Weight Loss Surgery
Learn everything about your treatment
Learn everything about your treatment
Weight loss surgery overview
What is weight loss surgery?
This weight loss surgery overview aims to explain what weight loss surgery is, how it works and the different types of weight loss surgery available to you.
Weight loss surgery is an increasingly popular and effective method in tackling obesity. The medical name for this type of surgery is bariatric surgery. It aims to create substantial and sustained weight loss in those with:
- A BMI of greater than 35 (if you have other medical conditions that would benefit from weight loss e.g. high blood pressure or diabetes).
- A BMI of greater than 40 (if you have no other medical conditions that would benefit from weight loss).
While there are different types of weight loss surgery available, they generally all work by the same principles. These principles include:
- Restricting how many calories your body can consume.
- And/or by changing how your body absorbs calories and fats .
What types of weight loss surgery techniques are available?
There are different types of surgical techniques your surgeon can use for your weight loss surgery. Consequently, the technique that they decide to use will depend on a number of factors. These may include:
- The goals you have for your weight loss surgery.
- Your current BMI.
- Your current health status.
- The possible risks you may encounter with each procedure.
This approach can be done using a local anaesthetic and sedation. Your surgeon will insert a deflated balloon through your mouth, down your food-pipe and into your stomach. He or she will then inflate the balloon with a salt-water solution. The presence of this inflated balloon will restrict the amount of space available in your stomach. Consequently, it will also restrict the amount of food that you will be able to eat. This balloon will stay in place for 6 to 18 months.
This technique can allow for up to 30% weight loss of excess weight in the first 6 months. It is generally most suitable for patients with a BMI of 27 to 30. Equally, it can also be used as a first-step for those who require initial weight loss before another technique can be used.
This method is quick, reversible and carries the least risk of all the weight loss surgery methods available. Your surgeon will make small, ‘keyhole’ incisions on your abdomen so that they can insert a band around your stomach. This band will be inflatable and adjustable. When inflated, it will restrict the amount of food that can fit in your stomach at one time and therefore, you will eat less food as a result.
Using this approach, up to 45-50% of excess weight can be lost. It is most suitable for patients with a BMI of 30 to 40. In addition, it may also be suitable for patients who are not ready to commit to an irreversible procedure.
In this procedure, your surgeon will use small, ‘keyhole’ incisions to remove 70% of your stomach. He or she will then staple the remaining 30% into a small, banana shaped tube. This technique physically limits the amount of food you can eat and allows you to feel full by eating less. Unlike the gastric bypass and duodenal switch surgeries, your normal digestive tract will remain intact. Consequently, you will only require nutritional supplements for a short period after your surgery.
Using this method of weight loss surgery, up to 60-70% of excess weight can be lost in the first 12 months. It is suitable for those with a BMI of >30.
Similar to a gastric sleeve surgery, your surgeon will use small, ‘keyhole,’ incisions to reduce the size of your stomach in a gastric bypass. However, in addition to this they will also alter the length of your digestive tract. This will reduce the amount of food you can physically eat and the amount of calories your digestive tract can absorb. Because this surgical technique alters the absorption in your digestive tract, you will need to take life-long vitamin and mineral supplements to ensure you get the nutrients you require.
This surgery allows up to 70% of excess weight to be lost in the first 2 years and is suitable for patients with a BMI of 30 to 50.
A duodenal switch is the second part of a two-stage procedure. The first stage is similar to a gastric sleeve surgery, in that your surgeon will remove a large portion of your stomach to restrict the amount of food you can eat. The purpose of this first stage is to allow enough weight loss so that the second stage is safer to carry out.
The second stage is the duodenal switch. This is similar to a gastric bypass, where your surgeon will alter the length of your digestive tract. However, in a duodenal switch, they also remove your gallbladder. Consequently, this will modify your body’s ability to absorb both calories and fats.
Overall, the two-stage process causes weight loss by restricting the amount of food you can eat and limiting the amount of calories and fats your digestive tract can absorb.
The duodenal switch has the highest weight loss results long-term, with up to 70-80% of excess weight lost at 2 years after surgery. This technique is most suitable for patients with a BMI of 60 to 65.
Which weight loss surgery procedure is best for me?
Your surgeon will discuss all the options available to you and explain which technique they think is most appropriate in your case.
Weight loss surgery candidates
Why choose to have weight loss surgery?
Weight loss surgery is an increasingly popular way to tackle obesity for weight loss surgery candidates in the UK. Obesity is medically defined as having a BMI of 30 or more. You can read more about obesity, here. As well as having excess body fat, people who are obese are also at risk of a number of other health conditions. These can include but are not limited to:
- Type 2 Diabetes
- Coronary heart disease
It is important to lose weight to reduce your health risks from obesity. Typically, many people can achieve weight loss by doing regular exercise and maintaining a healthy, balanced diet. However, this is not the case for everyone. Some obese people really struggle to lose their excess weight, even when trying their best with diet and exercise. Others may lose weight at first with diet and exercise but then, after a certain point, their weight loss will stop and their weight will plateau. Weight loss surgery is suitable for these types of obese people who need further help with their weight loss and would like to consider surgical options.
Who is a suitable candidate for weight loss surgery?
Suitable candidates for weight loss surgery:
- Patients who have a BMI of >35 and a medical condition that can benefit from weight loss (e.g. diabetes or high blood pressure).
- Patients who have a BMI of >40.
- Are experiencing health issues because of their obesity.
- May be experiencing mobility issues as a result of their obesity.
- May have depression or self-esteem issues because of their obesity.
- Have tried diet and excercise to lose weight with no or limited success.
- Are willing to commit to a new, healthier lifestyle post-surgery.
- Have a positive outlook for their surgery.
- Have realistic goals for their surgery.
These are general attributes that suitable weight loss surgery candidates may have and therefore, it is not a requirement to possess all of these.
Weight loss surgery procedure
How is weight loss surgery performed?
There are multiple types of weight loss surgery procedures available. Therefore, your procedure may take between 20 minutes to 4 hours to perform. Below is a general guide to what your weight loss surgery procedure may involve. When you meet with your surgeon, he or she will be able to give you more specific details on your exact surgery.
Before your surgery, you will meet with your surgeon. To confirm that you would like to go ahead with your weight loss procedure you will have to sign a consent form. We advise that you take your time to read the form carefully. Take the time to ensure that you fully understand all the risks and complications your surgery involves, and be sure to ask any questions you may have before signing your consent.
You will also meet your anaesthetist before your surgery. The anaesthetic agent that your surgeon chooses to use will depend on the type of weight loss procedure you are having.
A gastric balloon procedure can be done under local anaesthetic with sedation. Therefore, you will be awake but drowsy throughout the procedure. The use of local anaesthetic will ensure you do not feel any pain. As the sedative wears of, you will feel less drowsy. This will take a few hours. As the local anaesthetic wears off you may begin to feel a little discomfort. Your surgeon will prescribe appropriate pain medication to help manage this.
All of the other weight loss procedures will require the use of a general anaesthetic. Therefore, you will be asleep for the duration of the procedure. You will wake up gradually but may feel a little drowsy for a few hours until the general anaesthetic wears off. You may notice that your memory and concentration are affected for a day or so but this will return to normal with time.
A gastric sleeve procedure does not involve any incisions as your surgeon will insert the balloon through your mouth, down your food-pipe and into your stomach.
If you have choose to have any of the other weight loss procedures available, your surgeon will make 1 to 5 ‘keyhole’ incisions in your abdomen. These incisions will be small, minimally invasive and should consequently leave small scars that heal quickly. Your surgeon will be able to tell you more about the incisions specific to your surgery when you decide together which weight loss procedure type is most suitable for you.
4. Closing of incisions
Your surgeon will use sutures to close your incisions when the surgery is over. They may insert drains into your tummy to reduce swelling. You will have to return to the hospital within 10 to 14 days of your surgery so that your surgeon can remove your stitches and drains (if applicable). The staff at the hospital will give you an appointment for this before you are sent home.
5. Return to the ward
The hospital staff will take you back to the ward when your surgery is complete. If you have a gastric balloon procedure, you will remain drowsy for a couple of hours before you feel fully awake again. As your local anaesthetic wears off, it is possible that you may experience some discomfort. You can take your pain medication to help manage this.
If you have had a general anaesthetic, you will wake up gradually. You will feel a little confused and drowsy but this will wear off within a few hours. You may notice an affect on your memory and concentration, but this will return to normal within 1 to 2 days. Your surgeon will prescribe appropriate pain medication to manage any pain you may have after your weight loss surgery procedure.
Weight loss surgery consultation
What can I expect from my weight loss consultation?
If you decide that you would like to go ahead with weight loss surgery, you will first need to have a weight loss surgery consultation. During this consultation, you will meet with your surgeon. This meeting will usually last between 15 minutes to 1 hour. During this time, your surgeon will explain what the surgery involves, what they think is the most suitable procedure for you and the risks and complications involved. They will also ask you a series of questions to learn more about you and your medical background. These questions may include but are not limited to:
- What is your current health status?
- Do you suffer from any serious health conditions?
- What is your past medical and surgical history like?
- Do you take any regular medications? (This includes any prescribed, over-the-counter and herbal medications).
- Can you tell me a bit about your previous attempts at weight loss?
- What is your current diet and exercise regimen like?
- Do you smoke/drink alcohol/ use any recreational drugs?
- Are you prepared to make lifestyle adjustments post-surgery to get the best results possible?
While this may seem like a lot of information to share with your surgeon, it is important that you answer these questions as honestly as possible. Remember, your surgeon is a healthcare professional. They ask these questions in order to determine the best possible treatment plan suitable for you. If you do not answer honestly, you may not get the treatment plan you require.
What questions should I ask during my consultation?
This weight loss surgery consultation is also the perfect opportunity for you to ask any questions you may have. It is an opportunity for you to clarify any details you may not quite understand or double check your understanding of things you’re unsure about. Therefore, we generally advise patients to think carefully about what they would like to ask before they come to this meeting. Some patients find it useful to write down their questions on a sheet of paper. That way, they can bring it with them and are less likely to forget to ask things that are important to them.
Below, we have made a list of questions you may like to ask during your consultation, but feel free to add your own. Remember, there is no such thing as a stupid question!
- Do you think my goals for this weight loss surgery are realistic?
- Which weight loss procedure do you think is most suitable for me?
- What have the results of previous weight loss surgeries you have performed been like?
- What will my final scars look like?
- Will I be in pain after my surgery?
- Are the results of this surgery permanent?
- What types of lifestyle changes will I have to make post-surgery?
- Will I need to take nutritional supplements after my surgery?
Weight loss surgery risks and complications
What are the main weight loss surgery risks and complications?
Every surgery comes with risks and complications. Before you agree to go ahead with your treatment, it is important that you educate yourself on those that apply to your procedure. If you have any questions, be sure to ask your surgeon at your consultation. We have made a list of the main weight loss surgery risks and complications. They include, but are not limited to:
A seroma is a collection of fluid under the skin. These often occur under and around the incision sites. To avoid them developing, your surgeon may insert drains into your tummy after your surgery. These will drain excess fluid and reduce swelling.
If a seroma does occur, you may or may not need treatment to drain the fluid. Small seromas often resolve themselves as your body naturally reabsorbs the fluid. However, larger seromas may need to be drained. Your surgeon will be able to assess your recovery at your review appointment 10 to 14 days after your surgery.
Bleeding & bruising
If bleeding occurs, it generally happens during or very soon after surgery. However, it is also possible that you may experience some bleeding up to 2 weeks after your surgery. Bleeding and bruising is often minor. If more severe bleeding were to occur, you would have to go back to theatre for further treatment. This may delay your recovery a little. In addition, you may have a little more bruising than expected. Despite this, your final results should not be affected.
All types of surgeries carry the risk of infection. Your surgeon will do everything they can to reduce this risk. If an infection does occur, they are often mild and can be treated with a short course of antibiotics. In some cases however, infections can become more severe and require you to go back to hospital for treatment.
Below are some signs of infection you should look out for:
- A temperature over 38°C.
- Redness spreading away from your wound site >48 hours after surgery.
- Yellow/foul-smelling discharge coming from your wound.
- Pus oozing out of your wound
- Pain that is not responding to pain medication.
If you have any of these symptoms after surgery it is important that you seek medical help.
Vitamin & mineral deficiencies
There is a risk of developing vitamin and/or mineral deficiencies when you have certain weight loss surgery procedures. These include the gastric sleeve, gastric bypass and duodenal switch procedures. These procedures all make changes to your digestive tract. Consequently, your body may no longer able to absorb essential vitamins and minerals. Depending on which procedure you have, this side effect may be temporary or permanent.
Your surgeon will be able to advise you specifically on which nutrients your body may be lacking post-operatively. In addition, they will advise you on what nutritional supplements you can take to prevent any deficiencies and consequential side effects.
Most gallstones form as a result of high cholesterol levels. Therefore, patients undergoing weight loss surgery may already have gallstones.
Rapid weight loss as a result of weight loss surgery patients also increases the risk of developing gallstones. Furthermore, the risk of complications associated with gallstones also increases.
Gallstones can often cause no symptoms. Therefore, many patients may be unaware that they have gallstones. Sometimes however, gallstones can cause recurring episodes of severe tummy pain. The solution to this problem is gallbladder removal, which includes a further surgery.
The only weight loss surgery procedure which avoids this complication is the duodenal switch as the gallbladder is removed during this procedure.
All weight loss surgery procedures , except the gastric balloon, will leave you with scarring. Aside from the gastric balloon, all the other procedures are carried out laparoscopically. This involves inserting a camera and surgical tools through small, ‘keyhole’ incisions in your tummy. These incisions heal quickly and produce small scars that fade with time. Ask your surgeon for more advice on how best to look after your scars after surgery.
There is always the risk that you will be unhappy with the results of your surgery for aesthetic reasons. For example, as a result of weight loss you may be left with excess skin you may not like the look of. Your surgeon will be able to advise you on what your options would be if this were the case.
General surgical complications
There are some general complications that can occur with every surgery. These include:
- Blood clot formation.
- Nausea and vomiting.
- Side effects of anaesthesia.
- Post-operative pain.
Your surgeon will make every effort to ensure that none of these complications occur. It is also important that you follow your surgeon’s specific guidance before and after surgery to further reduce your risk of complications.
Weight loss surgery preparation
How can I prepare for weight loss surgery?
As the time approaches for you to have your weight loss surgery, it is absolutely normal to feel a little anxious. Fortunately for you, weight loss surgery preparation can help distract your mind and give you something useful to focus your attention on!
If you are a smoker, you can start preparing for your surgery by stopping smoking for at least 6 weeks to 3 months before the procedure. If you smoke, your risk of surgical complications both before and after surgery are increased. Therefore, we really stress the importance of stopping as soon as possible before your surgery. Click here for tips on how to kick the habit!
To help build up your body’s strength before surgery, it is important that you try to follow a healthy balanced diet and practice regular exercise. Your surgeon will give you further advice on what you will be able to eat and drink in the lead-up to your surgery. They will also advise you on which medications you will and will not be able to take on the day of your surgery.
Weight loss surgery preparation is also the key to a relaxed, speedy recovery. Below are some things you can do before your surgery to make your recovery as easy as possible.
Household work can sometimes involve a great deal of physical effort. During your recovery, it is important that you do not over-exert yourself. Therefore, there are some chores that you may like to get out of the way while you are still fit to do so, before you come into hospital. For example, you may like to take out the bins and do the laundry.
It may also be useful to place some things you know you will need at an accessible level. For example, placing crockery and food stuffs on a shelf where you will not have to bend or stretch up. This will prevent you from putting unnecessary stress on your stitches.
You may not feel up to going shopping for a week or so after your surgery. Therefore, it can be really helpful to do a big food shop to stock up on what you need before you go into hospital. Some patients also like to cook meals and freeze them so that they don’t have to cook during their recovery. Online shopping is another great resource you can make use of. You may like to make yourself familiar with how this works before your surgery if you are unsure.
Pets and children
If you have any children or pets, you may like to ask friends and family for some help looking after them during your recovery. Pets and children can be hard work so you should ask for help to avoid over-exerting yourself.
You may not be able to drive from 5 to 14 days after your surgery. Your surgeon will be able to give you more specific advice on this during your weight loss surgery consultation. Because you will be unable to drive, you will have to organise for a friend or family member to take you home from hospital.
Eating and drinking
After the surgery, you will need to reintroduce foods very slowly back into your diet. Initially you will be limited to clear liquids only, then thicker drinks, then soft foods. Eventually solid foods can be reintroduced. When you return to eating a normal diet, it is important that it is a well-balanced, healthy one.
You should select some loose pieces of clothing to wear during your recovery. Items that zip at the front are usually less restrictive so may be more comfortable. You may also like to wear slide on shoes for a week or so to prevent any unnecessary bending. This way, you will not put any unnecessary strain on your stitches.
You may like to make sure you have spare pillows or cushions around the house. This way, you can rest or sleep propped up. This will likely be more comfortable for you in the first few days after your surgery. In addition it will help reduce or prevent any swelling. Your surgeon will prescribe appropriate pain medications so that any pain you experience should not affect your ability to sleep.
Weight loss surgery aftercare
What can I expect after my weight loss surgery?
Knowing what to expect after your weight loss surgery is an important factor to consider when making your decision on whether to have surgery or not. To help you get a better idea of what to expect, we have put together some information on weight loss surgery aftercare that we think you might find useful. This information is general to all weight loss surgery patients. Your surgeon will be able to give answers to your questions which are more specific to you and your surgery.
How will I feel after surgery?
If you have a gastric balloon procedure, your anaesthetist will use a local anaesthetic with a sedative. The local anaesthetic will numb the treatment area so you don’t feel the balloon being inserted. The sedative will make you drowsy but you will not be asleep for the procedure. When the procedure is over, you will continue to feel drowsy for a few hours but this will wear off. As the local anaesthetic agent wears off, you may experience a little discomfort but the medical staff will manage this for you.
If you have any of the other weight loss surgery procedures, your anaesthetist will use a general anaesthetic. Therefore, you will be asleep for the duration of the procedure. You will wake up slowly when the procedure is complete. You may feel a little drowsy and confused but this will wear off within a few hours. Your memory and concentration may be affected to 1 or 2 days but this will soon return to normal. If you experience any discomfort or pain after your surgery, your surgeon will prescribe appropriate pain medication to manage this.
When can I go home after my surgery?
You will need to stay in hospital from 1 to 3 nights after your surgery. Before you leave, you will be given an appointment to come back within 10 to 14 days. During this appointment, your surgeon will assess your progress and ensure that you are recovering as expected. If you are experiencing any issues, let your surgeon know at this appointment.
When can I drive after my surgery?
You may not be able to drive for 5 to 14 days after your surgery. Your surgeon will be able to advise your more specifically on this during your consultation.
Because you will be unable to drive straight after surgery, you will need to arrange for someone to take you home from hospital. You may like to ask a member of your family or a friend.
Will I be in pain after my surgery?
Your surgeon will prescribe simple pain relief for approximately the first week after your surgery as this is when you will be in the most discomfort. After this first week, you should be able to switch to over-the-counter pain relief medications. By the third week after your surgery, most of your pain and discomfort should have subsided and you should no longer require pain relief medications.
When can I go back to work after my surgery?
The amount of time you will need to take off work will depend on the type of job that you do. If your job is less active, (e.g. an office job) you can probably return to work within 1 to 2 weeks of your surgery. If your job requires physical exertion, (e.g. waitressing) you will probably require 3 to 4 weeks off work before you return. In any case, you should avoid even light activities for at least 2 to 4 weeks.
When can I exercise again after my surgery?
After your surgery, your surgeon will likely advise that you try to do a little light walking every day to avoid the formation of blood clots. Aside from this however, you should avoid all other forms of exercise for at least 4 weeks after surgery. Aerobic activities can increase swelling. Furthermore, you should hold off on all sexual activity for at least 2 weeks after surgery.
From 4 to 8 weeks after your surgery you can begin to reintroduce light aerobic activities like cycling or swimming. You will also be able to partake in activities that do not involve vigorous movement, such as lifting weights.
From 8 weeks after surgery, all activities and sports should be possible again. Keeping active is an essential part of your new healthy lifestyle post-weight loss surgery.
How can I look after my scars?
Initially, when your wounds heal, your scars will appear pink and a little lumpy. Regular scar care can help to improve their appearance with time.
Scar care can involve daily massage using a scar gel or a moisturiser. You can begin daily scar care as soon as your wounds have fully healed. As your scars get less tender, you can increase the pressure of your massage to smooth out the scar tissue and reduce the lumpy appearance.
Another important aspect of scar care is covering them up in the sun or using a high SPF on them on sun exposure. This will help prevent any discolouration of the skin in your scar area. It is vital that you follow the exact scar care regime that your surgeon gives you.
When will I see the final results of my surgery?
It will take some time before you see the final results of your weight loss surgery. It can take from 8 to 12 weeks before your body feels back to normal again after surgery. By this point, you will likely have begun to notice some weight loss.
Following an appropriate diet and exercise regime, you should continue to lose weight for 1 to 2 years, depending on which weight loss procedure you have.
In order to get the best results from your surgery, it is important to try your best to maintain a stable weight through regular exercise and a healthy diet.
Weight loss surgery FAQs
What are some common weight loss surgery FAQs?
Here are some common weight loss surgery FAQs. We hope that they help to answer some of the questions that you may have.
Do I need a GP referral to have weight loss (bariatric) surgery?
The majority of bariatric surgeons will be more than happy to see you for an initial consultation without a GP referral. However, they may wish to contact your GP if you do decide to go ahead with the weight loss surgery. This will be to gain more information about your medical background.
What effects do smoking/alcohol/drugs have on surgery?
The risks of complications from surgery can be greatly increased if you smoke, drink alcohol or use recreational drugs. In particular, smoking will increase your risk of infection and delay the time it takes for your wounds to heal. Consequently, we strongly advise that you stop smoking and using all nicotine products for at least 6 weeks to 3 months before and after surgery to reduce the risk of complications. We also stress the importance of following your surgeon’s advice regarding smoking and the use of alcohol and recreational drugs.
How do I know if I am suitable for the surgery?
This will depend on a number of factors. These include your BMI, your age, your current medical and psychological health, and your desire to go ahead with the surgery. The final decision on your suitability for weight loss surgery will be made by your surgeon.
Are the results of weight loss (bariatric) surgery permanent?
How long the results of your weight loss surgery last will depend on the effort you are willing to put in to maintaining a healthy lifestyle post-surgery. A healthy diet and regular exercise are important to encourage and maintain weight loss. The effects of some procedures, (e.g. stomach size in a gastric sleeve procedure) can be slowly reversed if patients do not adhere to a healthy, balanced lifestyle.
Will I have excess skin after weight loss?
After weight loss, some skin sagging is inevitable. The extent of this is dependent on how much weight you lose, your age and your skin elasticity. Every patient is different. Some patients are unbothered by a little excess skin, while others may choose to opt for a further surgical procedure to remove this. If you have any concerns or further questions about the possibility of excess skin after weight loss surgery, you surgeon will be able to give you more information.
Will weight loss surgery affect my ability to get pregnant?
Yes! Weight loss surgery should have a positive impact on pregnancy and childbirth. Many obese women suffer from subfertility as a result of their weight. However, as you lose weight, your fertility increases and you are much more likely to be able to conceive. It is important you are aware of this effect if you want to avoid getting pregnant!
ln addition, losing weight will also result in a significant reduction in the risk of complications for both you and the baby during childbirth. Your weight loss will allow you to be much more active both during and after pregnancy. This will ensure that you can get maximum enjoyment out of what should be a very happy time in your life.