Obesity and Metabolic Surgery
Obesity surgery is the group of surgical treatments used in advanced obesity when diet and exercise have not produced a lasting result. The aim is not weight loss alone but a change in the course of obesity-related conditions such as type 2 diabetes, high blood pressure, sleep apnoea and fatty liver disease.
Who is assessed for obesity surgery
- People with a body mass index (BMI) of 40 or above.
- People with a BMI between 35 and 40 who have at least one obesity-related condition such as type 2 diabetes, hypertension or sleep apnoea.
- In selected patients with type 2 diabetes that cannot be controlled, the BMI range of 30–35 may also be assessed for metabolic surgery.
- A documented period of supervised diet and lifestyle change without a lasting result is expected.
- Uncontrolled psychiatric illness, active alcohol or substance use and severe systemic disease affect suitability.
Why surgery is needed
In advanced obesity the body resists weight loss hormonally. Hunger hormone levels rise, satiety signals weaken and basal metabolic rate falls. This is why most of the weight lost through willpower and calorie restriction alone is regained within a few years.
Obesity surgery changes that hormonal balance. The result is determined as much by removing or bypassing the regions where hunger and satiety hormones are produced as by the reduction in stomach volume. This is where the term "metabolic surgery" comes from.
Which operation suits whom
There is no single correct operation. The decision rests on body mass index, eating patterns, the presence of reflux, the duration of type 2 diabetes and whether insulin is used.
- Sleeve gastrectomy is generally the shorter option and leaves the continuity of the digestive tract unchanged.
- Gastric bypass may come to the fore in patients with significant reflux or long-standing insulin-treated type 2 diabetes.
Both operations can be performed robotically or laparoscopically in suitable patients.
Preparation before surgery
Obesity surgery is the work of a team rather than a single doctor. Before the operation, assessments are made by endocrinology, respiratory medicine, cardiology, psychiatry and a dietitian. Upper gastrointestinal endoscopy examines the lining of the stomach.
These assessments improve the safety of the operation and also determine which procedure is chosen.
Life after surgery
The operation is not the sole cause of weight loss; it is the tool that starts the process. What makes the result durable is the eating pattern afterwards, protein intake, regular activity and continuing follow-up.
Eating progresses stepwise from liquids to solid food. Supplements of vitamin B12, iron, vitamin D and calcium are usually continued for life, with blood levels checked at regular intervals.
Key facts
| Main operations | Sleeve gastrectomy, gastric bypass |
|---|---|
| Method | Laparoscopic or robotic (keyhole) |
| Anaesthesia | General anaesthesia |
| Hospital stay | Usually 2–4 days |
| Return to work | About 2–3 weeks for desk-based work |
| Follow-up | Lifelong vitamin and mineral monitoring with regular review |
How the process works
First consultation
Weight history, previous diets, accompanying conditions and expectations are discussed.
Investigations
Blood tests, endoscopy, ultrasound and the necessary specialist reviews are completed.
Decision
The appropriate operation, its risks and the expected outcome are considered together with the patient.
Surgery
Performed by the keyhole method; patients usually get up on the day of the operation.
First six weeks
A stepwise eating programme from liquids to solids is followed with a dietitian.
Long-term follow-up
Reviews at 3, 6 and 12 months, then annual follow-up with vitamin level checks.
Frequently asked questions
Can the weight be regained after obesity surgery?
Partial regain can occur if the eating pattern and activity habits are not maintained. This is why regular follow-up and dietitian support are an inseparable part of the process.
How long before I can return to work?
Desk-based work is usually possible within 2–3 weeks. For physically demanding work the period is longer and is planned individually.
Can I become pregnant after surgery?
Yes, but pregnancy is not advised during the first 12–18 months when weight loss is rapid. This should be planned before surgery and reviewed together with an obstetrician.
Will I have loose skin?
Loose skin can follow rapid and substantial weight loss. Regular exercise and adequate protein intake reduce the effect; where it is marked, plastic surgery options are considered once weight has stabilised.
I live abroad — how does the process work?
You can send your existing test results in advance by WhatsApp or email. After an initial review, examination, investigations and the operation can be scheduled consecutively to suit your travel plans.
The information on this page is for general guidance only and does not replace a consultation. The treatment that suits you can only be determined after examination and tests.
Appointments and enquiries
Describe your symptoms and questions briefly; you will receive a reply after review.