Answer these 10 easy questions to discover the weight loss operation that should suit your situation best.

1. What is your Age?

< 18 19-40 41-60 61-70 > 70

2. BMI*

*BMI = Body Mass Index = Weight (kg) divided by the square of your Height (in metres).
< 30 30-35 35-40 40-50 50-60 > 60 Weight >200kg

3. Diabetic Status (type 2)

Not diabetic Pre diabetic Diabetic diet controlled or tablets Diabetic needing regular injections

4. Hypertension (high blood pressure)

Not hypertensive Borderline hypertension Hypertension on tablets

5. Reflux status

No reflux symptoms Mild heartburn at times Significant heartburn Acid volume in the mouth Severe reflux with food regurgitation

6. Sleep Apnoea

No diagnosis made Diagnosed mild-mod sleep apnoea Diagnosed Severe Sleep apnoea

7. Previous surgery

Gastric band Sleeve gastrectomy Anti reflux surgery Stomach Stapling Bowel surgery eg. Bowel resection None

8. Blood thinners, NSAIDS* and smoking

*NSAIDS = Non Steroidal Anti Inflammatory medications
I regularly...
Do none of the above Do one of the above Do two of the above Take blood thinners, smoke, and take NSAIDs

9. Usual bowel habit

Normal Severely constipated Mildy constipated Diarrhoea

10. Risk tolerance

I will only have the safest, gentlest procedure, fully reversible, no stomach cutting I am willing to take some risk within reason to achieve good weight loss I want the most powerful procedure to lose the most weight and keep it off regardless of extra risk

DISCLAIMER:The suggested procedure may not always be applicable to your individual circumstances. Consultation with an experienced practitioner is necessary before making a final decision regarding operative choice

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Comments and Further Information

BMI

Patients with BMI < 30 will find the risks and adverse effects of bariatric surgery will outweight any medical benefits from the weight loss. The Orbera implantable balloon may be an option to consider.

BMI 30-35. These patients represent the grey area for the more invasive operations. The medical benefits conferred by the weight loss may not outweight the risks and adverse effects of the surgery. However quality of life and psychosocial issues may be significant and each case should be taken on its merits. The exception is injection dependent diabetics in whom bypass might be considered. Patients of asian background may qualify at lower BMIs as their propensity to develop metabolic diseases from obesity is higher.

Weight > 200kg. In this group sleeve may be best as bypass and SIPS surgery can be too difficult or dangerous. A second stage procedure once weight loss has occurred may be entertained

Blood thinners, NSAIDS and smoking

Orbera balloon should not be implanted in patients on blood thinners. NSAIDs and smoking increase the risk of ulcers occuring at the top join between stomach pouch and bowel (marginal ulcer) in gastric bypass surgery. Blood thinners can increase the risk of these ulcers bleeding.

Diabetes

Injecting diabetics may get a more profound response from gastric bypass or SIPS

Hypertension, Sleep Apnoea, Joint Pains

The more obesity related medical conditions and the more severe the condition, the more it is reasonable to look at the more powerful procedures (sleeve, bypass, SIPS) to achieve control of these conditions

Age factors

The extremes of suitable ages for weight loss surgery (e.g. early 20s, mid to late 60s) raise some difficult questions. There are no definitive answers however the more complex operations (e.g. bypass, SIPS) may be overkill for older groups as the long term benefits are unclear and complication rates may be higher. On the other hand, younger patients choosing sleeve or SIPS are taking on procedures with much less long term follow-up data available compared to bypass or banding for example

Previous Surgery

Most patients with previous bands or stomach stapling procedures are likely to be better off with gastric bypass as a revisional procedure. This procedure is relatively robust in terms of anatomical distortions from the previous surgery and adds a small malabsorption and hormonal component to the restrictive function. SIPS (loop duodenal switch) may be an elegant alternative for patients who have regained weight with sleeve, although bad refluxers should probably stick with the bypass. Those who have had bowel surgery before or similar will be more challenging to perform bypass or SIPS due to abdominal scar tissue and adhesions

Usual Bowel Habit

Many bariatric operations tend to reduce the frequency of bowel motions due to reduced intake. However SIPS surgery is usually associated with diarrhoea due to fat malabsorption. This could be a useful side effect for those who suffer long term chronic constipation

Learn More

Sleeve Gastrectomy

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Gastric Bypass

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Gastric Banding

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SIPS Surgery

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Orbera Balloon

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