1 Billion. No, we’re not talking about the number of followers the Kardashians have.
That’s the number of people currently suffering from obesity worldwide – out of which, 379 million are just adolescents and children. The truth is that almost all US states have an obesity rate of over 20%. This right here is a highly alarming situation.
But before we move on to its consequences and the solutions, let’s first define what exactly obesity is.
- Obesity means having too much body fat, which basically indicates that your calorie intake is more than your calorie expenditure – usually referred to as having a positive energy imbalance.
- Obesity is determined by checking the BMI (body mass index), which is a calculation that takes a person’s weight and height into account to measure their body size. If their BMI is greater than 30 kg/m2, it is classified as being obese. If it is greater than 40 kg/m2, an adult will be considered as being morbidly obese.
- Obesity is not just about the weight you gain or how you look. It makes way for a number of diseases, such as cardiovascular diseases, hypertension, type 2 diabetes mellitus, fatty liver disease, gallbladder disease, osteoarthritis, sleep apnea, and even certain forms of cancer.
You’d be surprised to learn that obesity is, in fact, linked to 60+ chronic diseases. It kills more people than actual starvation does!
Unfortunately, obesity has become quite common in today’s world. According to the World Health Organization, the worldwide prevalence of obesity among adults (aged over 20) in 2008 alone was close to 13%, or about 600 million people. The percentage has only increased at an alarming speed since then.
Of course, our lifestyle does play a major contributing factor to it: excessive carbs, fat and sugar intake, majorly because of regular takeout meals, lack of sleep, an increased amount of screentime, lack of physical activity, and so on. However, obesity is also impacted by hereditary or genetic factors, which when complemented by other factors, complete the picture.
Here’s a truth bomb, though: Most obesity cases today have little to no link to genetic factors.
- The go-to first-line therapies for obesity focus on dietary and exercise regimes to induce weight loss. Doctors recommend some necessary lifestyle changes that can make your journey to a healthier life easier. However, non-surgical options aren’t always effective at helping people lose weight. At times, a more drastic approach is needed.
- Needing a little more help is okay. No, it doesn’t mean that you’re any less hardworking than others. No, it doesn’t mean you’re going for a shortcut. It only means that you were strong enough to ask for the help that you and your health needed.
So yes, we know that deciding to have weight-loss surgery, or bariatric surgery, is tough enough. On top of that, you have to choose between several procedures – each with different results and potential risks.
That’s where we come in. You’ve made the best decision for yourself, so we’re here to make it easier for you. Keep reading to know everything you need to know about the different types of weight loss surgeries you can go for and which one would be best for you.
Traditional Bariatric Surgeries
Adjustable Gastric Banding
In this surgery, an inflatable band is used to squeeze the stomach into 2 sections, a smaller upper pouch and a larger lower pouch. The 2 are connected by a small channel, which slows down the emptying of the upper pouch. This is a form of restrictive weight loss surgery.
This surgery is easier, safer and has a shorter recovery period. It is also reversible. However, the weight loss is slower than other surgeries with chances of regaining the lost weight over the years. The risks that are involved include vomiting from eating too much too fast and complications with the band, such as misplacement or leakage.
Sleeve Gastrectomy
This procedure, also a form of restrictive weight loss surgery, involves reducing stomach size by 75%, leaving what is a narrow sleeve connecting to the intestine. This reduces the hunger hormone resulting in a decreased appetite.
This surgery is a safer option for those who are severely obese or unwell. Since it doesn’t directly affect the intestines, it doesn’t impact how you absorb food and hence maintains nutrient levels. However, unlike gastric banding, a sleeve gastrectomy is irreversible. The risks involved include sleeve leakage and clotting of the blood.
Gastric Bypass Surgery
This is a combination of both restrictive and malabsorptive approaches, which limits nutrient absorption within the body. Similar to gastric banding, it involves dividing the stomach into 2 sections, but the upper section is sealed off from the lower one. Next, the upper section is directly connected to the lower section of the small intestine.
It’s okay, you can read that again for it to make sense. So, what is essentially happening here is by creating a shortcut from the stomach to the intestine, the body absorbs lesser calories. This surgery has far more effective, long-term results. However, since the way you absorb food has been altered, it might lead to a deficiency of nutrients. Resultantly, patients are on supplements for potentially the rest of their life.
Another side effect is the dumping syndrome, which is caused by improper indigestion of the food and can result in nausea, pain, weakness, sweating, and diarrhea. It is a common side effect of eating high-carb and sugary foods. Gastric bypass is also irreversible and has only been reversed in rare cases.
Given the invasive nature of the surgery, it makes sense for it to have greater risks involved, including infection, blood clots, hernia, and gallstones.
Biliopancreatic Diversion
This surgery is like a more drastic version of the gastric bypass, where around 70% of the stomach is removed and bypasses even more of the small intestine. There is a less drastic version of this surgery, known as the Biliopancreatic Diversion with the “duodenal switch”, which removes less of the stomach and bypasses less of the small intestine. With the latter, dumping syndrome, lack of nutrients and ulcers are less common.
Naturally, the results in biliopancreatic diversion are greater. Another benefit (which might be even more attractive for some) is that it lets the patient eat larger meals without the risks of the side effects. So not only can you lose weight effectively, you can even enjoy larger meals while doing so.
However, it is important to tell you that this is one of the most complicated bariatric surgeries. The biliopancreatic diversion poses a higher risk of hernias, which may require surgery. Surgeons aim to decrease the risk by using minimally invasive procedures such as laparoscopy.
Traditional Bariatric Surgery Comparison Table
| Traditional Bariatric Surgeries | Gastric Banding | Gastric Sleeve | Gastric Bypass | Biliopancreatic Diversion |
|---|---|---|---|---|
| Ideal Candidates | Morbidly obese (BMI =< 35) for 5+ years | Morbidly obese (BMI =< 35) for 5+ years | Morbidly obese (BMI =< 35) for 5+ years | Morbidly obese (BMI =< 35) for 5+ years |
| Invasive | Minimal/ Laparoscopic/ Least Complex | Minimal/ Laparoscopic/ Least complex | Minimal / More complex than Gastric Banding/Sleeve / Laparoscopic/ | Minimal / More complex than Banding, Sleeve Bypass or BD/ Laparoscopic/ |
| Reversibility | Yes | No | Yes | No |
| Expected Weight Loss | 50% within 2 years | 30-50% within 6-12 months, 50-70% within 2 years. | 60-85% within 12-18 months | 75-90% within 18 months |
| Weight Loss Rate | Slower & Lesser than other procedures | Slower than Gastric Bypass | Fast | Fastest |
| Caloric Restrictions | Yes | Yes | Yes | No |
| Side Effects | Vomiting from excess eating, Band leakage/misplacement. | Sleeve leakage, Blood clotting, acid reflux, heartburn. | Improper digestion | Blood Clotting, Improper digestion, Bowel obstruction. |
| Adjustability | Yes | No | No | Yes |
| Out/Inpatient | Outpatient | Outpatient | Outpatient | Inpatient |
| Recovery Time | Fast | Fast | Fast | Fast |
| Age Requirements | 14+ | 14+ | 14+ | 14+ |
| Cost | $16,000 | $20,000 | $25,000 | $30,000 |
| Surgical Risk | Lowest | Low | Moderate (Ulcers) | High (Hernia) |
| Nutrient Deficiency | Lowest | Low | Moderate to High | Highest |
| Weight Regain | More likely | More likely | More likely | Less likely |
Now let’s move on to a more different approach – implantable weight loss devices.
Yes, there are actual devices that can help suppress your appetite, and consequently, help you lose weight.
Implantable Devices to Treat Obesity
Enteromedics Maestro Rechargeable Vagal Blockage (vBloc)
To be able to understand this device, we’ll need to give a bit of background. So among the cranial nerves (12 paired nerves at the back of your brain), the vagus nerve is the longest. It extends from the brain, through the neck, the thorax and down to the abdomen. It also communicates hunger signals from the digestive system to the brain.
I think you might see where we’re going. vBloc is an implanted device, almost like a pace-maker, that sends regular electrical impulses to the vagus nerve, signaling the brain that the stomach is full. The device is placed under the rib cage and can be operated by a remote control.
Unlike traditional bariatric surgeries, the vBloc surgery is the least invasive of weight loss surgeries. The procedure is completely reversible, safe and FDA-approved. Like most surgeries, it poses risks such as infection and pain at the implantation site, but overall, it has a low rate of serious complications. However, there is one major con to the surgery: if the battery of the device completely runs out, a surgeon will have to reprogram it which might have side effects such as nausea, belching, difficulty in swallowing, heartburn, and chest pain.
AspireAssist - Gastric Aspiration Port
This device is inserted into the stomach by an endoscopic procedure, which is connected to the outer end of an A-tube. So what happens is that after the user eats, the AspireAssist® helps remove part of the ingested food before it enters the small intestine, which is called aspiration. The aspiration is done 30 minutes after eating and is done by flushing the food particles in the A-tube and out of the body.
The AspireAssist removes a third of the food before it is digested, which is enough to cause weight loss while ensuring that the body receives the calories it needs to function. Unlike traditional surgeries like the vBloc, the Aspire Assist procedure is non-invasive, reversible and FDA approved.
Intragastric Balloons
So we have established that bariatric surgeries are recommended when lifestyle modifications and medications aren’t working. Even then, only 1-2% of eligible patients decide to undergo bariatric surgery, majorly because of the associated significant risks. In this case, there is an IGB – Intragastric Balloon – which is a minimally invasive intervention. You could call this somewhat in the middle of medications and bariatric surgery, which makes it an attractive option for many patients.
Essentially, what an IGB does is that when placed in the stomach through endoscopy, it takes up space that would otherwise be filled with food. If your stomach is already full, your appetite will be limited and you’ll feel fuller faster. Simple to understand, yeah?
A popular IGB in the market is the Orbera, which is inserted endoscopically through the esophagus and placed into the stomach, making it a quick and easy 10 to 30 minute procedure. The treatment lasts about 6 months, after which the IGB is carefully removed and is followed by the aftercare program.
You can also find the Spatz3® IGB, which is similar to the Orbera IGB. Like all IGBs, it is recommended that it is combined with necessary lifestyle modifications to witness the best weight loss results.
Ingestible Intragastric Balloons for Treating Obesity: Elipse™ and Obalon®
Yeah, there’s an even less invasive version for IGBs! The latest IGBs do not need endoscopy and are simply encapsulated in ingestible pills. There are two ingestible IGBs available, Ellipse and Obalon. Both are more comfortable than conventional IGBs and promote weight loss. However, many patients are known to regain the lost weight after the completion of the treatment.
TransPyloric Shuttle Implant® (TPS)
This device aims to treat obesity by slowing gastric emptying. The TPS, consisting of a spherical bulb connected to a small cylindrical bulb, is placed endoscopically in the stomach where it positions itself across the pylorus to slow gastric emptying.
Yes yes, we’re explaining it. So the pylorus is a valve that opens and closes during digestion, allowing digested food to pass from the stomach and to the small intestine. So when you slow down the gastric emptying, you reduce the time it takes for the stomach to be empty and hence, reduce the appetite.
The device is temporarily inserted for 12 months, is reversible and much less invasive than traditional surgical options.
Implantable Device Comparison Table
| Implantable Devices | Enteromedics Maestro Rechargeable Vagal Blockage (vBloc) | Aspire Assist | Intragastric Balloons | Elipse™ and Obalon® | TransPyloric Shuttle Implant® (TPS) |
|---|---|---|---|---|---|
| Ideal Candidates | Morbidly obese (BMI =< 35) for 5+ years | Morbidly obese (BMI =< 35) for 5+ years | Obese (BMI =< 30) | Obese (BMI =< 27) | Morbidly obese (BMI =< 35) |
| Invasive | Minimal/ Endoscopy | Minimal/ Endoscopy | Less invasive than vBLOC & AA/ Endoscopy | Least Invasive than all (traditional & implantable) / Oral (Ingestible Pills) *Removal for Obalon requires endoscopy. | Less invasive/ endoscopy |
| Reversibility | Yes | Yes | Yes | Yes | Yes |
| Expected Weight Loss | 26% within 2 years | 30% within 1 year | 10% within 6 months | 14.2% within 4-6 months | 5-9.5% within 12 months |
| FDA Approval | Yes | Yes | Yes | Obalon – Yes (PMA) | Yes |
| Ellipse – Under Review | |||||
| Weight Loss Rate | Slow & sustained | Faster than vBLOC & sustained | Slower than vBLOC & AA. | Faster than IGBs but slower than vBLOC & AA. | Slowest |
| Caloric Restrictions | No | No | Yes | Yes | Yes |
| Side Effects | Minimal (infection/pain at the implantation site) | Minimal (occasional indigestion, vomiting, nausea, constipation, diarrhea.) | Minimal – (abdominal pain, vomiting, acid reflux.) | Minimal – (Nausea, vomiting, abdominal pain) | Minimal – (Nausea, vomiting, abdominal pain) |
| Adjustable/ Removable | Yes | Yes | Yes | Yes | Yes |
| Out/Inpatient | Outpatient | Outpatient | Outpatient | Outpatient | Outpatient |
| Recovery Time | Fast | Fast | Faster than vBLOC & AA | Fastest | Fast |
| Age Requirements | 18+ | 22+ | 18+ | 18+ | 22+ |
| Cost | $20,000 – 30,000 | $8,000 – $13,000 | $900+ | $5500 | $15,000+ |
| Risk | Low – Nausea, belching, difficulty swallowing, heartburn, chest pain – if battery dies. | Low – Abdominal discomfort/pain, irritation, inflammation of implantation site | Moderate – Stomach wall ulceration, erosion, and perforation. Deflated IGBs may cause bowel obstruction | Moderate – Gastrointestinal obstruction, ulcers, gastric + esophageal perforation. | Moderate – Gastrointestinal disorders, stomach wall perforation, bowel obstruction. |
| Nutrient Deficiency | Low | Low | Low | Low | Low |
| Weight Regain | Less likely (Weight loss sustained) | Less likely (Weight loss sustained for up to 4 years) | More likely | More likely | More likely |
Here’s What We Think.
We hope you’re feeling much more knowledgeable about bariatric surgeries and implantable devices than you did when you just started reading this. There are so many options to treat obesity, each with their own advantages and risks; all you need is finding the one that works for you.
For instance, if you’re running on a tight budget, hate incisions, stitches, and scars, and prefer faster fixes, then devices like Orbera, Elipse and Obalon would be your best shot – but do keep in mind that the weight might return just as fast. But if you can’t take anesthesia, Elipse would be ideal for you.
If, however, you are focused on long-term, sustainable results, then Biliopancreatic Diversion, vBLOC or AA should be your call. Individuals aged under 18 can choose between traditional options but not implantable ones due to age restrictions.
In terms of the best weight loss results with almost no caloric restrictions, Biliopancreatic Diversion definitely takes the cake. All in all, new implantable devices still fall short when it comes to the results obtained from traditional surgeries.
But like we said, you don’t have to follow the herd and listen to what others have to say about your body. You are the best – actually, the only person to make this decision.
Well, other than your doctors. But they aren’t there to make the decision for you, they are only there to help you in making the choice that is meant for you.
Frequently Asked Questions
What is the safest medical weight loss procedure?
The minimally invasive laparoscopic procedure works by restricting food consumption, decreasing appetite, and slowing digestion. This is one of the least invasive and least dangerous surgical weight loss alternatives.
What is the safest less invasive weight loss surgery?
Weight loss is considerable after endoscopic sleeve gastroplasty. It aids in weight loss by restricting how much you can eat. Furthermore, the technique is less invasive, lowering the risk of operational complications and allowing for a rapid return to normal activities.
What is the new alternative to bariatric surgery?
Endoscopy is a technique in which doctors insert a thin, flexible tube fitted with a camera into your digestive tract through your mouth. This permits them to reach your digestive system without requiring open surgery, which is more dangerous.
Can you shrink your stomach without bariatric surgery?
Surgery is the only technique to physically and permanently reduce the size of your stomach. You can lose general body fat by consuming healthy foods over time, but this will not change the size of your stomach.
What is the least painful bariatric surgery?
Endoscopic sleeve gastroplasty is a relatively new type of minimally invasive weight-loss surgery. A suturing device is introduced into your throat and down to your stomach during endoscopic sleeve gastroplasty.
