Sleep Care

Weight Loss Series: Surgery

Is Weight Loss Surgery Right For You?

Obesity is reaching epidemic proportions in the United States. In fact, more than one-third of adults are obese according to data from the National Health and Nutrition Examination Survey. And the number is climbing, which has health care professionals concerned.

Being obese increases a person’s risk for diabetes, heart disease, high blood pressure, sleep disorders and other health related problems. But because there is no single cause for obesity, there is no single treatment. As a result, treatment must be tailored for each person. For instance, treatment may include a combination of diet, exercise, behavior modification and sometimes even weight-loss drugs. In extreme cases, weight loss surgery may be recommended.


Although weight loss surgery is an increasingly popular way to address extreme cases of obesity, it is not for everyone. As

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with any surgery, there are risks associated with it including complications, infection and sometimes even death. In order to determine whether a person is right for the surgery, most obesity surgeons require their patients to see a psychiatrist, cardiologist and a sleep specialist in order to have a complete work up of their situation.

Typically, patients must meet several guidelines in order to qualify for weight loss surgery. These include having a body mass index (BMI) of 40 or more (or 100 pounds overweight for men and 80 pounds overweight for women). They also must fully understand the surgical risks and have failed to lose weight traditionally. Sometimes people with lower BMIs will be approved if they have a serious health problem related to obesity like heart disease, diabetes, severe sleep apnea or high cholesterol.

Patients who are then approved for surgery have to be disciplined throughout the entire process including following all doctor’s instructions and guidelines. They also may be closely monitored by a medical team both before and after the surgery. And, many times weight loss surgery will involve more than one surgery including adjustments that may need to be made or removal of excess tissue.

There are several types of weight loss surgery including:

1.) Adjustable Gastric Banding

2.) Sleeve Gastrectomy

3.) Gastric Bypass Surgery

4.) Biliopancreatic Diversion

Adjustable Gastric Banding

This type of surgery is the least invasive of all weight loss surgeries. During the procedure an inflatable band is used to squeeze the stomach into two sections. There is a smaller upper pouch and a larger lower section. Although the two sections are still connected, the channel between them is very small. As a result, the emptying of the upper pouch is slowed down because the banding physically restricts the amount of food that can be eaten. Most people can only eat a half to one cup of food before feeling too full or sick. There are several brands of adjustable gastric bands available including LAP-BAND and REALIZE.

Sleeve Gastrectomy

This weight loss surgery is relatively new and involves removing about 75 percent of the stomach using a laparoscope. The remaining stomach is a narrow tube or sleeve that connects to the intestines. Usually the sleeve gastrectomy is the first step in a sequence of weight loss surgeries and may be followed by the gastric bypass or biliopancreatic diversion. However, in some cases it is the only surgery needed.

Because it is a simpler procedure, this surgery is used for people who are too obese or sick for other surgeries. As result, it provides a lower-risk way to start losing weight. Then, once the patient has lost weight and their health has improved, they can go on to have a second surgery, such as gastric bypass.

Gastric Bypass Surgery

Making up about 80 percent of all weight loss surgeries in the U.S., gastric bypass is the most common type of weight loss surgery. And it can be done as either minimally invasive or open surgery. During the surgery, the surgeon divides the stomach into two parts, sealing off the upper section from the lower. Then, the upper stomach is connected directly to the lower section of the small intestine. Essentially, the surgeon is creating a shortcut for the food, by bypassing a section of the stomach and the small intestine. Skipping these parts of the digestive tract means that fewer calories get absorbed into the body.

With this weight loss surgery, weight loss is quick with most of it happening in the first six months. It may continue for up to two years after the operation. Because of the rapid weight loss, health conditions affected by obesity — like diabetes, high blood pressure, high cholesterol, arthritis, sleep apnea, heartburn, and other conditions — often improve quickly. Additionally, some studies have found that many people keep most of the weight off for 10 years or longer.

However, keep in mind that this surgery impairs the body’s ability to absorb food. As a result, people are at risk for serious nutritional deficiencies. For instance, the loss of calcium and iron could lead to osteoporosis and anemia. People undergoing this surgery have to be very careful with their diet including taking supplements for the rest of their lives.

Biliopancreatic Diversion

This procedure is the most complicated and risky of all weight loss surgeries and involves removing as much as 70 percent of the stomach and bypassing even more of the small intestine than the gastric bypass surgery. This surgery has the most dramatic weight loss of all the procedures. In fact, studies show that people can lose 75 to 80 percent of excess weight. Additionally, the pouches of the stomach that are remaining are larger than those in gastric bypass and banding procedures so people can eat larger meals with this surgery than with others. But there is a risk of dumping syndrome, malnutrition and ulcers. What’s more, the risk of death is much higher.

Connection between Weight Loss Surgery and Sleep Apnea

Experts have long been aware of the connection between weight and sleep disorders. In fact, as a person gains weight, especially in the body and neck area, the risk of breathing issues while sleeping increases. But the connections may go beyond that.

For instance, people who are overweight or obese and have a sleep disorder like sleep apnea, are most likely unmotivated to exercise or diet due to daytime sleepiness and fatigue. In fact, research shows that it may be even harder to begin and sustain an exercise program. What’s more, building up a sleep debt over time can impair metabolism and hormone levels making weight loss a challenge and weight gain more likely.

For this reason, many doctors are turning to weight loss surgery to help not only with weight loss but to lessen sleep apnea conditions.

Yet, there are serious risks. A new study published in the New England Journal of Medicine suggests that while weight loss surgery may be safer than originally thought, some people – especially those with sleep apnea or a history of blood clots – are more likely to experience problems. Severely obese people who are not able to walk at least 200 feet prior to surgery also are at risk.

Sleep apnea is often associated with high blood pressure, vascular changes and a greater risk of heart disease. As a result, researchers believe the effects of the condition contribute to the higher surgical risk.

Furthermore, it is important to note that while sleep

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apnea may be lessened following weight loss surgery it is usually not eliminated according to a study in the Journal of Clinical Sleep Medicine (JCSM). Unfortunately though, most patients recognize reduced sleep apnea symptoms and falsely believe they no longer have a problem and they end up taking risks with their health. In fact, participants in the JCSM study noticed that their symptoms had eased following surgery and quit using their CPAP machines. However, research showed they still needed the machines to breathe better while sleeping. As a result, sleep experts recommend that following weight loss surgery that patients not discontinue using their CPAP machines with a sleep test and a doctor’s approval.

Overall determining whether or not weight loss surgery is right for you includes examining your goals, your doctor’s preference, your current health, and of course, which procedures, if any, are covered by insurance. Additionally, it is important to remember that although weight loss surgery can drastically improve your present weight issues, it is not a cure. It is only the first step toward a healthier life. In fact, for the surgery to help, you must be committed to making drastic, lifelong changes regarding eating and exercise.