Deciding on Bariatric Surgery

Last Updated: Nov. 1, 2003

Is the surgery for you?
Gastrointestinal surgery may be the next step for people who remain severely obese after trying nonsurgical approaches, or for people who have an obesity-related disease. Candidates for surgery have:

• BMI of 40 or more
• A life-threatening obesity-related health problem such as diabetes, severe sleep apnea, or heart disease and a BMI of 35 or more
• Obesity-related physical problems that interfere with employment, walking, or family function

If you fit the profile for surgery, answers to the following questions may help you decide whether weight-loss surgery is appropriate for you.

Are you:

• Unlikely to lose weight successfully with nonsurgical measures?
• Well-informed about the surgical procedure and the effects of treatment?
• Determined to lose weight and improve your health?
• Aware of how your life may change after the operation (adjustment to the side effects of the surgery, including the need to chew well and inability to eat large meals)?
• Aware of the potential for serious complications, dietary restrictions, and occasional failures?
• Committed to lifelong medical follow-up?

Remember: There are no guarantees for any method, including surgery, to produce and maintain weight loss. Success is possible only with maximum cooperation and commitment to behavioral change and medical follow-up; this cooperation and commitment must be carried out for the rest of your life. Surgery to produce weight loss is a serious undertaking. Anyone thinking about surgery should understand what the operation involves. Patients and physicians should carefully consider the following benefits and risks:

Benefits of surgery
Right after surgery, most patients lose weight quickly and continue to lose for 18 to 24 months after the procedure. Although most patients regain 5% to 10% percent of the weight they lost, many maintain a long-term weight loss of about 100 pounds.

Surgery improves most obesity-related conditions. For example, in one study blood sugar levels of 83% of obese patients with diabetes returned to normal after surgery. Nearly all patients whose blood sugar levels did not return to normal were older or had lived with diabetes for a long time.

Risks of surgery
About 10% to 20% of patients who have weight-loss surgery require follow-up operations to correct complications. Abdominal hernia was the most common complication requiring follow-up surgery, but laparoscopic techniques seem to have solved this problem. In laparoscopy, the surgeon makes one or more small incisions through which slender surgical instruments are passed. This technique eliminates the need for a large incision and creates less tissue damage. Patients who are superobese or have had previous abdominal surgery may not be good candidates for laparoscopy, however. Less common complications include breakdown of the staple line and stretched stomach outlets.

Some obese patients who have weight-loss surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss, a person’s risk of developing gallstones increases. Taking supplemental bile salts for the first 6 months after surgery can prevent gallstones.

Nearly 30% of patients who have weight-loss surgery develop nutritional deficiencies such as anemia, osteoporosis, and metabolic bone disease. These deficiencies usually can be avoided if vitamin and mineral intakes are high enough.

Women of childbearing age should avoid pregnancy until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus.

Medical costs
Gastrointestinal surgery costs about $15,000. Medical insurance coverage varies by state and insurance provider. If you are considering gastrointestinal surgery, contact your regional Medicare or Medicaid office or insurance plan to find out if the procedure is covered.

Source: National Institutes of Health

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