Obesity is a medical condition, not a failure of willpower — driven by hormones, genetics, medications and environment as much as by diet. That matters, because it explains why diet and exercise alone so often fail to hold weight off in the long term, and why surgery, by changing the underlying signals of hunger and fullness, can succeed where effort alone has not.
The aim of surgery is not a number on a scale. It is the resolution or improvement of the conditions that shorten life — and a body that can move, work and recover better than before.
Who it suits
Surgery is generally considered when weight has stayed high despite genuine non-surgical attempts, and where weight-related illness is present or likely. Suitability is assessed individually and usually involves a dietitian, a physician and, where helpful, a psychologist — not the surgeon alone. The purpose of that assessment is to make sure the operation is the right tool for you, and that you are set up to do well from it.
A considered decision. Bariatric surgery is permanent and asks for lasting change in how you eat. Ram's practice is to spend the time getting the decision right before getting to theatre.
The operations
Sleeve gastrectomy
About three-quarters of the stomach is removed, leaving a narrow tube. It reduces appetite partly by removing the part of the stomach that produces the main hunger hormone. It is technically simpler than a bypass, has no rerouting of the bowel, and is the common first operation.
Roux-en-Y gastric bypass
A small stomach pouch is created and joined directly to the small bowel, bypassing the rest. It has the strongest and most reliable effect on type 2 diabetes and on reflux, and remains the benchmark against which other operations are measured.
One-anastomosis gastric bypass
A bypass with a single join rather than two. Fewer connections can mean a shorter operation; it is considered for selected patients and discussed alongside the alternatives.
Life after surgery
Recovery from keyhole bariatric surgery is usually quick — a short hospital stay and a staged return to eating over several weeks. The lasting work is nutritional: smaller meals, attention to protein, and lifelong vitamin supplementation with regular follow-up. Patients who stay connected to the team do best, and follow-up is built into the practice rather than left to chance.
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