Bariatric surgery: Types, benefits, costs and NHS options in the UK

Weight loss surgery works by stopping you from eating as much (usually by reducing the size of the stomach), changing how your stomach or intestines handle food, or using a combination of both methods.

The most common types of bariatric surgery are the gastric bypass, gastric band, gastric balloon, and sleeve gastrectomy. Let’s explore these in more detail.

Gastric bypass

A gastric bypass is a surgery that involves cutting the stomach into 2 parts. For the most common type, known as Roux-en-Y, the top part is made into a small pouch, which is then connected straight to your small intestine, but lower down, bypassing the other part of your stomach completely. Other types of gastric bypass may have slightly different configurations.

After the surgery, the food you eat will completely bypass the lower part of the stomach and the first part of the small intestine. Because of this, you will absorb fewer calories in your food, and you will feel fuller sooner as the size of your stomach has shrunk. Feeling fuller sooner should help you to eat fewer calories.

Although a gastric bypass can be useful for absorbing fewer calories, it can also make it harder to absorb important vitamins and minerals. In some cases, a leak may form where the new stomach pouch attaches to the small intestine.

Gastric band

A gastric band is a specially-designed silicone band that’s inserted around the top part of the stomach. As the stomach is then split into 2 parts, the top part fills up with food more quickly, telling your brain you’re full. The food you’ve eaten then gradually moves into the other part of the stomach and then into your intestines.

Once the band is inserted, you’ll need to eat less food to feel full. How much food you can eat depends on where the band is placed within the stomach.

The band is inserted during a surgical procedure, but it’s still possible to adjust the band from the outside of your body once the surgery is over. A port is placed underneath your skin so the band can be adjusted by a doctor to find the best positioning.

Over time, the band may need to be replaced or its positioning may slip, meaning you may need another surgery. The band can also be taken out at a later point in time if you change your mind about the procedure, but people often regain the weight they’ve lost in these circumstances.

Gastric band insertion is one of the most common and safest weight loss surgeries, although it does come with some risks. It can take some time to get used to the band once it’s fitted and to change your eating habits to feel comfortable and lose weight.

Gastric balloon

A gastric balloon is a soft, expandable silicone balloon that is inserted into your stomach through your gullet (oesophagus).

Before insertion, a special tiny camera is passed through your mouth and oesophagus into your stomach to check for anything that could cause a problem, such as a hernia or ulcers.

Once the doctor knows it’s safe to insert the balloon, you’ll swallow it, and then a tube will be passed down to fill it with water. The water allows it to fill up an area of your stomach and keeps it in place.

New technology has also been developed, so it’s possible to swallow the balloon without the need for the camera and then have an X-ray afterwards to check it’s in the right position.

As there’s less space in your stomach after the balloon is inserted, you’ll need to eat less to feel full. A gastric balloon can only be kept in place for up to 6 months, so it’s a temporary solution. It may be possible to replace the balloon with another, but they are typically used as a short-term weight loss intervention.

Sleeve gastrectomy

A sleeve gastrectomy involves removing one side of your stomach so that just a “sleeve” remains. The part of the stomach that’s left after the operation resembles a small tube that connects the oesophagus to the small intestine.

Since the stomach is smaller, you can only eat a small amount of food before feeling full, which helps you lose weight.

This type of operation is usually much quicker than a gastric bypass and may be suitable for people for whom more complex surgery would be too risky. It may be possible to do another operation later to convert the sleeve into a bypass, which typically leads to better weight loss results.

Like all types of surgery, bariatric surgery comes with risks, including an increased chance of:

• a blood clot in the lungs (pulmonary embolism)
• a blood clot in a vein (deep vein thrombosis)
• a lung infection
• a wound infection
• excess bleeding
• death (very rare)

If you have a general anaesthetic, there are more risks than if you just need a sedative for your procedure. Being obese increases the chance of experiencing complications of a general anaesthetic.

After surgery, if you lose a lot of weight, there is a chance that you’ll be left with large amounts of loose skin. Cosmetic surgery may help with this, but it’s not always funded on the NHS.

Losing a lot of weight can also increase your risk of developing gallstones.

Each type of surgery comes with its own individual risks. A gastric band could slip or erode through the stomach. Common symptoms are feeling sick, being sick, or experiencing heartburn.

A gastric bypass or sleeve can sometimes leak, causing food and stomach contents to spill into your abdomen. This will need treatment with antibiotics.

Sometimes, after a weight loss surgery, the stomach or intestine can become narrowed with scarring and become blocked. Cutting up your food into small pieces, chewing well, and not drinking with your meals can help avoid this.

If some of your stomach and small intestine have been removed, you may be at risk of developing a vitamin deficiency as your body cannot absorb vitamins as easily. This can be treated by taking a supplement.

What recovery after bariatric surgery looks like

Depending on the type of surgery you’ve had, you’ll usually be able to return home from the hospital around 1 to 3 days after your procedure. It can take 4 to 6 weeks to feel like yourself and get back to your usual routine.

Regardless of the type of surgery you’ve had, you’ll usually need regular follow-up appointments for the rest of your life. This will usually be with a specialist for the first few years, then if things are going well, your GP may be able to take over.

During these appointments, your vitamin levels will be monitored via blood tests, and you’ll have time to discuss your physical and emotional health.

If you’ve had a gastric band fitted, you’ll need a follow-up appointment to adjust the settings of the band depending on what you’re eating and how you’re feeling. You’ll need an appointment to remove your gastric balloon after 6 months if this is the procedure you’ve had.

If you want to get pregnant, you should avoid pregnancy in the first 12 to 18 months after your surgery because the impact that rapid weight loss has on a developing baby is not yet fully understood. You may find that losing weight improves your fertility, so make sure to consider contraception.

After your surgery, your body has changed, and you will no longer be able to eat and drink in the same way that you used to.

You'll need to make some changes, including:

• eating more slowly
• chewing carefully
• eating small amounts at a time (especially to start with)
• being careful when eating foods that can block your stomach (like soft white bread)

As your body is no longer able to absorb nutrients in the same way it could before, you should take regular vitamin and mineral supplements. This will ensure your body gets everything it needs, helping you avoid a deficiency.

After your surgery, you’ll be provided with a personalised diet plan to follow. You may not be able to eat solid foods right away as your body needs time to recover.

A typical diet plan includes water and other fluids, including thin soups, for the first 2 weeks, progressing to runny foods for 2 weeks (like yoghurt or puree), soft foods for 2 weeks (like mashed potato), and then a gradual return to a healthy diet of solid foods.

Remember, you’ll be able to eat significantly smaller portions than you could before. That does not mean you’ll lose weight regardless of what you eat or drink, however, and you’ll need to be careful of sugary drinks that are high in calories but do not fill you up.

Although you will not be able to exercise right after surgery, it’s important to work out regularly when you feel up to it or when your surgeon has told you that you can. This will help you maintain your muscle mass as you lose weight.

Weight loss surgery is a specialised treatment that requires a referral to a weight loss clinic.

You may be eligible for bariatric surgery if you:

• have a body mass index (BMI) of at least 40
• have a BMI between 35 and 40 and a weight-related health condition, like high blood pressure, diabetes, arthritis, or breathing problems
• agree to attend follow-up appointments and make lifestyle changes

If you are from a South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family background, a lower BMI cut off may be used.

Bariatric surgery availability varies in different areas of the UK, and it’s not always possible to access it through the NHS. You may be able to pay to have the surgery done privately, but this is often expensive.

If you can access weight loss surgery through the NHS, the surgery is free. However, if you cannot, you may choose to pay privately for bariatric surgery.

A private provider may offer surgery based on a lower BMI cutoff as long as they feel it’s the best option for you.

Prices for private bariatric surgery vary from £4,000 to £15,000 (and upwards). A gastric balloon or gastric band tends to be at the cheaper end of this range, costing £4,000 to £8,000, while a gastric sleeve or gastric bypass surgery tends to be at the upper end.

Although bariatric surgery typically gives the best weight loss results, it comes with risks and is not suitable for everyone. Weight loss surgery is not the only option – there are lots of other effective weight loss treatments available, including injections and tablets.

Orlistat

This weight loss tablet works by blocking the absorption of fat in your diet. You take orlistat 3 times a day with meals that contain fat.

Orlistat is available under the brand names Xenical, which contains the full 120mg dose, and alli, a lower dose medication that’s available without a prescription.

Around 60% of people taking orlistat lose at least 5% of their body weight within 12 weeks.

Mysimba

Mysimba is another weight loss tablet that’s taken daily to start with, then increased to twice daily. It works on the hunger centres in the brain that are responsible for your food cravings, and contains the ingredients naltrexone and bupropion.

In clinical trials, 50.8% of people taking Mysimba lost at least 5% of their body weight within 16 weeks.

Mounjaro

Mounjaro is a GLP-1 weight loss injection. It works similarly to hormones found naturally in the body to regulate blood sugar levels, slow down how quickly the stomach empties, and act on the brain’s hunger centre.

Mounjaro should be injected once weekly, and results show 96.3% of people lose at least 5% of their body weight within 72 weeks at the highest dose.

Wegovy

Another GLP-1 medication, Wegovy, works in a very similar way to Mounjaro and is also injected weekly.

Studies suggest that 83.5% of people taking Wegovy lose 5% or more of their body weight within 68 weeks when taking the highest dose.

Nevolat

Nevolat or generic liraglutide is also a GLP-1 receptor agonist that is injected daily. Research shows that 67.5% of people taking liraglutide 3.0mg can lose 5% or more of their body weight within 12 weeks.

If you’d like to explore the alternatives to weight loss surgery, Asda Online Doctor offers a variety of weight loss medications as part of our weight loss service. Simply fill in the online consultation form to get started: