All about operations to lose weight

Every year in France, there are 50,000 surgical proceduresfor weight loss. Over the past fifteen years, obesity surgery has continued to increase its popularity – the number of procedures has tripled during this period, and continues to increase. It must be said that France does not escape the scourge of obesity. One in two French people is overweight, while 16% of the population is obese. Is bariatric surgery the solution to lose weight? What types of operations are practiced today? How effective is an intervention in the long term? So many questions that we have tried to answer.

Who is bariatric surgery for?

Surgical operationsdedicated to weight loss are mainly aimed at peoplewith obesity. They are not suitable for people who only have a few pounds to lose. To qualify, the BMI must be greater than 35. In addition, surgery can only take place if all attempts at weight loss have ended in failure (diets, follow-up by a nutritionist, diet rehabilitation, therapy, sports practice …).

An operation therefore involves several interviews with themedical profession, which will consider, at its sole discretion, the need to operate. In addition, bariatric surgery requires the patient to make a significant personal investment, both before and after the procedure. Indeed the operation is not trivial and has consequences on the body. The patient must put in place hygiene-dietary measures in line with the purpose of the operation: food rebalancing, cessation of food compulsions and practice of physical activity, under penalty of regaining the lost weight.

Modes of action of obesity surgery

There are two types of techniques used in bariatric surgery: restrictive techniques, which aim to reduce the size of the stomach to cause a change in food intake (size, nature, frequency), andmixed, restrictive and malabsorptive techniques, which consist of reducing the size of the stomach and reducing the assimilation of food by the body. The springs used to encourage weight loss are:

• Slowing down the passage of food through the stomach
• The effect on hunger, with the lowering of ghrelin levels (the hunger hormone)
• The effect on satiety, which occurs more quickly
• Dumping syndrome: the ingestion of sweet foods causes a feeling of malaise with disgust, nausea, rapid pulse
• Reduction of food intake and greater chewing, under penalty of regurgitation

What are the operations practiced today?

Sleeve gastrectomy

More commonly known as sleeve, it is the most common bariatric surgery operation today in France, in terms of weight loss. It is intended for people with a BMI between 35 and 40 (severe obesity) with obesity-related complications, as well as patients with a BMI greater than 40 (massive obesity). It consists of reducing daily food intake by removing part of the stomach (about 2/3). Food, taken in small quantities, will be digested more quickly. The patient’s appetite is de facto reduced and weight loss is systematic. The average loss of excess weight in one year is about 60%. The operation lasts about 1 to 2 hours and requires hospitalization for a few days. Operative complications are rare. The sleeve, moreover, is not without effects:

Gastroplasty

Gastroplasty, or gastric banding, is a reversible operation. Like the sleeve, it is a restrictive surgical technique. It consists of modifying the physiology of the stomach, by placing a surgical silicone ring around the upper part of the stomach, to separate it into two pockets, like an hourglass. The ring, which is inflatable, remains permanently adjustable. This allows the healthcare team to control postoperative weight loss. After laying the ring, food can only be taken in small quantities, chewed well. It will descend into the upper part of the stomach, above the ring, where it will be digested. The feeling of satiety will therefore occur more quickly. Gastroplasty is intended for people whose BMI is between 35 and 40 with complications related to obesity, and for patients with a BMI of 40 to 45. Placing a band is an easy and well-controlled operation ( practiced for about twenty years), and lasts from 30 minutes to 1h30. Gastroplasty is less popular today than it was fifteen years ago. In question: the inconveniences (frequent vomiting in post-operative period), the assessment in terms of weight loss (on average 40% of the excess weight in one year), the appearance of other techniques more popular with the great audience. Gastroplasty is less popular today than it was fifteen years ago. In question: the inconveniences (frequent vomiting in post-operative period), the assessment in terms of weight loss (on average 40% of the excess weight in one year), the appearance of other techniques more popular with the big audience. Gastroplasty is less popular today than it was fifteen years ago. In question: the inconveniences (frequent vomiting in post-operative period), the assessment in terms of weight loss (on average 40% of the excess weight in one year), the appearance of other techniques more popular with the big audience.

Gastric bypass

The bypass is a kind of gastric bypass, which consists of reducing the size of the stomach by changing the usual food circuit, while modifying the absorption of food. Food no longer passes through the upper part of the stomach, but is diverted directly to the middle part of the small intestine. The effects are multiple:

• The stomach no longer receiving food, its size is reduced
• Sweet foods are difficult to digest and cause the patient to feel sick or even nauseous.
• Fatty foods are “poorly digested”, therefore less assimilated by the body, thus leading to weight loss
• The feeling of satiety occurs more quickly, as well as hunger (decrease in ghrelin)

This type of intervention is particularly aimed at patients whose BMI is greater than 45 and who consume a lot of sugary foods. It is also popular if the patient suffers from a hiatal hernia, which will be relieved. The operation is technically difficult and requires 2 to 3 hours, as well as hospitalization for several days. However, it is the second operation requested, in the context of weight loss, because it is very effective: the average loss of excess weight in one year is 70%. The long-term consequences are sometimes complicated (intestinal obstruction, anastomotic ulcer), without being systematic.

The biliopancreatic diversion

This operation is one of the least commonly performed and is reserved for individuals whose BMI is greater than 50 and/or after failure of another technique. It is based on restriction and malabsorption. It consists of combining the “benefits” of a sleeve and a bypass: the size of the stomach is reduced by gastrectomy and the small intestine is divided into two parts. Then the stomach is connected to the first part of the small intestine (the food loop). The second part of the small intestine (the biliopancreatic loop), meanwhile, is connected to the end of the first part, so that food is only digested and assimilated in a very short portion of the small intestine. . Thus they are evacuated without having been fully absorbed. The biliopancreatic diversion is a major intervention, requiring 4 to 5 hours. But it is very effective: after one year, the average loss of excess weight is 75 to 80%. Not without risk, it can lead to nutritional deficiencies, drug malabsorption and diarrhea.

Gastric Balloon

It is not a surgical act, but a temporary device, intended to modify the eating habits of the patient. The procedure consists of inserting a balloon into the stomach of the individual, through the esophagus. It is then inflated, in order to fill part of the stomach pocket and mechanically cause a feeling of satiety faster in the patient. In principle, the balloon is maintained for 6 months, sometimes more, at the discretion of the doctor. The gastric balloon method is intended for patients who are overweight in the order of 20 to 50% compared to their “ideal” weight, i.e. non-obese individuals who cannot claim obesity surgery. The installation of a gastric balloon is part of a comprehensive care: food rehabilitation, rediscovery of feelings of hunger and satiety,behavioral therapy. Success depends a lot on the commitment of the patient, who must be an actor in his weight loss.

Weight loss surgery: the results

Following an operation, good results are observed in the short and medium term. People with obesity lose a lot of weight (maximum loss after 12 to 18 months) and regain anormal BMItag. Beyond 20 kg, weight loss must be closely monitored by the medical profession, because deficiencies and cardiac consequences are sometimes present.

In the long term, the majority of patients maintain a healthy weight, the operation having raised awareness about diet and lifestyle in general. A moderate weight gain is still possible. Today the health authorities have enough perspective to express themselves on the effectiveness of bariatric surgery in terms of weight loss: an international study carried out over ten years (available on the HAS website) demonstrated that surgical treatments leadto significant and lasting weight loss .

Finally, it is necessary to specify it again: surgery alone does not allow you to lose weight. It must be part of the implementation by the patient of a series of long-term hygiene-dietary measures: modification of diet, physical activity, medical follow-up.