CSOWM - BARIATRIC SURGERY PROCEDURES
& NUTRITION QUESTIONS WITH CORRECT
ANSWERS 2026
Bariatric and Metabolic Surgery Procedures - CORRECT ANSWER - -
Previously known as weight loss surgery
- Impact the physiological regulation of body weight
- Improve morbidity and mortality rates among overweight/obese populations
Combination Procedures - CORRECT ANSWER - -
Gastric manipulation, causing some restriction and neural/hormonal changes
Examples: Sleeve Gastrectomy (SG), Roux-en-
Y Gastric Bypass (RYGB), and Biliopancreatic Diversion (BPD/DS)
Sleeve Gastrectomy (SG) - CORRECT ANSWER - -
80% of stomach is removed (specifically the fundus, which significantly reduces ghrelin production)
Sleeve Gastrectomy (SG) Advantages - CORRECT ANSWER - -
performed more quickly which means shorter anesthesia duration and lesser degree of post op syste
mic response
- fewer complications
- decreased risk of micro-nutritional problems
-
decreased risk of long term complications (obstructions, ulcers, dumping syndrome, hypoglycemia, etc
)
- can be revised/converted
- allows access to both biliary & pancreatic duct (for upper GI/EGD)
- favorable change in the gut microbiota.
Sleeve Gastrectomy (SG) Disadvantages & Risks - CORRECT ANSWER -
- may exacerbate GERD due to preservation of acid producing cells
,-
unknown long term data (10+ years) regarding durability of weight loss and comorbidity improvement
s
-
contraindicated in patients with severe GERD, lower esophageal sphincter incompetence, and Barrett's
esophagus
Roux-en-Y Gastric Bypass (RYGB) - CORRECT ANSWER - -
Step 1 Restriction: The surgeon separates the upper portion of the stomach from the lower portion. Th
e upper portion (or the "pouch") is then connected to a limb of the small intestine, called the "Roux li
mb." The new stomach pouch restricts the amount of food you can eat, making you feel full after eati
ng only a small amount of food.
Step 2 Malabsorption: The pouch is then connected to the middle of the small intestine (the jejunum)
- the duodenum and part of the jejunum are bypassed.
Roux-en-Y Gastric Bypass (RYGB) Mechanisms - CORRECT ANSWER - -Ghrelin Suppression
- nutrient exposure to the intestine is sufficient for food-induced ghrelin suppression
- it may cause partial vagotomy
Increases Satiety and Suppresses Appetite
-
accelerates delivery of nutrients into the hindgut (cecum, large colon, small colon and the rectum) wh
ich increases the secretion of gut hormones (GLP-1, PPY, OXM, CCK) and bile acids
Roux-en-Y Gastric Bypass (RYGB) Advantages - CORRECT ANSWER - -
more weight loss than the LAGB and SG
- better comorbidity outcomes (CAD, T2DM, HTN, OSA, GERD, and cancer)
-
lifetime expectancy increased (~7 years) due to significant improvement or remission of comorbidities
- favorable change in gut microbiota
Roux-en-Y Gastric Bypass (RYGB) Disadvantages & Risks - CORRECT ANSWER - -
obstruction (due to hiatal hernia)
, - adhesions
- ulcers (NSAIDs, tobacco smoking) such as anastomotic ulcers
- dumping syndrome
Biliopancreatic Diversion (BPD) / Duodenal Switch (DS) - CORRECT ANSWER - -
80% of stomach is removed (essentially a sleeve gastrectomy is performed) and the gastric pouch is co
nnected to a very short length of the ileum (bypasses duodenum and jejunum).
The biliopancreatic loop (portion of the small intestine that was bypassed) is connected to the distal p
art of the digestive loop (portion of the intestine that remains and that food will travel through) formi
ng a channel to the colon
Biliopancreatic Diversion (BPD) / Duodenal Switch (DS) Advantages - CORRECT ANSWER - -
greater weight loss @ 1 year follow up
- most effective against diabetes compared to RYGB, SG, and LAGB
Metabolic Impact
- decreased ghrelin (which decreases hunger)
- increased PYY (which increases satiety)
- increased GLP-1 (which increases satiety)
Biliopancreatic Diversion (BPD) / Duodenal Switch (DS) Disadvantages - CORRECT ANSWER - -
higher complication rates and mortality
- requires longer hospital stay
- greater potential for protein and vitamin/mineral deficiencies
due to malabsorption and diarrhea
-
patient compliance (lots of follow up visits and strict adherence to dietary and lifelong vitamin/minera
l supplementation)
& NUTRITION QUESTIONS WITH CORRECT
ANSWERS 2026
Bariatric and Metabolic Surgery Procedures - CORRECT ANSWER - -
Previously known as weight loss surgery
- Impact the physiological regulation of body weight
- Improve morbidity and mortality rates among overweight/obese populations
Combination Procedures - CORRECT ANSWER - -
Gastric manipulation, causing some restriction and neural/hormonal changes
Examples: Sleeve Gastrectomy (SG), Roux-en-
Y Gastric Bypass (RYGB), and Biliopancreatic Diversion (BPD/DS)
Sleeve Gastrectomy (SG) - CORRECT ANSWER - -
80% of stomach is removed (specifically the fundus, which significantly reduces ghrelin production)
Sleeve Gastrectomy (SG) Advantages - CORRECT ANSWER - -
performed more quickly which means shorter anesthesia duration and lesser degree of post op syste
mic response
- fewer complications
- decreased risk of micro-nutritional problems
-
decreased risk of long term complications (obstructions, ulcers, dumping syndrome, hypoglycemia, etc
)
- can be revised/converted
- allows access to both biliary & pancreatic duct (for upper GI/EGD)
- favorable change in the gut microbiota.
Sleeve Gastrectomy (SG) Disadvantages & Risks - CORRECT ANSWER -
- may exacerbate GERD due to preservation of acid producing cells
,-
unknown long term data (10+ years) regarding durability of weight loss and comorbidity improvement
s
-
contraindicated in patients with severe GERD, lower esophageal sphincter incompetence, and Barrett's
esophagus
Roux-en-Y Gastric Bypass (RYGB) - CORRECT ANSWER - -
Step 1 Restriction: The surgeon separates the upper portion of the stomach from the lower portion. Th
e upper portion (or the "pouch") is then connected to a limb of the small intestine, called the "Roux li
mb." The new stomach pouch restricts the amount of food you can eat, making you feel full after eati
ng only a small amount of food.
Step 2 Malabsorption: The pouch is then connected to the middle of the small intestine (the jejunum)
- the duodenum and part of the jejunum are bypassed.
Roux-en-Y Gastric Bypass (RYGB) Mechanisms - CORRECT ANSWER - -Ghrelin Suppression
- nutrient exposure to the intestine is sufficient for food-induced ghrelin suppression
- it may cause partial vagotomy
Increases Satiety and Suppresses Appetite
-
accelerates delivery of nutrients into the hindgut (cecum, large colon, small colon and the rectum) wh
ich increases the secretion of gut hormones (GLP-1, PPY, OXM, CCK) and bile acids
Roux-en-Y Gastric Bypass (RYGB) Advantages - CORRECT ANSWER - -
more weight loss than the LAGB and SG
- better comorbidity outcomes (CAD, T2DM, HTN, OSA, GERD, and cancer)
-
lifetime expectancy increased (~7 years) due to significant improvement or remission of comorbidities
- favorable change in gut microbiota
Roux-en-Y Gastric Bypass (RYGB) Disadvantages & Risks - CORRECT ANSWER - -
obstruction (due to hiatal hernia)
, - adhesions
- ulcers (NSAIDs, tobacco smoking) such as anastomotic ulcers
- dumping syndrome
Biliopancreatic Diversion (BPD) / Duodenal Switch (DS) - CORRECT ANSWER - -
80% of stomach is removed (essentially a sleeve gastrectomy is performed) and the gastric pouch is co
nnected to a very short length of the ileum (bypasses duodenum and jejunum).
The biliopancreatic loop (portion of the small intestine that was bypassed) is connected to the distal p
art of the digestive loop (portion of the intestine that remains and that food will travel through) formi
ng a channel to the colon
Biliopancreatic Diversion (BPD) / Duodenal Switch (DS) Advantages - CORRECT ANSWER - -
greater weight loss @ 1 year follow up
- most effective against diabetes compared to RYGB, SG, and LAGB
Metabolic Impact
- decreased ghrelin (which decreases hunger)
- increased PYY (which increases satiety)
- increased GLP-1 (which increases satiety)
Biliopancreatic Diversion (BPD) / Duodenal Switch (DS) Disadvantages - CORRECT ANSWER - -
higher complication rates and mortality
- requires longer hospital stay
- greater potential for protein and vitamin/mineral deficiencies
due to malabsorption and diarrhea
-
patient compliance (lots of follow up visits and strict adherence to dietary and lifelong vitamin/minera
l supplementation)
