Anyone who's struggled with reaching or maintaining a healthy weight probably has heard comments like, "If you want to lose weight, just eat less and exercise more" or "Losing weight is all about willpower." But weight loss is much more complicated. Genetics, socioeconomic status, mental health issues, such as depression and anxiety, and certain medications can affect your ability to lose weight and keep it off.

That's why weight loss requires a complex, multipronged approach, including nutrition education, consulting a dietitian, joining a support group and possibly taking medications or undergoing weight-loss surgery.

Are you ready?

You have to be mentally ready for weight-loss surgery. Some people reach a turning point when they can't bend over to pick up a child, have to ask for a seat belt extension on an airplane or experience a hospitalization. The reasons people consider weight-loss or bariatric surgery are as personal and varied as the people themselves.

You may have considered weight-loss surgery for years, but it takes that turning point to push you to contact your healthcare professional about the procedure. If you've reached that turning point, here are some things to consider.

What weight-loss surgery does

Weight-loss surgery helps you lose weight and lowers your risk of medical problems brought on by obesity, including:

• Cancer
• Heart disease
• High blood pressure
• High cholesterol
• Infertility
• Obstructive sleep apnea
• Stroke
• Type 2 diabetes

Candidates for surgery typically have tried to lose weight by improving their diet and exercise habits.

How weight-loss surgery works

The surgery helps you lose weight in two ways:

1. By physically limiting the amount of food your stomach can hold, which decreases the number of calories you can eat
2. By shortening or bypassing the small intestine, which reduces the amount of calories and nutrients your body can absorb

The two most common bariatric surgery techniques are:

1. Gastric bypass
   Following this surgery, swallowed food will go into a small stomach pouch and then directly into the small intestine.
2. Sleeve gastrectomy
   With this surgery, about 80% of the stomach is removed, leaving a tube-shaped stomach about the size of a banana.

Both procedures are performed laparoscopically, which involves inserting surgical instruments through multiple small incisions in the upper abdomen. No bariatric surgery is without risks, which can include infection, blood clots and adverse reactions to the anesthesia.

What to expect from surgery

The benefits of weight-loss surgery include:

• Substantial weight loss, with people often losing 60% to 80% of their excess body weight within the first year after the procedure.
• Improved overall health and reduced or resolved obesity-related health conditions like Type 2 diabetes, high blood pressure, sleep apnea and joint pain.
• Enhanced quality of life, including higher energy levels, increased self-esteem and the ability to participate in activities you may have avoided.

You need to understand that bariatric surgery isn't a quick fix, and you won't reach your goal weight overnight. Even with surgery, your body mass index, or BMI, still may be considered overweight, but that doesn't mean the surgery wasn't successful. Losing a significant amount of weight still is transformative and life-changing.

There's also a potential financial cost to weight-loss surgery. The surgery itself typically is covered by insurance. In most cases, the removal of excess skin on the stomach and arms isn't covered by insurance. But this additional surgery, performed by a plastic surgeon, can greatly improve your self-esteem and body image.

Bariatric surgery gives you a tool for long-term weight management, but it requires a commitment to lifestyle changes, including a balanced, nutritious diet and regular exercise. You'll need to watch not only what you eat but also how much because the surgery can restrict the quantity of food your body can handle.

Five years after surgery, people typically have kept off 50% of the weight they've lost by embracing a new lifestyle and way of eating, and staying active.

If you've been considering bariatric surgery, contact your healthcare team to discuss if it's a good option for you. Once you've made a decision, they'll connect you with a weight management team, including a dietitian, and behavioral health and exercise physiology professionals to support you through this life change.

Kathriena Greenwell, M.D., is a bariatric surgeon in La Crosse, Wisconsin.

This article first appeared on the Mayo Clinic Health System blog.

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