Weight Loss Surgery Overview

Weight loss surgery called bariatric surgery is an obesity surgery that helps people lose weight and reduce or eliminate obesity-related diseases. Generally, gastric surgery stimulates weightloss in the following ways:

• restriction (the amount of food that can be held by the stomach is significantly limited, so the calories intake is very low)
• malabsorption (the part of the small intestine is bypassed or shortened, which also results in a low-calorie intake).

Weight loss surgeries are sometimes associated with plastic surgeries or other cosmetic procedures, but we need to stress that a bariatric surgery belongs to the category of regular life-saving surgeries and is performed due to medical reasons, not a patient’s whim. People should start losing weight by following a healthy lifestyle (balanced diet, exercising, enough sleep, minimizing stress, eliminating food disorders), and only if it does not bring any results, they may look for a surgical solution.

The bariatric branch of medicine has been evolving for hundreds of years and the weight loss surgery options and types of weight loss surgery have been changing over time. Modern medicine offers different types of weight loss surgery than in the past and the surgeons and scientists are working on constant improvement of each type of weight loss surgery. Well, as for the gastric weight loss surgery options, they include:

Gastric sleeve (called vertical sleeve gastrectomy)

It is a surgery that permanently removes up to 80% of the stomach, thanks to which patients are able to eat the minimum amount of food at a time. The additional asset of the procedure that together with the stomach resection, the ghrelin (hunger hormone) production is reduced or even eliminated. Gastric sleeve is performed laparoscopically – the surgeon puts a camera in the stomach through the mouth, then makes a few small cuts (tiny dots) in the stomach through which the long instruments are inserted. The stomach inside is visible on the video screen, so no long incisions in the body are necessary. Nowadays, many specialists claim that it is the best weight loss surgery.

Gastric bypass

Gastric bypass procedure changes the way in which the small intestine and stomach deal with the eaten food and makes the stomach smaller. After the surgery, eaten food omits some parts of the small intestine and stomach, so not all eaten calories are absorbed. Generally, the surgery consists of 2 stages: firstly, the stomach is divided into 2 parts – the small upper part is of a walnut size and there the food goes, the large lower part is excluded from the digestive system and secondly, the small upper part of the stomach is connected to the small intestine, thanks to which the huge part of the stomach is bypassed by food. The surgery is done laparoscopically, which minimizes the risk of complications and infections.

Gastric balloon

In fact, balloon weight loss surgery is a non-surgical procedure performed under local anesthesia with sedation. Again, it is done laparoscopically. The surgeon puts a camera with the deflated balloon into the stomach and once it is in the right place, the balloon is inflated with the saline. The balloon takes a great part of the stomach, so there is very little space for food. What is interesting about this procedure, the balloon is placed temporarily. After 6 or 12 months, there needs to be a second procedure performed and the balloon must be taken out. Usually, however, the time of having a balloon inside is enough to lose much weight and change eating habits.

Gastric band

During the gastric band surgery, the silicone band is placed around the upper part of the stomach, thanks to which the stomach size and food intake are decreased. This procedure was very common in the past, but now, it is done less frequently mainly because the sleeve gastrectomy or gastric bypass gives better results.

Please, take a look at the 3 main types of weight loss surgery comparison:

The connection between bariatric surgery and diabetes has been known for many years. A weight loss surgery helps lose weight and consequently stabilizes the sugar level and manages type 2 diabetes. However, recently, numerous studies have proved that weight loss surgery itself has also a direct influence on how our bodies use insulin. Besides, bariatric surgery for type 2 diabetes works in the following way:

• the cells using insulin are improved, which lowers the blood sugar level
• the hormones in the gut change the way they work, they “learn” how to make enough (not too much) insulin
• the cells become more sensitive to insulin due to increasing the bile acids amount.

Regardless of the type of bariatric surgery for diabetes treatment, it always helps people reduce food intake, which in the sequel affects insulin managing, of course in a positive way. In 2016, over 40 international diabetes organisations (e.g. Diabetes UK) published and backed up new guidelines on gastric surgery for diabetes claiming that weight loss surgery role is inducing the fast and safe weight loss, but also inducing the remission of type 2 diabetes for some groups of people. Of course, to maintain bariatric surgery diabetes remission, people are obliged to follow a healthy lifestyle and keep their weight on the recommended level.

Some people worry about intensified complications or side effects risk as for bariatric surgery for diabetes treatment, however, no such a relation has been proved. The risk of the surgery for people with type 2 diabetes and without it is the same.

Before the surgery, there is always a consultation with the doctor, then he can make the decision which option is the best and the safest for the patient

Deciding which weight loss surgery is best belongs to a surgeon only. Even if patients have a huge knowledge about the safety, possible complications, and other aspects of bariatric surgeries, they cannot ask for a surgery they think would work best. Before determining the surgery type, patients are asked many questions (e.g. about the lifestyle, previous attempts to lose weight, any disorders or addictions) and examined in terms of a physical and psychological condition. Only after analysing the outcome of medical tests and patients’ answers, surgeons determine what is best weight loss surgery.

Also, we would like to caution against the online tests entitled “Which weight loss surgery is best for me”, “Check which surgery you should have” etc. available on the Internet – again we stress that patients themselves are not in a position to give any diagnosis or choose the surgery type. So, we strongly advise everyone who considers gastric surgery to visit their GP (or straight away consult a bariatric surgeon) arrange a consultation and ask for the opinion and further instructions – it is the only reasonable way to get to know which gastric surgery would be the best.

The Safest weight loss surgery

Determining which is the safest weight loss surgery or which is the most successful weight loss surgery is generally extremely hard. There are a few surgeries regarded as safe – e.g. gastric sleeve or gastric band. Usually, the more risk is involved in the revision weight loss surgery, so when patients undergo a second or third procedure. Also, the safety of the surgery is evaluated individually for each patient, and for someone, the gastric sleeve can be best, while others are advised to opt for gastric bypass. Surgeons always take into consideration the actual weight, health condition, any diseases connected to obesity and perform many diagnostic tests to see what is the safest form of weight loss surgery for each patient.

Yet, if we are to decide which surgery is the safest in general, we would say that gastric sleeve. It is a simple and fast procedure performed for morbidly obese people. The complications and risks involved are very rare and the success rate reaches 90%.

A candidate for weight loss surgery needs to meet certain criteria to be qualified for the procedure and generally, the criteria for weight loss surgery are very similar for gastric sleeve, gastric bypass and gastric band.

The important aspects include:

• being healthy enough to bear the procedure and anaesthesia
• being prepared for recovery time that will require a lot of consistency and dedication
• being prepared for rapid and demanding lifestyle changes.

There are some universal guidelines as for the weight loss candidacy that surgeons and insurance companies follow.

The criteria include:

• BMI equalling or exceeding 40 (there are many websites with BMI calculator, e,g, HERE);
• having type 2 diabetes, heart disease, high blood pressure, obstructive sleep apnea are also surgery indicators
• patients must have attempted to lose weight in a regular way (dieting and exercising) for at least 2 years
• patients struggle with obesity for at least 4-5 years
• patients have enough motivation
• patients are non-smokers
• the age is between 18 and 65
• patients are not alcohol or drug addicted
• patients are eager to cooperate with the surgeon, psychologist and dietician and agree for the aftercare program and diet

What is more, people should be aware that sometimes they may weigh too much to have the procedure, and only after losing some weight, surgeons agree to perform the surgery. It is connected only to a health condition and too high risk of death during the surgery. Of course, patients are not left to their own devices, they are under dieticians and surgeon care, and losing weight for the surgery is treated as a first stage of the process of weight loss. Another important aspect is a patient’s age. Some clinics agree to perform the surgery for patients under 18, while some don’t. Usually, teenagers are encouraged to change their lifestyles and habits, they also often struggle with various eating disorders, so surgeons try as much as they can to help them without the surgery. For most young patients, the help and support of their parents, a dietician, a psychologist (or even more preferably psychiatrist), also a bariatric surgeon is enough to lose the excess weight. If not, parents should do the research to check which clinics perform weight loss surgery for young patients.

BMI criteria may be different for different kinds of surgery. The doctor needs to take into consideration additional information like medical condition as well while deciding on the type of weight loss surgery

Regarding BMI, the criteria might be slightly different for various weight loss surgeries, so often BMI influences the recommended surgery type. For example, the gastric balloon might be performed for people with, class 1 obesity (BMI 30-35), and gastric sleeve or gastric bypass for people with class 2 obesity (BMI 35-40). Patients who have BMI lower than 40, but have some diseases stemming from obesity (e.g. hypertension, type 2 diabetes, heart disorders, liver disorder) would also be qualified for weight loss procedures. People with BMI of 40-50 are morbidly obese, which means that weight loss surgery would probably save their lives, and they must lose weight with the help of surgery as soon as possible. And finally, there are also patients with a BMI over 50, but their health condition usually precludes performing surgery. To minimize the risk of death during the surgery, these patients are often asked to lose some weight before the procedure.

Patients should start the preparation for weight loss surgery and the afterward life just after being qualified by the surgeon. The whole idea of weight loss surgery boils down to the lifestyle change, and only if patients implement healthy habits, they will lose weight. So, it is always better to start earlier and get better results faster. Of course, patients are given a specific pre-op diet prepared by a dietician. Such a diet is high in protein and low in carbohydrates, and its aim is reducing the liver size and forcing the body to use fat as energy. However, even before getting such a diet, we advocate changing the eating habits – thanks to it, patients will avoid shock after the surgery, they will lose some additional kilograms before the surgery, and will get much more motivation for the future.

Some other preparing for bariatric surgery tips include:

• stop smoking
• stop drinking alcohol
• moderate exercising
• taking nutritional supplements and multivitamin
• complete and collect all the necessary documents, medical history, and other paperwork
• organise the life after the surgery (take time off work, get assistance for the first days, organise care for pets or children)
• prepare food and liquids for the recovery according to the surgeon’s instructions
• attend the support meetings or meetings with dieticians / psychologists once your clinic offers them.

It may seem that there are many things to organise, which seems too hard to handle, however usually patients have a few weeks or even months before the surgery, so it is enough to make a good plan and a checklist and day by day prepare yourself for the procedure.

We also present some useful suggestions on what patients should start paying attention to just after they are qualified for bariatric surgery:

• patients must start observing the reasons why they eat (e.g. stress, boredom, award, habits) and if they observe that they reach for food for other reasons than hunger, they are obliged to inform the doctor about it because it indicates some psychological problems;
• prepare and follow a list of non-food ways to deal with emotions and stress;
  patients should stop comparing themselves to other people, e.g. people having the same surgery on the same day don’t have to lose the same amount of weight at the same time;
• people should try to think long-term because the surgery itself is just the beginning, and they will be losing weight for years; here follow-up appointments organised by the clinic are highly valuable;
• introducing regular meals and thorough chewing is compulsory after the surgery, so it is recommended to get used to these habits earlier
• drinking water plays a major role in life, especially after the surgery patients need to avoid dehydration; we advise to sip water all day instead of drinking large amount at one time
• controlling the daily calories intake is easy when people note down what they eat
• one of the best motivating factors is the visible change, so we propose taking photos e.g. once a week.

Pre weight loss surgery diet

Before the surgery, the patient must start a pre bariatric surgery diet, which aim is to reduce the size of the liver and decrease the risk of post-op complications

The interesting fact is that for each 1% of weight loss before the gastric surgery, patients lose 1,8% more weight after the procedure. In addition, the surgery for patients who were on a diet before the surgery lasts much shorter than for other patients (this study was performed by Stanford University’s School of Medicine). It shows that following a pre-operative diet plays an important role in losing weight and recovery, however these are not the main reasons for keeping it.

The main role of a pre bariatric surgery diet is reducing the size of the liver and decreasing the risk of post-op complications (hence, such a diet is also called a liver diet before bariatric surgery). The liver is situated in the abdomen over the stomach, so if its size is too big, it may get injured during the surgery or a surgeon may have difficulties in moving it aside to get to the stomach. The liver of people with BMI over 35 tends to be very large because of excessive glycogen and water stores, it is also overly fatty. The duration of a pre-weight loss surgery diet depends on a surgeon and dietician, but generally, these are 1-2 weeks of a strict, obligatory diet (of course patients are strongly advised to start dieting much earlier, thanks to which they are gradually preparing for bariatric surgery diet).

The diet before weight loss surgery involves:

• keeping to the calories daily limit and spreading their intake evenly during the day
• drinking at least 2 litres of liquids a day (it includes water, juices, caffee, tea, etc.), but patients must remember to count the
• calories from liquids also
• separating drinking and eating
• avoiding alcohol and cigarettes
• take nutritional supplements or medications recommended by the surgeon or dietician
• keep an active lifestyle
• high intake of proteins

In weight loss surgery pre-op diet, patients are allowed to eat 800-1000 calories a day including only up to 100g of carbohydrates. The diet is low-fat and rich in proteins. Every patient is provided with a list of acceptable products and sample meals by a dietician and bariatric surgeon.

After the weight loss surgery patient usually stay in the hospital for around 1-3 days when is under a profound observation all the time

After the weight loss surgery, patients usually spend 1-3 days in the hospital, if there are any complications, this time is longer of course. Also, patients after a surgery performed laparoscopically are allowed to leave a hospital earlier than patients after a regular surgery. During the patient’s stay in the hospital room, they are under a profound observation all the time – it involves checking the pulse, blood pressure, temperature, respiration, mobility, and breath. Also, such conditions as anxiety, nausea, pain, muscle spasms, short breath, or coughing should be immediately reported to a nurse.

Of course, patients feel discomfort while their stay in a hospital, so some difficulties with sleep, vomiting, moderate pain, fatigue, no appetite, or flatulence are normal and do not indicate any complications. However, patients should talk to the medical staff each time they feel worse or have any concerns about bariatric surgery aftercare.

Regarding the pain, each patient experiences it after surgery. Usually, it appears in the incisions sites, and in the case of laparoscopic surgeries, the pain appears in the neck and shoulder areas. If the pain causes much discomfort, patients will get painkillers.

During the stay in a hospital, patients have meetings with dieticians and psychologists, where they get all the necessary instructions and guidelines for the future. Besides, patients should start walking just after the procedure. However, it may seem that after the surgery, long rest, and regeneration is indicated, it does not work out for bariatric patients. An immediate standing up, walking, basic exercises, even changing the position in bed help patients recover, reduce the risk of complications, promote circulation, and prevent blood clots. The nurses always explain how to exercise and breathe, and help move at the beginning, they will look out for patients and their mobility in the hospital.

Once a surgeon decides about discharging patients from the hospital, patients are provided with a detailed diet plan and exercise instruction, also they are informed about the usual course of recovery. It is also the last chance to have a longer discussion with the surgeon, so if patients have any questions, it is the best time to ask them. The surgeon would probably schedule the first follow-up meeting then.

During the recovery, patients may experience the following symptoms (which are normal and shouldn’t pose any concern):

• some swelling and bruising
• discomfort and pain which should alleviate after painkillers
• temporary numbness and itching in the area of the incision
• the scars are pink or red, but it is ok (usually it’s been a year before the scar heals).

There are also symptoms that patients should not ignore and inform the surgeon about them.

They include:

• Fever over 38°C
• constant swelling and redness, increasing pain (when painkillers don’t help)
• pain in chest or difficulties with breathing
• vomiting and nausea lasting over 12 hours
• rare urinating (fewer than 4 times in 24 hours)
• legs pain and swelling.

When patients get home, there are some activities that must be avoided:

• exhausting activity is forbidden for the first 3-4 weeks
• patients cannot lift anything heavier than 9 kilograms
• vacuuming and other push/pull motions are not recommended for 6 weeks
• patients should avoid sitting or standing for a longer time and remember to move in the meantime to prevent blood clots

As for the recommended activities, walking plays a key role in recovery. Patients should take short walks even 4-5 times a day so that after 5 weeks they are able to spend up to 45 minutes walking,

Following a weight loss surgery diet prepared by a dedicated dietician is of vital importance. The aim of such a diet is limiting the daily calorie intake, maintaining balanced meals, keeping the nutrients supplementation, and finally achieving the weight loss surgery results.

The general guidelines for patients include:

• eating regularly small portions
• following a low-calories diet
• avoiding sweets, fast-foods and fatty or sugary meals
• drinking about 2 litres of fluids (about 8 glasses a day)
• keeping a record of each meal and calories
• chewing every bite thoroughly
• avoiding raw vegetables, rice, fresh fruits, tough meats e.g. steaks or pork
• the calories limit for the first 2 months is 300-600 a day and meals should have rather liquid and puree forms
• later on, a daily calories intake is up to 1000 calories.

The foods to eat after weight loss surgery should contain many proteins. It includes fish, eggs, meats, poultry, tofu, soy milk, milk products e.g. cottage cheese, and yogurt. The desired amount of proteins is 65-75 grams a day. Sometimes, patients need to take nutritional supplements and vitamins – however, it must be always agreed with the doctor.

So, what to eat after weight loss surgery?

In the hospital and for the first days at home, only clear liquids are allowed.

After 1-2 weeks, patients may add pureed or blended food. At this stage, protein shakes are recommended (but they should be high-protein and low-calories). Patients must remember about a thorough chewing, small bites, and slow drinking (an hour before and after the meal, drinking should be avoided).

The recommended liquids at this time include:

• sugar-free pudding
• milk (maximum 1%), including lactose-free and soy milk
• low-fat cottage cheese
• yogurts
• low-fat soups
• refined and thinned cereals, such as cream of wheat or rice (however oatmeal is not allowed)

In weeks 2-4, patients can extend their diet with portions of soft food and purees (about 300 calories a day is allowed), they may add:

• cooked/pureed vegetables
• cottage cheese and yogurts
• applesauce
• mashed potatoes
• scrambled eggs (or egg substitutes)
• noodles
• canned fruit
• hot cereals
• tofu
• poultry or other  lean ground meats.

By the 8th week after the surgery, patients can extend their diet to 500 calories a day and eat 6-8 small meals. When there are 2 months after the surgery, the daily calorie intake is 900-1000. The optimal diet includes:

• 3 servings of low-fat meat or it’s alternative
• 3 servings of low-fat dairy products or milk
• 3 servings of starch (bread and rice should be rather avoided)
• 1 serving of fruit
• 2 servings of cooked vegetables.

Over time, patients should change their diet to 3 main meals and 2 snacks a day. Also, the variety and consistency of products may be diversified. After adding a new product, patients must observe their body reaction and if it causes any stomachache or indigestion, it must be avoided for some time. Choosing low-calorie and low-fat food and drinks is vital not only at the beginning but also later on to keep weight. The detailed dietary instructions are prepared for every patient individually and the majority of clinics offer the dietician help even up to a year after the surgery, so generally, patients can contact specialists at any time during their post-operative diet.

The weight loss surgery results depend on such factors as a patient’s age, starting weight, type of bariatric surgery, overall health condition, physical activity, following a diet before and after the procedure, and finally a patient’s motivation, commitment, and support from family and friends. On average, patients lose 50% of their weight and maintain it for 5 years. After that time, patients tend to gain little weight, but still, their BMI is proper. It is also observed that patients lose the greatest number of kilograms in the first 6 months (some lose 50% of the excess weight during that time), afterward losing weight is slower, but between the 6th month and 18th month, they lose an additional 20%-30% of the weight. Obviously, patients with a BMI higher at the beginning tend to lose more weight than those with lower BMI.

Apart from losing weight, bariatric surgery helps to reduce or eliminate:

• sleep apnea (within a year after surgery, most patients forget about sleep apnea problem, also sleepiness during the day and snoring is reduced or eliminated)
• back pain (the spine is no longer overburdened by the body mass)
• high blood pressure (about 70%-80% of patients who suffer from hypertension and have to take medications regularly, reduce this disorder within 6 months after surgery to such an extent that no medications are necessary)
• type 2 diabetes (the surgery helps over 90% of patients with type 2 diabetes within a few weeks)
• depression (patients change physically, which influences their self-esteem and gives the power to live actively, they simply become joyful and satisfied with their lives)
• heart disease (normalizing blood pressure, cholesterol, and diabetes reduces the risk of heart diseases and cardiovascular diseases)
• breathing problems (more active lifestyle and less kilograms make that patients get rid of breathlessness)
• reflux (this disorder improves a few days after surgery)
• asthma and breath shortness (the majority of asthmatic patients admit that they have fewer asthma attacks and that they are less severe than before surgery).

Finally, we would like to admit that the achieved results depend mainly on the patient. Bariatric surgery, regardless of its type, is just a tool thanks to which losing weight becomes faster and easier. The final results always depend on a patient’s commitment to making lifelong lifestyle changes.

Please check the pros and cons of weight loss surgery that are universal for each type of procedure.

Pros of weight loss surgery

A longer life

The JAMA research conducted and published in 2018 proves that bariatric patients who underwent gastric sleeve, gastric bypass, or gastric band live longer than people of the same sex, age, and BMI who haven’t undergone such a surgery.

Significant and fast weight loss

A weight loss surgery enables people to lose 50%-70% of weight within a year, which would be impossible using any other methods. However, the pace of losing kilograms is remarkably fast (especially at the beginning), it is also safe and does not induce yo-yo effect.

Reduction of cardiovascular disease risk

There is strong evidence that the risk of coronary artery disease is significantly decreased for people having had weight loss surgery. The ASMBS published the data confirming the positive influence of bariatric surgeries on the cardiovascular system in 2018.

The quality of life is improved

Patients become more mobile, active, they start to derive real pleasure from walking, swimming, and other activities. Also, the most visible and rapid is a physical change, it is also the best motivator for further changes. The change of physical appearance has a huge positive impact on patients’ mentality and their perception about themselves. Usually, people after weight loss surgery live a more interesting life rich in travelling, socializing, staying among people, often they fall in love, have children, change work, so these are all very positive and beneficial life changes.

Reducing or eliminating other health problems related to obesity

Weight loss procedures help patients normalize the blood pressure, cholesterol, blood sugar level, any gastric problems (e.g. indigestion, reflux), Also, the problems with sleeping or depression are tackled.

Cons of weight loss surgery

Surgery risks related to medical conditions

Patients who have such conditions as liver disease, blood clots, or kidney stones might experience intensifying of these problems after surgery.

Psychological and social concerns

Usually, patients have a long discussion with a psychologist who checks whether people are mentally prepared for immediate life long changes. Only those who are prepared for it are qualified for bariatric surgery, yet some people just find the new reality too difficult to handle and they may struggle with depression, alcohol disorder, relationships changes, even hair loss or gallstones.

Fertility and pregnancy

Women usually become more fertile during first months after the surgery, but at the same time, it is not recommended for women to get pregnant for 18 months after a weight loss procedure.

Second- bariatric revision surgery may be necessary

There are patients who are not able to lose excess weight after the first surgery, or who do not feel well after the surgery, then surgeons look for a different type of procedure that would enable patients to lose weight in a safe way. It is called bariatric revision surgery.

We also present a shortlist of the advantages and disadvantages of specific gastric surgeries:

Losing much weight after bariatric surgery may be regarded as a great accomplishment of patients, often the greatest in their lives. However, such an excessive and relatively fast weight loss has also a dark side, which is loose skin. People lose fat, but the skin that was stretching and expanding for years when they were gaining weight remains and literally hangs.

Skin is the most extensive organ which makes a barrier protecting the body against the environment. The deepest skin layer consists of proteins, mainly elastin and collagen. These two proteins are responsible for skin strength, firmness, and elasticity. Once a person gains weight, the skin stretches and collagen fibers, as well as elastin, get damaged.

Factors that contribute to loose skin after bariatric surgery include:

• amount of weight that is lost (the more kilograms lost, the more skin is left)
• the time of gaining weight and being overweight or obese (the more years with too much weight, the looser skin is afterwards)
• genetics (it has an influence on the skin reaction to weight gain and loss)
• age (the older skin produces much less collagen than the younger one)
• chronic exposure to sun reduces the collagen and elastin production
• smoking (it damages the collagen and reduces the production of new collagen fibres, which results in sagging loose skin).

Getting rid of excess skin after losing weight is a concern of many patients who are physically and emotionally affected by this problem.

So, how to get rid of loose skin after weight loss without surgery?

We advise you to try the following methods:

• strength training (it helps build muscles and keep the skin elastic and young, it is regarded as one of the best method to keep the skin in a good shape)
• taking collagen (it is proved that collagen hydrolysate has a protective influence on skin)
• appropriate supplementation and staying hydrated (the recommended daily amounts of proteins and water are very important,
• also taking Vitamin C and Omega 3 fatty acids helps get rid of excess skin after weight loss)
• firming creams containing elastin and collagen (only their regular using can bring the effects)

The above guidelines should be followed by everyone regardless of weight. If people neglect their bodies for years, following these methods might bring poor results, and getting rid of excess skin after weight loss without surgery is physically impossible. Then, a good solution would be full-body lift after weight loss surgery.

Body lift consists of a few procedures and it can be performed when the weight is stabilized after the weight loss

Such surgery includes several specific procedures:

1. tummy tuck, called abdominoplasty (removing excess skin from the abdomen area)
2. lower body lift (removing excess skin from thighs, hips, buttocks, and belly)
3. upper body lift (removing excess skin from back, sides, and breasts)
4. arm lift, called brachioplasty (removing excess skin from upper arms)
5. thigh lift (removing excess skin from inner and outer thighs).

Generally, body lift after weight loss surgery is performed when the weight is stabilized (usually 1-2 years after weight loss surgery). Some patients need only one body part to operate (usually abdomen), but there are also patients who have sagging skin on the whole body (then, the body lift procedures are performed in 2 or 3 stages). The cost of excess skin removal surgery is rather high, so if patients cannot afford it, it might be a good idea to look for a renowned clinic abroad.

Weight loss surgeries belong to highly effective and safe surgeries. Yet, complications of bariatric surgery may occur, as in any other surgical procedure.

Bariatric surgery side effects include:

• Blood clots – they usually can be avoided by wearing special leg stocking or taking blood-thinning medications, however, some patients still experience this problem especially on legs or lungs. The symptoms of blood clots are a pain in legs, leg swelling, tenderness, redness, and the feeling of warmth, breath shortness, and cough, chest pain, feeling dizzy or faint.
• Wound infection – these complications after bariatric surgery may be avoided when patients take proper care of their wounds while healing. The infection symptoms are swollen skin, red, and the hot areas around the wound, pain, pus, or blood draining from the wound.
• Leaking in the gut – in the first days (sometimes weeks) after gastric sleeve or gastric bypass, the food might be leaking out into the tummy, as a result of which, the tummy infection may develop. The signs of such a leakage include: pain in the tummy, high temperature, shivering, heartbeat, and breathing faster than normal, chills.
• Gut blocking – it might happen that the gut becomes very narrowed or blocked as a result of the reduction of blood flow. Then guts get twisted and food can easily be stuck there. The symptoms of this condition are vomiting, pain in the tummy, constipation, difficulties with swallowing food. This type of side effects of bariatric surgery can be prevented when patients eat small bites, chew every bite thoroughly, and avoid drinking and eating at the same time.
• Malnutrition – it is very frequent bariatric surgery long term side effects. It is very hard to provide all necessary macronutrients, micronutrients, and vitamins after weight loss surgery because the stomach holds only tiny food amounts. Also, some surgeries (e.g. gastric bypass) make it harder for the body to absorb all vitamins and minerals from food. Patients suffering from malnutrition experience: tiredness, lack of energy, breath shortness, heart palpitations, weakness, pale skin. A balanced diet composed of a dietician and nutrients supplementation usually helps in this case.
• Gallstones – they tend to develop within 1-2 years after the surgery. These tiny stones usually appear in the gallbladder as a result of a rapid weight loss. These complications of weight loss surgery can be recognized by a sudden and acute pain in the tummy which lasts for a few minutes or even for a few hours.
• Loose skin – when patients lose dozens of kilograms during a short time, the skin does not keep up. Skin cannot shrink down when patients lose kilograms, so it often needs to be removed surgically.
• Risk of dying – of course, it is exceptionally rare for weight loss surgeries, however, as in any other surgery, there is such a risk.

All bariatric surgery side effects complications are explained in detail by the surgeon before the surgery. Each patient needs to confirm that he or she understands the possible side effects of weight loss surgery, also any bariatric surgery risks side effects questions, misconceptions, concerns should be explained before the procedure.

Patients who consider bariatric surgery usually wonder how to get weight loss surgery on the NHS because the weight loss surgery prices are simply high. Weight loss surgery NHS is available for people meeting certain criteria (they can vary across the UK, so the criteria should be verified by the GP).

The National Institute for Health and Care Excellence lists the criteria that must be met to get the bariatric surgery NHS:

• BMI of 40 or higher (when a patient suffers from diseases related to obesity e.g. type 2 diabetes, hypertension, the BMI of 35 is accepted)
• a patient has tried to lose weight by diet and exercise but with no effects (when patients’ BMI is over 50, they may be qualified for weight loss surgery NHS without meeting this criterium)
• a patient must agree to attend continuing follow-up meetings and follow all the diet and exercise instructions
• a patient is ready to make lifelong lifestyle changes
• the health condition allows for undergoing surgery under general anesthesia.

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

Patients who meet the above criteria should visit their GP first and discuss the idea of getting NHS weight loss surgery UK. The GP will examine a patient’s health condition, determine BMI, and gather all other important details. Once a GP admits that a patient is a suitable candidate for weight loss surgery on NHS, a patient will get a referral to the hospital. There, patients have visits with the surgeon, nurses, dietician, and psychologist or psychiatrist and undergo specific medical tests. A bariatric surgeon decides about putting a patient on NHS weight loss surgery waiting list. Usually, these are many months until a patient has the surgery but the weight loss surgery prices (especially weight loss surgery cost UK) are very high, so many people keep waiting for their turn.

The price for weight loss surgery UK ranges from 3900 GBP to 15 000 GBP and depends on the surgery type.

Below, we present weight loss surgery prices for a different type of procedure:

• Gastric balloon: from 3900 GBP to 4900 GBP
• Gastric band: from 5000 GBP to 9000 GBP
• Gastric sleeve: from 8000 GBP to 12 000 GBP
• Gastric bypass: from 8000 GBP to 15 000 GBP.

Clearly, the weight loss surgery cost UK varies greatly and is determined by:

• surgery type (gastric balloon and band are one of the cheapest procedures while gastric sleeve and bypass are rather expensive)
• clinic reputation (the more distinguishable and valued is the clinic, the higher prices are settled)
• a surgeon’s experience (if a surgeon has hundreds of successful bariatric surgeries performed, numerous achievements, many
• trainings, conferences, and courses, there are usually many patients waiting to visit such a specialist, so no wonder the cost of the procedure is higher)
• customer care  (if a clinic provides patients with full package of meetings, assisting and help, the overall price is exorbitant)
• anaesthetist and hospital fees.

Weight loss surgery cost depends on a few factors like the type of the surgery, clinic reputation, or surgeon’s experience

Patients need to make sure what exactly weight loss surgery prices include and if there isn’t any hidden bariatric surgery cost. It is usually most economic for a patient when the weight loss surgery cost includes the whole package (surgery, medical care before and after the procedure, consultations, hospital stay, anaesthesiologist care, medical tests, dietician help after the surgery). Some clinics divide these costs and it may seem that gastric surgery is really affordable. Even if patients choose such a clinic, the surgeon is obliged to list all the additional costs at the beginning so that a patient knows what to expect and can make a decision about choosing the clinic.

Besides, the cost of a specific type of weight loss surgery UK may vary in one clinic because it is more and more frequent that clinics offer various packages (they usually name them 1,2,3, or basic, extended, premium, or bronze, silver, gold, etc.). The more expensive option, the more services are included. So, again the price for the basic package might seem low, but not all services are included. Also, these packages usually differ in time of aftercare – the basic one may have no aftercare at all (or e.g. 1-2 months), while the most extended one has a 1-year aftercare program. Of course, patients should pay attention to a clinic’s policy regarding long-term post-op care because the support of a dietician, surgeon, psychologist, and regular follow-ups or group meetings are often a key factor strengthening patients’ motivation and monitoring their progress.

Having a weight loss surgery abroad is an alternative for patients who cannot afford the surgery in their country and do not qualify for NHS funding (or NHS waiting list is too long).

Weight loss surgery abroad is a great option for patients who cannot afford the surgery in their country. Currently, there is a wide choice of options available

The truth is, medical tourism in Europe is developed to such an extent that there are weight loss clinics dedicated specifically to foreign patients, assistance in flights and hotel booking, English is used in almost every clinic and new technology solutions are widely used (e.g. online meetings and consultations, virtual walks around the clinic- which is great when a patient does the clinic research, all the paperwork may be scanned, there are the newest systems for computer data protection and personal data security).

The European destinations which are chosen by people for bariatric surgery abroad are Poland, Lithuania, Czech Republic and Turkey. These countries offer prices even twice as cheap as in the UK, Germany, Spain or Scandinavian countries. The reason for offering such a cheap weight loss surgery is simple – the costs of maintaining the clinic and salaries are relatively low. So, usually, patients choosing one of these countries can afford the top private clinic there and the most extended package, and still, the price is affordable.

Of course, regardless of the country, we always advise patients to do deep research as for the clinics and surgeons to be sure they will be in good hands and feel comfortable and well-cared. It is quite easy because nowadays almost every clinic has an English version of the website. Regarding surgeons, it is a good idea to check the patients’ opinions and reviews, any rankings that are available, and find information about a surgeon’s training, experience, accomplishments (this information is usually available on clinics’ websites, but patients also can call or mail the clinic and ask for such information.

The other important aspect to mention regarding bariatric surgery abroad is aftercare. It is obvious that patients would not be able to come to a different country every 3-4 weeks for a meeting or follow-up visit. So, firstly patients need to make sure if a clinic offers such support, and if yes if there are online meetings available. Most modern clinics have introduced such solutions, and they work out, even domestic patients more often prefer online meetings and post-op consultations. What’s also important, patients can get secured for their medical trip, which makes their travel and stay abroad much safer. Clinic Hunter & AXA Partners have created a medical tourism insurance dedicated solely to medical tourists.

Below, we list average weight loss surgery abroad cost.

As can be seen, the weight loss surgery cost varies among countries. No wonder, many people decide to travel abroad for the surgery. We also strongly advise to look for medical travel agencies help – their service is usually free, and they offer help with finding the best clinic and surgeon within a patient’s budget, organising the accommodation, flights, transportation and often the individual assistance during the whole stay. It makes travelling for surgery much easier and allows patients to focus on the surgery only.

Weight loss surgery Turkey

Turkey is one of the leading destinations for medical tourists. In 2018, there were over 10 million foreign patients, thanks to which Turkey prides itself with the annual turnover of over 100 billion dollars. Weight loss surgery Turkey is the 3rd most frequently performed procedure (after hair transplantation and dental treatment). The main reasons for coming for bariatric surgery in Turkey are:

• very competitive prices
• the numerous accredited health centres
• very high quality of services
• customized procedures and individual approach to patients
• a short time of staying
• equipping the clinics with the newest technology available on the market
• Very rich cultural and historical heritage.

The clinics and surgeons in Turkey are well-controlled by the law, for example:

• The Ministry of Health controls and regulates all medical services in Turkey
• many clinics, medical centres and hospitals have JCI accreditations
• the hospitals are audited at least once a year (usually, however, these are twice a year)
• if the surgeon does not follow the regulated rules, they may be abeyed or excluded from the surgeon’s list.

Bariatric surgery Turkey is most frequently performed in Alanya, Antalya and Istanbul mainly because foreign patients want to benefit from these beautifully located places and make a short holiday at that time also.

Weight loss surgery Poland

Poland is a very popular destination for bariatric surgery patients. The main reasons for this are the prices and high quality of treatment

Poland is a country located in the centre of Europe, so getting there is fast and easy for most of Europeans, which is a great advantage of choosing Poland. The prices for treatments and surgeries (including dentistry, cosmetic surgery, and obesity surgeries fields) are highly competitive and many people find weight loss surgery in Poland cheaper than in Western European countries even after adding the cost of flights or accommodation. The nations choosing Poland most frequently include Germans, British, Russian, Swedish, Italian and Norwegian.

The European Union puts a great emphasis on medical tourism in Europe and monitors the clinics’ standards, trends and policy. Poland, of course, benefits from the EU programs and follows its guidelines. It allows for developing the services offered to foreign patients (including surgeons’ training, clinics’ equipment, surgery methods, new technology, tourists attractions, infrastructure, domestic and international flights extending). Also, the fact that Poland is obliged to meet all the EU standards makes people deciding to come there feel safe and protected.

The idea that is followed by most clinics is to provide the best quality treatment or surgery at a low price and more and more often people decide for weight loss surgery Poland because of the high quality of medical procedures and one of the best surgeons in the world, and the low price is just an additional pleasant aspect.

Weight loss surgery Poland is a very frequently performed surgery on foreign patients. The main reason for this is the price. Bariatric surgeries belong to one of the most expensive surgeries and no wonder people look for destinations offering more affordable cost for such surgeries.

The main reasons why people decide to have weight loss surgery in Poland include:

• well organised and regulated medical tourism
• fundings from the EU specifically for medical tourism development
• no waiting time
• easy bus/train/plane access to major Polish cities such as Warsaw, Cracow, Wroclaw
• such languages as English, Russian, German are prevalent in clinics
• prices are 40%-80% cheaper than in the Western European countries
• as a country, Poland has a lot to offer for tourists (mountains, sea, rich history, unique tradition and cuisine, many tourist attractions in the cities)
• the highest standards of treatments.

We are glad to present the weight loss surgery before and after photos. Please, see some of them below.

Considering a weight loss surgery is the first major step towards the new healthy life because it means that people start to realize that their weight becomes morbidly dangerous. It is extremely important to familiarize oneself with the bariatric surgery materials, and we hope that this article has been very informative, helpful, and encouraging to have weight loss surgery.

There are several procedures that are considered highly effective and relatively safe, the two most frequent are gastric sleeve and gastric bypass. It is worth mentioning that it is a surgeon who decides which procedure is the best for a patient because there are many individual and medical factors that are taken into consideration.

Last but not least, people have 3 options of getting a weight loss surgery: performing it in their home country in a private clinic, trying to get NHS funding, or travelling to a foreign country to get an affordable surgery there. Regardless of the choice, bariatric surgery gives a unique opportunity to change lives for the better and start a healthy and happy life.

Ethan Willse Published Feb 12, & Ethan is a health writer who specializes in research and discussing topics ranging from diet. (2019, August 07). 75 Statistics, Facts & Quotes about Weight Loss (2019). Retrieved July 13, 2020, from https://renewbariatrics.com/75-statistics-quotes-facts-about-weight-loss/

(n.d.). Retrieved July 13, 2020, from https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/

The Checklist – Top 10 Ways to Prepare for Bariatric Surgery. (n.d.). Retrieved July 13, 2020, from https://www.obesityaction.org/community/news/bariatric-surgery/the-checklist-top-10-ways-to-prepare-for-bariatric-surgery/

Orna Reges, P. (2018, January 16). Association Between Bariatric Surgery vs Usual Care Obesity Management and All-Cause Mortality. Retrieved July 13, 2020, from https://jamanetwork.com/journals/jama/fullarticle/2669726

Weight-loss Surgery Reduces Risk of Coronary Heart Disease By 40 Percent. (2020, May 06). Retrieved July 13, 2020, from https://asmbs.org/articles/weight-loss-surgery-reduces-risk-of-coronary-heart-disease-by-40-percent

How effective is bariatric surgery? (2019, January 16). Retrieved July 13, 2020, from https://uihc.org/health-topics/how-effective-bariatric-surgery

Health Tourism in Turkey. (n.d.). Retrieved July 13, 2020, from https://www.antalyahomes.com/health-tourism-in-turkey

John Rabkin, M. (2019, June 07). Weight Loss Surgery Quiz – Learn Your Top 2 Procedures. Retrieved July 13, 2020, from https://www.bariatric-surgery-source.com/best-weight-loss-surgery-options.html

Grabowska, K. (2019, December 20). Gastric Sleeve Surgery Poland – Gastrectomy Abroad, prices, reviews. Retrieved July 13, 2020, from https://beautypoland.com/procedures/gastric-sleeve-surgery-poland/

Zastapilo, J. (2019, July 15). Gastric Bypass – price comparison – check the prices all over the world. Retrieved July 13, 2020, from https://beautypoland.com/procedures/gastric-bypass-poland/gastric-bypass-price-comparison/