Bariatric Surgery – Endoscopic Sleeve Gastroplasty

Bariatric Surgery – Endoscopic Sleeve Gastroplasty

Hello! So as some of you may know, I work as a bariatric dietitian both privately and for the NHS. I’ve worked in the area of bariatrics since 2013 (I qualified as a dietitian in 2009) and I absolutely love it; working with patients through their weight loss journey after surgery is just so rewarding, and although it isn’t all plain sailing, the results and improvements in quality of life can be out of this world.


To briefly explain, bariatric surgery is obesity surgery and it usually involves making the stomach permanently smaller to help people to eat less and lose weight. The three most popular types of surgery are the gastric bypass (making the stomach into an egg shape and moving the intestines up to meet the stomach), gastric sleeve (removing 3/4 of the stomach and making the remaining stomach into a banana shape) and gastric band (a band is placed around the stomach to help increase the feeling of fullness).


After surgery you usually have to follow a high-protein liquid diet for several weeks, before moving onto pureed textures and then soft and crispy foods. Once ‘normal’ textures are introduced it is imperative that all foods are chewed well and that the majority of foods eaten are high in nutritional value (rather than filling up on biscuits, sweets and cakes which provide a lot of calories but not very many nutrients). Foods and drinks must be kept separate at all times, and you are required to take vitamin and mineral supplements, as well as attend yearly blood tests, for life.


I see patients both before and after weight loss surgery (usually for 2 years after) and patients are expected to lose around 75% of their excess body weight 1-2 years after surgery. After this time a little weight regain is usually experienced. It is possible to lose more than 75% excess body weight however I usually see this with patients who are young (in their 20’s and early 30’s) and who take part in high levels of regular exercise.


You can read more about weight loss surgery on the NHS Choices and Ramsay Health websites. Please note though that bariatric surgery should only be considered once you have tried more conventional weight loss routes such as slimming clubs and seeing a registered dietitian or registered nutritionist.


So what’s the reason for this blog post I hear you ask? Well in January of this year I gave an interview to the Channel 4 show ‘How to Lose Weight Well’, and (unfortunately) only a very short part of it made it to screen (as you can see below!). I wanted to share with you everything that I said so keep on reading to find out more about bariatrics and this new type of surgery!



P.S you can see and hear more about the surgery in the full part of the show that my interview appeared in in the video below.


Channel 4 How to Lose Weight Well Interview


We’re looking at a new procedure called an ‘endoscopic sleeve gastroplasty’. It’s non-invasive, reversible and seems to be very promising at the moment! We’re want your perspective as someone who works closely with patients who have undergone different types of bariatric surgery on the NHS and to hear your thoughts about this procedure:


  • What sort of problems do patients generally have with more invasive bariatric surgeries? 

From a surgical point of view more invasive procedures such as gastric bypass or gastric sleeve could lead to more bleeding or chance of infection, but from a nutritional point of view more invasive procedures can lead to micronutrient deficiencies, especially if patients aren’t compliment with the life-long vitamin and mineral supplements and/or don’t eat a healthy balanced diet.


  • Is weight loss surgery the only option for some people?

It’s not the only option however the more that someone is overweight, or the longer the length of time that they’ve spent being overweight, the harder it will be to lose weight in a more conventional way. This might be for a number of reasons; the bigger someone gets, the more likely it is that their mobility is compromised which makes it difficult to shop, prepare meals and also exercise, and often the harder it is to break bad habits that have formed over decades of years.


  • If the current procedures are effective, why are we turning to new methods for weight loss?

In principle this new surgery sounds great; it’s not as invasive, it’s quicker and it’s not permanent, but often the problem with procedures such as these, just like we’ve seen in the past, is that they can often have a much higher failure rate (so more weight regain), with people needing to be re-operated on or even having to go through a more invasive weight loss surgery anyway.


  • What are the most popular surgeries you see at the moment?

I see people undergoing the gastric bypass and the gastric sleeve the most and this tends to be because people with a much higher BMI, for example of 50 or more, have a better chance of losing more weight with these operations than say the less invasive gastric band or gastric balloon.


  • Have you seen an increase in the number of patients having weight loss surgeries in recent years?

I’ve definitely seen more patients enquiring about the surgery but as the NHS criteria is quite strict, either not everyone qualifies who wants it or people end up changing their minds after they find out more about what’s involved. It’s not uncommon to hear about patients who think that weight loss surgery involves the physical removal of fat from the stomach area and so it can be quite disappointing for them when they find out that it doesn’t involve that at all.


  • Is the new endoscopic sleeve gastroplasty procedure something that could eventually be seen on the NHS?

It could end up being an option in the future for patients who for one reason of another can’t be operated on more invasively however the NHS has to be wise when it comes to spending money and at the moment there isn’t much data on the effects of the surgery in the long-term. The costs of the surgery have to be weighed up against the surgical risks and long-term benefits.


  • Do you personally think the new procedure could be good?

It has the potential be a good procedure for people who don’t have too much weight to lose, yet can’t undergo surgery, but right now we can’t say one way or another if it’s an effective long-term weight loss solution. The fact that it may need to be repeated or revised is also a little off putting!




P.S If you want to see me chatting more about my day to day work, as well as hearing from two great bariatric nurses, check out [this video].



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