For many people struggling with obesity, losing excess weight feels like a huge, elusive challenge. Years of yo-yo dieting and sporadic exercise programs seem to make no difference, and often people just get fed up with even making the effort. Even though bariatric surgery has been around for decades, the inherent dangers of surgery make it an unappealing or unsafe option for a lot of people. In recent years, though, there has been a marked increase in the number of alternatives both to traditional diet and exercise-based methods as well as standard surgical methods.
DR. CHRISTOPHER MCGOWAN
Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.
Medical Weight Loss Procedures
In the past, the only real options for bariatric surgery involved invasive incisions that usually had a variety of complications and side effects. The whole game changed, however, when laparoscopy began being used to reduce the need for invasive surgery. But even laparoscopy carries risk of infection, bleeding, or other problems. These days, weight loss centers like True You rely on endoscopy, a newer, less invasive method that has a similar outcome without the risks of surgery. Below is an overview of the most common weight loss procedures available today:
Laparoscopy
Roux-en-Y Gastric Bypass: Once referred to as the “gold standard” of bariatric surgery, the Roux-en-Y variant of gastric bypass is by far the most common type of weight loss surgery. This surgical procedure works by dividing the stomach into a small gastric pouch and the remainder of the organ. A segment of the small intestine is connected to the gastric pouch while the stomach remnant gets reconnected to the small intestine further down the line. Weight loss is achieved by both restricting the amount of food (and thus calories) that can be eaten as well as reducing time food spends being absorbed by the small intestine.
Gastric Band: Also known by the commercial name Lap-Band, a gastric band bariatric procedure involves fitting an adjustable, inflatable silicone band around the upper part of the stomach. Once inflated, the band constricts the stomach and essentially creates a small pouch at the top of the stomach where food first enters. This has the effect of reducing stomach volume so that less food can be eaten in one sitting, thereby lowering daily caloric intake. Unlike gastric bypass and other types of surgery, the gastric band procedure is reversible.
Sleeve Gastrectomy: The sleeve gastrectomy procedure has become quite common around the world, and it also promotes weight loss by reducing stomach volume. In this case, the stomach is reformed into a banana-shaped pouch (referred to as a gastric sleeve) by removing a large portion along the greater curvature of the stomach. The remaining stomach tissue is stitched together with surgical staples, and the resulting sleeve shape is approximately 15-20% of its original size.
Duodenal Switch: Also known as gastric reduction duodenal switch (GRDS), this procedure is related to a sleeve gastrectomy in that the stomach is first reformed into a gastric sleeve with smaller capacity. This procedure is more complicated, however, because it requires separating the small intestine into two parts in a similar way as gastric bypass. The name of the procedure comes from the fact that the small intestine is divided at the duodenum, the place where digestive juices enter the digestive tract. As in gastric bypass, food bypasses a significant section of the small intestine in order to reduce absorption time. Additionally, the section of intestine still connected to the duodenum is connected to the small intestine down the line, further reducing the amount of calories that can be absorbed into the bloodstream.
Endoscopy
Endoscopic Sleeve Gastroplasty: An endoscopic sleeve gastroplasty (ESG) is actually quite similar to a sleeve gastrectomy because they both involve reforming the stomach into a smaller, sleeve-like shape. The primary difference between the two, however, is that ESG is performed endoscopically. Rather than a laparoscopic approach, a suturing tool mounted on the endoscope is used to exclude 70-80% of stomach volume from the inside of the stomach. Because no incisions are needed, the procedure is inherently less invasive and doesn’t even require the removal of stomach tissue.
Gastric Balloon: A gastric balloon (as in the ORBERA® Managed Weight Loss System) is a specialized medical device that is endoscopically inserted into the stomach in order to promote weight loss. After placement, the deflated silicone balloon is filled with a harmless saline solution until it is around the size of a grapefruit. By physically occupying space in the stomach, the balloon limits the amount of food that can be eaten in one sitting and causes a feeling of fullness sooner.
Bariatric Revision: A bariatric revision isn’t a standalone procedure; it only comes into play when someone has already had gastric bypass surgery. As noted above, a small stomach pouch is formed during gastric bypass to reduce the amount of food that can be eaten. Over time, however, this pouch can become stretched out, thereby nullifying some of the calorie reduction benefits. In a bariatric revision, an endoscope is used to tighten the pouch from the inside; with the gastric pouch back to the original size, the original benefit of the gastric bypass is restored and weight loss can resume.
Who Can Benefit From Weight Loss Surgery?
Each year, over 200,000 Americans opt for weight loss surgery of some kind, yet that represents only about 1% of the total number of people who are actually eligible for the surgery. For most medical weight loss procedures, whether or not someone is a good candidate is determined by body mass index (BMI). BMI is a numerical value derived from comparing a person’s height and weight, and it is useful for indicating the likelihood of a person being overweight or obese. Depending on the procedure, most bariatric surgeons require a BMI between 30-40 or higher in order to be considered a good candidate.
Selecting the Right Procedure
With so many options to choose from, it can be overwhelming to figure out which one to pick. While there are pros and cons to each procedure, the best option will likely be dependent on factors like your starting weight, finances, tolerance for recovery time, and whether or not you’re healthy enough for a certain type of surgery. Moreover, it’s important to evaluate your commitment level; all of these procedures require a dedicated effort to make the necessary lifestyle changes and eating habits after the surgery is complete.
It is precisely because of these many different factors that True You is passionate about finding the best non-surgical weight loss solutions for an individual patient. If you have been considering a weight loss procedure, contact us today to request a consultation. Our highly trained and experienced staff will be able to review your options and help you make the right choice for you. Freedom is waiting!
