Weight Loss Surgery Options

Dr. Christopher McGowan
October 18, 2021

If you’re like many other Americans, you’ve probably attempted to lose body weight on numerous occasions in the past. Any such attempt probably involved a traditional approach to weight management that undoubtedly included a combination of fad diet and aggressive exercise. While this approach can work for some people, the fact is that most of these attempts end in failure or a pattern of yo-yo dieting where you lose some weight and then put it right back on within a few months. 

Even with all the time and effort devoted to weight loss, though, obesity is still on the rise in the United States. Yet while those traditional methods just aren’t right for most people, recent developments in bariatric and endobariatric medicine have made weight loss surgery a much more accessible option. Moreover, the results speak for themselves: study after study continues to show that patients who opt for some form of bariatric surgery have a much higher success rate at losing weight and keeping it from coming back.   

What is Weight Loss Surgery?   

Weight loss surgery is a broad term that can refer to any medical procedure whose aim is to promote weight loss by restricting the amount of food that the stomach can hold or by creating moderate malabsorption of nutrients from ingested food. In addition to the direct effect of creating a calorie deficit, weight loss surgery can also have a beneficial impact on the hormones that affect hunger and satiety. Over time, the combination of these effects can lead to substantial weight loss and the ability to maintain a healthy weight in the future. 

These kinds of surgical procedures are meant for patients who are considered obese or morbidly obese. Most doctors look to a patient’s body mass index (BMI) to help determine whether or not they are a good candidate for surgery. A person’s BMI is derived by a comparison between their height and weight; 18-24 is considered normal, 25-29 is considered overweight, and 30 or higher is considered obese. The patients who are the best candidates and can benefit the most from the procedure are those with a BMI of 30 or higher. 

Types of Weight Loss Surgery

In the earliest days of bariatric surgery procedures, they involved large incisions and a long recovery process. Eventually laparoscopy was developed, a method that utilizes special surgical tools with cameras mounted on the ends that are inserted through smaller incisions; the smaller incisions meant fewer complications and a shorter recovery. In recent years, however, a new sub-discipline called endobariatrics has emerged that uses an endoscope and requires no incisions at all. Below is an overview of some common bariatric and endobariatric procedures: 

Laparoscopic Procedures

Gastric Bypass: Gastric bypass surgery has been the most common weight loss procedure for many decades, and it is sometimes even referred to as “the gold standard” because of its history of success and relatively low complications rate. There are several types of gastric bypass surgery, but they all essentially involve first dividing the stomach into a small pouch and large pouch. The large section is bypassed, and the small section serves as a lower-volume stomach that is the primary way calorie restriction is achieved. 

The most common variation is called Roux-en-Y gastric bypass, and it involves using a part of the small intestine to create a Y-shaped bypass tube. One section connects the smaller stomach pouch to the rest of the digestive tract, and the other section connects the larger stomach pouch to the small intestine further down the line. This second section allows helpful gastric juices to still drain into the small intestine to aid in digestion. It also additionally reduces calorie intake by giving food less time to be absorbed by the small intestine. 

Gastric Sleeve: A laparoscopic sleeve gastrectomy is similar to gastric bypass in the basic fact of reducing the size of the stomach. In this procedure, the bariatric surgeon removes a large portion of the stomach along the greater curvature. The remaining stomach tissue is reformed into a banana-shaped sleeve. After the surgery, the stomach is approximately 20% of its previous size and physically limits how much food can be eaten in any one sitting. In some cases, an additional procedure called a duodenal switch is performed; this utilizes a similar bypass strategy as in gastric bypass. 

Adjustable Gastric Banding: Usually referred to as “lap-band,” this procedure involves placement of an inflatable silicone band around the section of the stomach closest to the esophagus. When in place, the band essentially creates a small stomach pouch similar in size to what is used in gastric bypass. Since only partially digested food is able to pass into the larger stomach section, the small pouch restricts the amount of food that can be eaten at one time. The silicone band is adjustable so that it can be tightened over time as the patient loses weight and needs less food. 


Sleeve Gastroplasty: An endoscopic sleeve gastroplasty (ESG) is similar to a sleeve gastrectomy in that they both involve creating a smaller, tube-like shape out of the stomach. In an ESG, though, the procedure is performed via an endoscope that is fed down the esophagus; a special suturing tool mounted on the end of the scope allows the endobariatric physician to close off a large section of the stomach from the inside. ESG is able to achieve similar results as a sleeve gastrectomy yet without any incisions; as a result, recovery times are shorter and complications are much more rare. 

Gastric Balloon: With the ORBERA Managed Weight Loss System, a small, deflated silicone balloon is placed in the stomach by endoscope. The balloon is then filled with a safe saline solution until it is about the size of a grapefruit. The balloon is designed to remain in the stomach for six months; during that time, it physically takes up space in the stomach and reduces the amount of food you can eat so that you’ll feel full sooner. 

Bariatric Revision: For patients who have already had gastric bypass or a sleeve gastrectomy several years in the past, a bariatric revision can help correct any stretching or other problems that may have negatively impacted weight loss. With an endoscope, these adjustments can be made without the need for incisions. 

Benefits of Weight Loss

Though weight loss is often thought of as a cosmetic pursuit in popular culture, the truth is that obesity increases the risk for a whole host of related health problems. High blood pressure, high cholesterol, heart disease, type 2 diabetes, kidney diseases, and even sleep apnea are just some of the medical conditions that you’re more likely to develop if you’re obese. The good news is that many of these conditions begin to improve rapidly once you start losing weight. 

Request a Consultation

With so many surgical options, it can be difficult to know which one might be right for you. Bariatric surgery has become very safe and commonplace in recent years, but because incisions are required, there are always some risks to the inpatient surgery. Moreover, the recovery time can last up to two months for some patients. With the endoscopic procedures offered by True You, however, the procedure takes less than an hour, and you’ll be able to return home the same day. Additionally, most patients are able to return to their normal routines after only a few days of rest and recovery.  

At True You Weight Loss, we are passionate about helping people finally find the freedom they’ve been looking for. If you have a BMI of 30 or higher and haven’t had success through diet and exercise alone, you may be a good candidate for a weight loss procedure like ESG or one of the other options. To learn more about what is involved in an endobariatric procedure, please request a consultation. Freedom is waiting!   

Dr. Christopher McGowan
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.

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