From fertility worries to cosmetic concerns, we answer women’s biggest surgical weight-loss consultation questions.
About 80% of surgical weight loss patients are women, says Meredith Duke, M.D., a surgeon in the Vanderbilt Surgical Weight Loss Program. And women have some unique considerations when it comes to deciding whether to undergo the procedure. We asked Dr. Duke to answer some top questions women have on their minds about the surgery. These were some common surgical weight-loss consultation questions she has received.
Are women typically happy with the procedure?
Duke said she asks her patients a year out from their procedure if they have any regrets. Most often they tell her they’d wished they’d had the surgery sooner.
“So many people feel like they’ve gained the future freedom of health,” she said, especially since many women get off medications for conditions like type 2 diabetes and hypertension. “And they feel like they can really play and interact with their kids and get on a plane without a seatbelt extender. Things that they didn’t really think would ever be possible in their lives are made possible with surgery.”
Surgery is only the beginning and serves as a jumpstart to one’s weight loss journey. “This is a tool that allows people to have the success that they weren’t able to have before,” Duke said. She explained that weight loss is often a complicated battle against one’s own genetics and metabolism.
Will surgical weight loss affect fertility?
Bariatric surgery has the potential to restore fertility, often related to polycystic ovarian disease. “For women who did not have normal cycles before surgery,” Duke said, “up to 70 percent of them will develop normal cycles after surgery.”
To avoid nutrient deficiencies and other concerns, the surgical team at Vanderbilt typically recommends that people wait 12 to 18 months after the procedure before trying to get pregnant. This period allows the body to adapt.
The great news is, after weight loss surgery, pregnancy risks associated with obesity tend to decrease, Duke said. Gestational diabetes, preeclampsia, preterm labor or having a baby that is either too small or too large for its gestational age are all risks that go down with weight loss.
How will surgical weight loss affect other conditions?
Bariatric surgery can ease or eliminate other symptoms of PCOS, as well, such as excess facial hair and thickening of the skin. “What a lot of people don’t realize is that bariatric surgery is not cosmetic,” Duke said. “It is a treatment for obesity-related comorbidities.”
Another comorbidity that often improves with weight loss surgery is type 2 diabetes. “We cure type 2 diabetes for some, and most others get their blood sugar under significantly better control with fewer medications after bariatric surgery.”
Medications that patients will typically remain on long-term, however, include those for depression and anxiety. “A lot of patients think that if they get thinner and they get off some of their medicines that they’re going to have less depression,” Duke explained. “And in reality, surgery can be stressful, and we don’t find that it’s recommended to stop those medications. We continue those during and after surgery.”
How will weight loss surgery alter appearance?
Weight loss will change one’s body shape, and some women have concerns about where the weight will come off. Although Duke said she can’t predict where inches will be lost, she noted that it tends to be from all over the body and fairly uniform. Sagging skin is another concern, but each situation is unique to the individual. Some women choose to undergo plastic surgery after weight loss, while others don’t experience sagging skin or aren’t bothered by it. Some bariatric surgery patients also experience thinning hair, but Duke said that can often be minimized with diligent attention to vitamins and minerals.
What are the risks associated with surgical weight loss?
“A lot of patients come in and they say, ‘I want to get smaller and I want to get healthier, but I don’t want to have any complications. I don’t want to die from surgery,’” Duke said. She puts her patients at ease by letting them know the risk of death with weight loss surgery is the same as for gall bladder surgery; it’s incredibly small. “There are certainly risks associated with any surgery,” she explained, “but obesity is dangerous, too. Your all-cause mortality goes up about 10 percent for every five BMI points above normal. So walking around with a BMI of 40 or 45 is significantly riskier to your mortality than surgery.”