What is bariatric surgery? Types of surgery, eligibility, risks, and diet

Key Points

• Bariatric surgery works like a body reset - it shrinks your stomach's food capacity and reduces hunger signals, leading to rapid, sustained weight loss
• If you have a BMI over 40, or between 35-39 with health issues, and other weight loss methods haven't helped, you might be a candidate
• There are a few options, but the most common procedures are gastric sleeve and gastric bypass. Both work differently but get similar results.
• 9 out of 10 patients keep their weight off long-term and feel better, physically and mentally, with lifestyle changes during recovery and beyond

If you've struggled with obesity, you know the daily challenges - from joint pain to constant exhaustion, from breathing difficulties to fertility struggles and heart health concerns. These health issues can hold you back from living the life you want to live.

You're not alone, and it's okay to seek additional help when diet and exercise have not produced the results you need. Bariatric surgery has helped thousands of people achieve significant, lasting weight loss each year.

In this guide, we'll explore bariatric surgery, who qualifies, and what to expect before and after the procedure. We'll also discuss essential dietary changes that support long-term success.

What is bariatric surgery?

Bariatric surgery, also known as weight loss surgery, is a medical procedure that modifies your digestive system to help you lose weight. The surgery can help you regain the ability to participate fully in the activities that matter most to you. It helps regulate gut hormones and metabolism while reducing hunger, making it easier to achieve and maintain a healthy weight.

According to Gia Eapen, MD, "Bariatric surgery has become increasingly common, with nearly 300,000 procedures performed annually in the United States, according to the American Society for Metabolic and Bariatric Surgery (ASMBS). The results are promising; research shows patients typically lose over 50% of their excess weight and maintain most of this loss even a decade after surgery."

Types of bariatric surgery

There are a few types of bariatric surgeries, but the most common ones are gastric sleeve and gastric bypass. 

Gastric sleeve (Sleeve gastrectomy)

The gastric sleeve has become the most commonly performed bariatric surgery today. During this procedure, surgeons remove approximately 80% of the stomach, leaving a narrow, sleeve-shaped pouch. This smaller stomach not only restricts food intake but also reduces the production of ghrelin, the hormone responsible for triggering hunger signals.

Gastric bypass (Roux-En-Y gastric bypass or RYGB)

Gastric bypass is another effective approach to weight loss surgery. This procedure creates a small stomach pouch about the size of a golf ball and connects it directly to the lower portion of the small intestine. This modification limits food intake and reduces nutrient absorption.

'Roux-en-Y' is French for "in the shape of a Y," which describes the result of the procedure. Once the stomach pouch and small intestine are connected, they form a Y shape.

Understanding if you qualify

Many people wonder if bariatric surgery might be right for them. Healthcare providers typically recommend this option when:

• Your BMI is over 40 (class III obesity)
• Your BMI is between 35-39, and you have serious weight-related health conditions
• You've made consistent attempts to lose weight through other methods without lasting success and have weight-related health problems
• You're ready to commit to long-term lifestyle changes

Obesity can lead to medical complications like heart disease, stroke, sleep apnea, breathing difficulties, arthritis, fatty liver disease, and even increase the risk of Alzheimer's disease and dementia. Excessive weight from obesity may also increase the risk of certain cancers like endometrial cancer, breast cancer, and colon cancer.

Eapen, MD, notes, "A high BMI may also impact ovulation and impair fertility, making it harder to get pregnant naturally or through in vitro fertilization. Plus, once you're pregnant, the excess weight can cause pregnancy-related complications like gestational diabetes, preeclampsia, and even miscarriages."

Preparing for surgery

Your healthcare team will guide you through several important preparation steps before bariatric surgery:

• Comprehensive medical evaluation
• Nutritional counseling with a registered dietitian
• Psychological assessment
• Smoking cessation (if applicable)
• Pre-surgery diet protocol, which typically involves following a specific meal plan for 2-3 weeks before surgery to help reduce the size of your liver and prepare your body for the procedure

A successful bariatric surgery procedure relies heavily on proper nutrition, both before and after your procedure. Let's explore the dietary changes you'll need to make throughout this process.

The bariatric diet: Before and after surgery

Your relationship with food will undergo a significant transformation through this journey. The pre-bariatric surgery diet typically focuses on:

• Consuming 64 ounces of water daily
• Following a protein-rich diet
• Reducing portion sizes
• Eliminating certain foods as directed by your healthcare team

After surgery, your diet becomes even more crucial for success. Your new stomach—now roughly the size of an egg—requires careful attention to nutrition. Following a 'protein-first' approach becomes essential, along with:

• Drinking adequate fluids between meals
• Eating slowly and mindfully
• Avoiding high-sugar and high-fat foods
• Incorporating whole, non-starchy vegetables
• Taking recommended supplements

What are the benefits of bariatric surgery?

90% of people who undergo bariatric surgery procedures lose half or more than half of their excess weight and keep it off in the long term. This weight loss can reduce the risk of heart attack and stroke, type 2 diabetes, and certain cancers.

Weight loss from bariatric surgery can lower breathing difficulties caused by obesity, such as sleep apnea and asthma. It also helps regulate hormones and improve metabolism, giving people a boost of energy, less pain, and the ability to move around easily.

Research shows that bariatric surgery often improves mental health. After surgery, many patients report reduced symptoms of depression and anxiety, likely due to improved mobility, health, and quality of life.

What are the risks of bariatric surgery?

Like any major surgery, bariatric procedures carry some risks. Early complications can include:

• Bleeding at the surgical site
• Infection
• Blood clots
• Reactions to anesthesia
• Lung problems
• Gastrointestinal leaks

While serious complications are rare, they can occur and should be discussed thoroughly with your surgical team.

What are the long-term side effects after weight loss surgery?

After bariatric surgery, some patients may experience:

Nutritional challenges

• Difficulty absorbing certain nutrients
• Need for lifetime vitamin and mineral supplements
• Risk of anemia or bone density issues if supplements aren't taken

Digestive changes

• Dumping syndrome (rapid emptying of stomach contents)
• Nausea or vomiting
• Changes in bowel habits
• Acid reflux
• Potential for ulcers

Other considerations

• Gallstones from rapid weight loss
• Possible hernias at incision sites
• Changes in how your body processes alcohol
• Need for careful attention to eating habits

Eapen, MD, notes, “Proper medical care and lifestyle adjustments can effectively manage most complications. Success rates are highest when patients maintain regular check-ups with their healthcare team and follow recommended dietary guidelines.”

Frequently asked questions

How much weight can I expect to lose from bariatric surgery?

Most people lose approximately 50% of their excess weight following bariatric surgery. Typically, they maintain this rapid weight loss long-term with proper diet and lifestyle changes.

Is bariatric surgery "taking the easy way out"?

"No, bariatric surgery isn't the easy way out," explains Eapen, MD. "It's a serious surgery that requires significant lifestyle changes. Typically, a healthcare provider recommends it only after a few other weight loss methods haven't worked. For eligible patients, it offers hope - a chance to manage their metabolic and hormonal imbalances through diet and activity, helping them enjoy daily activities that others may take for granted.”

How does bariatric surgery compare to medications like Ozempic and Wegovy (semaglutide) for obesity?

There are two distinct paths for weight loss for people with obesity when diet and exercise alone do not work.

Weight loss medications help patients lose 10-20% of their weight, but treatment must continue long-term to maintain results. Once the medication stops, people may gain weight again. Ozempic and other GLP-1 agonist medications allow patients to adjust dosage and change drugs when needed. These meds are also noninvasive and pain-free.

Bariatric surgery, on the other hand, offers more lasting results, with patients maintaining significant weight loss even a decade after surgery. There is a one-time cost incurred during the surgery, so there is no fear about long-term insurance coverage for sustained weight loss. However, the results are more permanent with no opportunity to reverse the procedure if you change your mind.

Talk with your healthcare provider about whether Ozempic-like medications or bariatric surgery make sense for your situation. Your doctor will consider your health goals, medical history, and lifestyle when making a recommendation.

What are the dietary restrictions after bariatric surgery?

Initially, you'll follow a liquid diet, gradually progressing to soft foods and then regular foods. Long-term restrictions include avoiding highly processed foods, sugary beverages, and large portions.

When can I return to normal activities?

Recovery after a bariatric surgery procedure varies by individual and procedure type, but most people return to work within 2 to 4 weeks. Your surgeon will provide specific recommendations based on your situation.

The importance of the bariatric diet

Taking the first step toward exploring bariatric surgery shows commitment to your health. While it's a significant decision, having the right support makes a difference in your success.

A bariatric dietitian understands how your modified digestive system affects nutrition and creates tailored plans that ensure you're getting essential nutrients while managing portions. They help you develop sustainable eating habits that support both your weight loss goals and long-term health.

Ready to learn more? Find a bariatric dietitian to discuss your options and create a personalized plan for your weight loss journey.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.