Bariatric & Metabolic Surgerythe decision, stated plainly
The most effective treatment we have for severe obesity, and the one with the most to weigh up. A team decides whether you qualify — and the follow-up afterwards matters more than the operation itself.
Four procedures, different trade-offs
Which one suits you depends on your BMI, reflux, diabetes, previous surgery and what you can commit to afterwards.
All four are keyhole operations
Laparoscopic access means smaller incisions, less pain and a faster return to moving — which is itself
the best protection against clots.
Who qualifies
Thresholds used for South Asian populations sit lower than the international ones, because metabolic risk appears at a lower BMI. These are a starting point; the workup is what decides.
Who it is not for
Any one of these pauses the pathway until it is addressed. Some are temporary; none are a judgement.
- Untreated or active eating disorder
- Active substance or alcohol dependency
- Untreated psychiatric illness affecting capacity to consent or comply
- Medically unfit for general anaesthesia
- Unwilling or unable to commit to lifelong supplementation and follow-up
- Pregnancy, or planning pregnancy within the next 18 months
One clinician cannot approve you
Surgery, medicine, dietetics and psychology each assess you independently and decide together. Any of them can hold the pathway. That safeguard is there for your benefit, not as an obstacle.
From first assessment to lifelong follow-up
The operation is one day of a pathway that does not have an end date.
- 01
Multidisciplinary workup
Surgery, medicine, dietetics and psychology each assess you. Endoscopy, bloods and imaging as indicated. The team decides jointly — one clinician cannot approve you.
4–8 weeks - 02
Pre-operative preparation
A short pre-op diet to shrink the liver and make the operation safer, plus nutritional loading and stopping certain medications.
2–4 weeks - 03
Surgery
Laparoscopic, under general anaesthetic, typically two to three hours depending on the procedure.
Day 0 - 04
Hospital stay
Usually two to three days. Mobilising early is the single best thing you can do to reduce clot risk.
2–3 days - 05
Staged diet progression
Clear fluids, then full fluids, then purée, then soft, then textured food — advanced only on your dietitian’s instruction.
6–8 weeks - 06
Lifelong follow-up
Bloods, micronutrient checks and dietetic review at set intervals, continuing indefinitely.
Ongoing
Risks and complications
All surgery carries risk. You should read this section before the results section, not after it.
| Category | What can happen | What it means |
|---|---|---|
| Common | Nausea, fatigue, constipation, shoulder-tip pain, temporary hair thinning | Expected and time-limited. Managed with fluids, supplementation and dietetic adjustment. |
| Less common | Reflux, dumping syndrome, food intolerance, gallstones, dehydration | Usually manageable with diet changes or medication; occasionally needs further treatment. |
| Uncommon but serious | Anastomotic or staple-line leak, bleeding, blood clots, stricture, internal hernia | Require urgent assessment and sometimes reoperation. Fever, tachycardia or severe pain need same-day review. |
| Long term | Micronutrient deficiency, anaemia, bone density loss, weight regain | Prevented and detected by the follow-up schedule. This is why it never ends. |
| Mortality | Small but not zero | Discussed openly and specifically for your risk profile before you consent. |
Fever, a racing heart, breathlessness or severe abdominal pain in the weeks after surgery need same-day assessment. If you cannot reach us, go to an emergency department.
Sleeve, bypass or mini bypass
A general guide only. Revisional surgery is assessed case by case and is not comparable here.
| Sleeve | Roux-en-Y | Mini bypass | |
|---|---|---|---|
| Mechanism | Restriction + hormonal | Restriction + malabsorption | Restriction + malabsorption |
| Reversible | No | Technically reversible | Technically reversible |
| Reflux | May worsen it | Often improves it | May worsen it |
| Diabetes effect | Strong | Strongest | Strong |
| Supplements | Lifelong | Lifelong, more extensive | Lifelong, more extensive |
| Operating time | Shortest | Longest | Shorter than RNY |
What actually changes
The operation restricts what you can eat. Everything below is what determines whether that translates into a result you keep.
- 01First 6 weeksStaged diet, small volumes, slow eating and separating drinks from meals. Most people return to desk work in two to four weeks.
- 02Supplements for lifeMultivitamin, B12, iron, calcium and vitamin D as a minimum, adjusted by bloods. This is not optional.
- 03Protein firstProtein at every meal protects muscle while weight falls quickly. Your dietitian sets and reviews the target.
- 04AlcoholAbsorbed faster and tolerated less well after surgery, with a recognised risk of dependency developing.
- 05PregnancyGenerally advised to wait 12–18 months, once weight has stabilised and nutrition is secure.
- 06RegainSome regain from the lowest point is normal. Significant regain is a clinical signal to reassess, not a failure.
Follow-up is the treatment
Deficiency after bariatric surgery is common, often silent and genuinely harmful. Bloods, micronutrient checks and dietetic review continue indefinitely — not for a year, indefinitely. If you cannot commit to that, surgery is the wrong operation for you and we will say so.
Bariatric surgery, answered
How much weight will I lose?
It varies by procedure, starting weight, adherence and biology, and published averages are not a prediction for any individual. We set realistic expectations against your own history at assessment rather than quoting a figure here.
Is the surgery reversible?
A sleeve is not — stomach tissue is removed. Bypasses are technically reversible but reversal is a major operation in itself and is not undertaken lightly.
How long until I am back to normal?
Most people manage desk work at two to four weeks and heavier physical work at around six. Full dietary progression takes six to eight weeks.
Will I need plastic surgery afterwards?
Some people choose skin surgery after weight stabilises, usually at 18 months or later. It is a separate decision and separate cost, not part of this pathway.
Do I have to take supplements forever?
Yes. Deficiencies after bariatric surgery are common, often silent, and genuinely harmful. Supplementation and monitoring are lifelong and not negotiable.
Can diabetes go into remission?
Often, and sometimes rapidly — before much weight is lost — because the gut hormone changes act independently of weight. Remission is not guaranteed and can relapse.
What is dumping syndrome?
Food, particularly sugar, passing too quickly into the small intestine, causing cramping, nausea, palpitations and light-headedness. More common after bypass, and largely manageable with diet.
Will I need a second operation?
Most people do not. Revisional surgery exists for complications, inadequate response or significant regain, and carries higher risk than first-time surgery.
Can I have surgery if I have already had a balloon?
Usually yes. Previous balloon treatment does not rule surgery out and is often useful information about how you respond.
What if I am on GLP-1 medication?
Tell us. It affects anaesthetic planning because of delayed gastric emptying, and there are specific pre-operative instructions.
Who actually decides if I am suitable?
A team — surgeon, physician, dietitian and psychologist. Any one of them can pause the pathway, and that safeguard exists for your benefit.
What does it cost?
It depends on the procedure, hospital stay and any comorbidity workup. We set this out fully in writing before you commit, with no obligation.
Start with an assessment
Nothing is decided at a first appointment. Send your details and we will confirm a time.