Bariatric and Metabolic Surgery with Dr. Kyle Thompson
Is metabolic and bariatric surgery safe and effective?
In this episode, we unpack the ins and outs about this weight management intervention. I'm joined by Dr. Kyle Thompson, a bariatric and foregut surgeon at St. Joe's Hospital in Denver. Dr. Thompson completed his general surgery residency at St. Joe’s and a fellowship in minimally invasive and bariatric surgery at the Minnesota Institute for Minimally Invasive Surgery.
On top of that, he’s the chair of Surgical Subspecialties at St. Joe’s and sits on the boards of the Denver Academy of Surgery and the Colorado Obesity Society, with a focus on bariatric surgery and surgical education. Needless to say, he’s an expert in his field.
When it comes to weight loss, bariatric surgery is an evidence-based option that can also make a big difference in managing conditions like diabetes, sleep apnea, and heart disease. In this episode, Dr. Thompson breaks down the safety and benefits of the most common bariatric procedures.
Eager to learn more? Continue reading to get all the details on bariatric surgery.
Sleeve, Gastric Bypass, and SADI (Single Anastomosis Duodenal-Ileostomy)
Bariatric surgery has become an effective solution for weight loss and the management of metabolic diseases. With different surgical options available, understanding how they work can help patients make informed decisions about their health.
Sleeve Gastrectomy
The most commonly performed weight loss surgery worldwide is the sleeve gastrectomy, also known as the vertical sleeve gastrectomy. This procedure involves reducing the stomach’s size from that of a football to about the size of a banana, removing roughly 80% of the stomach. The primary mechanism for weight loss in this surgery is restriction—patients feel full after consuming just a few bites of food, which naturally decreases how much we eat.
Additionally, this procedure affects hormones, particularly by reducing ghrelin, our “I’m hungry” hormone. However, compared to other bariatric surgeries, the sleeve has fewer metabolic benefits since ghrelin is not as critical to metabolic health as hormones like GLP-1 or GIP, which play a major role in appetite and satiety.
Gastric Bypass
Another widely used bariatric procedure is the gastric bypass, which not only reduces stomach size (to just about the size of an egg) but also re-routes the digestive system by bypassing the first part of the small intestine. This surgery is sometimes referred to as a “natural GLP-1 agonist” because it leads to hormonal changes similar to those seen in patients using GLP-1-based medications.
The result is reduced appetite, earlier satiety, and improved metabolic outcomes. Patients undergoing gastric bypass often experience greater weight loss and better resolution of conditions like high blood pressure and diabetes compared to those undergoing sleeve gastrectomy.
The SADI Procedure
A newer option gaining popularity is the Single Anastomosis Duodenal-Ileostomy (SADI). This surgery is a modification of the traditional duodenal switch, which has been available for decades but is less common due to its higher risk. The SADI procedure begins with a sleeve gastrectomy, followed by an intestinal bypass that is more extensive than a gastric bypass. The main advantage of SADI is that it requires only one intestinal connection rather than two, which reduces potential complications while still providing substantial and sustained weight loss.
The American Society for Metabolic and Bariatric Surgery (ASMBS) officially endorsed the SADI procedure in 2020, and since then, it has continued to gain acceptance. Although the traditional duodenal switch remains an option, it is performed less frequently due to its higher risk of complications such as chronic diarrhea and nutrient deficiencies. SADI offers a middle ground, delivering comparable weight loss benefits with a lower complication rate, making it a promising alternative for patients seeking long-term results.
Why Bariatric Surgery Works Long-Term
One common concern about bariatric surgery is the belief that the stomach stretches out over time, making the procedure less effective. However, this is really a misconception. While the sleeve or gastric bypass pouch may become slightly more compliant, meaning it does not feel as restrictive as it did in the initial days after surgery, it does not return to its original size. Patients still experience fullness after consuming small portions, and this effect remains for life.
This durability is what sets weight loss surgery apart from other interventions like diet, exercise, or even medications, which often stop working once discontinued.
When powerful GLP-1 medications first became available, many patients sought them as an alternative to surgery. However, accessibility and affordability remain significant barriers. Many individuals lack insurance coverage for these medications, leaving surgery as the most viable option for achieving substantial, long-term weight loss. Research continues to show that bariatric surgery remains the most cost-effective method for treating obesity on a larger and long-term scale.
It is important to recognize that no single approach guarantees success on its own. Weight loss—whether achieved through diet, exercise, medication, or surgery—requires ongoing commitment. The human body naturally resists weight loss and strives to regain weight over time. Surgery provides a powerful tool, but patients must still support it with healthy eating, regular movement, and other lifestyle changes to maintain their results lifelong.
Dr. Thompson explained that a helpful way to think about weight loss is as a pie chart, where different factors contribute in varying proportions. Surgery is just one piece of the pie, alongside medications, diet, exercise, sleep, and other lifestyle factors. Each person’s journey is unique—some respond better to dietary changes, while others may find more success with surgery or medication. The key is using these tools together to create a sustainable, individualized approach to managing weight and overall health.
Bariatric Surgery: Common Questions and Realities
Many patients considering bariatric surgery wonder about weight loss expectations, risks, and recovery. Data shows that weight loss varies by procedure—around 20% of total body weight with a sleeve gastrectomy, 30% with gastric bypass, and up to 40% with a duodenal switch. For a 300-pound patient, this could mean reaching 180 pounds, a life-changing outcome that makes surgery an appealing option.
Despite its effectiveness, many hesitate due to fear of surgery. This is understandable, but modern bariatric procedures are minimally invasive and as safe as gallbladder removal. Advancements, including a multidisciplinary approach and improved techniques, have significantly lowered risks while ensuring better long-term outcomes.
Updated guidelines now recommend surgery for patients with a BMI over 35, or over 30 with obesity-related conditions like diabetes or hypertension. However, many insurance providers have yet to adopt these changes. While people often assume surgery is only for extreme cases, many qualify without realizing it. Obesity is more common than perceived, and surgery offers a powerful tool for long-term weight management when combined with lifestyle changes.
Obesity Treatment Isn’t Cheating—It’s Healthcare
There’s often resistance to medications or surgery for obesity, with many believing lifestyle changes should be enough. However, those in the field know that unfortunately diet and exercise alone don't often lead to lasting results. Biological factors, hunger, and social challenges make sustained weight loss particularly difficult.
Even in health-conscious places like Colorado, most people seeking medical help have already tried lifestyle changes. Plus, weight loss triggers physiological responses like increased hunger and slowed metabolism, making it tough to maintain long term. While promoting healthier food and exercise is important, it hasn’t stopped the rise rates of obesity.
Unfortunately, the stigma around medical treatment persists, even within healthcare. Some doctors dismiss bariatric surgery, but for many, it’s a vital part of their journey to improve health and longevity. Like diabetes, obesity is a chronic disease that requires more than advice—it needs a comprehensive treatment plan, whether through lifestyle changes, medication, or surgery.
Medical treatment isn’t “cheating.” It’s about taking control of one’s health, just like using an inhaler or treating an infected gallbladder isn’t considered a shortcut.
Finding the Right Support for Bariatric Surgery Success
When considering obesity treatment, it’s crucial to seek the right expertise. If you're thinking about weight loss surgery or medications, consult a certified bariatric surgeon or obesity medicine specialist. If your primary care doctor isn’t comfortable with these options, ask for a referral.
Obesity treatment today can feel like the Wild West, especially with easy access to things like compounded injectables online, which is not always the best choice. The key to effective treatment is a comprehensive plan that may include surgery, medication, or both. Working with an expert ensures you get the right care and information.
For surgery, look for accredited Centers of Excellence that specialize in bariatric procedures. But most important to remember is that surgery alone isn’t enough for long-term success – support before and after is essential. The best programs provide ongoing care with a team of specialists, including surgeons, dietitians, and behavioral health experts to help you make lasting lifestyle changes.
For more insights, tune in to this week’s episode!
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