How Do I Know if I Qualify for Sleeve Surgery?

The road to weight loss and a healthier life is a difficult path for so many. This is especially true for those who have spent years fighting weight gain and weight related health problems. Most people believe obesity results because of a person’s lack of willpower when in fact, high body weight is 50-70% associated with one’s genetics and leads to a clear physiologic state that has stacked the cards against those struggling to lose weight and managing hunger.

Today, weight loss surgery is the most effective and sustainable method to achieve successful and long-lasting weight loss.  Surgery through gastric bypass or sleeve gastrectomy achieves 25-35% total body weight loss or 50-60% excess weight loss. Surgery comes with complications as well, but today’s bariatric surgeons only offer surgery when the benefits outweigh the risks for an individual patient. Weight regain can occur after surgery, so it remains important to apply lifestyle changes through dietary, social and active means.

‍

Today, weight loss surgery is the most effective and sustainable method to achieve successful and long-lasting weight loss. 

‍

Let's examine below the common bariatric surgery options, how eligibility is determined, and the crucial elements people should consider before making a health decision.

The Most Common Bariatric Surgery Options

‍

Today, two procedures make up the majority of modern weight loss surgeries. LapBands are being removed, endoscopic procedures are in their early stages, SADI/DS are reserved for unique very high weight patients, but the sleeve gastrectomy and the gastric bypass, considered incredibly safe and reliable procedures, have thereby emerged as the most commonly performed weight loss surgeries in North America. 

1. The Vertical Sleeve Gastrectomy (VSG)

Sleeve gastrectomy, in particular, by an order of magnitude, is the most commonly performed weight loss procedure globally. Vertical sleeve gastrectomy (VSG) involves removing 60-80% of the stomach. This treatment was developed to lower the volume of the stomach while also reducing the production of ghrelin and increasing GLP-1 levels. This limits the amount of food one can consume and also leads to a lasting effect by decreasing the sensation of hunger. Sleeve surgery is performed within an hour and has no new connections or anastomosis made between bowel. It should be avoided in patients with significant pre-surgical reflux or bad esophagitis seen on scope. It is a good option for those that don’t want any malabsorption affecting their nutrient, vitamin or medication intake.

Sleeve gastrectomy, in particular, by an order of magnitude, is the most commonly performed weight loss procedure globally

Some studies show slightly less long-term weight loss compared to RYGB. When combined with a lifestyle commitment, sleeve patients achieve long term weight loss success in the vast majority of cases. Although sleeve surgery is not reversible, it can be converted to a bypass or SADI/DS procedure.

2. Exploring the Roux-en-Y Gastric Bypass (RYGB)

The Roux-en-Y gastric bypass (RYGB) is a bariatric surgery that involves forming a small gastric pouch from the stomach, which is then affixed directly to the small intestine. The malabsorption and restriction of food as a result of this treatment can effectively reduce weight and increase feelings of fullness. RYGB results in higher GLP-1 levels in the body and thereby increases the satiety balance in the brain helping to curb eating.

The RYGB takes roughly 1 hour and 15 minutes to complete and is performed in Canadian hospitals. It can be reversed but doing so is another major surgical procedure with increased risks compared to the original procedure. RYGB involves making two connections between bowel. It is also a good anti-reflux procedure and is favored for those who suffer from bad pre-operative reflux. It can lead to malabsorptive effects so it is imperative patients reassess the dosages of their chronic medications with their doctors after surgery. It can also contribute to nutritional and vitamin deficiencies, so taking vitamins regularly after surgery is critical.

Am I Eligible for Sleeve Surgery?

‍

Sleeve surgery is a major surgical procedure. While it has a myriad of advantages, there are also things to watch out for. To make sure that your weight loss surgery is a success, you need to meet the criteria for the procedure.

Evaluating your bariatric surgery eligibility is simple. Here are key things to consider

‍

‍BMI

The following patients, based on the 2022 guidelines from the American Society of Metabolic and Bariatric Surgeons can benefit from weight loss surgery. They should try a pre-surgical weight loss plan and if this fails – surgery can effectively help them achieve this weight loss.

• Patients who have a BMI above 30 kg/m2 and present obesity-related comorbidities like obstructive sleep apnea (OSA), gastroesophageal reflux disease (GERD), hypertension, and diabetes)
• Patients who have a BMI greater than 35kg/m2

The criteria for sleeve eligibility in Canadian hospitals may be expanded in the near future following these revised guidelines from the American Society for Metabolic and Bariatric Surgery. 

Sleeve surgery in Ontario and many parts of Canada however is limited to those who do not qualify for RYGB surgery.

In Ontario for instance, Gastric sleeve surgery is covered by OHIP if:

1. Your BMI is more than or equal to a BMI of 60

2. You have a significant amount of scarring within your abdomen that is prohibitive for undergoing a gastric bypass operation.

3. You have a medical condition that makes performing a Gastric Bypass operation unsafe or clinically not recommended for you.

If you are interested in OHIP covered bariatric surgery, please discuss this with your family doctor who will send a referral to the Ontario Bariatric Network.

‍

‍Medical History and Contraindications

There are very few medical conditions that completely disqualify an individual from getting weight loss surgery. These include a dependency on drugs and/or alcohol, active cancer, and uncontrolled psychiatric disorders.

The following factors do not affect your eligibility. However, these factors are important considerations if you want a higher chance of success:

For the procedure to succeed, it is important to be in the right mindset prior to surgery. This means appreciating that surgery alone cannot totally treat obesity. There are so many more mechanisms in your body that lead to weight gain than weight loss, so to achieve long term success, one must apply dietary changes, mental health measures and sometimes even medications. 

Being true to yourself is central to success. Having a support structure to help you achieve the best and long-lasting results is critical.

‍

‍Nutritional Preparation and Dietary Expectations

For bariatric surgery to be successful, good nutrition and portion control is crucial. While you are expected to adjust your diet after surgery, making healthy adjustments to your nutrition before your surgery can help you achieve the best and quickest results.

‍

‍Embracing Lifestyle Changes and Support Systems

It can benefit you if you establish healthier eating routines and participate in physical activities. These lay the groundwork for your life change. Additionally, make sure you have a solid support network so you can attain long-term success. Don’t hesitate to rely on your healthcare provider, family, and friends.

‍

‍Dealing with your Own Expectations

One of the hardest parts of undergoing weight loss surgery is dealing with your own expectations. We are our own toughest critics. Your genetic makeup is different than close family and friends. Results will vary between all these people. 

Using a target number as a marker of success is also not helpful. Instead, focus on things in your life that you want to be able to do with weight loss surgery and use these quality of life markers to serve as your milestones. Don’t expect perfection from yourself either. Get living life as soon as you can. 

‍

You are capable of achieving your goals and finding success and happiness in your life. Let others help you when they offer their support. You don’t need to do this alone.

‍

There are so many more mechanisms in your body that lead to weight gain than weight loss, so to achieve long term success, one must apply dietary changes, mental health measures and sometimes even medications. 

‍

Taking Action: Embracing a Healthier Future

If you’re considering getting sleeve surgery in Canada, take the first step by reaching out to MyLife Bariatrics. We are a newly established bariatric surgery clinic in Toronto and Hamilton. We will help you as you embark on a journey toward a healthier you.

Contact our bariatric surgery clinic today to consult with our surgical experts and learn about our pre-operative and aftercare programs! Visit us at mylifebariatrics.com or call at 416-293-6111.

‍