If you are extremely obese and have tried without success to get your weight under control, your doctor may recommend a weight-loss surgery (bariatric surgery) known as biliopancreatic diversion with duodenal switch (BPD/DS). The surgery has been shown to help reduce obesity and related illnesses, including heart disease, high blood pressure, and especially type 2 diabetes.
BPD/DS is a complex weight-loss surgery that makes it hard to ingest and absorb enough calories, vitamins, and minerals. You'll be at high risk of developing nutritional deficiencies afterward, including some that can be life-threatening if untreated. When deciding whether to have the surgery, these complications and other surgical risks should be carefully considered along with the benefits.
Doctors may recommend the BPD/DS to people who are severely obese, usually with a body mass index (BMI) of 50 or greater or a BMI of 40 or greater with serious type 2 diabetes. These health problems include:
Type 2 diabetes
High blood pressure
Nonalcoholic fatty liver disease
BPD/DS is a complex procedure that tackles weight loss in 3 different ways. First, the surgery takes out a large portion of the stomach to stop you from overeating. With less stomach to fill, you will feel full more quickly and eat less food and fewer calories.
The second part of the procedure reroutes food away from the upper part of the small intestine, which is the natural path of digestion. This cuts back on how many calories and nutrients your body is able to absorb.
The third part of the BPD/DS procedure changes the normal way that bile and digestive juices break down food. This cuts back on how many calories you absorb, causing still more weight loss.
BPD/DS is done as either laparoscopic or traditional open surgery. In an open surgery, the doctor makes a cut in your belly area long enough to reach the stomach and intestines. Laparoscopic BPD/DS requires 5 to 7 much smaller cuts – typically only about a half-inch to an inch long. And it uses tiny tools with a lighted camera to perform the surgery. Laparoscopic surgery can help you recover more quickly and may reduce the risk for complications such as hernias.
People who are quite obese may not be good candidates for laparoscopic BPD/DS. Laparoscopic surgery may also not be appropriate for people who have already had some type of stomach surgery or those with serious medical problems.
The BPD/DS can cause drastic, significant weight loss, because it restricts how much food you can eat and reduces how many calories you can absorb.
BPD/DS reduces the absorption of essential vitamins and minerals and can result in serious, long-term complications. People who have BPD/DS may develop anemia, osteoporosis, or kidney stones.
In addition, people who have undergone BPD/DS are at high risk for calcium and iron deficiencies, as well as deficiencies in vitamins A, D, E, and K, the so-called fat soluble vitamins.
Although rare, a thiamine deficiency resulting in a condition called beriberi can occur after BPD/DS surgery. Beriberi can permanently damage the nervous system if untreated.
Up to 18% of people with a BPD/DS surgery also develop some element of protein-energy malnutrition. When severe, this conditions is known as kwashiorkor, a severe and potentially life-threatening form of malnutrition.
If you have BPD/DS surgery, you will need to take vitamin and mineral supplements and have regular blood testing for the rest of your life in order to prevent severe vitamin deficiencies and related complications. Even if you take the supplements as prescribed, you still may develop nutritional problems and require treatment.
Like any surgery, the BPD/DS procedure carries certain risks:
Potentially fatal blood clots in your legs that can move to the lungs or heart
The American Society for Metabolic and Bariatric Surgery (ASMBS) recommends that doctors prescribe these daily supplements after BPD/DS weight-loss surgery to help prevent nutritional deficiencies:
Vitamin A, starting 2 to 4 weeks after surgery
Vitamin D, starting 2 to 4 weeks after surgery
Vitamin K, starting 2 to 4 weeks after surgery
Multivitamin with 200% of the daily values, starting the first day after discharge from the hospital
Minimum of 18 mg to 27 mg of iron, and up to 50 mg to 100 mg a day for menstruating women or adolescents at risk for anemia, starting the first day after discharge
Calcium supplements, usually taken as 3 doses to 4 doses of 500 mg to 600 mg doses, starting on the first day after your discharge or within the first month after surgery. Note: Don't take these at the same time as iron supplements; wait a couple of hours.
Vitamin B12 supplements containing 350 mcg to 500 mcg; some people will need to give themselves B12 injections
Optional B-complex vitamin
Up to 3 servings of calcium-rich dairy beverages
The ASMBS also recommends that you eat small but nutritious meals that are high in protein, along with fruits, vegetables, whole grains, and omega-3 fatty acids. You should avoid meals high in sugar.
It's important to understand that following a healthy lifestyle is critical to maintaining weight loss after surgery. This includes eating a healthy diet and getting plenty of regular exercise. And it requires a lifelong commitment. For these reasons, BPD/DS surgery should not be considered a quick fix to lose weight.