Gastric Sleeve Overview

Gastric sleeve, called also a sleeve gastrectomy, is a bariatric surgery performed for obese people who need a significant weight loss to regain health. The main idea of gastric sleeve is removing 70% – 80% of the stomach. The small pouch that is left has a shape of a sleeve.

Apparently, the aim of sleeve gastrectomy is limiting the amount of food that can be held in the stomach. All the functions, including the digestive function of the stomach, are preserved. The surgery is performed laparoscopically, which means that the surgeon uses a small video camera (called laparoscope) to see the inside of the abdomen. Firstly, a surgeon makes 5-6 small incisions in the abdomen area, through which the long narrow instruments are put. With their use and with the use of a laparoscope, a surgeon performs the procedure. The operated area is also cleared and inflated by introducing CO₂ gas, which is harmless of course, which enables a surgeon to perform the surgery.

Gastric sleeve surgery itself does not make a person slim. It is only the first, yet milestone, stage. After the stomach is reduced, a patient is able to eat an amazingly small amount of food to be full and it causes a rapid, fast and effective weight loss.

How does a gastric sleeve work?

Like any bariatric stomach surgery, gastric sleeve causes weight loss. There are three main aspects showing how does the gastric sleeve work.

They are:

• reduction of a stomach volume, which makes that patients are full after a tiny meal and physically are not able to eat more;
• the stomach motility is increased, thanks to which food passes the stomach and intestine smoothly and quick;
• the change of hormonal receptor responsible for hunger (after the surgery, the secretion of a hunger hormone called ghrelin is reduced, thanks to which patients feel much less hungry and their appetite is suppressed).

The weight loss process starts immediately after the sleeve gastrectomy, however, patients need to maintain the recommended meals and portions to prevent stomach stretching.

Is gastric sleeve safe?

Gastric sleeve operation is a regular surgery performed under general anaesthesia, so it is completely normal to have concerns about it. However, bariatric surgeries, especially gastric sleeve, are considered to be a safe surgery that is performed with over 85% success rate.

A laparoscope that is used in sleeve gastrectomy makes the procedure much less invasive and hence significantly reduces the possibility of complications. It also shortens the recovery time and stay in a clinic.

Gastric sleeve candidate

BMI is the most important factor while qualifying for weight loss surgery. To be qualified for gastric sleeve, a patient needs to have BMI 35 or higher (in some cases, BMI 30 is also accepted)

Sleeve surgery is dedicated to obese people. However, obesity itself is not a criterion for the procedure. The most important aspect is the BMI (body mass index). To be qualified for gastric sleeve bariatric surgery, a patient needs to have BMI 35 or higher (in some cases, BMI 30 is also accepted). So, people who are only overweight are not considered good candidates. There are many websites with BMI calculation, so you shouldn’t have any problems with estimating your BMI (assuming that you know your weight and height). Regarding kilograms (or pounds), it is said that candidates for gastric sleeve have over 45kg (100lb) excessive weight. Patients with BMI lower than 40 usually must meet one more criterion, which is additional health issues caused by obesity, for example, type 2 diabetes, hypertension, asthma, sleep apnea or joint pain.

Apart from body mass index, a candidate for gastric sleeve has to be mentally ready for the surgery as well as pre-surgery and post-surgery periods. Handling the stress of the procedure, preparation and afterwards diet might have a profound influence on the surgery effects. Also, patients have to build a healthy attitude towards food, diet and exercise. Many clinics offer help from psychologists before and after the surgery, so we encourage everyone to make sure that such help would be available.

The most common question that patients ask is: How long does the gastric sleeve surgery take? Well, gastric sleeve obesity-surgery takes about sixty minutes, so it is a relatively short procedure. It is performed laparoscopically, thus its minimally invasive nature resulting in faster recovery reduced bleeding and pain, and a shorter stay in a clinic.

At the beginning of the operation, a surgeon makes incisions in the abdomen (usually, there are 3-5 incisions). The holes allow a doctor to put a laparoscope and other necessary instruments inside the stomach. The laparoscope is a tiny tube with a video camera connected to a monitor standing in the operating room, so the operated area is visible there. The most important part of the surgery is removing the extensive part of the stomach (up to 80%) and creating a “new” stomach with the use of surgical staples. Once it is done, the surgeon removes all the tools and puts stitches on the incisions.

How to prepare for gastric sleeve surgery?

Each clinic and surgeon have their own recommendations and requirements for the pre-surgery period. However, there are some general instructions common to all the bariatric patients.

They include:

• quitting smoking (smoking greatly increases the possibility of blood clots, pneumonia, infections; it also increases the risk of post-operative complications and slow healing)
• following a gastric sleeve pre-op diet (usually, 2-3 weeks before the surgery, patients start a high protein and low calories liver reducing diet which would reduce the fat accumulated around the liver)
• making sure that you are ready to change your life completely, visiting a psychologist or attending special education classes organized by many clinics
• organizing family life, care after children, pets, making sure you have a person that would assist you for the first days after the operation
• some medications (e.g. Aspirin based ones) are forbidden, so patients need to discuss with the surgeon any meds they take.

Patients also ask what to take to the hospital for gastric sleeve surgery? Each clinic has its own recommendations of course, but you should remember about all the preoperative paperwork and instructions, ID card or passport, a cell phone, toiletries and pyjamas, pillow, and blanket.

After gastric sleeve surgery, patients spend only 1-3 days in a hospital. Before leaving the clinic, the doctor prescribes gastric tablets, pain medications and gives instructions for special post-op diet and exercises

The surgery gives a patient a perfect tool for losing weight, however, it is the aftercare and gastric sleeve recovery that play a key role in losing weight.

How long do you stay in the recovery room after surgery? If everything heals properly, patients spend only 1-3 days in a hospital after surgery. Before leaving the clinic, the surgeon prescribes gastric tablets and pain medications and gives instructions for special post-op diet and exercises. It is important to start moving (even a slow walk is good) just after waking up in the hospital. Any activity will influence the recovery in a positive way and will speed it up.

Regarding the short-time recovery at home, patients are recommended to take 3-4 weeks off. Of course, if the job is purely physical, this time should be longer. During this time, patients get used to the new lifestyle, follow a special diet, engage in light physical activity, take the prescribed meds and simply cope with all the changes in life.

Gastric sleeve diet- what to eat after bariatric sleeve surgery and what foods to avoid?

A gastric sleeve diet is obviously the most important thing in recovery and aftercare. In the beginning, patients consume liquids, then smooth and soft food and gradually progress to solid food.

• 1-2 days after surgery – patients are allowed to drink only fluids, the maximum serving is a half-cup, and the maximum daily amount is 8 cups.
• 3-7 days after surgery – patients can introduce liquid food to their diet. It includes milk, unsweetened yoghurt, soy drinks.
• 1-2 weeks after surgery – the diet may include mashed and pureed food, such as soups, pureed vegetables, cottage cheese, mashed fish, some forms of cereals e.g. oats.
• 2 weeks after surgery – introducing soft food and crackers is allowed. Patients can eat eggs (scrambled or boiled), meatballs, cooked vegetables, some fruits, and crackers.
• 1 month after surgery – some solid food can be added. Usually, at this stage patients can eat fresh fruit and vegetables, bread, grains, and legumes.
• 2 months after surgery – it is the time when patients should focus on a regular and balanced diet based on solid food. The diet should include high protein food and vegetables.

Correct diet after weight loss surgery is very important. Diet should be rich in proteins and vitamins from the very beginning

It is very important that the diet is rich in proteins and vitamins from the very beginning, hence patients often must take nutritional supplements. However, it is the surgeon or dietician who can advise on the right supplement chosen on the basis of health condition and nutritional deficiency.

Patients deciding for gastric sleeve should also be aware of the fact that they won’t go on a temporary, short-term or even long-term diet, but will have to change their eating habits for the rest of their lives. Only then can they achieve the desired results and, more importantly, get treated. Therefore, there are some general instructions for eating habits, which should be followed permanently:

• slow and thorough chewing
• eating small portions (4-5 small meals instead of 3 big ones)
• preparing high protein food
• finishing a meal once you feel full
• refraining from eating between the meals
• avoid eating as an award, stress relief, or punishment (if you observe such a habit, you should talk to the specialist in eating disorders)
• drinking at least 1,5l fluid (especially water) daily
• taking recommended supplements.

What not to eat after gastric sleeve surgery?

Knowing what to eat after bariatric sleeve surgery, please check what foods to avoid after gastric sleeve:

• meals rich in empty calories – the size of your stomach after a gastric sleeve resembles an apple, so it is extremely difficult to supply yourself with all necessary macro and microelements eating so little. No wonder, it is pointless to eat empty calories such as sweets, chips, pastries, popcorn. Besides, eating food rich in sugar may lead to a dumping syndrome causing nausea, vomiting, weakness or diarrhoea;
• alcohol – it also contains empty calories and by no means can be treated as a hydrating fluid; bariatric surgery makes alcohol absorption bigger, so there is a high risk of intoxication;
• dry food – it is not recommended to drink while eating, so swallowing a dry meal might cause problems
• drinks rich in sugar and caffeine – again, these are calories that take valuable space in your stomach; any drinks sweetened with sugar, fructose, corn syrup, also soda and juices should be avoided; caffeine can dehydrate you, so if possible, please choose a decaffeinated coffee;
• high-fat meals – the food that must be eliminated include butter, bacon, hard cheese, sausages, and fast foods of course;
• bread, pasta, rice – you should be careful with this food; it is starchy and might be hard to swallow; there are also cases where such food blocks the stomach.

Patient after weight loss surgery should avoid foods rich in empty calories like crisps or chips

Of course, it is not true that your life will circle around food after the surgery. Over time, you will build new, healthy eating habits and get to know your organism again. Then, you will start to eat valuably and make the right food choices automatically. The food won’t play a key role in your life again but will give you energy and vitality to live a high-quality life.

How much weight I will lose after the gastric sleeve surgery?

Gastric sleeve results vary from patient to patient and to a great extent depend on the patient’s attitude and their following all the diet and activity instructions. Generally, however, the weight watchers after sleeve surgery lose even 70% of the excess weight. In the first two weeks, patients lose about 0,5 kg a day. After 3 months, about 35%-45% of the weight should be lost, after 6 months, it is 60%-70%. The majority of patients get the final results within 1-2 years. 

How long I have to wait for the effect?

Weight loss after the surgery is individual depends on factors like physical activity, age, obesity level before the surgery, health condition or following the diet. Usually, most kilograms are lost within the first 6 months after the surgery

Weight loss is very individual and the time of losing the excess weight depends on such factors as physical activity, diet following, age, obesity level before the surgery, health condition and additional diseases. Yet, before the surgery, a doctor estimates the time needed to achieve the final results individually for each patient. Undoubtedly, the first year is crucial and then within that time, a patient weight should be stabilized. The further diet depends on the patient. If there are still excessive kilograms that can be lost, a patient will follow a strict diet, but if a BMI is ok and a patient feels good, only balanced food and physical activity would be enough. The truth is that most kilograms are lost within the first 6 months after the surgery and a dietician with a surgeon decides on the next steps individually. So, if you wonder what to expect after bariatric surgery and how long it takes for your stomach to shrink, the answer is simple – you will lose the excessive weight very fast starting from the first day after gastric sleeve because your stomach wouldn’t be able to place big amounts of food.

Getting to know the pros and cons of gastric sleeve is crucial before making the decision about the surgery. Patients have to realize all the aspects and consequences and should ask the surgeon any questions they come up with (e.g. What are the risks involved? How to prevent hair loss after bariatric surgery?).

Regarding gastric sleeve pros and cons, the former undoubtedly outweigh the latter. The dominance of gastric sleeve is achieved thanks to the following:

• feeling full after eating small food portions – due to the fact that the stomach is even 80% smaller after gastric sleeve, patients feel full after tiny meals, so there is no feeling of hunger or negative emotions connected with starvation;
• a sleeve is the least invasive bariatric surgery – it is performed with a laparoscope, which minimizes the possibility of the complications, the cuts are minimal, the afterwards diet, as well as minerals and vitamin absorption, is minimally changed and the digestive system is left intact;
• dumping syndrome is extremely rare – dumping syndrome, called also rapid gastric emptying, means that the food moves from the stomach to the small intestine too quickly;
• there are no foreign body inserted inside the body;
• the risk of ulcers appearing is reduced (comparing gastric sleeve vs gastric bypass);
• the surgery can be performed for morbidly obese people (who are not qualified for other bariatric surgeries because of their weight);
• on average, it allows patients to lose even 70% of their weight in 1-2 years;
• the gastric sleeve can be converted into a gastric bypass if needed.

Complications and side effects

Even though a gastric sleeve procedure is technologically advanced and refined, there is still a risk of gastric sleeve side effects and problems. Below, there are complications that might occur:

• staple line leak (this complication has become very rare, yet it might happen)
  bleeding
• vitamins and nutrients deficiency (hence, it is advised to take dietary supplements)
• weight regain (this risk can be eliminated if a patient follows the diet)
• excessive skin that is left in the abdomen area
• blood clot
• gastric sleeve scars
• irreversibility – the huge part of the stomach is cut off, so there is no possibility to undo the procedure, but it can be transformed into another bariatric surgery type (e.g. bypass)
• severe iron deficiencies and anaemia due to iron and B12 vitamin shortage
• stomach stretching.

A surgeon always informs patients about all the gastric sleeve complications, and generally about the bariatric surgery side effects before the procedure. It is worth remembering that even if you are qualified for the surgery, the final decision about undergoing it always belongs to you!

There are several types of bariatric surgery. Gastric sleeve is the most popular one, however, there are also 3 types of surgery procedures that are worth mentioning, they are gastric band, gastric bypass, and gastric balloon.

Gastric banding

Gastric band is used less often than in previous years

Gastric band, also called gastroplasty, involves placing a band made of silicon around the upper part of the stomach. Once it is placed, it is adjusted (it may be tightened and loosened) with the use of saline water. The band makes the stomach much smaller, thanks to which there is room for little food only. In the past, the gastric band was a leading bariatric surgery, but now it is used less often. It is recommended for people who do not qualify for more serious surgery as gastric sleeve or bypass due to too high complications risk.

Gastric bypass

Gastric bypass is very popular among bariatric surgeries

Gastric bypass, called Roux-en-Y Gastric Bypass, involves making a smaller stomach pouch by transecting the stomach and connecting the new stomach pouch directly to the small intestine. As a result, “the old stomach” is totally excluded from the digestive system, and the “new one” is able to hold 30ml food. Bypass reduces the absorption of calories, nutrients and vitamins. It also changes the gut hormones.

Gastric balloon

Gastric balloon requires two procedures

Gastric balloon – specifically, it is Orbera balloon. The surgery involves implanting a soft silicone balloon in the stomach for 6 or 12 months. Balloon serves as a filler in the stomach, which gives a feeling of fullness after eating a tiny meal. The procedure is rather fast (about 30 minutes) and simple. The main characteristic is its temporariness – patients need to undergo a second procedure of balloon removal.

Lastly, we shouldn’t forget about a non-surgical alternative – which is a diet and physical activity. It is the safest and most healthy way of losing excessive weight. However, patients tend to overlook the moment when their weight limits them in every field and then, they need surgery to start the ball rolling. Anyway, we always advise trying going on a healthy and balanced diet and exercise because it may help avoid any surgery!

Gastric sleeve surgery is possible on the NHS but there are some criteria that have to be fulfilled to get the surgery

Obesity in the UK and the United States has been growing in recent years. Now, over half of British and Americans struggle with this disease. The authorities of European and American countries have decided to fight against it and refund the treatment costs. So, weight loss surgery UK is possible on the NHS and it includes gastric sleeve NHS of course.

NHS’s criteria for gastric sleeve UK may vary across the United Kingdom, so it is best to ask the GP for the specifics and guidelines.

The criteria for a weight loss surgery on NHS are indicated by NICE (National Institute for Health and Care Excellence) and are as follows:

BMI is crucial for those who want to have weight loss surgery on NHS

• BMI equalling 40 or higher (sometimes, NHS agrees for the BMI of 35-40, but there has to be other serious condition related to obesity or caused by it, for example, a high blood pressure or type 2 diabetes);
• patients must have tried non-surgical methods of losing weight – which is mainly a diet and physical activity (the exception is BMI exceeding 50 – then, patients may be qualified without fulfilling this condition);
• a patient’s agreement to make permanent lifestyle changes and attend long-term control visits;
• a patient’s health condition allows for applying the general anaesthetic;
• the surgery has to be performed by a specialist in obesity treatment.

If you fulfil the criteria for gastric sleeve surgery in the UK, you need to visit your GP and ask for the referral which will start the whole process. The criteria can be easily found in your local PCT (Primary care trust) or on the Internet (please search for your local PCT or PALS websites). The main concern among patients is NHS weight loss surgery waiting list and time. The local PCTs work independently, so some can deal with the referrals fast, while some need more time, they also need different documents, so it is vital to check the guidelines thoroughly.

Being put on the waiting list for gastric sleeve UK means that the funding is accepted and all the assessments are completed. From this time, patients must follow all the instructions from the surgeon, hospital, and NHS. In general, the time between the initial visit to your GP and the surgery day varies from 2 months to even 2-3 years and often, it is not dependent on patients.

How much is gastric sleeve?

Gastric sleeve surgery cost varies depends on the region, but it is relatively expensive. Generally, the cost ranges from 8000 GBP to 12 000 GBP

Weight loss surgery prices including gastric sleeve cost performed in the private clinic are relatively expensive. Hence, we strongly advise to check whether undergoing the surgery on NHS is possible. The truth is, however, that not everyone meets all the requirements set by the NHS or the waiting time is too long. That is why bariatric centres and clinics have been growing in popularity.

Gastric sleeve price in the UK

Gastric sleeve surgery cost varies depending on the region (city) and demand level. Generally, gastric sleeve cost UK ranges from 8000 GBP to 12 000 GBP. We also strongly advise making sure what the price actually includes (e.g. surgery, stay in the clinic, examinations before the surgery, anaesthesia, medications, dietician and psychologist support). The majority of clinics offer a price including the comprehensive patient’s service, however, there are still places where the given price refers only to the surgery and other services are paid additionally.

Below, we provide the starting prices for a sleeve gastrectomy in the dominant private clinics in the UK:

-Ramsay Health Care UK – from 7 999 GBP
-The Hospital Group – from 9 950 GBP
-The London Clinic – from 9 885 GBP
-Healthier Weight – from 9 990 GBP
-Spire St Anthony’s Hospital – from 10 300 GBP

Below, there are average prices for gastric sleeve surgery in selected countries:

Gastric sleeve price in the USA

The details of gastric sleeve cost in the USA are in the table below based on research done by Bariatric Surgery Source:

*Data were taken from https://www.bariatric-surgery-source.com/

Please remember that the clinics offer the lowest possible price on their websites (which is a perfectly normal practice for all the companies) and the final price is individually adjusted to every patient, so it may be different from the one that is advertised.

Weight loss surgery abroad might be a good choice for those who want to get high quality for lower prices

Patients who are not qualified for gastric sleeve surgery on NHS or cannot afford the surgery in their country can still undergo the procedure. The more and more popular solution is having bariatric surgery abroad. The leading regions are Poland, Hungary, Czech Republic and Turkey. There, the low gastric sleeve cost stems from mainly the reasonable administrative and labour costs. The medical tourism, especially in Poland and Turkey, is developed to such an extent that there is absolutely no risk of being cheated or tricked while going abroad. Please check the reasons why it is a good option to consider gastric sleeve abroad in the mentioned countries:

• the price for sleeve gastrectomy is twice or even three times cheaper than in the UK or the United States (it starts from 4000 GBP)
• there are international bariatric centres and hospitals specializing in treating foreign patients
• only bariatric surgeons are licensed to perform weight loss surgery
• it is possible to get health insurance abroad or get the gastric sleeve on NHS abroad (you would need to get more information from your GP or NHS)
• the flight connections are expanded, so getting to the destination country is fast and comfortable
• there are many accredited medical agencies offering help with organising the surgery, flights, stay and offering help in other trip aspects, thanks to which patients put a minimal effort to arranging the treatment
• in the clinics treating foreign patients, surgeons, psychologists and clinics staff speak English fluently (and many a time German, Norwegian, Russian, Dutch)
• more and more clinics and medical agencies offer full packages / all-inclusive packages – where a patient makes one payment, which includes the surgery, stay in the clinic, stay in the hotel, all the transfers, medications, the specialists (dietician and psychologist) care, control visits in the clinic
• patients can afford the top and luxury private clinics where the costs still are lower than in their country;
• the clinics run English websites, so it is easy to check the equipment, surgeons, and conditions
• medical tourism gives the possibility to visit wonderful places and do some sightseeing during the stay
• patients can get secured for their medical trip, which makes their travel and stay abroad much safer. Clinic Hunter & AXA Partners have created a travel insurance for surgery abroad dedicated solely to medical tourists.

Gastric sleeve in Poland

Gastric sleeve Poland is a very frequent procedure among British and American patients. Poland offers clinics in all the major cities, for example, Warsaw, Wroclaw and Cracow. These cities have direct flight connections with over 100 European and several American cities. The Polish clinics are famous for the excellent care and renowned bariatric surgeons and the affordable prices of course.

Poland is one of the most popular destinations among medical tourists. The Polish clinics are famous for the excellent care, renowned bariatric surgeons and the affordable prices

There are two clinics in Poland that deserve attention. They specialise in treating foreign patients and are known on the international market.

EMC clinic, located in Wroclaw, offers the gastric sleeve price of 4836 GBP. This price includes surgery, general anaesthesia, hospital stay, medications, all the tests and examinations, consultations (including dietician and psychologist care), control visits, accommodation in the hotel in the heart of Wrocław, airport transfers and all the taxi transfers between the hotel and clinic.

KCM clinic, located in Jelenia Góra near Wroclaw, offers the price of 5333 GBP. The price includes surgery, general anaesthesia, a hospital stay with the complex medical care, all the consultations and medical tests, a diet plan for 2 months, a 5-year support package, a personal assistant (a host) in the clinic, all the transfers between the airport, hotel and clinic, and hotel accommodation.

Gastric sleeve in Turkey

Turkey is popular among foreign patients because of relatively low prices

Gastric sleeve in Turkey is the most popular bariatric surgery performed there. The main advantage of the surgery in Turkey is the low price, which starts from even 3800 GBP. It is one of the cheapest prices that are available on the medical market. The top cities that patients visit are Istanbul, Alanya and Antalya. There are many medical tourism agencies that help with finding the top surgeon, clinic and organizing the whole trip. We encourage you to engage their service because there might be places with a doubtful supply and reputation. The yearly number of medical tourists for a gastric sleeve in Turkey varies depending on a political situation. Sometimes, there is a threat of stability, so the number of tourists diminish. Nonetheless, currently, it is totally safe to visit Turkey and get an affordable and effective gastric sleeve there.

Obesity is the serious disease it also triggers conditions like type 2 diabetes, high blood pressure, cholesterol problems, asthma, heart disease and other. Gastric sleeve surgery is a life changing procedure which can restore patient’s general health

The laparoscopic sleeve gastrectomy, called gastric sleeve, is a relatively new bariatric surgery which reduces the size of stomach to the minimum (even to 15% of the original size). The excessive part of the stomach is removed, and the remaining part comes in a tube or sleeve shape. The result of gastric sleeve is a fast weight loss – the stomach is filled very quickly, so patients eat tiny meals to feel full and the hunger hormone (ghrelin) is blocked to a great extent. All other digestive processes are not disturbed. The surgery is performed laparoscopically, thanks to which only a few small cuts are made, there is less postoperative pain, a shorter stay in a hospital and faster recovery.

Gastric sleeve requires a special diet, but gradually patients are allowed to eat normal food. The recommendations for the further diet are just like for any other balanced diet, that is avoiding fatty food and sweets, eating 4-5 small meals a day, drinking water, and undertaking physical activity. Following these guidelines helps patients lose up to 75%-80% of their starting weight.

There are a few options of undergoing gastric sleeve:

• gastric sleeve on the NHS
• gastric sleeve in the private clinic in the UK
• gastric sleeve abroad

You need to think over what option would be best for you and search for more information and help from dedicated institutions and agencies. Anyway, the money should not be an obstacle because you can sign in for a sleeve on NHS or perform it in e.g. Poland or Turkey, which is up to 3 times cheaper than in the UK.

Lastly, we all should remember that obesity is the serious disease itself as well as it triggers such conditions as type 2 diabetes, high blood pressure, cholesterol problems, asthma, heart disease, problems with kidney and liver, which may, God forbid, lead to death. So, if your BMI shows you weigh too much, it is high time to act and restore your health, figure and self-esteem. Your happy and healthy life is worth a courageous step and leaving the comfort zone for a while, so please do not hesitate and consider having a gastric sleeve!

Please see the photos of our patients presenting their figures before and after surgery gastric sleeve.

“1 Recommendations: Obesity: Identification, Assessment and Management: Guidance.” NICE, www.nice.org.uk/guidance/cg189/chapter/1-Recommendations.

“Beauty Poland / Clinic Hunter.” Plastic Surgery Poland and Cosmetic Surgery Abroad – Beauty Poland, www.beautypoland.com/procedures/gastric-sleeve-surgery-poland/#Gastric-sleeve-surgery-in-Poland-is-much-cheaper-that-in-the-UK-or-Germany.

Dansinger, Michael. “Gastric Sleeve Surgery for Weight Loss: Procedure, Risks, Recovery.” WebMD, WebMD, 25 Dec. 2018, www.webmd.com/diet/obesity/what-is-gastric-sleeve-weight-loss-surgery#1.

“Data and Statistics.” World Health Organization, World Health Organization, 2 June 2020, www.euro.who.int/en/health-topics/noncommunicable-diseases/obesity/data-and-statistics.

“Facts & Statistics About Dieting.” LIVESTRONG.COM, Leaf Group, www.livestrong.com/article/390541-facts-statistics-about-dieting/.

“Medical Information and Health Advice You Can Trust.” Healthline, Healthline Media, www.healthline.com/health.

Rabkin, John. “Gastric Sleeve Surgery – 14 Ways It Will Affect You.” Bariatric Surgery Source, Bariatric Surgery Source, LLC, 6 June 2019, www.bariatric-surgery-source.com/gastric-sleeve-surgery.html.