’t get out. What does it take for me to get a gastric bypass on the NHS??? I pay my taxes! I don’t want to be thin to be a model or just like everyone else I want to be thin to be healthy to get my confidence back to wake up everyday and not cry!

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fussie said on 25 May 2013

Dear mysticalpickle. I read your post with real compassion your frustration and desperation are so evident. I wanted GB surgery but was encouraged by my family to try other methods as we lost a family friend in the operating room having this procedure. I tried many things as you have but I persevered with Lighter Life and now I am so glad I did, some packs were OK but generally I had to think of it at nutrition. Ultimately, all I was doing was eating what I could have done after surgery and the counsellor was fantastic helping me to make the changes I wanted in both my diet and lifestyle and enabling me to start thinking about me and food differently. I know that being morbidly obese is a lonely place but the support of the group and the management group that I still attend every now and then is worth it. I am so proud that I own the responsibility of my weight loss and it is mine alone not dependant on an NHS budget or a GP opinion, Weight management isn’t about what you eat it is about how we use food for a variety of reason. I wish you all the luck in the world with weight loss but please don’t let the GP door closing stop you from doing what you need to do,

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mysticalpickle said on 21 May 2013

Hi, im a 40 yr old mum, im 5ft 7, i now weigh 20stone. I suffer with Fibromyalgia, severe depression/ migraines, i have a wheat and glutten issue( some diet foods make me worse) Ive had an acl recon, ive damaged ligamemnts in one ankle, I suffer with Achillies tendonopothy on both feet/ankles, i suffer with plantar facilitus on both feet and ganglion syst on one foot which can not be removed, its hard to breath at times, I also have ligament damage on one of the shoulders and carple tunnel damage in one of my wrists after a car accident. my sciatica is in overdrive. I do not claim disability as i am not disabled enough lol I can not walk unaided, im sick of taking pills, i can not attend a gym due to the above conditions, i have tried 5 diets( cambridge, lighter life, slimming world, weightwatchers and diet chef) i am not working , not because I am not qualified or dont have the incentive, but medical conditions stop me and companies wont epmploy insurance risks or obese( fact). I have begged for help from my gp in the past, and they suggest the normal.(gym and healthy food) I dont smoke, dont do drugs nor do i drink. My mental and emotional state are so low, its hard to see myself live the rest of my life like this. I have 2 children and want to be around for them, grandkids etc to enjoy my life and etc. i dont have a personal life, everything is sooo painful, i desperatly need some help. Having read the types of op, bypass, band etc , i read about the balloon too. which is similar to the band but can be altered to fix the need of each person. im going up and up in weight, and its hard for us over weighties to keep weight off through daily routine. I have no friends for support and family is miles away. Can anyone suggest something, im not after sympathy or a magic wand, but i just cant get me wobbly bits off. Im quite scared to go back to my GP. Would i be a good candidate for these procedures? surely having a better lif, healthier life is better than struggles

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nata1ie said on 08 May 2013

Im 32 5′ 3" and a bmi of 53 since i had my daughter when i was a size 10 ive suffered from extreme lower back pains which made me put the weight on as i can hardly walk with the amount of pain im in i dont leave the house as apart from the pain, ive gained a phobiia that everyones looking and laughing at me.
Ive tried excercise to get my weight down but because of the pain i cant do it so i asked my doctor for weight loss surgery and he refused im at a loss why did he refuse when im obviously needing the help !! I just dont know where to turn anymore, if this comment gets read then plz help me xx

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Marina3 said on 05 October 2012

I am 18 years old, 5"3 and 105kilos. My BMI is 41. I have always been big in my life due to many bad experiences during my early life. I have been to my doctor today to discuss my weight, they just told me what I have already been trying to do since I was 14. I have done every diet possibly, hypnosis (didn’t work), calorie controlled diets, non carb diets, all have not worked. I have quite an active life style. Yet I also suffer with Asthma. My weight can extremly make me depressed and stop me from doing what I want to do. I really need medical help now, Please.

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gilboandco27 said on 07 August 2012

Why can’t my 21 year old Son have the gastric band fitted when he is over 28 stones and lives in his bedroom all of the time because he is so afraid of what people think of him. Does he have to wait untill he has a heart attack, diabetes or a stroke. He fits all of the criteria and also his mental health now because of the fear of going out of the house. I had the gastric band fitted 7 years ago now and I lost 11 stones and kept it off. I wonder if anyone will respond to this letter?

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Lose weight

Weight loss resources to help you lose weight healthily, including the NHS 12-week diet and exercise plan

‘Is weight loss surgery right for me?’

Find out whether weight loss surgery, including gastric band and gastric bypass, is right for you, and how it would affect your diet and lifestyle






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