Medically reviewed by Brandon Roy, MD, FACS, FASMBS

While it is thought of as a “new” thing, weight loss surgery began in the United States in the 1950’s when the first operation was performed at the University of Minnnesota.

Over the decades, surgery options have evolved, and in recent years, weight loss surgery is gaining traction as an effective and desirable method to lose weight. Yet, the stigma remains. Some argue that weight loss surgery is the easy way out and that people who are truly committed to losing weight and keeping it off need only eat less and move more. The data shows this is simply not true.

Dr. Brandon Roy, a WakeMed general and bariatric surgeon, explains weight loss surgery and why it is one of the safest, most effective methods for losing weight. He also shares how people come to the decision to take this brave and bold step.

The Dangers of Dieting

Most people who decide to have weight loss surgery have already tried many methods. Traditional weight loss options (diet and exercise) generally are not effective for those who need to lose more than five, 10 or 15 pounds. When speaking of people who need to lose 100 pounds or more, it’s clear from the longitudinal data that diet and exercise, alone, generally do not lead to sustained, substantial long-term weight loss.

People have a biologically set point for their weight that their bodies strive to maintain. When people eat less, hunger signals increase to the point where simply eating less and moving more are no longer effective, and the body will demand food to get back to its set weight. Many people with obesity have tried popular plans, such as Weight Watchers, South Beach and Atkins as well as fad diets, including no fat, all fat, high carb and no carb diets. For people with a body mass index (BMI) in the 40th percentile or higher, the vast majority do not experience success with any diet.

They initially lose weight, but the body sends strong hunger cues, and then resets to a new and higher plateau. As such, patients’ previous attempts involve losing 15 pounds, then gaining 20, then losing 30 and ultimately gaining 40. As a result of dieting, they essentially become heavier and heavier.

Barriers to Weight Loss Surgery

Despite mounting evidence that diet and exercise alone often do not work, numerous barriers prevent people from receiving weight loss surgery.

Traditionally, people who are overweight are considered to lack willpower. There is often shame around being heavy, and they and their loved ones may view surgery as a shortcut.

From the standpoint of employer insurance, weight loss operations are often considered cosmetic, so employers may not include them in their coverage. Providers wind up treating the complications of obesity, including arthritis, sleep apnea, diabetes, heart attacks, strokes and cancers, and the root cause of these conditions are never addressed.

Moreover, weight loss surgery is not indicated for some patients. While the surgery is a good idea for most people suffering with obesity, for the rare person, it is not advised. People with undiagnosed or untreated issues with depression, suicide or eating disorders should not undergo weight loss surgery until these conditions are under control. Surgery and the aftermath is stressful, and while people who have weight loss surgery generally do well, lose weight and become happier and healthier, the process can be hard. Therefore, if someone is struggling with an undiagnosed or untreated mental health condition, he/she may not experience success.

Additionally, people who’ve had a lot of abdominal surgery may be too high risk for weight loss surgery.

Lastly, financial commitments are a reality that people considering weight loss surgery need to be aware of, mostly around access to healthy food and vitamins. If someone is in a situation in which he/she can’t afford and $100 a month or more in vitamins and healthy foods, this is a barrier.

Why Weight Loss Surgery is the Right Choice

Literally millions of people should have weight loss surgery. Instead, many feel better about starting with injectable weight loss drugs, but these require lifelong commitments. If people stop taking them, they will experience rapid weight gain. What’s more, insurers are scrutinizing coverage for a lot of these medications, and they are expensive out-of-pocket. Cost can be up to $1000 per month for the rest of the patient’s life. Plus, they are not without minor side effects, such as irritation in the gastrointestinal tract, and while they are safe, some people cannot tolerate them.

For these reasons, weight loss surgery can be a better choice. The medications mimic what we do hormonally during surgery. Functionally, what surgery changes is how people perceive hunger and fullness. Weight loss surgeries also have decades worth of data and long-term outcomes. Injectable medications, on the other hand, are fairly new with limited data, and long-term outcomes are not yet known.

Plenty of research shows evidence of how surgical weight loss increases longevity and decreases cardiovascular, diabetes and cancer risks.

Weight loss surgeries take one to two hours to perform and may require an overnight stay in the hospital. They are safer than many common surgeries, such as hip replacement. Patients are looking at minor upfront surgical risks for a lifetime of benefits.

Weight Loss Surgeries Available at WakeMed

1. The minimally invasive sleeve gastrectomy basically tubularizes the stomach. It makes it look like a banana. This operation has been around for quite a long time. It has fairly good outcomes. Patients will lose about 20 to 30 percent of excess weight with this option.
2. Next is the gastric bypass, which is a bit more extensive. It is a very traditional operation that’s been done for decades. It makes the stomach smaller. It gives patients a smaller pouch and rearranges the intestines, so some of the intestines are bypassed. This option results in a weight loss of about 30 percent of excess body weight.
3. The third operation WakeMed surgeons perform is the duodenal switch, which like the sleeve gastrectomy, tubularizes the stomach. This is combined with bypassing the majority of the intestines. Patients will lose the most weight with this option.

The right surgery will depend on how much weight a patient needs to lose, current diseases processes, prior operations and other medical factors.

These operations are done laparoscopically, so pain and scars are minimal. Minor pain may last for just under a week. There will usually be two tiny incisions made. There is a three- to five-millimeter incision, about the size of a dime. The other is around a centimeter. These scars fade and, with time, are often difficult to spot.

How to Prepare for Surgery

Our WakeMed team helps patients prepare for surgery physically and emotionally as the process is fairly rigorous.

The first step requires the patient to decide that weight loss surgery is the option. We want the patient to draw that conclusion for him/herself, motivated by the desire to improve their health.

• We transition patients into dietary counseling right away — requiring modifications to their diet.
• We also connect patients with exercise specialists since they need to begin a safe level of exercise before surgery. Some of our patients were once college athletes. Others have always led rather sedentary. We meet patients where they are and encourage them to be more active.
• Behavioral change is the foundation of a successful surgery. There’s a psychological evaluation where we look for undiagnosed or untreated eating disorders or any mood disorders that may interfere with a person’s success. These challenges must be addressed prior to surgery.
• Patients meet with the anesthesia providers beforehand because most have anatomical challenges. It’s important that the anesthesia team has an appropriate and specific plan in place.
• We do health evaluations for comorbidities or medical conditions that might exist as a result being overweight, such as sleep apnea.

Essentially, the preparation process is all encompassing. We want to equip patients with the tools they need to be successful once they leave the hospital.

The Uphill Climb

I tell patients prior to surgery that surgery is just the beginning. Many have in mind that the goal is surgery. Surgery is not the endpoint. Once surgery is complete, a lot of work follows. The process leading to the surgery and the lifestyle changes that come afterward are hard work.

Surgery is not the easy way out.

Patients have to radically rethink how they will interact with food for the rest of their lives. Consider this: every milestone in our culture is celebrated with food. These include birthdays, holidays, special occasions, weddings, vacations and even funerals. If food is a problem, the person has to come to terms with how to interact differently with it.

Despite the hard work, I must stress that patients come to me and they are happier. If there is any regret, it is having waited so long to finally have the surgery. They regret the wasted years.

Patients have glowed about being able to do things they’d not done in years:

• Sitting on an airplane without extender
• Riding on an amusement park ride
• Walking through a turnstile
• Using a public toilet
• Tying their shoes
• Crossing their legs

A Lifetime of Support

We continue to see patients after surgery for two, five, 10 years or longer. They are welcome to visit for the rest of their lives. We also offer an online support group that all of our patients are eligible to participate in. Our Facebook group is another option, so there are numerous avenues for support. We discuss mental health issues, nutrition, successes and more.

Schedule An Appointment with our Team at WakeMed Bariatric & Medical Weight Loss

WakeMed Bariatric Surgery & Medical Weight Loss‘s experienced bariatric surgery team includes surgeons, anesthesiologists, nurses, technicians and support staff who have expertise in the most advanced surgical techniques to provide our patients with positive health outcomes. We perform all of our weight loss surgeries at WakeMed Cary Hospital where we are a Bariatric Surgery Center of Excellence.

Rather than sending patients to numerous professionals, our program offers a comprehensive, unified and personalized approach. Our team of experienced and knowledgeable professionals will partner to provide you with all of the individual attention, compassion, resources and support you need along your journey to better health and vitality.

Led by expert board-certified bariatric surgeons, members of our weight loss surgery program will participate to use their expertise to meet your healthcare needs. These individuals include your bariatric coordinator (also called a navigator, or advocate), nurses, psychologists, dieticians/nutritionists and exercise/health and fitness specialists. They will work closely with you to answer questions, gather information, guide your recovery and make plans to support you before, during and after bariatric surgery.

As you can see, bariatric surgery takes hard work and determination to be successful, but with a team such as ours supporting you, the results can lead to a bolder and braver you.

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About Brandon Roy, MD, FACS, FASMBS

Dr. Brandon Roy is board certified in general surgery, and his clinical interests are advanced laparoscopic treatment of reflux, hernias, and the surgical treatment of obesity. He specializes in bariatric surgery which helps restore extremely overweight patients to more normal weight levels, allowing them to live healthier, fuller and more active lives.

Dr. Roy received his medical degree from the University of Minnesota Medical School in Minneapolis, MN, and completed his residency at the Medical College of Wisconsin in Milwaukee, WI, and his fellowship in minimally invasive surgery at the University of Alabama -Birmingham. He also holds a Bachelor of Science degree in genetics and cell biology from the University of Minnesota.

Dr. Roy’s research has been published in journals such as The American Surgeon.

Bariatric Surgery & Medical Weight Loss