Surgical Options

Why All the Controversy?

In cases of extreme obesity and among patients for whom other weight loss treatment options have failed, obesity surgery presents a possible option to achieve weight loss.

Obesity surgery is recommended as an option in the treatment of obesity only for patients with either a body mass index (BMI) of more than 40 or a BMI of 35 to 39.9 when other serious obesity-related medical conditions are present.

Who is Having Obesity Surgery?

The International Bariatric Surgery Registry (IBSR) has established a database with information on more than 14,500 people who have had obesity surgery.

The patients having obesity surgery exhibited the following weight and body mass index (BMI) characteristics:

  • Average Weight at Time of Operation: 279.4 pounds (+/- 60.3 pounds).
  • Average BMI at Time of Operation: 46 (+/- 8.3).
  • A body mass index between 35 and 39.9: 19.7 percent.
  • A body mass index of 40 or more: 76.1 percent.

What are the Benefits of Obesity Surgery?

Most patients experience rapid weight loss and continue to do so for 12 to 18 months following obesity surgery:

  • Patients may experience weight loss of up to 50 percent of their excess weight in the first six months and 77 percent of their excess weight within one year55 of obesity surgery.
  • Patients may maintain 50 to 60 percent of their weight loss 10 to 14 years after obesity surgery.

What are the Risks?

While obesity surgery remains a viable option for patients who have had no success pursuing other treatments, there are risks involved:

  • Complications requiring a hospital stay of seven or more days were reported in 1.35 percent of patients in the IBSR database. Some of the obesity surgery complications involve the heart or liver, rupture of blood vessels in the lungs, infection in the diaphragm area, leaking and bleeding of the stomach and intestines, blood clotting in veins, and blockage of the small intestine.
  • Obesity surgery complications requiring a hospital stay of less than seven days were reported in 5.28 percent of patients in the IBSR database. These complications include breathing difficulties, wound infections, and injury to the spleen.
  • Ten to 20 percent of patients needed follow-up operations to correct obesity surgery complications such as abdominal hernias.
  • Gallstones develop in more than one-third of patients as a result of significant weight loss. Taking medication can prevent gallstones. The condition is irrelevant if the gallbladder is removed during surgery.
  • Anemia, osteoporosis, and other bone diseases are nutritional deficiencies that develop after the obesity surgery due to long-term loss of absorptive function. Nutritional deficiencies, which occur in almost 30 percent of patients, can be prevented with proper attention to vitamin and mineral intake, especially vitamins B12 and D, calcium, foliate, and iron.
  • Women of childbearing age should be aware that quick weight loss and nutritional deficiencies can harm a developing fetus.
  • Vertical-banded Gastroplasty (VBG) and Roux-en-Y Gastric Bypass (RGB) death rates are relatively low. Within 30 days of obesity surgery, death occurred in less than a quarter of one percent (0.17 percent) of patients in the IBSR database. Pulmonary embolism was the most frequent cause of death.
  • Possible death (1 out of 200 cases).
  • Surgical Techniques (See Section Notes Above)

Making a Sound Decision

Despite significant progress in developing safer and more effective surgical techniques, obesity surgery remains a last option for patients attempting weight loss.

Before considering obesity surgery, it is important that patients understand all of the risks and benefits involved. The full team of medical professionals involved in the weight loss planning process – which may include a general practitioner, an endocrinologist, an ob/gyn, a nutritionist, a psychologist, and others – should be available to offer their expertise and guidance. If the patient has an underlying endocrine or other serious health condition such as heart disease or risk for stroke, obesity surgery may not be the best option.

It is also important to remember that surgical candidates must be willing to alter their diet and physical lifestyle following the surgery in order to achieve long-term weight loss success.

The following chart outlines the most common surgical treatments for obesity, and their associated risks and benefits: