Eve Glazier and Elizabeth Ko

DEAR DOCTOR,

I feel like I’ve tried every diet, and no matter what, I just can’t seem to lose weight. A friend who had a surgery that removed part of her stomach was finally able to lose 65 pounds. I wonder if that’s safe?

— TUCK, DROP AND ROLL

DEAR ‘TUCK,’

You’re referring to a sleeve gastrectomy, a laparoscopic surgery that promotes weight loss by changing the digestive system. In a sleeve gastrectomy, the surgeon removes about three-fourths of the stomach, then uses the remaining tissue to create a pouch shaped somewhat like a banana.

The new stomach is significantly smaller, which restricts the amount of food that it can hold. That means feeling satiated faster and with a smaller volume of food. This change in stomach size also results in a reduction of ghrelin, the so-called “hunger hormone,” which is produced primarily by the stomach. A decrease in ghrelin causes a decrease in feelings of hunger.

Sleeve gastrectomy, which is not reversible, is an increasingly popular procedure that began in the early 1990s. Originally introduced as part of a two-step weight-loss surgery, it has since become a stand-alone procedure. Unlike other bariatric procedures, such as gastric bypass surgery, the sleeve gastrectomy isn’t as strongly associated with malabsorption of nutrients, which can lead to malnutrition.

Patients who qualify for this surgery are typically between 18 and 75 years old, are morbidly obese, have a body mass index (BMI) of 40 or more and prior difficulty trying to lose weight. Although results vary, patients can lose 60% of their excess weight in the first two years after surgery.

As with any surgery, sleeve gastrectomy carries risks. Bleeding, infection, adverse reaction to anesthesia and blood clots are risks common to all surgeries. Although rare, it is possible for the newly formed “sleeve” to leak. Longer-term complications can include an increase in acid reflux, hypoglycemia, malnutrition, gastric obstruction and ulcers.

Some researchers believe the drop in ghrelin may also have long-term effects that are not yet known. Ghrelin not only stimulates appetite, it aids in fat storage and plays a role in regulating blood sugar and in the release of growth hormones.

After the procedure, while the digestive tract is healing, patients must follow a structured eating plan that provides nutrients but doesn’t stretch the newly constructed stomach. The first stage restricts patients to a liquid diet. This is followed by a gradual switch to pureed foods, followed by soft foods.

About three months after surgery, patients will have completed a highly controlled switch to solid foods. Life with a sleeve gastrectomy means small, nutrient-dense meals. Dehydration is a risk, so it’s important to drink plenty of water each day.

In our own practices, we continue to first recommend conservative lifestyle interventions for weight loss. These include following a regular exercise program, working on nutrition and sometimes talking with a therapist. However, we have had patients who do everything correctly and are unable to reach a safe and healthy weight.

In those cases, we find that weight loss surgery can be effective.

Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu

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