Dr. Ramírez is a respected bariatric surgeon with extensive experience in bariatric and metabolic surgery in Tijuana, México. We interviewed him on this occasion to explain more in depth about the options and the reach of weight loss surgery in patients.












Q: How do I know if I am a candidate? 

A: We all know that the United States and Mexico are leading countries in obesity and that it is very difficult to lose weight. I think we all have gone through wanting to do certain diets and lose weight; But often our lifestyle forces us to eat outside; at late hours, eat junk food, over eating and so on. It takes a lot of discipline that people generally do not have to achieve weight control.

To find out if you are a candidate you can calculate your body mass index, people above 35 BMI and who have comorbidities (pre-diabetic, hypertension, glucose problems) could be candidates for metabolic or bariatric surgery. Books or standards say patients with a BMI over 40 are already candidates for metabolic surgery. Obviously considering that these patients have already tried to lose weight with diet, exercise and have failed, that’s when they are recommended metabolic surgery. It is important to mention that we could operate a patient with a BMI

less than 40, talking to the patient.

Q: What types of bariatric surgery are there?

A: There are several procedures, broadly divided into two:

Some are the restrictive procedures; That limit the amount of food you can eat; And others are malabsorptive procedures, where what you eat is not completely absorbed.

There are mixed procedures that restrict the amount you eat as well as the absorption; You could say that those are the most complete. At one time Gastric Bypass was considered the gold standard of this type of surgery, because it combined both procedures: Restrict what you eat and absorption of calories.

Gastric Bypass consists of cutting the stomach and leaving a small pouch where it fits a small amount of food much smaller than before, and we make a short circuit where the food leaps and unites more distally towards the intestine. Depending on the length we want to give, we can jump up to 3 meters of intestine or more where there will be no absorption. By jumping the pancreas or duodenum we then have a positive metabolic effect for the patient. This surgery helps control comorbidities more than the gastric sleeve. Therefore, some patients with diabetes, glucose intolerance or metabolic syndrome could greatly benefit from the bypass.

Gastric sleeve
But one of the simplest and most successful procedures we have had is what we call the gastric sleeve; Which consists of cutting a part of the stomach, thereby eliminating its great storage capacity, leaving it in the form of a tube that is calibrated with a spark plug and cutting the rest.

With this we achieve that the patient does not eat as much food and at the same time to eat more times per day. It also gets rid of a hormone that is partly responsible for being hungry. So, if we eliminate a great part of the production of this hormone the patient has no longer the anxiety to eat.
The gastric sleeve is technically one of the easiest surgeries with the best results.


Duodenal Switch
And lastly one of the most common procedures is the duodenal switch, where we combine the gastric sleeve and skip a large part of the intestine leaving the absorption of food in about two meters of intestine before passing to the large intestine for elimination. This is the only procedure where it has been seen that there is no re-gain of weight. Since both gastric sleeve and bypass could expect a re-gain of weight within 10 to 15 years depending on the care given by the patient, however with the duodenal switch there is not.

The disadvantage of the duodenal switch is that it requires a lot of care with nutrients. Because the patient can become malnourished if not fed correctly. Then the patient must visit the nutritionist constantly to take care of all their nutrients and micro elements to maintain optimal health.

How much weight will I lose with bariatric surgery?
A: With the gastric sleeve let’s say you can expect a loss of 70% to 80% of the patient’s overweight. Also with weight loss helps the patient to control comorbidities like diabetes, hypertension and dyslipidemas.

The bypass has a greater success rate of weight loss and the duodenal switch even more, up to 90% of the weight loss. That’s why I mentioned that in the duodenal switch, we have to take great care of nutrition, because we can go to the other extreme.

Q: What is the impact in a patient’s life?

A: Well, it’s completely radical … In an overweight patient; Their self-esteem, their quality of life are seriously affected. Obviously if the patient is very young, he may not feel it as much, but as the years’ pass, the overweight begins to affect the knees, the spine, and gives some osteoarthritis because of being overweight. Hypertension, diabetes and other diseases also begin to appear. Then by eliminating all this, it greatly enhances the health of the person.

On the other hand is the aesthetic aspect. The patient now looks thinner, looks better, becomes motivated, starts to exercise that he has never done or to be more constant. Then he becomes much more motivated and starts to take care of his diet. Something very important, is not to see this type of surgeries as the definitive way to lose weight and to be well. It is more a tool to learn to eat well, learn new habits that lead to a healthier lifestyle, lose weight and enjoy a better health for longer time.

Dr. Salvador Ramírez is a surgeon with specialty in laparoscopic surgery certified by the Mexican Association of Endoscopic Surgery and the Mexican Institute of Social Security.

If you want to know more information about costs or consultations for these and other procedures, please call (664) 608-6460 and (619) 955-6845 from the United States, you can also access to a virtual consultation on the following http link :