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Bariatric (weight-loss) surgery

Surgical roomWeight-loss surgery is called bariatric surgery. It can be an option for people who are very obese and who can't control their weight through any other methods. If obesity is complicated by other medical conditions such as diabetes and heart problems, then weight-loss becomes even more important. Surgery may be an option if you have several significant health problems related to your obesity.

The aim of the surgery is to control the amount of food you're able to eat and reduce your excess appetite for food. This limits the calories you're able to consume and allows your body to burn stored energy in the form of fat. This allows you to lose weight.

What are the types of bariatric surgery?

Sleeve gastrectomy

Sleeve gastrectomy involves surgically removing a portion of the stomach turning it from a bag into a tube and reducing the volume from 2 litres down to 100 ml. This is a permanent change that can not be reversed. It does result in a faster rate of weight loss over 9 to 18 months.

Gastric bypass

Gastric bypass involves removing a portion of the stomach and top part of the small bowel. Then it's attached it to the small bowel further down, effectively bypassing much of the stomach and part of the small bowel where absorption of food takes place. The stomach volume is reduced to around 30ml. This is effective in reducing appetite and results in good weight loss over 9 to 18 months.

Gastric band

Gastric band surgery is no longer offered publicly or privately in the South Island. This is because of a high rate of repeat operations needed. The procedure involves placing a silicon band around the top of the stomach, reducing its size. Weight loss is generally slower than with other types of surgery. Also, although reversible, people can develop complications. If you're having difficulty with your gastric band, see your GP to be referred to a surgeon.

Who's eligible for publicly funded bariatric surgery?

A limited number of people aged between 18 and 65 years are eligible for publicly funded weight loss surgery. Publicly funded means that the surgery is paid for by the public health system.

Other criteria that need to be met to qualify for consideration for publicly funded surgery include:

Exclusions to having publicly funded surgery include:

Because there's a limit on the number of publicly funded surgeries available, there is an assessment and selection system in place. Funding for weight-loss surgery is pooled across the district health boards (DHBs) in the South Island. Some patients selected for weight-loss surgery might have to travel elsewhere in the South Island for their surgery.

If you don't want to wait or you can afford to pay for your surgery, you may wish to look at having it done privately.

The assessment and selection process

Important: The following process is the only way to apply for publicly funded weight-loss (bariatric) surgery.

  1. The first step is to see your general practice team.
    • Your doctor will measure your body mass index (BMI). Only patients with a high BMI (>40) are considered for publicly funded surgery.
    • Your doctor will check if you meet the South Island criteria for bariatric surgery.
    • Before you're considered for surgery, you must have been obese for at least five years. It's also expected that you'll have followed an intensive weight-loss programme for at least two years.
    • Your doctor will ask you about your general health and find out if you have any health problems related to your obesity.
    • Your doctor will assess that you have a clear understanding about the surgery and any potential complications.
    • You may need other checks, including blood and urine tests.
    • If you meet all the qualifying criteria and you want to be considered for surgery, your doctor will explain the process.
  2. Your doctor will then send a referral to the surgical service at your local DHB. All your relevant medical information will be included in this referral, so that the surgeon can consider your case.
  3. First, you'll be scored based on the information provided by your GP on the referral form. The triaging doctor will use the National Bariatric Prioritisation Scoring tool to determine your prioritisation score relative to other patients. This scoring system helps decide which patients would most benefit from surgery. As the number of surgeries provided each year is limited, only those patients who achieve a score over the threshold will be offered an appointment with a bariatric surgeon or other health professional.
  4. At this first appointment your prioritisation score will be confirmed. You'll be asked questions about your health and be examined to help decide if you're a suitable candidate for surgery. The surgeon will explain about the surgery and ask about your understanding of what's involved, and your expectations.
  5. If you're still interested in surgery, your name will be forwarded for the next step (see below).
  6. Following this first appointment, your case will be reviewed by a committee of experts (South Island Bariatric Surgery Service Multi Disciplinary Selection Committee). They meet four times through the year to select the most suitable candidates for surgery. It may take up to four months before you find out the outcome.
  7. During this process, your medical records will be seen by the surgeon who assesses you and gives you your ranking. The committee of experts who reviews your case will also see your medical records. Your doctor will make sure that you understand this and that you give your consent to your medical records being used in this way.

If your application is successful

  1. You will be offered a team assessment appointment with a surgeon, dietitian, psychologist, and exercise specialist.
  2. Your surgery will be arranged with a surgical provider in Christchurch or Invercargill.

If your application isn't successful

General surgical risks

Any surgical procedure has some risks. Your surgeon will talk through possible surgical risks with you and answer your questions.

Along with the more general short term complications that can occur with any surgery, there are several complications that can occur with bariatric surgery up to several years after having this done. The complications depend on the type of bariatric surgery you have and can include strangulation of the stomach, a leak of stomach contents along a staple line, internal hernias, and vitamin deficiencies. Your surgeon will explain these in more detail if you're having one of these surgeries done.

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Written by HealthInfo clinical advisers. Last reviewed November 2018.

See also:

Overview of surgery

Page reference: 51647

Review key: HIBAR-51647