Severe obesity has become much more prevalent in the United States in recent years, with about 1 in 11 adults (9%) suffering from it. Standard interventions like dietary changes and exercise routines generally do not make a significant difference, however, and that is why weight loss surgery has become the preferred treatment. Gastric bypass surgery is one of the most common types of bariatric surgery performed today, but the amount of weight one can lose and the timeline of those losses can vary significantly from person to person.

How Does Gastric Bypass Surgery Work?   

Gastric bypass (more specifically Roux-en-Y gastric bypass) is a bariatric procedure that involves altering the anatomy of the digestive system in order to promote weight loss. Gastric bypass is an inpatient surgery that is considered minimally invasive due to the use of laparoscopic techniques. To qualify for the surgery, patients must typically have a body mass index (BMI) of 35 and above or between 30-35 and an obesity-related health condition like heart disease, high blood pressure (hypertension), or type 2 diabetes.

The first step in the procedure is for the bariatric surgeon to create a small pouch at the top of the stomach; this involves separating the stomach along the greater curvature and then placing sutures to enclose the new pouch. With only about 20% of its former capacity, the new stomach pouch limits the amount of food that can be eaten in one sitting. In addition to physically being able to eat as much, the smaller size promotes positive changes to the feelings of hunger and satiety.

Next, the small intestine is divided, and the lower portion is attached directly to the small stomach pouch. This "Roux limb” is one part of the Y-shape that gives the procedure its name, and it is also the new path for food to travel. This part of the procedure is also where the “bypass” happens; food entering the stomach pouch travels directly to the latter half of the small intestine and bypasses much of the jejunum where most of the nutrients are absorbed from broken down foods.

Since the upper section of the small intestine is still connected to the separated lower part of the stomach and the duodenum, it is then reattached to the middle of the Roux limb to complete the Y shape. Food enters through the stomach pouch on one side, and stomach acid and pancreatic juices flow down from the duodenum; then they meet at the Roux limb having bypassed a significant portion of the small intestine’s absorptive capacity. So in addition to reducing how much food can be eaten, the surgery also limits the number of calories that can be absorbed by the digestive system.

Weight Loss Timeline for Gastric Bypass Patients

How much weight you can lose and how long it takes to lose it can vary greatly from person to person depending on things like age and starting weight. Perhaps the biggest factor in whether a person will have weight loss success, though, is adherence to the program. The more devoted a patient is to making the necessary lifestyle changes, the more weight they’ll be able to lose. Nevertheless, there are some milestones based on average weight loss over time:

• Post-surgery (0-3 months): In the initial weeks after surgery, patients typically experience a period of rapid weight loss. This is sometimes referred to as the “honeymoon phase,” and during this time individuals may lose a significant amount of weight due to the sudden reduced caloric intake and changes in nutrient absorption.
• Early months (3-6 months): Weight loss continues, but the pace may slow down compared to the immediate postoperative period. This phase is crucial for adapting to new eating habits and incorporating physical activity into one’s routine.
• First year (6-12 months): During the first year, patients can experience substantial weight reduction as well as notable improvements in any obesity-related conditions like hypertension and sleep apnea.
• Stabilization (1-2 years): After the often dramatic weight loss results of the first year, it tends to stabilize in the second year. During this time, it is essential for the patient to focus on maintaining a healthy lifestyle with a balanced diet and regular physical activity.
• Long-term (2 years and beyond): While weight loss can continue in the second year and beyond, the pace is typically much slower. Even when an ideal weight is reached, though, the primary goal shifts to maintaining the weight and avoiding the kind of overeating that can put the pounds back on.

Possible Complications of Gastric Bypass

While gastric bypass can be an effective approach for a weight loss journey, it isn’t without risks and concerns. Like any kind of surgery, there is a chance for complications and side effects that need to be considered by prospective patients. For instance, because the procedure requires several nights in a hospital and the use of incisions, there is a natural risk of infection, bleeding, or symptoms related to general anesthesia. Also, the recovery process in general can take up to a month to be fully back to normal activities.

Beyond the risks specifically related to surgery, gastric bypass can also cause a number of complications related to the function of the digestive system; examples include dumping syndrome, the formation of gallstones, or stomach ulcers. Moreover, the nature of bypassing part of the small intestine can lead to actual deficiencies of certain nutrients that can cause a variety of other problems for a person’s overall health. Finally, one of the most basic problems is that the procedure can lose its effectiveness and need to be revised.

Endobariatric Alternative to Gastric Bypass

There’s no doubt that gastric bypass can work for some patients, but the potential toll the procedure can take on the body makes it a risky proposition for many. Fortunately, though, new advances in medical technology over recent decades have made available an alternative procedure that is similarly effective but without the need for actual surgery. One such example of an alternative is called endoscopic sleeve gastroplasty, an endobariatric procedure that is performed entirely with a minimally invasive endoscope.

Endoscopic sleeve gastroplasty (ESG) works on the same principle as another surgical procedure called sleeve gastrectomy. In both ESG and gastric sleeve surgery, the stomach is formed into a banana-shaped sleeve that is about 20-30% of its original size. One of the biggest differences between the two is that ESG is done with an endoscope inserted through the esophagus; this means that the suturing of the stomach into the new shape is done without the need for any incisions.

Like gastric sleeve surgery, endoscopic sleeve gastroplasty promotes long-term weight loss by limiting the amount of food that can be eaten in one sitting. Having less space in the stomach leads to the patient feeling fuller faster after eating; over time, changes to the hormones that regulate hunger and satiety can help foster a new relationship with food and new eating habits. The resulting calorie deficit then leads to excess weight loss.

Find Help for Your Weight Loss Goals 

If you’re like many Americans and are wary of a weight loss procedure like gastric bypass, you’re not alone. At True You Weight Loss, we want to help patients finally find the freedom they’ve been looking for. For more information about endoscopic sleeve gastroplasty or a gastric bypass revision, please contact us today to request a consultation. Our highly qualified and friendly team is eager to help!