How does sleeve gastrectomy affect the weight loss process?
Sleeve gastrectomy is a surgical procedure that transforms the stomach into a thin, banana-shaped tube by surgically removing approximately 80% of the organ. The most significant impact of this operation on weight loss is the severe restriction of stomach volume. With a smaller stomach capacity, patients achieve a feeling of fullness by consuming much less food. However, it is not just a physical restriction; a hormonal change is also involved. Levels of the "hunger hormone" known as ghrelin, secreted from the fundus part of the stomach that is removed, decrease significantly, which ensures that the patient's appetite is remarkably reduced after surgery. This two-way effect paves the way for rapid and effective weight loss within the first year.
How much weight can be lost with gastric bypass?
Gastric bypass surgery is considered the gold standard in obesity surgery and is a method that has both restrictive and malabsorptive properties. In this surgery, the stomach is turned into a very small pouch and a portion of the small intestines is bypassed and connected directly to this small stomach. This structural change allows patients to lose an average of 70% to 80% of their excess weight within the first 18-24 months. Gastric bypass does not only reduce the amount of food eaten but also limits the absorption of calories and fats by shortening the intestinal path. Therefore, it can provide slightly more weight loss compared to sleeve gastrectomy, especially in individuals with a very high body mass index.
Which surgery leads to faster weight loss?
The rate of weight loss is quite high in both methods in the first six months after surgery. However, gastric bypass usually provides a slightly more aggressive start to weight loss compared to sleeve gastrectomy, thanks to its malabsorptive effect. In the first three months, patients generally lose close to 30% of their excess weight. In sleeve gastrectomy, weight loss progresses more through portion control and decreased appetite. Although the speed factor varies from person to person, metabolism, and compliance with the post-operative diet, those who undergo bypass are slightly more likely to see a faster decrease on the scale. However, what matters in the long run is not the speed, but how much of the lost weight comes from fat mass and how long it can be maintained.
Which method is more permanent in the long term?
When it comes to long-term weight maintenance success, research shows that the gastric bypass method is ahead by a small margin compared to sleeve gastrectomy. In five to ten-year follow-ups, it has been observed that the risk of regaining the lost weight is lower in gastric bypass patients compared to sleeve gastrectomy patients. The reason for this is that the absorption restriction provided by bypass surgery creates a safety net even if the patient makes nutritional errors. In sleeve gastrectomy, the stomach may expand slightly over time, and since there is no change in absorption, weight regain can occur more easily in patients who consume high-calorie liquid foods or snacks. In both methods, the key to permanence is lifestyle change.
Does body mass index affect the choice of surgery?
Body mass index (BMI) is one of the most critical parameters in determining the surgical method. Generally, sleeve gastrectomy is seen as an excellent option for patients with a BMI value between 35-50 and gives very successful results. However, in individuals with a BMI value over 50 (super obesity) or exceeding 60 (super-super obesity), methods that interfere more strongly with absorption, such as gastric bypass or duodenal switch, are more frequently preferred. The reason for this is the concern that just shrinking the stomach may not create a sufficient metabolic effect in extremely overweight individuals. Nevertheless, surgeons make the most appropriate choice by evaluating the patient's general health status, comorbidities, and eating habits.
Which method should Type 2 diabetes patients choose?
If a patient is experiencing Type 2 diabetes along with obesity, gastric bypass surgery is generally considered metabolically superior. The early contact of food with the later parts of the intestines after gastric bypass triggers the rapid secretion of hormones that regulate blood sugar (such as GLP-1). This situation triggers the "remission" process, which allows patients to stop using insulin or medication even on the day they leave surgery. Although sleeve gastrectomy is also very effective on diabetes, the metabolic improvement rate and the duration of keeping diabetes under control provided by bypass are scientifically higher. Therefore, bypass is a more radical and permanent solution for diabetic patients.
Which surgery is suitable for those with hiatal hernia?
The choice of surgery is of vital importance for patients with hiatal hernia and severe heartburn (reflux). Sleeve gastrectomy can increase the pressure inside the stomach, which can worsen existing reflux symptoms or start a new reflux problem. Therefore, sleeve gastrectomy is generally not recommended in patients with chronic and severe reflux. In contrast, gastric bypass is known as a surgery that treats reflux. Thanks to the disabling of the large acid-producing part of the stomach and the new anatomical structure, the escape of acid into the esophagus is prevented. If you have a hiatal hernia and reflux complaints, your doctor will most likely recommend the gastric bypass method for your health and comfort.
How do eating habits change after surgery?
In both types of surgery, eating habits must evolve dramatically. After the operation, patients go through clear liquid, then puree, and then soft solid phases in the first weeks. However, the real change is in portion sizes. The large portions consumed in one sitting before the surgery are replaced by meals that are satisfied with a small bowl of soup or two-three meatballs. Gastric bypass patients become more sensitive to sugary and excessively fatty foods due to malabsorption; this creates a natural barrier for a healthy eating discipline. Sleeve gastrectomy patients can eat more diversely, but it is essential for them to stick to a protein-oriented nutrition plan for the continuity of weight loss.
Which one has a higher risk of vitamin and mineral deficiency?
The risk of vitamin and mineral deficiency is significantly higher in gastric bypass surgery. Bypassing a part of the intestines reduces the absorption of critical elements such as iron, calcium, vitamin B12, and folate. Therefore, it is essential for bypass patients to use regular multivitamin and mineral supplements for life. Although the absorption area does not change in sleeve gastrectomy, some deficiencies (especially B12 and iron) may be seen due to the decrease in stomach acid and the very low amount of food consumed. However, the need for supplements is generally less intense in sleeve gastrectomy patients and is only necessary for the first few years in some cases. Patients in both groups should not neglect their annual blood tests.
How does dumping syndrome affect weight loss?
Dumping syndrome is a condition that can be seen in approximately 50-70% of patients who have gastric bypass surgery, occurring when sugary or excessively fatty foods pass very quickly from the small stomach to the intestine. Symptoms include palpitations, sweating, nausea, and cramping. Although this sounds scary, it actually functions as a helpful "deterrent mechanism" in losing weight. Because the patient knows that they will experience these uncomfortable symptoms when they consume sweets, they learn to stay away from sugary foods. Dumping syndrome is rarely seen in sleeve gastrectomy, which may allow patients to tolerate "empty calorie" sweet foods (such as ice cream, sugary desserts) more easily and thus cause the weight loss process to slow down.
How does stomach reduction decrease appetite?
Stomach reduction decreases appetite in two basic ways: mechanical and hormonal. Mechanically, since the stomach volume drops to a capacity of less than a cup, a very small amount of food sends a "full" signal to the brain by stretching the stomach wall. Hormonally, the ghrelin hormone, the conductor of appetite, decreases significantly. Ghrelin is a hormone that sends a feeling of hunger to the brain when the stomach is empty, and when 80% of the stomach is removed, the production center of this hormone is also discarded from the body. In this way, patients do not experience unbearable hunger crises as they did before the surgery. This hormonal silence period is a window of opportunity provided by surgery for the patient to break the emotional bond with food and get used to a new order.
Does rerouting the intestines increase weight loss?
Yes, rerouting the intestines, that is, creating "malabsorption" (absorption disorder), definitely increases weight loss. In gastric bypass and similar procedures, the point where food meets digestive enzymes and bile is moved to a further part of the intestines. This means the body cannot get calories from everything it eats. Especially the absorption of fats and complex carbohydrates is restricted. This anatomical change also speeds up the metabolic rate by stimulating intestinal hormones (incretins). Since sleeve gastrectomy does not include this intestinal intervention, weight loss depends only on the amount of food taken and hormonal change. Therefore, bypass is a more powerful weight loss tool in metabolically more resistant patients.
How much weight is lost in the first year?
The first 12 months after surgery is called the "honeymoon period" and is the period when weight loss is fastest. During this time, patients generally lose 60% to 70% of their excess weight. For example, an individual with 100 kilos of excess weight may have lost 60-70 kilos at the end of the first year. Weight loss flows like a waterfall in the first 3 months, slows down slightly from the 6th month onwards but continues. Gastric bypass patients can generally lose 5-10 kilos more than sleeve gastrectomy patients during this period. During this period, the body perfectly adapts to the negative calorie balance and starts to burn fat stores rapidly. However, the habits acquired in the first year are of vital importance to maintain this success.
Does the weight loss process stop in the second year?
When entering the second year, the rate of weight loss slows down significantly and weight loss usually comes to a stopping point between the 18th and 24th months. The body is now used to its new weight and has reached a metabolic balance (set point). At this stage, patients transition to the "maintenance phase." A very slight weight regain (3-5 kilos) is considered normal in some patients during this period; because the metabolism has now started to burn fewer calories. In gastric bypass patients, the weight loss process may last a few months longer than in sleeve gastrectomy due to the absorption disorder. The weight achieved at the end of the second year will usually be the person's long-term permanent weight, and maintaining this weight depends entirely on discipline.
In which method is weight regain more common?
According to statistical data, from the 5th year after surgery, weight regain is seen slightly more frequently in patients who have undergone sleeve gastrectomy. Since sleeve gastrectomy is a purely restrictive method, an increase in volume may be experienced over time due to the flexibility of the stomach tissue. If the patient starts consuming high-calorie snacks (grazing), weight gain becomes inevitable. In gastric bypass patients, dumping syndrome and absorption restriction create a protective barrier. However, bypass patients can also gain weight if they turn to sugary drinks and high-calorie liquid foods. In conclusion, no surgery is a magic wand that makes it "impossible to gain weight for life"; patient compliance is essential in both methods.
How do hormonal changes help with weight loss?
Obesity surgery is not just a mechanical intervention, but actually an "endocrine surgery." After the surgery, satiety signals in the body become stronger while hunger signals weaken. Especially after gastric bypass, hormones such as PYY and GLP-1 secreted from the small intestine increase; these hormones send a feeling of fullness to the brain and break insulin resistance. After sleeve gastrectomy, the drop in ghrelin suppresses the feeling of hunger. These hormonal changes allow obese individuals to eat less naturally, without having to fight their willpower. The reprogramming of the metabolism is the most fundamental scientific fact explaining why people trying to lose weight with diet usually fail but why surgical patients succeed.
How does the ghrelin hormone decrease with sleeve gastrectomy?
The ghrelin hormone is produced by cells in the fundus region of the stomach when the stomach is empty and enters the blood, sending a hunger signal to the hypothalamus. During sleeve gastrectomy surgery, this fundus part of the stomach is completely cut and taken out of the body. Therefore, the main ghrelin production center in the body is destroyed. In tests conducted after the surgery, it was observed that ghrelin levels dropped by 70-80% compared to before the surgery. This situation is the main reason why patients say, "I am eating not because I am hungry, but because it is mealtime." Such suppression of appetite makes it easier for the patient to comply with calorie restriction and turns the weight loss process into a comfortable process.
How does gastric bypass speed up metabolism?
Gastric bypass affects metabolism not only by reducing calorie intake but also by changing the way the body uses energy. Positive changes in the intestinal flora (microbiota) after surgery and differences in the cycle of bile acids support the basal metabolic rate. Furthermore, the direct reach of nutrients to the last parts of the intestine triggers the "ileal brake" mechanism, which ensures that satiety hormones peak. When sufficient protein is taken to protect muscle mass, gastric bypass patients tend to burn more fat even at rest. This metabolic acceleration is also the primary factor helping patients quickly get rid of problems such as diabetes and high cholesterol.
What is the importance of exercise after surgery?
Although surgery starts the weight loss, exercise largely determines where this weight will go. In patients who lose weight only with diet, the risk of muscle loss is high, which causes the metabolism to slow down and sagging to increase. Regular exercise, especially resistance training, maximizes the body's fat burning rate by protecting muscle mass. Weekly 150 minutes of moderate-intensity physical activity is the strongest factor preventing the regain of weight in both sleeve gastrectomy and bypass patients. Also, exercising regulates the psychological fluctuations that occur after rapid weight loss and helps the patient adapt to the new body image in a more positive way.
Do emotional eating habits change the results?
The surgery shrinks your stomach but does not change your mind. Individuals with emotional eating habits (those who turn to food in moments of stress, sadness, or happiness) can find ways to bypass the physical restriction of the surgery. For example, a patient who cannot eat solid foods can sabotage the weight loss process by constantly melting and eating high-calorie chocolate or consuming sugary drinks. This situation also brings the risk of "cross-addiction"; the place of food can sometimes be taken by alcohol or shopping. Therefore, it is of vital importance for patients with emotional eating problems to receive psychological support before and after the surgery so that the physical advantage provided by the surgery is supported by a mental discipline.
In which cases is revision surgery necessary?
Revision surgery comes to the agenda when sufficient weight loss cannot be achieved after the first surgery or when the lost weight is significantly regained. Also, revision may be required in cases of uncontrollable reflux developing after sleeve gastrectomy. Generally, when a patient who has had sleeve gastrectomy gains weight, this procedure is converted to a gastric bypass. In this way, malabsorption is added to the restriction. However, revision surgeries are more complex and risky procedures than the first surgery. Therefore, it is aimed that patients show maximum compliance in their first surgery and do not need revision. The success rate in revisions may be slightly lower than in the first operation.
In which method is the recovery process more comfortable?
Since both surgeries are performed with the laparoscopic (closed) method today, recovery times are quite short. However, sleeve gastrectomy surgery is technically simpler as it does not involve intestinal intervention and the anatomy remains more natural. Patients usually start walking 3-4 hours after the surgery and are discharged on the 2nd day. In gastric bypass surgery, because there are intestinal connections (anastomosis), the return of intestinal movements to normal may take a bit longer and complication monitoring requires a bit more meticulousness. Still, most patients can return to desk jobs within a week in both methods. There is no significant difference between them in terms of pain control.
Do surgical complications affect weight loss success?
Surgical complications, especially in the first months, can directly affect the patient's nutritional pattern and morale, disrupting the weight loss process. For example, if a leak or narrowing develops, the patient may need to be re-hospitalized, fed intravenously, or undergo additional procedures. This situation leads to muscle loss and metabolic stress. However, in the long run, after complications are successfully treated, patients can reach their weight loss goals. What is critical here is that complications are diagnosed on time and managed by an experienced team. Patients who go through a healthy recovery process stick to their diet and sports programs more tightly by maintaining their motivation.
Does the patient's age change the rate of weight loss?
Age is a factor that directly affects the metabolic rate. Patients in their 20s and 30s generally lose weight much faster because they have higher muscle mass and a more active hormonal structure, and their skin elasticity is better. In patients over 60 years of age, weight loss may be slower and the body may be more resistant to fat burning. However, at advanced ages, the main goal of the surgery is not just to lose weight, but to get rid of joint pain, control diabetes, and increase quality of life. Although younger patients get faster results, patients of all ages can reach a healthy weight by taking advantage of the metabolic benefits offered by the surgery.
Is gender a factor in surgical success?
As a general observation, male patients tend to lose weight faster than female patients in the post-operative period. The primary reason for this is that men generally have more muscle mass and their basal metabolic rate is higher. Also, the fat distribution of men is generally "apple type" (abdominal region), and these fats are metabolically more active and burned quickly. In women, hormonal cycles, menopause effects, and "pear type" fatness can slow down the rate of weight loss a bit. However, in the long run, both genders reach similar success rates with correct nutrition and an active lifestyle. Weight loss success depends on individual discipline rather than gender.
How is the improvement of comorbidities related to weight loss?
The improvement of comorbidities related to obesity (hypertension, sleep apnea, cholesterol, etc.) is in a linear relationship with weight loss. Usually, even when the first 10% of excess weight is gone, a significant relief in sleep apnea and a dose reduction in blood pressure medications are seen. The improvement of diabetes after gastric bypass starts much earlier with hormonal changes, regardless of weight. As weight loss continues, the load on the joints decreases and chronic pain alleviates. These improvements put the weight loss process into a positive cycle by allowing the patient to transition to a more mobile life. Getting healthy as you lose weight, and being healthier as you lose weight is the biggest reward of this process.
Does the pre-operative preparation process affect the results?
The preparation made before the surgery determines both the safety of the surgery and your success after the surgery. The "liver shrinking diet" applied before the surgery reduces the risk of complications by allowing the surgeon to work more comfortably inside the abdomen. Also, losing a few kilos before the surgery is an indicator that the patient has entered a mental discipline. Meetings held with a nutritionist and psychologist before the surgery are a rehearsal of the "new life" after the surgery. Patients who take the preparation process seriously cope much more easily with the difficulties they encounter after the surgery (liquid diet, portion control, etc.) and maximize their weight loss potential in the first year.
How important is psychological support in weight maintenance?
Obesity surgery changes the body but does not destroy the "obese individual" perception in the mind in one day. While patients lose weight rapidly, they may sometimes have difficulty recognizing their bodies or be disturbed by the attention of those around them (body dysmorphia). Also, people who use food as a coping mechanism can fall into a void when this mechanism is taken out of their hands. Psychological support is critical for managing this emotional transition period, treating eating disorders, and developing self-esteem. Long-term research shows that patients who receive regular therapy or participate in support groups maintain their weight much more successfully than those who proceed alone. Psychological resilience is the hidden hero of permanent weight loss.
Does alcohol and cigarette use prevent weight loss?
Smoking slows down tissue healing after surgery and seriously increases the risk of stomach ulcers and leaks; this puts the process in danger. Alcohol is one of the biggest enemies of weight loss. Alcohol has a high energy called "empty calories," and since its absorption is very fast in gastric bypass patients, it can cause heavy intoxication and fatty liver even in very small amounts. Furthermore, alcohol weakens the will and leads the patient to unhealthy foods. A patient who wants to maximize the weight loss process is recommended to stay completely away from smoking and keep alcohol consumption to a minimum, preferably not consuming it at all.
Why is protein consumption so critical?
The cornerstone of nutrition after surgery is protein. During rapid weight loss, the body is inclined to burn not only fats but also muscle tissue to meet its energy needs. If sufficient protein (60-80 grams daily) is not consumed, muscle loss occurs; this leads to weakness, hair loss, sagging, and most importantly, a slowing of the metabolism. Protein is also the food group that maintains the feeling of fullness for the longest time. Giving priority to protein (eggs, chicken, fish, legumes) at every meal is a rule for both sleeve gastrectomy and bypass patients. Adequate protein intake helps the body tighten and keeps the immune system strong, speeding up recovery.
How does the liquid diet period trigger weight loss?
The first 15-day liquid period after surgery is the phase when the body is introduced to very low calories and enters the ketosis process. During this period, the stomach stitches are still fresh and the stomach should not be tired for healing. Consuming only water, meat broth, protein drinks, and sugar-free compotes triggers the body to start using stored fats as energy. In this phase, patients usually lose their fastest weight (sometimes 10 kilos in 2 weeks). However, this is not a "diet," but a surgical necessity. The liquid period allows the patient to learn to respect their stomach and creates the necessary mental infrastructure for portion control in the transition to solid food.
What should be considered when transitioning to solid food?
When transitioning to solid food at the end of approximately 1 month, the "20-20-20 rule" gains importance: Every bite should be chewed 20 times, meals should last at least 20 minutes, and liquid intake should be stopped 20 minutes before/after the meal for solid-liquid separation. Chewing bites very well prevents fatigue of the small stomach and feelings of vomiting or discomfort. In this period, foods should be tried gradually against the risk of "dumping syndrome." Transition to solid foods is the time when the patient feels satiety signals most clearly. If the patient eats rapidly, the stomach fills and pain occurs before the stomach signal reaches the brain. Eating patiently and with awareness is the most important discipline for success after surgery.
Is sagging after surgery related to the rate of weight loss?
Sagging is directly related to the amount of weight lost, the speed, the patient's age, genetic skin structure, and whether or not they exercise. It is difficult for the skin to completely recover itself in large losses such as 40-50 kilos. Especially the very rapid weight loss experienced in the first 6 months after sleeve gastrectomy or bypass causes the skin to not keep up with the shrinkage speed. However, these saggings are not a failure, but traces of a great success. Although regular protein intake and muscle exercises reduce sagging a bit, body shaping surgeries (aesthetic surgery) can be considered as an option after the weight loss process is completed (usually after 1.5-2 years) for permanent and intense sagging.
Which surgery is considered safer?
Thanks to modern technologies and increasing surgical experience, both sleeve gastrectomy and gastric bypass surgeries are very safe procedures; their risk rates are as much as gallbladder surgery. However, sleeve gastrectomy surgery is technically considered "simpler" as the intestines are not intervened in and the operation time is shorter. Gastric bypass, on the other hand, is a slightly more complex procedure as it involves more stitch lines and connections. In terms of long-term safety, while sleeve gastrectomy carries a risk of reflux, bypass carries a risk of absorption disorder and vitamin deficiency. Which surgery is "safer" for you is determined by your surgeon based on your personal medical history (reflux, diabetes, previous abdominal surgeries, etc.).
Does the choice of doctor play a role in weight loss success?
The experience of the doctor plays a critical role not only at the operating table but also in the follow-up process afterwards. Bariatric surgery is a team effort; having a diyetisyen, psychologist, and coordinator specialized in obesity besides the surgeon directly affects your success. An experienced surgeon minimizes complications, while a strong follow-up team makes the necessary interventions for you when your rate of weight loss drops or your motivation decreases. Success rates are always higher in centers that follow their patients for years instead of the "operate and leave" approach. The number of cases of your surgeon and their competence in revision surgery provide you with a safe harbor.
How critical are personal goals in choosing surgery?
The choice of surgery should be based not only on medical data but also on the patient's lifestyle and future plans. For example, in a young woman planning to have a child soon, sleeve gastrectomy surgery, where vitamin absorption is better, can be prioritized. On the other hand, the deterrent effect of gastric bypass may be more beneficial in a patient who has an excessive fondness for sweets and is at the limit of diabetes. The patient's expectation from the surgery (just losing weight or getting rid of metabolic diseases?) should be discussed openly with the physician. Remember that the best surgery is the method that the patient can comply with for a lifetime and will feel the least risk of complications.
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