Is Bariatric Surgery Right for You? A Guide to Eligibility and Expectations
Bariatric surgery isn’t just about losing weight—it’s about reclaiming your health. But it’s not for everyone. Let’s explore who qualifies, what’s expected, and how to know if it’s the right step for you.
1. Are You a Candidate?
You’re typically eligible if:
- Your BMI is 40 or higher, or
- Your BMI is 35 or more with conditions like type 2 diabetes or sleep apnea
- You’ve tried and failed to lose weight through non-surgical methods
2. Are You Mentally Prepared?
Candidates go through a psychological assessment. You need to be emotionally ready to commit to lifelong changes in eating, activity, and mindset.
3. This Is a Lifestyle Commitment
Post-surgery success requires:
- Daily meal planning
- Regular physical activity
- Long-term follow-up with your care team
4. Work with a Trusted Bariatric Team
A surgeon, dietitian, psychologist, and support staff will guide you through the process—before, during, and long after surgery.
If you’re ready for change and meet the medical criteria, bariatric surgery could be a safe, effective path to better health. Talk to a specialist to explore your options.
References:
- NIH – Bariatric Surgery Guidelines
- ASMBS – Indications and Guidelines
- Mechanick, J.I. et al., Endocrine Practice (2013)
Obesity Facts, Definition, and Statistics
Obesity Definition and Criteria
The normal amount of body fat is between 25 and 30 percent in women and 18 and 23 percent in men. Women with more than 30 percent body fat and men with more than 25 percent body fat are considered obese. Morbid obesity is defined as having a Body Mass Index (BMI) of more than 40, which equates to approximately 100 pounds overweight for men and 80 pounds for women.
Obesity is a chronic disease that can cause a host of health problems and shorten your life. Bariatric surgery offers a way to achieve long term, sustainable weight loss and improve obesity-related medical conditions.
Obesity in South Africa: Rates and Percentages
South Africa is facing a significant obesity challenge, with a national obesity risk score of 8/10.¹ Here are some key statistics:
Obesity Prevalence in South Africa:
- Adult Obesity (2021-2022): The prevalence of obesity among adults in South Africa was measured at 30.4% for women and 11.5% for men.
- Overweight/Obesity (2016): Approximately 68% of women and 31% of men had overweight or obesity.
- Childhood Obesity (2016): Around 13.5% of children under 5 years old were classified as overweight.
Trends and Risk Factors:
- Increasing Obesity Rates: Obesity rates have been increasing steadily in South Africa, with a notable rise in childhood obesity.
- Education and Obesity: Women with higher education levels tend to have lower obesity rates, while the opposite is true for men.
- Comorbidities: Obesity is linked to various health issues, including diabetes, hypertension, and certain types of cancer.
State of Obesity in South Africa:
South Africa has implemented policies and programs to address obesity, including the National Food and Nutrition Security Survey. However, more efforts are needed to combat this growing health concern.
Causes of Obesity
The most common causes of obesity are overeating and physical inactivity. Other factors that can contribute to obesity include:
- Genetics (such as leptin deficiency)
- Slow metabolism
- Medications
- Psychological factors
- Diseases (hypothyroidism, Cushing syndrome)
- Ethnicity
- Childhood weight
Negative Effects of Obesity
Obesity has been linked to a number of health conditions that can affect your quality of life, and in some cases, shorten it:
- High blood pressure
- High cholesterol
- Type 2 diabetes
- Sleep apnea
- Stroke, heart attack and congestive heart failure
- Osteoarthritis
- Infertility and pregnancy problems, polycystic ovary syndrome and sexual dysfunction.
Weight Loss Facts
A modest weight loss of 5 to 10 percent and long–term maintenance of that weight loss can bring significant health gains including:
- Lowered blood pressure
- Reduced cholesterol levels
- Reduced risk of type 2 diabetes
- Decreased chance of stroke
- Decreased complications of heart disease
- Decreased overall mortality
Ghrelin
Ghrelin is a hormone your stomach produces and releases. It signals your brain when your stomach is empty and it’s time to eat. Ghrelin levels increase between mealtimes and decrease when your stomach is full. People who have obesity often have low ghrelin levels, while people who significantly restrict their calorie intake have high ghrelin levels.
Overview
What is ghrelin?
Ghrelin is a hormone produced by your stomach. Other parts of your body, such as your brain, small intestine and pancreas, also release small amounts of ghrelin.
Often known as the “hunger hormone,” ghrelin has numerous functions in addition to telling your brain you’re hungry. For example, ghrelin:
- Increases food intake and helps your body store fat.
- Helps trigger your pituitary gland to release growth hormones.
- Plays a role in controlling sugars and how your body releases insulin, the hormone responsible for processing sugar.
- Has a role in protecting your muscles from weakness and bone formation and metabolism.
What is the difference between ghrelin and leptin?
Ghrelin and leptin are two of many hormones that control your appetite and fullness. They’re involved in the vast network of pathways that regulate your body weight. Leptin decreases your appetite, while ghrelin increases it.
Ghrelin is made in your stomach and signals your brain when you’re hungry. Your fat cells produce leptin. Leptin lets your brain know when you have enough energy stored and feel “full.”
Ghrelin plays a role in the short-term control of appetite while leptin controls long-term weight control.
Function
What does the ghrelin hormone do?
Ghrelin has several key functions. The hormone:
- Signals part of your brain called the hypothalamus to increase appetite.
- Promotes fat storage.
- Stimulates your pituitary gland to release growth hormones.
- Stimulates your digestive system to move food from your stomach through your small and large intestines.
- Contributes to controlling insulin release.
- Plays a role in protecting your cardiovascular health.
What triggers ghrelin?
Your stomach releases ghrelin when it’s empty or mostly empty. Ghrelin levels are typically highest right before mealtimes.
Conditions and Disorders
What conditions and disorders affect ghrelin?
Ghrelin levels increase when your stomach is empty. Your body releases ghrelin to let your brain know when it’s time to eat. Then, when you eat, your ghrelin levels decrease.
Some conditions can lead to chronically low or high ghrelin:
Low ghrelin
Ghrelin levels are usually lower in people who have obesity. Some researchers think this connection could mean that people who have obesity have bodies that are naturally more sensitive to ghrelin. The theory is that these individuals may feel much hungrier with lower levels of ghrelin.
Certain gastrointestinal diseases are also associated with low ghrelin, including:
- Chronic gastritis.
- Functional dyspepsia.
- H. Pylori infection.
- Irritable bowel syndrome (IBS).
High ghrelin
People may have increases in ghrelin levels if they restrict their caloric intake, such as while on a restrictive diet. High ghrelin may also be associated with biological and genetic conditions such as:
- Anorexia nervosa.
- Cachexia, a condition that causes your muscles to waste away.
- Celiac disease.
- Inflammatory bowel disease (IBD).
- Prader-Willi syndrome.
How does gastric bypass surgery affect ghrelin levels?
Gastric bypass surgery and sleeve gastrectomy are two of the surgical therapies for severe obesity. People have sustained lower levels of ghrelin after these operations which are thought to be responsible for long-term weight control. A reduced stomach size is thought to be one of the causes of weight loss after bariatric surgery and is responsible for the lower ghrelin levels.
Care
What can I do to keep ghrelin levels healthy?
You can keep ghrelin and other hormone levels healthier by practicing good lifestyle habits, such as:
- Avoid fad or yo-yo dieting, where you gain and lose weight frequently.
- Eat a diet high in healthy carbohydrates, such as whole grains and lean proteins, like chicken or fish.
- Limit processed foods, especially foods high in sugar, high-fructose corn syrup and salt.
- Sleep at least seven to eight hours nightly.
- Stay hydrated by drinking plenty of water and eating water-filled foods such as fruits and vegetables.
- Control your stress responses as stress may increase ghrelin.
What foods suppress ghrelin?
No specific food suppresses ghrelin. In general, eating foods high in healthy carbohydrates (such as whole grains) and protein can lower your ghrelin levels.
How do you lower ghrelin?
Ghrelin levels tend to rise and fall with how much you eat. Ghrelin may decrease when you are hydrated and increase when you’re dehydrated.
The types of foods you eat affect ghrelin. For example, eating foods high in protein or healthy carbs lower ghrelin levels more than eating foods high in fat.
Source Credit: https://my.clevelandclinic.org/health/body/22804-ghrelin
THE 30-MINUTE RULE AFTER BARIATRIC SURGERY
After bariatric surgery you are recommended to eliminate eating from drinking. You have to drink your liquids at least for 30 minutes before a meal, and for 30 minutes after a meal. People ask, is it forever? Yes, it is forever.
Here’s why it’s not recommended to eat and drink together after bariatric surgery:
- Limited Stomach Capacity
One of the main goals of Bariatric surgery is to reduce size of the stomach and to restrict stomach capacity. Consuming both, food and liquids, together fills up the stomach quickly, potentially leading to discomfort, nausea, or vomiting and stretching the stomach.
- Slowed Digestion and Nutrient Absorption
Drinking fluids with meals dilute gastric juices and digestive enzymes, impairing the digestion and absorption of nutrients from food.
- Proper chewing
Need to drink with food comes more likely from too big bites and poor chewing, so you might have a wish to wash everything down with fluid. Digestion process of carbs begin in mouth by enzymes of saliva. If you do not chew your food properly, you slow down the digestion process.
- Satiety Feeling
By consuming food and fluids separately, individuals are more likely to feel full and satisfied with smaller portions of food and longer, which can aid in weight management and prevent overeating.
- Dumping Syndrome Risk
Dumping syndrome is quite a common side effect after bariatric surgery. It occurs when food or liquids move too quickly from the stomach into the small intestine, leading to symptoms such as nausea, sweating, weakness, and diarrhoea. Consuming food and fluids together can increase the risk of dumping syndrome. Recently doctors often mention dumping syndrome as a positive side effect of bariatric surgery as it motivates person to commit to dietary changes after bariatric surgery.
- Hydration and Nutrient Intake
Drinking fluids between meals, rather than with meals, helps ensure adequate hydration and allows for better nutrient absorption.
By following post- bariatric operative guidelines and avoiding simultaneous consumption of food and beverages you can support your nutritional needs, optimize weight loss results, and reduce the risk of complications after weight loss surgery.
THE BIG DEBATE: OZEMPIC VS. BARIATRIC SURGERY
There has been a lot of talk lately regarding Ozempic and whether or not it will replace bariatric surgery as a weight-loss treatment. The short answer to that question is No. No, it will not be replacing Bariatric Surgery any time soon. Certainly not in South Africa.
Ozempic is available in South Africa, but only with a prescription from a healthcare provider. You can buy Ozempic at major pharmacies like Dis-Chem and Clicks, or at independent pharmacies. You can check availability and pricing before visiting a pharmacy.
Ozempic is a prescription-only medication that is registered in South Africa for treating adults with type 2 diabetes. It is used to reduce blood sugar levels and the risk of cardiovascular events like heart attack, stroke, or death. Ozempic is not registered in South Africa for weight loss.
There are no generic versions of Ozempic registered in South Africa. The South African Health Products Regulatory Authority (SAHPRA) has warned the public about counterfeit Ozempic products that are sold on dodgy websites. These products may not contain the active ingredient, or they may contain dangerous levels of it. They may also contain harmful inactive ingredients, or they may be nonsterile and contaminated with microbes.
If you are considering an alternative to Ozempic, you should consult your healthcare provider. You should also consider the cost, efficacy, and potential side effects of the alternative.
Bariatric surgery remains the most effective treatment for severe obesity, but treatment will likely evolve to include a new combination of approaches in the future
Ozempic, and other drugs are not a solution for those who need to lose a significant amount of weight.
In the long-run Bariatric Surgery is the most cost-effective as well as the most medically effective solution for sustained weight-loss
Reference: https://columbiasurgery.org/
Complications as a result of Obesity
Obesity is one of the leading causes of preventable deaths and impaired quality of life it is an important underlying cause for number of serious and chronic disease conditions
- Type 2 Diabetes
- High blood pressure
- Joint problems (e.g., arthritis)
- Heart disease
- Strokes
- Fatty liver disease (non-alcoholic liver disease and non-alcoholic steatohepatitis)
- Gallbladder problems
- Certain types of cancer (breast, uterine, colon)
- Digestive disorders (e.g., gastroesophageal reflux disease, or GORD)
- Breathing difficulties (e.g., sleep apnea, asthma)
- Psychological problems such as depression
- Problems with fertility and pregnancy
- Urinary Incontinence
Risks to psychological and social well-being
- Negative self-image
- Social isolation
- Discrimination
Difficulties with day-to-day living
- Normal tasks become harder for people living with obesity as movement is more difficult
- You tend to tire more quickly and you find yourself short of breath
- Public transport seats, and cars may be too small for you
- You may find it difficult to maintain personal hygiene
Source Credit: https://www.ifso.com/consequences/
Weight-loss surgery may help people with obesity better manage high blood pressure
People with obesity who had weight-loss surgery were able to better manage their high blood pressure in the long term than those using medications and lifestyle changes, a new analysis finds.
The research, being presented Friday at the American Heart Association’s Hypertension Scientific Sessions in Chicago, is considered preliminary until full results are published in a peer-reviewed journal. The results were based on an analysis of data from 18 randomized controlled trials involving more than 1,300 participants.
“Our findings indicate bariatric surgery is a durable solution for obesity-related hypertension since it results in high blood pressure remission, or long-term control, while reducing the dependence on blood pressure medications,” lead researcher Dr. Sneha Annie Sebastian said in a news release. Sebastian is a researcher and a residency candidate from Alberta, Canada.
“Additionally, by improving blood pressure control, bariatric surgery also lowers the risk of cardiovascular disease and enhances overall heart health,” she said.
Bariatric surgery reduces the size of a person’s stomach, helping them feel full after eating less. It also can change the structure of the digestive system so that fewer nutrients and calories are absorbed. The American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders recommend the procedure for anyone with a body mass index of 35 or higher.
In the new analysis, researchers combined data for 1,386 adults with high blood pressure and obesity who took part in 18 studies across several countries from December 2002 to May 2024. Participants in the studies were randomly assigned to undergo bariatric surgery or a nonsurgical, medication or lifestyle intervention. Follow-ups were conducted for up to five years. Several types of weight-loss surgery were used in the studies, but most focused on Roux-en-Y gastric bypass and sleeve gastrectomy.
Compared to people assigned to the control group, those who underwent bariatric surgery were nearly three times more likely to lower their blood pressure to less than 140/90 mmHg without the need for blood pressure-lowering medication. They also were seven times more likely to lower it to less than 130/80 mmHg while substantially reducing their use of blood pressure-lowering medication. The bariatric surgery group lowered their systolic blood pressure – the top number – an average 3.67 mmHg more than those in the control group.
Sebastian said future research should focus on large randomized controlled trials with long-term follow-up, with a specific emphasis on hypertension since many currently focus on diabetes outcomes. “Furthermore, it is essential to evaluate the efficacy and cost-effectiveness of different bariatric procedures for various patient profiles and to identify optimal candidates for each type of surgery,” she said.
The findings underscore the beneficial impact of weight loss on blood pressure control, Dr. Michael E. Hall said in the news release. Hall, who was not involved with the new research, was chair of the writing group for the AHA’s 2021 scientific statement on weight-loss strategies for preventing and treating hypertension. He also is chair of the department of medicine at the University of Mississippi Medical Center in Jackson.
“Bariatric surgery consistently improved blood pressure control in individuals with obesity,” he said about the findings. “Further, given the effectiveness of newer weight loss medications and beneficial effects on cardiometabolic conditions like hypertension, we need randomized clinical studies comparing bariatric surgery to these newer medications to decide which people are better suited for a specific weight-loss strategy.”
Source Credit: https://www.stroke.org/en/news/2024/09/05/weight-loss-surgery-may-help-people-with-obesity-better-manage-high-blood-pressure
Bariatric surgery more effective and durable than new obesity drugs and lifestyle intervention
Systematic reviews of medical literature between 2020 and 2024 show that bariatric surgery, also known as metabolic or weight-loss surgery, produces the greatest and most sustained weight loss compared to GLP-1 receptor agonists and lifestyle interventions. The study was presented today at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2024 Annual Scientific Meeting.
Researchers found that lifestyle interventions such as diet and exercise resulted in an average weight loss of 7.4%, but that weight was generally regained within 4.1 years. GLP-1s and metabolic and bariatric surgery proved far superior. Studies included thousands of patients from clinical studies and several randomized clinical trials.
Five months of weekly injections of GLP-1 semaglutide resulted in 10.6% weight loss and nine months of tirzepatide produced 21.1% weight loss. However, once treatment stopped, about half the lost weight returned within a year, despite the drug used. If injections were continued, tirzepatide patients plateaued at 22.5% weight loss at 17–18 months. Patients on semaglutide plateaued at 14.9% during the same time period.
Metabolic and bariatric surgery procedures gastric bypass and sleeve gastrectomy demonstrated total weight loss of 31.9% and 29.5% one year after surgery, respectively. Weight loss of approximately 25% was maintained for up to 10 years after surgery.
“Metabolic and bariatric surgery remains the most effective and durable treatment for severe obesity. Unfortunately, it also remains among the most underutilized,” said study co-author and bariatric surgeon Marina Kurian, MD, NYU Langone Health. “Surgery needs to play a bigger role in obesity treatment and be considered earlier in the disease process. It is no longer a treatment of last resort and should not be withheld until more severe disease develops. There is no medical reason for this.”
“While the new drug treatments show great promise and will lead to more people being successfully treated, particularly if prices come down and insurance coverage improves, we are barely using the best tool we have to fight obesity—metabolic and bariatric surgery, which is safer and more effective than ever before,” said Ann Rogers, MD, ASMBS President-elect and Professor of Surgery at Penn State College of Medicine, who was not involved in the study. “For many people, the risk of death from obesity, diabetes, and heart disease exceeds the risks of surgery.”
The study included a systematic review of studies that examined weight loss through lifestyle modification, GLP-1s (semaglutide or tirzepatide) or metabolic and bariatric surgery. GLP-1 data included four randomized clinical trials conducted between 2021 and 2024 while conclusions on lifestyle modifications were based on a systematic review of eight studies. Metabolic and bariatric surgery (gastric bypass and sleeve gastrectomy) were subject to a review of 35 studies, including two randomized clinical trials. In all, researchers reviewed the weight-loss results of approximately 20,000 patients.
More information: A322: Effectiveness and durability of common weight loss methods
Provided by American Society for Metabolic and Bariatric Surgery
Source Credit: https://medicalxpress.com/news/2024-06-bariatric-surgery-effective-durable-obesity.html
Can You Drink Alcohol After Weight Loss Surgery?
People considering weight-loss surgery often ask if it is possible to safely incorporate alcohol into a healthy diet and lifestyle after surgery. The short answer is “yes,” but gradually and with modifications. Below are reasons why.
Altered metabolism
Research shows that blood alcohol levels peak higher and faster and take longer to return to normal due to altered metabolism after gastric bypass surgery. In addition, many post-surgical patients consume less food when they’re drinking alcohol, which contributes to expedited absorption of alcohol in the blood stream. For many post-surgical patients, all it takes is a single drink to elevate blood alcohol level to the point of legal intoxication. This is important to remember for maintaining a healthy diet and before getting behind the wheel.
Low blood sugar
Rapid weight loss and low carbohydrate intake can lead to reduced sugar or glycogen in your body. Alcohol consumption further depletes glycogen, which causes your blood sugar levels to drop, putting those who have had bariatric surgery at higher risk for developing low blood sugar.
Hypoglycemia, or low blood sugar, is a dangerous condition that can lead to loss of consciousness, brain and nerve damage or even death if left untreated. As a result, it’s important to be on the lookout for symptoms, which include loss of coordination and balance, slurred speech, poor vision and confusion.
If you experience symptoms of hypoglycemia, drink diluted juice or take a glucose tablet immediately to raise your blood sugar level, and then have a snack with complex carbohydrates and protein to sustain it. If hypoglycemic episodes occur frequently even without alcohol consumption, make sure you seek proper medical treatment.
Excess calories
Alcohol is high in calories and low in nutrients, which is why excess calories from alcohol can slow weight loss or even contribute to weight gain.
Addiction transfer
Patients with a history of addiction are at higher risk for developing a new addiction. With the dramatic reduction of food consumption after bariatric surgery, some patients may trade their food addiction for other addictive behaviors, including drugs, shopping, gambling, sex and alcohol.
Guidelines for drinking
Follow these guidelines to re-introduce alcohol without compromising your commitment to a healthy lifestyle after weight-loss surgery:
- Avoid alcohol for the first six months after bariatric surgery.
- When you get permission to start drinking alcohol again, avoid carbonated beverages and sugary drink mixers.
- Remember that after surgery, even small amounts of alcohol can cause intoxication and low blood sugar.
- Never drink and drive, even after consuming only minimal alcohol.
- Only drink with meals or while eating to help slow absorption of alcohol.
- Be aware of the calorie content of alcohol.
- If you find yourself drinking regularly to cope with emotions or stress, seek help by consulting with your doctor.
Taste Changes Following Bariatric Surgery
Also known as weight loss surgery, bariatric surgery is a procedure carried out to help people who are severely or morbidly obese to lose weight.
Image Credit: Ursula Ferrara / Shutterstock
Types of bariatric surgery
There are three types of bariatric surgery that may be performed:
- Gastric band procedure – During this procedure, the size of the stomach is reduced using a band that is placed around the stomach. This reduces the amount of food a person needs to eat in order to feel full.
- Gastric bypass – This procedure involves dividing the stomach into a smaller upper section and a larger lower section. The smaller section is then connected to the duodenum, which is the beginning portion of the small intestine. Food only passes into the small stomach and this part of the small intestine, thereby allowing it to bypass the remaining stomach and bowel. This reduces the number of calories absorbed when food is passed through the digestive system, while also decreasing the amount of food a person needs to eat in order to feel full.
- Sleeve gastrectomy – A sleeve gastrectomy procedure will involve the removal of a part of the stomach to reduce its size and limit the amount of food intake required for a person to feel full.
Sensory changes following surgery
Change in the taste, smell, or tolerance of food following bariatric surgery is a common phenomenon. In fact, one study has found that as many as 97% of patients experience at least one such change following these surgeries.
Fortunately, the sensory changes experienced by individuals post-bariatric surgery often benefit patients, with research showing that they help people to lose more weight as compared to those who do not experience these changes.
According to a study conducted by researchers from the University Hospitals of Leicester, which included 103 patients who underwent gastric bypass, 73% reported changes in the taste of food and almost 50% reported changes in smell. The most commonly reported taste changes were heightened sensitivity to sweet food, sour food, and fast food.
In this same study, some patients also developed an oversensitivity to sweetness in protein shakes, which can be a problem should patients need to follow a liquid-only diet after their operation. If this happens, a patient should talk to their doctor to ensure their dietary requirements are being met.
Eating behaviors may also change following bariatric surgery. Patients may be less likely to find that emotional eating is a problem, thereby reducing the impact that eating cues might have on an individual.
Evidence also suggests that the mood-altering effect of sweet foods may be reduced, with patients less likely to experience a “sugar high” after a bariatric procedure. The tendency to eat purely as a matter of habit may also fade.
Causes
The exact cause of these sensory changes following bariatric surgery is not yet clear; however, many researchers suspect that fluctuating gut hormones and their physiological effects on the nervous system may play a role.
The central nervous system (CNS) relays hunger, craving, and satiety messages between the brain and gastrointestinal tract. The nerves that carry these messages are affected when a part of the stomach is removed, which impacts a person’s sense of taste, smell, and satiety.
Ghrelin is a hormone that plays an important role in hunger. A reduced calorie intake and weight loss leads to increased ghrelin production, which makes people feel hungry. In contrast, weight loss as a result of bariatric surgery leads to decreased ghrelin production, which therefore reduces hunger and food intake following the procedure.
Another important hormone that is involved in satiety is leptin. The primary function of this hormone is to relay messages between the gut and brain about how full a person is and determine whether calories are burned or stored as fat.
Losing weight is believed to increase a person’s sensitivity to these messages, resulting in a person feeling full more easily after eating only small amounts of food.
Source Credit: https://www.news-medical.net/health/Taste-Changes-Following-Bariatric-Surgery.aspx
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