Although the following may not be enjoyable to read, you do need to be aware of the risks involved with surgery and possible complications. If you fully comply with the dietary advice provided, the risk of complications can be greatly reduced.
We conduct strict pre-operative tests to reduce any risks and will take your individual circumstances and health conditions into account both before and after surgery. However, we cannot foresee how surgery will affect you
If you have any questions prior to your procedure, please do contact us. We will endeavour to answer any queries you may have and can put you in touch with your surgeon if you require.
Early post-operative complications: less than 1% risk
Following your discharge, we expect no problems to be associated with your surgery and would allow you to be discharged only if we were reasonably certain that this was the case. However, if post-operatively you have any concerns or doubts about any aspect of your treatment you should telephone us; relevant numbers can be found at the back of this booklet.
It may be that you only need reassurance or advice, but we are always on hand to help you.
If you experience any of the following symptoms, you should contact us immediately for further advice:
- Constant pain around the site of the band
- Vomiting/regurgitation after all fluids/drinks
- Vomiting blood
- Chest pain and/or breathlessness (especially initially after surgery)
- High temperature (especially initially after surgery or a band adjustment)
- Open, oozing or red operation wound
- Calf pain (especially initially after surgery)
Remember you have access to urgent advice 24 hours a day
Emergency situations requiring readmission to hospital can usually be managed at your local NHS hospital under our advice. Otherwise, we may request you travel back to the hospital where you had the operation to receive prompt treatment from one of our weight loss surgeons. Your surgeon will make this decision based up on your symptoms at the time.
If you are admitted to another hospital, for whatever reason, you must advise them you have a gastric band and you must inform The Hospital Group’s nursing staff that you have been admitted to another hospital.
Please note: if you feel you need urgent medical attention (related to the gastric band or unrelated) always contact 999 in the first instance.
Swallowing problems, nausea and vomiting
A small number of patients struggle or are unable to tolerate fluids initially post-surgery. If you are struggling, you should firstly make sure you are following the guidelines. If you are struggling whilst still in hospital, you may be given intravenous fluids and medication for a time.
If your surgeon injected some fluid into your band at the time of surgery and you are unable to tolerate fluids, you may need to have some or all of the fluid removed from the band. This can be arranged quickly in this situation, and you can expect us to ensure a practitioner is available to perform the deflation within 48 hours of your call to us. Your appointment is likely to be in office hours, and so you may need to cancel your other commitments to ensure that you can attend at the time offered. You may also need to travel to an alternative clinic if no appointments are available at your nearest clinic. If you are unable to attend one of our clinics, we may advise you to attend an NHS accident and emergency department.
In severe cases, you may need to have another operation to unclip the band, following which you will need to rest for a few weeks before having it reclipped.
You should not expect to be pain-free, but any pain is usually controlled with medication (analgesia) such as paracetamol or cocodamol. Remember that you will need to take this in a soluble form. Pain around incision sites will usually ease during the first few days post surgery, although it does vary from patient to patient. If you do experience pain whilst in hospital, please speak to the nurse who will provide you with pain relief. You should also consider purchasing some soluble/liquid pain relief that you can take once you are home from hospital. Soluble/liquid paracetamol can be purchased off-the-shelf. Should you require soluble/liquid cocodamol (e.g. Solpadeine), this will need to be purchased over-the-counter.
Pain around where the port is sited is normal – you may find it is worse when you bend or stretch. This is because it is stitched to an abdominal muscle. It will ease with time. If there are any signs of infection around the wound (redness, swelling, oozing, heat) and/or if you have a high temperature, there may be an infection present (see below).
Wind pain can be particularly uncomfortable – see “Recovery”.
Infection: less than 1%
You are given antibiotics during the operation and stringent measures are taken to ensure the highest standard of cleanliness in order to minimise your infection risk at all times. However, in a small number of cases, infection can occur.
Wound infection can occur in any of the incision sites. Typical signs of infection include redness, swelling, oozing and/or heat around the wound. This is usually easily treated with regular re-dressing of the wound and antibiotics where necessary.
Intraabdominal (internal) infection can also occur.
Sometimes antibiotics are ineffective at treating an infection to the incision site under which the port is situated. Occasionally in this situation, the port may require removal and a new port will need to be placed at a later date (charges may apply).
In less than 0.5% of patients, the band system itself can become infected. Although rare, if this occurs it is difficult to eradicate with antibiotics as it is technically a foreign body. It may therefore be necessary to remove the port and/or band for three months followed by replacement.
Bleeding: less than 0.3%
This will usually present as a “haematoma” which is a collection of blood inside the body. The risk is higher during the first 24 hours following any surgical procedure, but it can still occur at a later stage.
The blood can usually be reabsorbed by the body. In the case of a major collection of blood, it may be necessary for patients to return to theatre for a second operation to remove this collection and stop any further bleeding. Whilst it is extremely rare, excessive bleeding may lead to a blood transfusion and can be a potentially life- threatening complication.
Deep vein thrombosis (DVT) and pulmonary embolism (PE)
During the operation, a blood clot can form in the legs (DVT). The symptoms that might suggest this has occurred include calf pain, swelling, heat and/or a rash. If a piece of the clot detaches, it can travel through the right side of the heart and become lodged in the lungs where it obstructs the circulation of blood (PE). Symptoms that might suggest this has occurred include shortness of breath, coughing (possibly including blood) and/or sharp pains on inhaling. This requires emergency attention as it can be life-threatening.
Fortunately, there are ways to reduce the risk of these complications. You will need to wear a specific type of stocking during surgery and for a specific period of time afterwards. You will also usually be given an anticoagulant to administer via injection for at least 5 days after surgery, which is also given prior to surgery.
Damage to internal organs
Keyhole surgery carries less risk than an ‘open’ procedure, which usually requires a longer anaesthetic and leaves a much larger scar, increasing the risk of infection. However, rarely there can be cases of damage to blood vessels, the spleen or liver during surgery or perforation of the stomach or oesophagus during surgery. The Hospital Group only uses experienced laparoscopic (keyhole) surgeons who are able to detect and deal with any technical problems as they arise.
- Risk of access - keyhole surgical difficulties
- Your operation time may be lengthened due to laparoscopic technique and previous surgical history
- Occasional anaesthetic or cardio-respiratory complications (e.g. heart attack, arrhythmia, chest infection) or acute kidney injury
- Conversion to open procedure – sometimes laparoscopic surgery may not be possible, especially if you have had previous surgery in the operative area. The surgeon may then need to carry out an “open” procedure resulting in more invasive surgery, a longer hospital stay, a longer recovery period and a larger scar. If it is felt that this may be a particular risk factor in your case, your surgeon will discuss options with you. This type of situation is possible in all laparoscopic cases, and the need for conversion to open surgery cannot always be predicted.
The risk of death from laparoscopic gastric banding is around 1 in 3000. The usual cause of death is a pulmonary embolism (blood clot in the lungs). At The Hospital Group, we take great care and consideration when assessing your suitability for surgery and any associated risk factors. Your surgeon will discuss your individual risk with you, and all measures will be taken to maximise your safety at all times.
Late post-operative complications
It is estimated that the risk of a late post-operative complication is 2-3% per year (cumulative). The benefit of most of the complications that can occur during the lifetime of the band is that the majority can be treated with a further operation. The gastric band is biologically inert, and so does not require removal routinely after a certain period of time. Most studies on gastric bands do not yet exceed 15-20 years, and so it cannot be predicted how long you may keep your band in place beyond this.
What is it?
The tiny portion of stomach above the band becomes enlarged, but the band’s position is not altered.
What causes it?
There are two types of pouch dilatation, early and late stage.
Early stage pouch dilatation can occur shortly after surgery and can be due to the position of the band, or if you do not follow the initial post-operative diet as recommended (see Dietary advice for weeks 1 & 2 and Dietary advice for weeks 3 & 4).
Late stage pouch dilatation is generally caused by long-term non-compliance to the required eating technique (i.e. repeatedly eating mouthfuls that are too large, not chewing enough and eating too quickly). This is often in combination with an overtight band. This causes food to be ‘stored’ above the band rather than squeezed through a mouthful at a time, which causes the area above the band to stretch. Another cause is excessive vomiting that continues for more than 24 hours. You can reduce the risk in this instance by calling us without delay to arrange a band deflation. Patients with oesophageal dysmotility and/or an untreated hiatus hernia are also at a higher risk of developing pouch dilatation. Chronic pouch dilatation can lead to the oesophagus also becoming dilated.
What are the symptoms?
It is sometimes characterised by increased appetite and larger portions. Often patients with pouch dilatation will experience heaviness/tightness under the breastbone after meals – this indicates that food has become “stored” above the band. Patients will often regurgitate food sometime after a meal, which is not the same as regurgitation, which occurs as a direct result of poor eating behaviour. Other symptoms include acid reflux at night and a night cough.
How is it treated?
If any of the above symptoms are apparent, initially we would loosen the band. If no improvement in symptoms is felt, then an in-depth assessment of eating behaviours would be carried out. If indicated, the band would be emptied and would be rested for 4-6 weeks. If symptoms remained following emptying the band, referral would be made for a barium swallow x-ray to investigate further (charges may apply). If symptoms had resolved following emptying the band, we will slowly start to re-inflate it following a 4-6 week rest period.
If left untreated, symptoms can become progressively worse, leading to an inability to tolerate even fluids and an increased risk of band slippage.
Illustration of band slippage (exact appearance of band will vary according to the brand)
What is it?
There are 2 types of slippage.
- Anterior band slippage occurs when pouch dilatation progresses to the point where the weight of the pouch causes it to slip past the band, changing the position of the band
- Posterior band slippage occurs when some of the main stomach (below the band) is forced up through the band (otherwise known as ‘prolapse’), causing the band’s position to alter. Posterior slippage is very rare due to adoption of an alternative surgical technique in around the year 2000.
In either case, passage of food and fluid through the band is compromised.
What causes it?
It can occur early post-op, in which case the cause is generally technical error during surgery. If it occurs months after surgery, it is usually as a result of pouch dilatation, the causes of which are highlighted above.
What are the symptoms?
The symptoms are the same as the symptoms of pouch dilatation, although often they will be more severe.
How is it treated?
Generally, patients with slippage will have already been treated for pouch dilatation (see above). A barium swallow x-ray is required to check the position of the band (charges may apply). If slippage is confirmed, the band will be emptied if it is not already empty, and generally surgery is required to unclip, reposition, replace or remove the band (charges may apply). If the band is removed, a few months’ rest are required before a new band can be placed (charges may apply), and in some cases, it is not possible to place a new band. Patients may also wish to consider converting to a different operation e.g. gastric bypass or sleeve gastrectomy (charges may apply).
Illustration of band erosion (exact appearance of band will vary according to the brand)
What is it?
The band works its way through the stomach wall into the stomach itself.
What causes it?
The causes are unclear but may include intraoperative trauma, aggressive tightening of the band, infection or undiscovered stomach wall injuries present before the band was placed. At The Hospital Group, we adopt a cautious approach to band adjustments, which reduces the risk of the band being tightened too much.
What are the symptoms?
Often there are no symptoms, but symptoms that may indicate erosion are a sudden increase in hunger and large portions despite confirmation that the band is not leaking or unclipped (since the band is no longer around the stomach), and late onset port infection.
How is it treated?
An endoscopy (camera down the throat under sedation) is required in order to view the inside of the stomach to confirm that the band has eroded into the stomach (charges may apply). If erosion is confirmed, the band is always removed (charges may apply). A new band can be placed at a later date (charges may apply), but in some patients this is not possible and so they may wish to consider converting to a different operation e.g. gastric bypass or sleeve gastrectomy (charges may apply).
Acute obstruction / food has got “stuck”
What is it?
Food becomes lodged above the band, obstructing the opening to the bottom of the stomach
What causes it?
If you do not adhere to the required eating behaviours, for example if you take too large a mouthful, don’t chew enough or eat too fast, food can become lodged above the band. Usually, stopping eating and waiting for the food to work its way through the band will solve the problem; you may also regurgitate the food. A sip of a fizzy drink can help dislodge the blockage, but generally drinking will make it worse and is best avoided. On occasion, the food will obstruct the opening to the bottom of the stomach, which is known as an acute obstruction.
What are the symptoms?
Pain/discomfort on eating, combined with an inability to regurgitate the food.
How is it treated?
We would initially remove 1ml of fluid from your band, or the volume last added to the band, whichever is greater. We would then ask you to have a drink; if you were unable to, we would remove a further 1ml. If you were still unable to drink, we would remove 50% of the remaining volume in the band. If you were still unable to drink, we would then empty the band.
If the symptoms then resolved, we would leave the band empty for at least 2 weeks to allow any swelling to subside, before reinflating the band slowly in at least 3 stages. If symptoms continued despite the band being empty, band slippage would be suspected (see above).
- Problematic access
Occasionally, your practitioner may not be able to access your port. If this occurs, you will be referred to an alternative practitioner in the first instance (you will probably have to travel to an alternative clinic).
If the second practitioner is unable to access the port, we may consider referral for an x-ray guided band adjustment (charges may apply). Should your port be inaccessible whilst under x-ray, a surgical procedure is usually required to reposition the port (charges may apply).
Figure 10: X-ray showing tubing fracture/disconnection (exact appearance of band and port will vary depending on brand)
Rarely, where the tubing is attached to the port, disintegration of the tubing may occur. Similarly, during a band adjustment the needle can miss the port and accidentally puncture the tubing. These cause leakage of saline from the system, resulting in an increase in appetite and portion size.
This is confirmed by a series of appointments with our practitioners to check the fluid present in the band (‘fluid checks’). If several discrepancies are identified in the volume of fluid found in the band, we may refer you for an x-ray to test the band’s integrity (charges may apply). Alternatively, the surgeon may wish to proceed directly with surgery to investigate and fix the problem, which might involve repair of the tubing, replacement of the port or the entire band system.
Some patients may have pre-existing oesophageal dysmotility or achalasia, which are conditions whereby the muscles in the oesophagus work less effectively. They often result in retention of food in the oesophagus. These conditions can be exacerbated by gastric band surgery, and in such cases adjustments to the band may need to be performed under x-ray only (charges may apply). Sometimes these conditions can mean that the band is not effective, and it may need to be removed (charges may apply).
A small number of patients may develop oesophageal dysmotility after the band is placed, but this is due to the band being too tight. This can require deflation of the band to allow the oesophagus to recover and cautious filling thereafter, but sometimes band removal is required. Patients may wish to consider converting to a different operation e.g. gastric bypass or sleeve gastrectomy (charges may apply).
Unclipping or ‘unbuckling’ of the gastric band has been reported, where the band’s locking mechanism opens. However, it is extremely rare.
It is characterised by increased appetite and portion size that is not rectified by addition of fluid to the band and where both a leak due to tubing fracture or tubing puncture and band erosion have been ruled out.
An x-ray would be required (charges may apply) to rule out any other cause. If unclipping was confirmed, it can usually be easily rectified by a simple surgical procedure to re-clip the band, although sometimes the band may need replacing (charges may apply).
Late infection is rare. It can occasionally be introduced from band adjustments or band erosion, but may also represent a latent very low grade infection. It is likely to require band removal.
A very small proportion of people become intolerant of their gastric band, causing discomfort or swallowing problems without any demonstrable functional problem. This can sometimes be due to a fibrous capsule around the band, but may not have an identifiable cause. It can lead to recommendation for band removal.
Weight loss is associated with development of gallstones, but so is obesity. There is also some evidence to suggest that the amount of bile secreted reduces following gastric bypass and sleeve gastrectomy, which would could be a contributing factor. Gallstones do not always become symptomatic and don’t always require surgical treatment. The main symptom of gallstones is abdominal pain on the right-hand side.
Weight loss surgery can successfully remove excess fat from your body, but can leave some people with excess folds of skin. There are several factors that affect this:
- How long you have been overweight. Generally,the longer you have been overweight, the higher the riskof loose skin.
- The amount of collagen and elastin present in your skin. These are proteins which are responsible forthe strength (collagen) and elasticity (elastin) of your skin. The amount you have depends on geneticsand also age (levels decrease as you get older), sun exposure (levels decrease if you are exposed to the sun without UV protection i.e. sun lotion) and diet (eating enough protein helps them to replenish and not decrease too much).
- The speed of weight loss. Iyou lose weight too quickly, there is agreater risk of loose skin. Weight loss tends to be gradual with a gastric band, potentially slightly reducing the risk of excess skin.
- Not including muscle strengthening exercises. This is frequent mistake many people make whenexercising to help weight loss. It is important to include muscle-strengthening exercises to helpreduce the amount of muscle you lose as a result of the weight loss. See Section 17 for more details.
Some patients find that they require surgery to remove excess skin. See Section 23 for more details.
Undernutrition / vitamin & mineral deficiencies
This is extremely rare following gastric banding and can usually be avoided by consuming a varied and balanced diet, taking a daily multivitamin and mineral supplement, and ensuring that your band is not too tight.
Reflux / indigestion / heartburn
Small hiatus hernias are repaired at the time of surgery to minimise the chance of reflux.
This may be caused by fatty/spicy/citrus/fatty foods, or foods that are not adequately chewed. When eaten, they can cause a backup which leads to discomfort.
Symptoms can sometimes be relieved by eating/drinking a small amount of dairy e.g. skimmed milk or low fat yogurt.
If it is occurring in the middle of the night, however, it is almost always a sign that the band is too tight. In severe cases, the gastric juices that travel up your gullet causing the reflux can pass into your wind pipe and lungs – this is extremely dangerous and can result in pneumonia. Never ignore nocturnal symptoms. If in doubt, please contact us for advice.
Treatment may involve loosening the band and taking anti-acid medication, but occasionally requires revisional surgery.
Lack of energy, fatigue and tiredness
These symptoms can occur due to the reduced food intake and weight loss. Rarely, they can be signs of anaemia as a result of low levels of one or more of the following:
- Vitamin B12
It may be that you are not tolerating the main dietary sources of these very well and additional supplementation is required. Speak to your dietitian for more guidance.
Delayed success – not failure!
Some patients struggle to achieve success with a gastric band within their initial aftercare period. What defines lack of success varies but it has been described as losing less than 25% of excess weight and/or BMI remaining above 35kg/m2. There are usually various reasons why this might be the case.
Up to 30-40% of people with gastric bands in place will regain some weight. Usually this has a dietary or behavioural cause, although sometimes can be due to a leak.
However, it should be noted that it can take some patients several months or even years to get used to working with the band, so don’t give up too soon! Contact us to arrange more intensive follow-up with the dietitian and nurse (charges will apply if your initial aftercare period has expired).
Following surgery, you can expect to see around 5 small incision sites across your abdomen. All scars can be red, pink and lumpy for up to 3 months post-surgery, after which they will gradually fade. In some skin types, especially in pigmented skin, scars may become hypertrophic or progress to Keloid. Always speak to your surgeon before your procedure if this is of concern to you. See Recovery for more details.
Heaviness / tightness / pressure / discomfort / pain when eating and regurgitation
These are relatively common side effects which can occur specifically in the first few months after gastric band surgery, but they are not limited to this time period. It is important to remember that they are not meant to occur. Should they occur too often (more than once or twice a week), they can cause the area above the band to become swollen and irritated, thereby increasing the risk of pouch dilatation and band slippage.
They are usually triggered due to one or more of the following:
- Taking too large a mouthful
- Not chewing enough
- Not leaving a gap between mouthfuls
- Leaving too long between meals. This this can cause you to become very hungry, thereby increasing the chances of points 1 to 3 above. Furthermore, the oesophagus can become ‘lazy’ and sit heavily on the band if you leave too long between meals, meaning it can be difficult to eat. Alleviate this by ensuring you eat every 4-5 hours and drink plenty of fluids between meals to keep the oesophagus active – hot drinks before meals can be particularly effective.
Remember the ‘20/20/20/20 Rule’ (See How the gastric band works).
If you are sure you are following the ‘20/20/20/20 rule’, then discomfort on eating and regurgitation may be as a result of attempting caution foods (see Dietary Advice for week 5 onwards) too early. If a food causes problems, remove it from you diet and then re-trial it again after a few weeks.
There are a number of other factors that can be associated with these symptoms that you also need to be aware of:
- Time of day – during the night, the oesophagus can become ‘lazy’ and sit heavily on the band, meaning it can be difficult to eat first thing in the morning. Alleviate this by having a few hot drinks throughout the morning (hot drinks are tolerated better than cold) and delay your breakfast for a couple of hours – don’t eat immediately after waking.
- Dehydration – most people will find that if they don’t drink sufficient fluids throughout the day, they will struggle to eat comfortably. It is important the oesophagus is kept ‘active’ as described above, and drinking plenty helps with this. Hot drinks are particularly effective.
- Climate – some people find that the band feels tighter in hot weather. The best way to cope with this is ensure you are drinking plenty.
- Menstrual cycle – some women have reported that the band feels tighter before and/or during menstruation. This can mean that only a soft diet is tolerated at this time of the month.
- Stress/anxiety – some people find that the band feels tighter when they are particularly stressed or anxious. Relaxation techniques are useful in this respect, as are the use of herbal teas such as camomile.
- Illness – some people find that the band feels tighter when they have a cough/cold. This can mean that only a soft diet is tolerated, but if it lasts longer than a few days, it would be sensible to have the band loosened slightly to prevent complications.
- Excessive vomiting – vomiting as a result of food poisoning/stomach bug or pregnancy can cause the band to tighten up and this can increase the risk of pouch dilatation and slippage (see Risks of Surgery, potential complications). If vomiting continues for more than 24 hours, you should contact us without delay to arrange a band deflation (aspiration).
- Flying/visting an area of high altitude/scuba diving – see Other Considerations.
- Posture – we find that patients who sit upright at a table to eat meals tend to have fewer problems. Try to avoid eating whilst sitting on the sofa and/or slouching when eating at a table.
What should I do if I am experiencing these symptoms more than once or twice a week?
If you know what is causing your symptoms:
For example, if you are struggling to remember to follow the ‘20, 20, 20, 20 rule’, drink enough, or eat regularly enough:
- Return to fluids only for 2-3 days then soft foods for 2-3 days – this may help any swelling/irritation to subside. This can help reduce the risk of complications such as pouch dilatation and slippage.
- If when reattempting textured foods you continue to experience symptoms more than once or twice a week, we recommend you contact us without delay to arrange a band deflation (aspiration).
Having the band loosened, along with guidance from the dietitian, will help you to address the cause of the symptoms more easily and reduce the risk of developing a complication such as pouch dilatation or band slippage.
Once you have addressed the cause of the symptoms and made improvements, you may then be able to cope with having the band a little tighter. Do NOT continue to experience symptoms unnecessarily, as it puts you at risk of complications.
If there is no obvious cause to your symptoms or there is blood in your vomit:
Your gastric band is almost certainly too tight. You should contact us without delay to arrange a band deflation (aspiration).
Nausea (feeling sick)
If nausea is a problem, make sure you stick to bland foods until it passes. Follow all the advice given, paying particular attention to the ’20, 20, 20, 20’ rule. Nausea can be due to the band being too tight around the stomach, so if symptoms persist please contact us as you may need the band loosened. Some people find that during the fluids-only stage (weeks 1 & 2 post-op), milky drinks/milkshakes can cause nausea (feeling sick). If this happens, switch to meal replacement soups. If you still find that these cause nausea, choose hearty soups such as lentil, bean and pea & ham, but ensure they are blended and thinned down with stock or milk to ensure the correct consistency. Alternatively, any soup’s protein content can be boosted by adding 1-2tbsp skimmed milk powder such as Marvel. Finally, you could try smoothie-style protein drinks such as Up Beat or protein water (e.g. Vieve, Asda Sports Nutrition).
Port visibility following significant weight loss
If you lose a large amount of weight, it is possible that you will be able to see a lump under the skin where the port is sited. This is unfortunately unavoidable and cannot be treated other than removing the whole band, as the port needs to remain accessible for adjusting the band as required.
It is relatively common to experience one or more of the following after surgery, but most are usually transient issues:
- The initial results of the surgery does not meet with your expectation. It’s important to be realistic.
- You may mourn the loss of food as a coping strategy or when used in a celebratory way.
- You may have perceived that all aspects of your life would improve following weight loss, but this may not be the case in reality. It is true that depression linked to weight naturally does decrease after surgery, but depression due to other factors may be unchanged. It’s important to remain in close contact with your GP and if you have one, your psychiatrist or psychologist.
- You may be unfortunate enough to experience physical complications from surgery, which can naturally cause your mood to dip. Remember that the vast majority of complications are treatable and the risks are low.
It’s important to make the most of your aftercare and discuss any concerns you may have with your dietitian, who may be able to offer some practical coping strategies. Speaking to other patients who have undergone surgery may also be useful – for example, by using your BandBoozled membership.
If you take antidepressant medication, there is a chance that this may not be as well absorbed following surgery so if you have noticed a dip in your mood, it is important to seek a review with your GP to discuss further as your dose may need to be adjusted.
Developing severe depression as a new diagnosis after surgery is much less common.
The health risks are much greater from staying overweight than the risk of surgery itself.