Who should be considered for weight loss surgery?
Weight loss surgery may only be recommended for individuals with a BMI of 40 or more, or a BMI of 35-40 and a serious health condition that could be improved such as diabetes or high blood pressure.
Guidance states that weight loss surgery should only be offered on the NHS if all the following conditions apply:
- All appropriate non-surgical methods have been attempted, such as diet and exercise, but have failed to achieve or maintain a beneficial level of weight loss for at least six months.
- Commitment to long-term follow-up treatment after surgery.
- The individual is fit and healthy enough to withstand the anaesthetic and surgery.
There may be slightly different criteria at local clinics/hospitals which could affect access to surgery.
For further information see the guidance published by National Institute for Health and Clinical Excellence (NICE) about who should be considered for bariatric surgery/weight loss surgery.
Different criteria may apply if the weight loss surgery is undertaken privately.
What are the types of weight loss surgery?
There are many different types of weight loss surgery but the main types are:
- Laparoscopic adjustable gastric banding (also known as stomach band or lap band) - This procedure places a constricting ring around the stomach. The band is adjustable so it can be altered once it is in place.
- Sleeve gastrectomy - During this procedure most of the stomach is removed leaving a sleeve-shaped cylinder of stomach with reduced capacity. This procedure is irreversible.
- Gastric bypass - This procedure re-routes the digestive system past most of the stomach so the individual digests less food. Biliopancreatic diversion is a more extensive form of the gastric bypass. It produces more extreme malabsorption. The biliopancreatic diversion is sometimes performed with a duodenal switch. This severely limits caloric absorption.
- Gastric balloon (or intragastric balloon) - This is an endoscopic rather than surgical procedure, which involves placing a silicone balloon inflated in the stomach to make you feel fuller for longer after eating a small meal. There are complications such as gastric erosions and ulcers with this procedure.
Which medical professionals are involved with weight loss surgery?
Weight loss surgery and adapting to life after surgery is a difficult process, requiring the input of different medical professionals, who need to work together as a team.
This is known as a multidisciplinary team (MDT) and it may consist of:
- a surgeon
- an anaesthetist
- a dietician
- a psychologist
- a gastroenterologist (doctor who specialises in treating digestive conditions)
- a specialist weight loss surgical nurse
What are the benefits of weight loss surgery?
The benefits of weight loss surgery include:
- Weight loss
- Helping to improve other medical conditions including diabetes, hypertension and heart disease
- Reducing the risk of strokes and heart attacks
- Improved general wellbeing
- Increased confidence
When is weight loss surgery not suitable?
Weight loss surgery may not be recommended if you have a serious illness that would not be improved after the operation, such as advanced cancer or liver disease .
It is also unlikely that weight loss surgery will be recommended if a mental health condition or other factors mean that an individual will not be able to commit to lifestyle changes.
Can children have weight loss surgery?
Weight loss surgery for obese children will only be considered in exceptional circumstances, and only if the child is physically mature i.e. around the age of 13 for girls and 15 for boys.
Most medical professionals would only recommend weight loss surgery as a last resort for children who are severely morbidly obese (a BMI of 50 of above), or who are morbidly obese (a BMI of 40 or above) and also have a serious health condition that would improve if they lost weight.
What should happen after the surgery has been performed?
Patients should receive regular specialist dietetic review and details of patient support groups after the surgery has been performed.
Individuals who have had weight loss surgery will need to stick to a strict lifelong plan to avoid putting weight back on or long-term difficulties. This will include a controlled diet and exercise as well the involvement of a multi-disciplinary team including the GP. This is vital because complications can occur many years after weight loss surgery.
What are the complications of weight loss surgery?
Potential complications of weight loss surgery include:
- Blood clots in the legs ( deep vein thrombosis ) or lungs ( pulmonary embolism )
- Band slippage. This can cause symptoms such as heartburn, nausea, vomiting. Further surgery will be required to repair the band.
- Leakage of gastric fluid which can cause severe infection, known as peritonitis. This is a severe and life threatening complication. The symptoms can range from a fever to extreme pain.
- Gastrointestinal ulcers or bleeding
- Small bowel obstruction
- Stomal stenosis - A frequent complication with a gastric bypass surgery is that the hole (stoma) that connects the stomach pouch to the small intestine becomes blocked by food. This is known as stomal stenosis. The most common symptom of stomal stenosis is vomiting. Stomal stenosis can be treated by directing a small tube, known as an endoscope, to the site of the stoma. A balloon connected to the endoscope is inflated to unblock the stoma.
- Nausea and vomiting due to overeating or stenosis at the surgery site.
- Dumping syndrome. Symptoms include flushing, light-headedness, palpitations, fatigue and diarrhoea.
- Injury to other organs such as the spleen.
- Malnutrition i.e. deficiencies in iron, calcium, folate and fat-soluble vitamin deficiencies can occur. Thiamine, B12 and copper deficiencies may cause neurological symptoms. Protein-calorie malnutrition can also occur.
- Inadequate weight loss and weight regain.
- Excess skin. Cosmetic surgery can be used to remove the excess skin. However, as this treatment is for cosmetic and not clinical reasons, it is not available on the NHS.
- Psychosocial effects of surgery
- Food intolerance. Around 1 in 35 people with a gastric band develop a food intolerance, often many years after their surgery. A food intolerance is when your body is unable to tolerate certain foods, such as red meat or green salad, resulting in a number of unpleasant symptoms such as, nausea, vomiting or gastro-oesophageal reflux disease (GORD) .
Is there a risk of death with weight loss surgery?
No surgery is entirely safe and all surgical procedures carry a risk of death.
Risk factors which increase the risk of death during or shortly after weight loss surgery:
- being over 45 years old
- high blood pressure
- having a BMI of 50 or above
- being male, as obese men tend to weigh more than obese women
- having a known risk factor for a pulmonary embolism
Will there be a need for revision surgery?
If the original operation fails, revision surgery should only be undertaken in specialised centres, by surgeons with extensive experience. This is because of the high risk of complications and increased mortality rate.
What is dumping syndrome?
Dumping syndrome is a group of symptoms that can develop when all or part of the stomach has been removed, or if the stomach has been surgically bypassed to help lose weight. It is also known as rapid gastric emptying. The syndrome occurs when the undigested contents of your stomach move too quickly into your small bowel. Common symptoms include abdominal cramps, nausea and diarrhoea.
Can I claim compensation for negligent weight loss surgery?
There are complications which can occur during or after weight loss surgery without anyone being negligent. These recognised complications are listed above. Other complications however can be described as negligent and can result in a medical negligence compensation claim.
Common weight loss surgery compensation claims include:
- incorrect placement of the gastric band
- incorrect stapling of the joins in gastric bypass surgery
- failure to promptly treat band slippage
- failure to recognise and treat puncture to the stomach during a gastric band operation
- wrong type of bypass procedure
- delay in diagnosis of post operative infection
What will I get compensation for?
Compensation is awarded where you have sustained an injury as a result of substandard care. The amount will be made up of compensation for the actual injury you have suffered, the pain and suffering you have experienced and the impact on your life.
You can also claim past financial losses and future losses such as loss of earnings, care, therapy or equipment which have reasonably arisen out of the negligence.