## Who should consider it? Any surgery is a risk, so resort to surgery only if your weight has significantly increased and threatens your health and wellbeing. The indications for bariatric surgery are: - Age 18 to 60 years old - BMI (body mass index) of 40 and over - BMI 30–40 in the presence of serious concomitant problems such as metabolic syndrome or type 2 diabetes, cardiovascular diseases, joint lesions, obstructive sleep apnea syndrome - BMI less than 30 with a sharp increase in weight and a history of obesity ## How does it work? Bariatric surgery uses two approaches. The first is a restriction (shrinking of the stomach), by which the amount of food eaten is limited, but the satiety center of the brain receives the signal that the stomach is full. The second is malabsorption, which is a reduction in the absorption of calories and minerals. This creates a "bypass route" for food — it enters the intestine and bypasses the 12 duodenum, which receives digestive enzymes. Until recently, doctors used to put a balloon in the stomach, which took up part of the space. Then temporary bandages were invented, with the help of which a small stomach was formed. Over time, it became clear that such operations were ineffective and fraught with serious complications. Today, doctors use endoscopic methods to treat obesity in the stomach and small intestine. They are less invasive and may be suitable for more people. For example, one method is endoscopic gastroplasty, in which the patient has a restrictive reduction of the stomach through the mouth using a gastroscope and a special stapling apparatus. The stomach is sutured, its volume is reduced, and the person eats less. This technology allows for minimal surgical intervention and improves postoperative rehabilitation. Additionally, a transpyloric shuttle (BAROnova Inc. Goleta, USA) can be launched into the stomach using an endoscope. While in the stomach, it moves up and down to open and close the exit section, allowing it to regulate the filling of the stomach and the flow of food into the intestine. Doctors also do laparoscopic minimally invasive surgeries including sleeve resections, gastrostomy, aspiration therapy, and more. ## How effective is it? The success of the surgery depends on the patient. If he or she clearly follows all the doctor's instructions for diet and lifestyle, he will begin to lose weight by about 10 % per month. There is a possibility of a slight slowdown to 3–5 %, but eventually, 70–80 % of excess weight can be eliminated. That is, if you are 5’6 tall and weigh 375 lbs, you can expect to lose 155–175 lbs of weight. The body adapts to new realities within a year, and in 1.5–2 years the weight loss reaches the plateau stage. ## What are the risks? - Complications after bariatric surgery occur in 2–5 % of cases, depending on the type of intervention. - Sagging of the skin due to rapid weight loss. - You will have to get used to every food item all over again. Unpleasant digestive problems are possible. - In the first 6 months after surgery, health problems such as gallstone formation may occur. - Vitamin and mineral deficiencies.