Bariatric surgery isn’t one size fits all, and there are wrong and right types for everyone’s lifestyle. For lap band surgery, doctors put a silicone ring around the top of your stomach to adjust the opening of the stomach into the intestines, Dr. Choi says. “The range of effectiveness is wide for lap band, because people have to learn how to eat around the band.”
A sleeve gastrectomy is when you cut out a significant portion of the stomach, until it’s like the size of a banana, Dr. Choi says. “When the stomach is smaller, you can’t eat as much, and it makes you less hungry because there’s a hormonal change.” Sleeve gastrectomies are pretty drastic (Dr. Choi says they cut out 70 to 80% of your stomach), although eventually you’ll get your appetite back.
Gastric bypass surgery involves cutting the stomach into the size of an egg, then hooking it up to your intestines, so when you eat food it’s processed in a different way, she says. “It gets bad press because there are a lot of complications, and if you don’t take vitamins after, there’s going to be issues.”
Your stomach literally won’t be able to hold as much food as you’re used to, so a total upheaval of your eating habits is usually necessary. “If you’re someone who enjoys food or events around food and you’re not ready to make diet changes, surgery isn’t right for you,” Dr. Choi says. “It’s not at all that you’ll never eat again, but you have to be limited.”
Most doctors require a six-month nutritional counseling period, not only to maintain or lose a little weight, but also to make sure you know what you’re in for. They also tell patients that, after surgery, eating has to become a “job,” and every four to six hours your body needs fuel. “Most people haven’t eaten like that in a long time.”
Long-term followup is required after any of these operations, Dr. Choi says. “In the beginning of the first year after surgery, the weight comes off no matter what — you can do whatever you want and still lose weight,” she says. “Over time, it comes back, so you have to understand the work that goes into maintaining weight loss and keeping your body healthy.” Activity, in addition to smart eating, is crucial to maintain some muscle. “If you don’t [exercise], your metabolism will be slower because you’re not eating as much and losing muscle mass,” Dr. Choi says.
Before you can even be considered, there’s an evaluation period in which doctors make sure you’re not smoking or doing drugs. “We want to make you as healthy as possible beforehand without setting unrealistic expectations,” Dr. Choi says. Many insurance companies require you to complete some sort of nutritional education to make sure you’re able to make small changes before they seriously alter your anatomy, she says. This is sort of like how Kate on This Is Us is sent to a “fat camp” by her doctor’s recommendation, although Dr. Choi says she hasn’t heard of an immersive program specifically meant for pre-surgery.
Psychology plays a much bigger part in bariatric surgery than many people realize, Dr. Choi says: “A fair amount of people have had psychological disorders or a history of abuse in the past.” Every patient will have a pre-op evaluation with a psychologist and a psychiatrist, in addition to all the other medical examinations.
This isn’t meant to discriminate against people who have mental health issues, it’s just that doctors want to make sure that you can sustain the lifestyle changes in a healthy way long after surgery. “Family dynamics are also an issue, because you need the support of your family, a safe place to live, and access to healthcare,” she says. “When you don’t have that support, it’s hard to maintain that lifestyle long-term.”
There’s a lot of shame associated with bariatric surgery, because people are unfortunately shamed about their weight in general, Dr. Choi says. For people who are considering bariatric surgery, just deciding to lose weight through diet and exercise isn’t an option. “That’s just not how the human body is built,” she says. “There’s a lot of stigma, and people are embarrassed and try to hide it.”
No matter what your reasoning is for wanting to get bariatric surgery, you should know what your goal is and find people that support you for whatever that may be, Dr. Choi says. “It’s much easier to have that goal in mind, rather than dealing with other aspects.”