Obesity has become a significant global epidemic, with an increasing number of Canadians seeking solutions to achieve safe and sustainable weight loss. In the quest for effective solutions, bariatric surgery has emerged as a game-changer for losing weight.

Innumerable studies have demonstrated the long-term benefits of surgery for people struggling with traditional methods of weight loss. 

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With advancements in medical technology and surgical techniques, the options for bariatric surgery in Canada have increased and given hope to those in need of effective weight management interventions. 

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In this blog, we will explore the world of bariatric surgery and the different types, mechanisms, benefits, and risks of the procedures.

Understanding Bariatric Surgery

Bariatric surgery, also metabolic surgery, refers to the set of surgical procedures that focus on patient weight loss and improvement of metabolic disorders such as high blood pressure and diabetes. Bariatric surgery has shown remarkable results for patients looking to transform their lives.

The average post-operative weight loss expectancy within the first year is 25%-35% of total body weight or 50-60% of one’s excess body weight.

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Moreover, studies demonstrate that bariatric surgery results in significant improvements in obesity-related comorbidities, such as hypertension, type 2 diabetes, sleep apnea, and joint pain. In addition to its physical health benefits, it can also help improve the quality of life and psychological well-being of the patients. 

Is Bariatric Surgery Done Laparoscopically?

The introduction of laparoscopic techniques has revolutionized bariatric procedures. It is a type of minimally invasive surgery that uses specialized instruments and small incisions. Its benefits include reduced post-surgical risks, shorter hospital stays, less post-operative pain, much better cosmetic results, and faster recovery times. 

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Who Is Eligible for Bariatric Surgery?

To qualify for bariatric surgery, you must meet the following criteria:

• Body Mass Index (BMI) of 35 or higher for metabolic surgery or a BMI of 30 or higher with obesity-related health conditions (like high blood pressure or diabetes, among others)
• Experience with unsuccessful attempts at weight loss through traditional methods
• Psychological evaluation to assess readiness for surgery and post-operative lifestyle improvements
• Commitment to lifelong dietary and lifestyle changes
• Medical clearance to ensure safety and suitability for surgery

Reach out to us at MyLife Bariatrics or seek guidance from your family doctor for a personalized evaluation to determine your eligibility based on your individual circumstances. 

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Is Bariatric Surgery Covered by OHIP?

OHIP is Ontario’s public health care provider that provides coverage for gastric bypass surgery for patients with a BMI of 40 or higher, or a BMI of 35 or higher along with significant weight-related health conditions. 

In certain cases, gastric sleeve surgery may be offered instead of gastric bypass if the patient has severe scar tissue from a prior surgery if gastric bypass poses an excessive risk due to medical conditions, and if the patient's BMI is under 60. 

These guidelines help determine eligibility for OHIP coverage of bariatric procedures.

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Types of Bariatric Surgery for Weight Loss: Mechanisms, Benefits, and Risks

Make an informed decision by understanding the different types of bariatric surgery.  

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1. Roux-en-Y Gastric Bypass (RYGB)

Roux-en-Y gastric bypass is one of the most common types of bariatric surgery for weight loss.

This widely recognized and effective bariatric surgical procedure involves the creation of a small stomach pouch and reroutes the digestive tract to bypass a portion of the small intestine.

It causes the ingested food to bypass the remaining stomach and 150 cm of the proximal small bowel.

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Since the smaller stomach pouch can only hold a small amount of food (30-40ml) and a portion of bowel is bypassed, it first results in restricting one’s intake and second, contributes to some malabsorption of nutrients and calories. Even more, when ingested food bypasses the proximal small bowel, GLP1 (satiety hormone) is secreted at higher levels thus making you feel physiologically fuller. Adding all these components together, the bypass has proven very effective as a surgical weight loss solution.

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Benefits of RYGB

• Significant and Sustained Weight Loss - Within the first year after surgery, patients can expect to lose a substantial amount of excess weight.

• Improved Health Outcomes - In addition to significant weight loss, patients can experience resolution or improvement of adiposity-related conditions, such as hypertension, sleep apnea, and diabetes. 

• Enhanced Quality of Life - Losing extra weight can help improve mobility, energy levels, and overall well-being.

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Like other types of bariatric procedures, RYGB may carry some risks, including potential complications during the procedure, deficiency in vitamins and minerals, ulcers near the gastric pouch, bowel obstructions (internal hernias) and the need for lifelong lifestyle and dietary changes. Nevertheless, there are plenty of success stories highlighting the transformative benefits of RYGB surgery in individuals struggling with weight loss problems.

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2. Vertical Gastric Sleeve (VSG)

Like RYGB, vertical gastric sleeve surgery (also known as sleeve gastrectomy, has also gained much prominence as an effective modern bariatric procedure. It involves the removal of roughly 80% of the distal stomach, which secretes “ghrelin”, the primary hunger hormone. 

It leaves behind a smaller sleeve-shaped stomach to reduce food intake. Through a restrictive and hormonal pathway it has proven approach to helping individuals lose weight. 

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Key Aspects of Gastric Sleeve Surgery

• Mechanism of Action - The reduced size of the stomach limits the amount of food intake, which results in easier portion control and decreased calorie intake. Lower levels of Ghrelin and higher levels of GLP-1 contribute to satiety after meals.

• Benefits – Patients experience significant weight loss, improved metabolic health, and resolution of obesity-related comorbidities. Patients can continue taking NSAIDs if needed for underlying conditions and have no risk of marginal ulcers or internal hernias.

• Considerations - Sleeve patients must also commit to a long-term, healthy lifestyle and dietary changes, as well as regular post-surgical follow-ups to monitor progress and ensure optimal results. Notably ⅕ patients after a VSG can experience new reflux. This is generally treated with anti-acid medications and sometimes if severe by conversion to a RYGB.

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High success rates of VSG, coupled with a lower risk profile compared to other weight loss procedures, have contributed to its popularity globally.

Gastric sleeve surgery is an effective option for those seeking weight loss and a reduction in obesity-related health issues.

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3. Adjustable Gastric Banding

Adjustable gastric banding, commonly known as lap band surgery, involves the placement of an inflatable band around the upper stomach, resulting in the formation of a smaller pouch.

The adjustable band can help regulate food consumption by tightening or loosening it through a port underneath the skin. It is no longer conventionally performed in Canada.

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Key Considerations for Adjustable Gastric Banding

• Mechanism of Action - The smaller stomach pouch created by the band leads to early satiety and reduced food intake.

• Advantages - This type of bariatric surgery is adjustable and reversible, which enables individualized weight loss progression. 

• Complications - bands can cause obstructions of the food pipe, vomiting, new reflux. They can erode into the stomach in some cases.

• Aftercare and Follow-Up - The bands need to be adjusted regularly for optimal weight loss and management of potential complications.

Adjustable gastric banding does not provide the same level of weight loss or improvement of comorbidities as other bariatric surgical options. It is no longer performed in Canada. Patients with band complications prefer to have them removed nowadays.

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4. Duodenal Switch

Duodenal switch is a more complex type of bariatric surgery.

It involves a sleeve gastrectomy to reduce the size of the stomach and a bypass of a much more significant portion of the small intestine.

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Key Aspects of Duodenal Switch Surgery

• Weight Loss Mechanism - The combination of VSG and RYGB results in restriction and malabsorption, leading to substantial loss of weight.

• Considerations - Duodenal switch surgery is ideal for patients with a high BMI or those who are non-responders to other bariatric surgeries. 

• Long-Term Considerations - Due to its significant malabsorptive nature, DS patients need long-term vitamin and mineral supplementation to prevent deficiencies. 

Duodenal switch surgery is a more complex and technically demanding procedure, but it can provide significant weight loss and improvements in obesity-related conditions for appropriate candidates.

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5. Endoscopic Procedures

Advancements in medical technology have paved the way for endoscopic bariatric procedures.

These minimally invasive alternatives use an endoscope, a flexible tube with a camera and surgical, which is inserted through the mouth. 

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Some notable endoscopic bariatric procedures include:

• Gastric Balloon - A deflated balloon is placed in the stomach and inflated to create a feeling of fullness, promoting weight loss. This is a short term solution on its own.

• Endoscopic Sleeve Gastroplasty - Suturing techniques from inside the stomach are used to reduce the stomach size without the need for a traditional surgical approach.

• Advantages and Limitations - Endoscopic procedures offer lower risk, quicker recovery, and no incisions; however, they may not achieve the same level of weight loss as tried, tested and more conventional surgical options.

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Endoscopic bariatric procedures belong to an evolving field, and while they may not be suitable for everyone, they provide a less invasive alternative for individuals seeking weight loss interventions.

Currently, among these procedures, only the gastric balloon is offered in Canada.

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Types of Bariatric Surgery: Final Thoughts

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Bariatric surgery has revolutionized the way we approach weight loss and obesity management and have transformed the lives of countless individuals. 

If you are considering bariatric surgery, consult with your family practitioner seek referral to a weight loss program.

Determine the most appropriate procedure for your specific circumstances can be challenging. If you have questions, we are here to help you navigate this process at MyLife Bariatrics.

With the advancements in bariatric surgery and now potentially combining surgery to medications like Ozempic, Canadians have an incredible opportunity to achieve long-term weight loss and reclaiming their health.

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Canadians have an incredible opportunity to achieve long-term weight loss and reclaiming their health.

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At MyLife Bariatrics, we understand the challenges of obesity and are dedicated to helping individuals achieve their weight loss goals through safe and effective bariatric surgery. Our team of experienced surgeons, along with a multidisciplinary support team, is committed to providing personalized care and guidance throughout your weight loss journey.

Contact us today to schedule a consultation at our weight loss clinic and take the exciting step towards transforming your life. Learn more about our comprehensive bariatric surgery options and find out how we can help you on your path to a healthier you.

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