Surgery can be used to treat obesity. This is called bariatric surgery.
There are different types of bariatric surgery. Most types of surgery make your stomach smaller. Some types of surgery also bypass a part of the bowel.
If you are referred for bariatric surgery, a team of specialists will work together to give you the best treatment and care. This team is called your multidisciplinary team (MDT).
Who can have bariatric surgery
You may be able to have bariatric surgery if:
- it is safe for you to have anaesthetic and surgery
- you can commit to long-term follow-up care
- you have a BMI of 40 or more
- you have a BMI between 35 and 40, and other medical problems related to obesity
You may be considered for bariatric surgery if your BMI is below 40 and your ethnic background is:
- South Asian
- Chinese
- other Asian
- Middle Eastern
- Black African
- African-Caribbean
Bariatric surgery is available through the HSE.
Preparing for bariatric surgery
Before you have bariatric surgery, you will be assessed by your MDT.
This team often includes a:
- dietitian
- physiotherapist
- psychologist
- doctor
- nurse
- surgeon
- occupational therapist
- social worker
You will usually have a few appointments with them.
To check if you are suitable for bariatric surgery, the MDT will assess your:
- physical health - this may include blood tests, camera (endoscopy) tests, questionnaires and other tests
- mental health - to check your mental health history, your relationship with food and the supports you have around you
- eating and drinking patterns - to help you prepare for the changes your MDT will recommend before and after surgery
These checks also help your team decide the type of surgery that is best for you.
The team will also work with you to help prepare you for your surgery.
They will give you advice and information on:
- obesity as a chronic disease and the need for long-term treatment
- smoking and how to quit
- reducing or stopping fizzy drinks and alcohol
- building long-term healthy eating habits
- keeping physically active
- coping with changes that might happen after surgery
- building a support network
- taking medicines as prescribed
After bariatric surgery
After bariatric surgery you will need to make some lifestyle changes and go to regular follow-up appointments.
Recovering after surgery
You can usually leave hospital 1 to 3 days after having bariatric surgery. Your care team will talk to you about your recovery plan.
If you've had a gastric band fitted in a non-HSE hospital, they should give you a follow-up appointment. This is to adjust your band based on your food intake and weight loss.
If you’ve had a gastric band in the past and have problems, contact your GP. They can refer you to a specialist obesity centre to investigate the problem.
Follow-up appointments
After surgery, you will have regular follow-up appointments. You will have these for the rest of your life.
These appointments will usually be in the specialist obesity management clinic for at least the first 2 years. This may then change to a check-up with a GP once a year.
Follow-up appointments may involve:
- blood tests to check your vitamin and mineral levels
- a physical health check
- advice and support about nutrition, physical activity, stress management and healthy sleep
- emotional or psychological support
How and what you eat
It's important to make changes to the way you eat and drink after the operation. This is because you'll have a smaller stomach and different appetite signals.
Soon after surgery, you will be given a nutrition plan to follow. This plan is recommended to help you with healing and recovery.
The plan will vary from person to person.
A typical plan may include:
- days 1 and 2 - liquid diet including protein-rich drinks
- weeks 1 to 12 - soft, low-fibre, high-protein foods such as yogurt, scrambled egg, minced meat and milk
- from week 12 - gradual return to a healthy, balanced diet which includes fibre, fruit and vegetables
Longer term after surgery, there are some eating and drinking patterns that are important to keep up.
Do
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eat slowly and regularly
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chew carefully
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only take small amounts of food at a time
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eat a variety of nutritious foods at every meal and snack
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try to eat protein-rich foods at every meal and snack - such as meat, fish, eggs, dairy foods and meat alternatives
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stay well hydrated by sipping water throughout the day
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take vitamin and mineral supplements recommended by your care team
Physical activity
After surgery, your team may advise you to gradually increase your physical activity levels as you recover.
They may also recommend you include regular muscle-strengthening activities. This helps to support strong, healthy muscles while your body is losing weight.
Eating enough protein is also important for healthy muscles and muscle strength.
Weight change after bariatric surgery
After bariatric surgery, health improvements and weight loss often happen in the first 12 to 18 months.
If you combine bariatric surgery and lifestyle changes, it is possible to lose between 20% and 40% of your total body weight. But this varies from person to person.
The surgery may improve weight-related health problems, such as:
- type 2 diabetes
- osteoarthritis
- sleep apnoea
- high blood pressure
Some weight regain is common after the first 12 to 18 months. This is not a sign that your surgery has failed. Your MDT will help you understand the things that can affect this, and help you manage them.
For example, they may support you to focus on:
- your nutrition and eating patterns
- regular activity
- healthy sleep
- medicines
- managing chronic pain, stress, and other health conditions
Pregnancy after bariatric surgery
Avoid pregnancy for 12 to 18 months after surgery, until your weight is more stable. This is because the effects of rapid weight loss on a developing baby are not yet understood.
Your fertility may increase because of weight loss.
Tablet-based contraceptives are not reliable forms of contraception after bariatric surgery. This is because surgery may affect the way they are absorbed. Instead, use non-tablet contraceptives such as a progesterone implant or a coil.
Possible complications
Bariatric surgery is a common and safe procedure. But, as with any operation, there are risks. Your doctor will explain these to you.
Blood clots
Blood clots are possible after bariatric surgery. This is because of how the blood flows and clots after surgery.
Blood clots often start in the lower leg (deep vein thrombosis). These clots may sometimes travel to the lungs (pulmonary embolism).
If you have a blood clot that causes pain or swelling, ask for an urgent GP appointment. Your doctor can give you anticoagulant medicines to help.
Stomach leak
If you have had a gastric bypass or sleeve gastrectomy, there is a small chance that food could leak out of your tummy (abdomen).
This can cause a serious infection inside your tummy. You will need to be treated with medicine or further surgery.
Wound infection
Wounds can become infected after surgery. Keeping a wound clean will reduce the risk of infection and speed up the healing process.
Blocked gut
Your stomach or small intestine can become blocked after bariatric surgery. This can be caused by scarring and reduced blood flow to the area.
Let your care team know if you are having any problems with swallowing or keeping food down after surgery. These may be symptoms of a blocked gut. You may need urgent treatment or surgery for this.
Reduce the risk of a blockage in the first few weeks by following the nutrition plan you’ve agreed with your healthcare team.
Gallstones
Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. They can form if weight loss happens quickly, for example after bariatric surgery.
Excess skin
After bariatric surgery, you may be left with excess folds and rolls of skin. This can happen around your breasts, tummy, hips and limbs.
Surgery, such as a tummy tuck, can be used to remove the excess skin.
This surgery is not cosmetic if the loose skin is:
- causing discomfort, irritation, infection
- reducing movement
- affecting your quality of life
You can ask your GP or specialist team if this type of surgery is available where you live.
Malnutrition
Bariatric surgery can make it harder for your gut to absorb nutrients from food. This means there's a risk you could develop malnutrition.
Symptoms can include:
- feeling tired or lacking energy all the time
- shortness of breath
- noticeable heartbeats (palpitations)
- paler than usual skin
- pins and needles
- feeling weak
Not everyone who has malnutrition will have symptoms.
To help you reduce the risk of developing malnutrition:
- follow the nutrition plan from your dietitian
- eat a variety of nutritious foods - especially protein foods
- take your nutritional supplements as recommended after your surgery
- take extra nutritional supplements (if your healthcare team tells you to)
- attend regular blood tests and appointments after surgery - to measure your vitamin and mineral levels and treat any problems
Emergency action required: Call 112 or 999 or go to your nearest emergency department (ED) if:
- you have difficulty breathing and pain and swelling in your leg
- you have chest pains and pain and swelling in your leg
- you have severe tummy pain
- you're bleeding non-stop from your bottom
- there's a lot of blood, for example, the toilet water turns red or you see large blood clots
- you're vomiting blood or poo, or your vomit looks like coffee grounds or soil
Urgent advice: Ask for an urgent GP appointment if:
you've had bariatric surgery and you have:
- redness, tenderness, swelling or pain in your leg that is not getting better or gets worse
- a high temperature or you're feeling hot and shivery
- a fast heartbeat
- tummy pain
- fast breathing
- difficulty swallowing
- regular vomiting (getting sick)
These symptoms could be a sign of a blood clot or a problem with your stomach.
Non-urgent advice: Contact a GP if:
- you have pain in or around a wound
- you have red, hot and swollen skin
- pus is coming from a wound
More support
Find out more about bariatric surgery from:
- Association for the Study of Obesity - asoi.info
- Centre for obesity management in St. Columcille’s Hospital - schcom.ie