Thinking about bariatric surgery, but not sure where to turn? All of your questions, answered

And there are NO silly questions: HCA Houston Healthcare is your one-stop shop for information

A couple cooks in the kitchen. (Jose Luis Pelaez Inc, Provided by HCA Houston Healthcare)

For Heather Sarten, one particularly difficult memory she lives with involves a trampoline.

Her children had just received the big-ticket item for Christmas, and Sarten’s son was begging her to join him for some bouncing. When Sarten agreed, and started climbing up, something caught her eye -- a tag for the trampoline. Sarten couldn’t help but notice that she exceeded the weight limit all on her own.

“I proceeded to sit in my yard and cry,” Sarten said. “This was the moment I knew something had to change.”

The trampoline situation was hard to swallow, but it represented a turning point and an opportunity for Sarten. This moment led her to take the reins and change her life.

She started looking at her options, and learned about lap band surgery.

“I decided I would take that path,” Sarten said. “I had the surgery and starting losing weight, and feeling so much better.”

Sarten is now the director of Bariatric Navigation with the Redefine Clinical Weight Loss Program at HCA Houston Healthcare. Her story is inspirational, uplifting and incredibly relatable. So many people in this country struggle with their weight, for a myriad of reasons. No solution is one-size-fits-all. Having the strength to change your circumstances makes the difference.

Heather Sarten, the director of Bariatric Navigation with the Redefine Clinical Weight Loss Program at HCA Houston Healthcare. (Photo provided by HCA Houston Healthcare)

Sarten, for her part, was never obese until turning the age of 23 or so, when her thyroid stopped working and she gained 100 pounds in nine months. She tried improving her diet and exercise routine, but struggled to lose the weight, even with her thyroid treatment. (More on her circumstances soon).

If that powerless feeling sounds familiar to anyone else -- or you’re wondering if bariatric surgery might be an option for you, this following question-and-answer section should help.

We turned to the experts from the Redefine Clinical Weight Loss program to answer some questions.

What is bariatric surgery?

For anyone who is struggling with obesity, and not seeing success with traditional weight loss methods, bariatric surgery might be a solution.

Undergoing bariatric surgery can improve people’s lives in many ways, from health to emotional well-being, according to HCA Houston Healthcare. Bariatric surgery helps limit food intake and absorption, and it allows for the maintenance of long-term, healthy weight-loss goals. These types of weight loss procedures can dramatically improve and control complications from health conditions such as Type 2 diabetes, high cholesterol, high blood pressure and sleep apnea. Other benefits of weight loss surgery include:

  • Decreased risk of heart disease
  • Less joint pain
  • Increased fertility during childbearing years
  • Relief from depression due to improved body image

Who is a good candidate for bariatric surgery?

“A person with a body mass index, or BMI, higher than 40, or who is more than 100 pounds overweight; a person with a BMI over 35 who also has at least one or more obesity-related condition such as type II diabetes, hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease; or someone who has been unable to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts,” said Dr. Khoi Du, general and bariatric surgeon with HCA Houston Healthcare.

What are the different types of bariatric surgeries?

There are several variations. Here are a few:

Roux-en-Y gastric bypass surgery shrinks your stomach, which limits the number of calories and fat your body can absorb. The stomach is disconnected at the top and a small pouch is formed. Then a loop of the small intestine is brought up and connected to that pouch, which reroutes the gastrointestinal tract. About 90-95% of the food you eat afterward bypasses the stomach.

Sleeve gastrectomy, also known as the gastric sleeve, involves removing 80-85% of the stomach itself, leaving a smaller “sleeve” in its place.

Duodenal switch surgery is a combination of the other types of bariatric surgery. Surgeons remove part of the stomach to create the “sleeve,” then do a more extensive version of gastric bypass surgery. This type of surgery can offer greater weight loss and greater metabolic effects, but it also carries a higher risk of complications than the other two types. Learn more about surgery options, and what they entail, here.

How do you decide which procedure is best for you?

Gastric bypass surgery is typically best for people with severe reflux issues, those with very high BMIs, and those with diabetes.

Sleeve gastrectomy surgery is best for people who have had multiple abdominal surgeries, along with high-risk patients, severely morbidly obese people (those more than 500 pounds), and people who take multiple medications.

The duodenal switch is good for patients with severe obesity, those who are good at following doctor’s orders, and those with metabolic diseases.

What’s involved in preparing for the surgery and how does your life change afterward?

Preparing for surgery takes several months. Patients need to start eating the diet that they will need to follow the rest of their lives, so they get used to it beforehand, doctors said. This involves eating smaller meals with fewer carbohydrates and more protein. Patients must start eating smaller meals and chewing their food slowly and thoroughly before swallowing it. After a gastric bypass, the stomach is the size of a D battery; after a sleeve, the stomach is the size of two C batteries lined up. That means patients who overeat after surgery will experience the unpleasantness of the food coming back up, as the new stomach can’t hold it all.

Patients also need to start an exercise routine, as exercise will be very important for them afterward to help shed the weight and keep it off. Most patients lose the largest amount of weight in the year after surgery. After that, it becomes more difficult to lose the weight.

In the days leading up to surgery, most doctors will have patients undergo a psychiatric evaluation to make sure they are doing the surgery for the right reasons, have realistic expectations, and are prepared for the limitations their new way of life will necessitate. Patients will also undergo rigorous blood tests and perhaps a sleep apnea test as well, as procedures to test the health of their hearts, lungs and gallbladder. Finally, most surgeons will expect a patient to stick to a largely liquid diet in the days immediately preceding surgery in order to shrink the liver to enable them to see better during the surgery itself.

How invasive are the surgeries? What are the recovery times?

Almost all bariatric surgeons now use minimally invasive surgical procedures, making five or six small cuts in the abdomen. Recovery time is much faster than it used to be, with most patients going home the day after surgery and feeling fully recovered within two or three weeks.

It’s important to remember that bariatric surgery is not a quick fix or a shortcut. Bariatric surgery is a tool that some people can use to help them on a lifelong weight loss and behavior modification journey.

How does COVID-19 impact people with high BMIs?

Obesity patients typically have more fatty tissue in the trunk area that decreases air flow. Many obese patients also have other conditions like high blood pressure, fatty liver and diabetes, to name just a few, which can make recovery more difficult.

Excess weight also makes it harder to intubate when breathing becomes difficult.

• According to the Centers for Disease Control and Prevention, adults with excess weight are at even greater risk during the COVID-19 pandemic.

• Having obesity increases the risk of severe illness from COVID-19. People who are overweight may also be at increased risk.

• Having obesity may triple the risk of hospitalization due to a COVID-19 infection.

• Obesity is linked to impaired immune function.

• Obesity decreases lung capacity and reserve, and can make ventilation more difficult.

• As BMI increases, the risk of death from COVID-19 increases.

That was a lot of helpful information -- but also a lot to digest.

For anyone who might be interested in talking to an expert about his or her personal circumstances, HCA Houston Healthcare wants to help. The Redefine Clinical Weight Loss program is unique in that it wants to assist its patients every step of the way. Deciding to undergo bariatric surgery is no small consideration, and experts from the program can get involved early when it comes to questions involving insurance, determining whether surgery is the right option, what kind of surgery each person might require; you name it -- from pre-surgery counseling and preparation to post-surgery support and education, you’ll be in the right hands, doctors said.

Take it from Sarten, who had been working as a wound and ostomy nurse prior to her weight-loss surgery. It was a twist of fate that landed her with in her current role with HCA Houston Healthcare.

“The surgeon I worked with asked if I could help him get the program started,” Sarten said. “I realized that was exactly what I wanted to do -- help others feel as great as I did. I eventually lost 110 pounds. I looked and felt healthier.”

In 2016, Sarten had a revision to a gastric sleeve. Her journey continues, personally and in helping others.

“I have been able to continue my journey and have never been happier,” Sarten said. “I went from being in the sideline of my life to now being the star player. I now participate in all activities with my kids. I am now dedicated to helping my patients be as successful as possible.”