The Gastric Guru

Surgery is an effective way to lose weight when dieting and exercise is no longer working. This article covers key considerations you will need to think about as you decide if surgery is right for you.

Weight loss surgery is not a ‘quick fix’ cure for obesity. Achieving your goal weight is a lifelong journey. We call it a journey because it's a lifelong process of making small commitments towards positive change and better health and happiness. Your ability to lose weight successfully will depend on how well you follow your aftercare plan and adapt to eating much smaller portions.

Why choose weight loss surgery?

If private healthcare is an option then the costs of the procedures are expensive and will involve cost planning. You will need to plan ahead and weigh up the financial costs against the benefits of having surgery. In making your decision, it can help to consider the financial and non-financial burden of living with obesity.

Before deciding on the right procedure you need that you know the risks involved (contraindications).

Contraindications

Weight loss surgery is not advised when it may be harmful or fatal. Certain medical conditions and symptoms can mean that surgery can put your life at risk. It is crucial to discuss your medical history with your surgeon before making a decision.

Some contraindications for weight loss surgery include:

Alcohol abuse or drug dependence
Barrett's esophagus or esophagitis
Cardiopulmonary (heart and lung) disease that makes the surgery risky
Uncontrolled psychiatric disorders such as depression or schizophrenia

WLS Risks and Complications

NHS Health Check

NHS criteria for weight loss surgery (UK only)

In the UK, weight loss surgery is available on the NHS for people who meet a criteria. However, the NHS criteria for the surgery can vary across England. You will need to check with your GP if you think surgery on the NHS pathway could be an option for you.

If you chose to go private you will need to carefully research the private clinics offering weight loss surgery. You might want to compare different surgeries by their patient feedback and the costs of their procedures.

Some people seek weight loss surgery outside of the UK where the cost of private surgery can be lower than in the UK. If you are considering surgery abroad then it is important to weigh up the potential savings against the potential risks. It is advised to carefully research each country against international healthcare standards and factor in any complications that can occur in delivering aftercare.

Deciding on a surgery type
Patient preferences	Surgery types	Expected health improvements
Fast weight loss	The Gastric Bypass; Mini Gastric Bypass & Biliopancreatic Diversion with Duodenal Switch (BPD-DS)	Helps people in severe discomfort from joint pain. A good choice for people who need to see results quickly to stay motivated.
Low BMI (under 40)	Gastric Band	Gastric Band is usually the first consideration due to being a reversable procedure
High BMI (over 40)	Gastric Sleeve; BPD-DS	An option for patients with a higher BMI (40+). Offers a combination of restriction and nutrient malabsorption
Long-term results	Gastric Bypass	Rapidly improves blood sugar control, making it popular procedure among people with Type 2 diabetes. Older procedures, well established.
Adjustable	Gastric Band	Gastric Band is the only adjustable procedure. Filling the band increases restriction to help speed weight loss, and decreasing the fill volume of the band reduces restriction to let your oesophagus heal if you get esophagitis or to let you increase your nutrient intake when needed, such as during pregnancy or if you become unwell.
Reversible	Gastric Band	Other surgery types are considered if gastric banding is ineffective
Convertible	Gastric Sleeve; Gastric Bypass	Gastric Sleeve can be converted to a BPD-DS if weight loss isn't satisfactory, but it cannot be reversed. Gastric Bypass can be redone or a band can be added (band over bypass). Newer procedure
Higher maintenance	Gastric Band	Requires closer attention. Patients must visit bariatric team for routine adjustments which takes place several times in the first year.
Fear of Needles	Gastric Band	Adjustments require your bariatric nurse to stick a needle in your access port near your belly button. You might feel a small prick or have topical local anaesthesia applied so you don't feel anything. If you have a fear of needles, the gastric band may not be for you.
Implanted Medical Devices	Gastric Band	Connection tubing and access port are all permanently inside of your stomach.
Non-implant surgical procedure	Gastric Sleeve; Gastric Bypass	Neither procedures require permanent medical devices inside the body
Restrictive	All surgery types	Reduces the size of the stomach so you feel full for loger after eating smaller meal portions
Malabsorptive	Gastric Bypass; BPD-DS	Reduces calories absorbed from food to help lose weight faster. Prevents bingeing on sweets because high-sugar foods can cause what is commonly known as dumping syndrome. Symptoms include shakiness, nausea, vomiting and diarrhoea. If you have a sweet tooth, gastric bypass and BPD-DS might be better choices.
Low-sugar diet	Roux-en-Y gastric Bypass (RYGB)	Recommended if you have a sweet tooth because the RYGB diet does not allow sweets
Young people and adolescents	Gastric Band	Less invasive and adjustable. Women who become pregnant can reduce restriction and increase dietary intake to support the baby.
High cost	Roux-en-Y gastric Bypass (RYGB)	Most likely to be covered by insurance.
Lower cost	Gastric Band	Least expensive surgery.