Many types of weight loss surgery are available for treating obesity and overweight. It's estimated that 41.9% of people in the United States live with obesity.
Without treatment, obesity could lead to serious complications. Diabetes, high blood pressure, and high cholesterol are some of the chronic disorders that are related to obesity.
This article covers several surgical weight loss options, their advantages, potential drawbacks, and risks.
Who Are Weight Loss Surgeries For?
Weight loss surgery (bariatric surgery) is a commitment. It involves making changes to diet and lifestyle to get the most benefits for weight loss and improved health.
Bariatric surgery is for people who are living with obesity. It's not always the first choice for weight loss, however. People with obesity usually try many strategies, but nothing works. Weight loss surgery is used to reduce the health risks that are associated with obesity, such as heart problems.
Weight loss surgery is for people with a particular body mass index (BMI) and/or obesity-related health conditions. Obesity is defined as a BMI of 30 or greater, and severe obesity is a BMI of 40 or greater.
Body Mass Index
Body mass index is a dated, biased measure that doesn’t account for several factors, such as body composition, ethnicity, race, gender, and age. Despite being a flawed measure, BMI is widely used today in the medical community because it is an inexpensive and quick method for analyzing potential health status and outcomes.
Understanding the Types of Weight Loss Surgery
Bariatric surgery might be categorized into types, including restrictive surgery, malabsorptive surgery, combination/mixed, and reduction of hunger hormones.
Restrictive surgery is effective for weight loss because it reduces the size of the stomach. After this surgery, people take in fewer calories because they get full after eating less food.
Malabsorptive surgery involves removing part of the small intestine or bypassing it. Shortening the small intestine means that fewer nutrients are absorbed from food.
Combination surgeries involve the small intestine and the stomach. A portion of the stomach is removed, and then part of the small intestine is either bypassed or reduced. Fewer nutrients are absorbed, and people feel full after eating less.
Some types of surgery also reduce the amount of hunger hormones produced in the stomach. Removing the section of the stomach that secretes these hormones produces less hunger.
Gastric Bypass Surgery (Roux-en-Y)
A gastric bypass, also called a Roux-en-Y, is a combination surgery that affects the stomach and the small intestine. It is primarily restrictive but also results in malabsorption, and it reduces hunger hormones.
Procedure
The procedure involves reducing the stomach's size. Staples are used to reduce the stomach to about the size of an egg. The smaller pouch stomach is then attached to the second section of the small intestine. Food bypasses the first and part of the second section of the small intestine.
Pros
Gastric bypass surgery is considered the gold standard for weight loss surgery. This surgery tends to result in more weight loss than other types.
A 2024 study found over 46% achieved remission of type 2 diabetes after gastric bypass, significantly more than people who had sleeve gastrectomy.
Another study showed the type 2 diabetes remission rate was high even if the person regained weight.
Cons
A gastric bypass is difficult to reverse if a future medical reason requires it. While this rate is much lower than other surgeries, about 4% of people with a Roux-en-Y bypass will regain some of the weight they lose.
Long-term complications of gastric bypass include dumping syndrome (food enters the bowel too fast after eating), iron deficiency anemia, gallstones, and bowel obstruction.
Risks
Gastric bypass has a higher risk of causing complications in the first month than other bariatric surgeries. In addition, in the five years after having this surgery, there's a higher likelihood of needing more procedures or surgeries compared to other types of bariatric surgery. There is about a 1% risk of a leak at the surgery site.
Adjustable Gastric Banding
This surgery may also be called lap band surgery or laparoscopic gastric banding surgery. It is a common form of weight loss surgery that reduces the amount of food the stomach can hold.
Procedure
In adjustable gastric banding surgery, a band is placed around the top part of the stomach. It results in a smaller stomach, which leads to being full sooner during a meal.
Pros
For people who live with diabetes, gastric banding surgery brings the disease into remission in 57% of cases. People might lose about 45% of what is considered their excess body weight. The band can be adjusted as needed or it can be removed, meaning this surgery is reversible.
Cons
Adjustable gastric banding may be less effective for weight loss than the surgeries that also involve shortening the small intestine.
Risks
This surgery tends to have lower rates of certain risks (including death) than some types of bariatric surgery. However, the rates of needing a second procedure in order to get the desired results are higher than they are in other forms.
Sleeve Gastrectomy
Sleeve gastrectomy, also called gastric sleeve surgery, is one of the more common weight loss surgeries in the United States.
Procedure
In gastric sleeve surgery, most (about 80%) of the stomach is removed and closed up with staples. The part that's left is narrower, in the shape of a banana. People have less area in the stomach, so they feel full quickly when eating.
Pros
Removing part of the stomach might result in the stomach making fewer hormones that control appetite, causing less hungry. This surgery may lead to more weight loss than with the adjustable gastric band, with people losing about 60% of their excess body weight. Only the stomach is affected, and the small intestine is not altered.
Cons
The stomach is not simply bypassed in this surgery, part of it is actually removed, so reversal is not possible. Some people may experience vitamin or mineral deficiencies after having this surgery.
Risks
This surgery comes with a risk of developing reflux (stomach acid coming up into the esophagus), which sometimes doesn't respond to any treatments. In some cases, this surgery may be converted to a Roux-en-Y gastric bypass if the reflux is severely affecting quality of life.
The reflux may be related to developing a hiatal hernia, which is when the stomach pushes up into the chest through a hole in the diaphragm.
Biliopancreatic Diversion
Biliopancreatic diversion surgery is used less often than gastric sleeve, gastric bypass, and gastric banding.
Procedure
A biliopancreatic diversion is done in two parts, affecting both the stomach and the small intestine. First, most of the stomach is removed, leaving only a small section.
Next, the second part of the small intestine, the jejunum, is surgically separated from the first section (the duodenum) and the last section (the ileum). The duodenum and the ileum are connected together, bypassing the jejunum.
Food travels through the small stomach and the two sections of the intestine. As a result, people feel full quicker when eating, and fewer calories are absorbed in the small intestine.
Pros
This surgery, which affects both the stomach and the small intestine, is effective for weight loss. One research review showed that 59% of people had effective weight loss at 34 months after surgery.
In addition to consuming and absorbing fewer calories, the hormones that control hunger (which are produced in the stomach) are also reduced. This procedure is effective for achieving remission from type 2 diabetes in up to 84% of people.
Cons
Because this surgery results in such high levels of calorie restriction, it could prevent the absorption of enough vitamins, minerals, and protein from food.
Risks
Due to severe malabsorption, 0.5% to 4.9% of people will need more surgery on the small intestine. Insufficient weight loss might occur in 0.5% to 2.78% of cases.
Single Anastomosis Duodeno-Ileal Bypass With Sleeve Gastrectomy (SADI-S)
Single anastomosis dueodeno-ileal bypass with sleeve gastrectomy (SADI-S) was developed to be a simplified alternative to the biliopancreatic diversion surgery.
Procedure
SADI-S surgery involves removing most of the stomach, closing off and bypassing the upper portion of the small intestine, and attaching the remaining stomach to the part of the small intestine that is left.
Pros
SADI-S is helpful in achieving remission of type 2 diabetes, with one study showing as many as 93% of people achieving that goal. The remaining 7% had partial remission or took medication to manage the disease. It is effective for weight loss, with 77% of people losing a medically significant amount of weight after the first year.
Cons
The rate of complications in the early days after having this surgery is about 5% (however, this is less than in other combination bariatric surgery types). SADI-S surgery is associated with a risk of developing reflux, with a rate of 2% per year and 8% of people having this complication after 15 years.
Risks
The risk of an incisional hernia after this surgery is about 3% per year. After 15 years, about 14% of people developed an incisional hernia. With an incision hernia, internal organs or tissues protrude through the abdominal wall that was weakened by the surgery.
The yearly risk of bowel obstruction is 0.3%, with about 1% of people experiencing this complication sometime in the 15 years after the surgery. Also, within 15 years, 4% of people have a revision to improve the desired results of the surgery or to manage a complication.
Weight Loss Devices
Aside from surgery, a few different types of devices are used to promote weight loss. They are less invasive than bariatric surgery, but they may result in less weight loss.
Gastric Balloon
Two types of balloons might be used for weight loss. They are placed inside the stomach using special tools inserted through the mouth and down through the esophagus (food tube).
Procedure
A gastric balloon is placed while the person is under anesthesia during the endoscopic procedure. The balloon is inserted into the stomach and filled with saline. With less space for food in the stomach, the person feels fuller quicker.
A second type of gastric balloon works by not taking up room in the stomach but by slowing the movement of food from the stomach and into the small intestine. People feel fuller for longer after eating a meal.
Pros
A gastric balloon is temporary, which may make it attractive to some. It is a procedure rather than a surgery, so it's not associated with surgical risks or a hospital stay. It can be used for people who are not able to or who do not want to have surgery.
In one study of 159 people, BMI was reduced from a mean (average) of 34 to a mean of 30.
Cons
The long-term effects of gastric balloon procedures are not yet known because they have not been in use long enough. However, they are only used temporarily, for six to 12 months. This means that another procedure is needed to remove the balloon within a year of having it placed.
This is not a passive weight loss option. It involves altering diet and lifestyle. The weight loss is often not as much as with surgical procedures.
Risks
After the balloon is placed, some people experience nausea, vomiting, abdominal pain and/or discomfort, and symptoms of reflux. About 5% of people might need to have the balloon removed because these symptoms do not resolve.
Other risks include injuries during placement, such as a hole in the stomach or the esophagus or the balloon moving out of place and causing an obstruction. Infection from bacterial overgrowth is another possible complication.
Vagal Blockade (vBloc)
In vagal blockade (vBloc) a medical device is used to affect the vagus nerve (which regulates digestion and other body functions). It alters the way this nerve works, which can lead to a change in how hungry or full people feel.
Procedure
A vagal stimulation device is placed using laparoscopic surgery. The person is under general anesthesia. The procedure takes under two hours to finish. The implanted device gives off an electrical charge at regular intervals to block the hunger signal.
Pros
Studies show excess weight loss of about 24% with vagal blockade. The procedure is reversible, so people can have the device removed.
Cons
The device does need to be charged twice a week. Not many studies have yet reported on the use of this device, so the long-term effects and results are not yet known.
Risks
Adverse effects may include heartburn, dyspepsia (indigestion), abdominal pain, belching, and dysphagia (difficulty swallowing). However, most of these symptoms are felt for only a short time and improve on their own. After 18 months, 7% of people needed surgery again to make an adjustment.
How to Choose the Right Weight Loss Surgery for You
A number of factors will help determine if weight loss surgery is right for you, as well as which procedure is the best one. People should use shared decision-making with their healthcare providers to understand all the pros, cons, and risks as applied to them as individuals.
Some things to consider include:
Ability to engage in diet and exercise to maximize weight loss
Cost of the procedure and insurance coverage
Having had prior surgery on the stomach, intestines, or abdomen
How much weight loss is desired
If other obesity-related conditions need to be managed
Overall health and being a good candidate for surgery (some preexisting conditions may not be compatible with some surgeries)
Recovery time involved (which may mean taking time away from work or school)
Personal feelings and beliefs about medical procedures
How Do You Qualify for Weight Loss Surgery?
Not everyone will qualify for weight loss surgery. Certain metrics must be met in order to be a good candidate. Some of the qualifications will be different based on where the procedure is being performed. Not every type of procedure is performed at every institution, and surgeons may have their own criteria for candidates.
Weight Loss Surgery Screening Process
The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has published the following guidelines for bariatric surgery:
A BMI of more than 40 without any other health conditions
A BMI between 35 and 39.9 and at least one serious condition related to obesity (such as diabetes, high blood pressure (hypertension), sleep apnea, or limitations on quality of life)
A BMI between 30 and 34.9 with metabolic syndrome or diabetes that isn't being controlled with medications
Aside from these objective factors, other conditions may need to be met. This can include first trying other noninvasive methods for weight loss, such as diet and exercise or certain medications.
A mental health screening may also be done to ensure that the person is ready for the impacts that the surgery may have on their life and emotional wellness. In addition, a person may need to be able to commit to making diet and lifestyle changes to ensure that the surgery is a success.
Weight Loss Surgery for Teens
Guidelines determine the eligibility of teens for bariatric surgery. The American Society for Metabolic and Bariatric Surgery (ASMBS) advises that surgery be considered for teens who meet one of these criteria:
BMI greater than or equal to 35, or 120% of the 95th percentile for age and sex, whichever is lower, and another obesity-related condition, such as obstructive sleep apnea, type 2 diabetes, hypertension, metabolic dysfunction-associated steatohepatitis, slipped capital femoral epiphysis (the upper part of the thigh bone shifts), Blount disease (bowed legs), or gastroesophageal reflux disease (GERD)
BMI greater than or equal to 40, or 140% of the 95th percentile for age and sex, whichever is lower
Bariatric Surgery for Teens
The ASMBS states that bariatric surgery is the standard of care for severe obesity in adolescents. The organization recommends that children with severe obesity be referred early to a metabolic and bariatric surgery center.
What Is the Outlook for Someone After Weight Loss Surgery?
Weight loss surgery has become more common and techniques have improved in recent years. Overall, the risks of complications are low, and most people do well.
One problem that people will need to watch for is regaining weight. Working with the support team to make the most appropriate and beneficial lifestyle changes will be important in achieving long-lasting success.
After having weight loss surgery, people can expect to make some changes to their diet and lifestyle. Vitamin and mineral supplements will be needed for life. Most people will be encouraged to exercise in order to maintain weight loss. Quitting smoking and drinking less alcohol will also be recommended.
Frequent follow-up appointments are required in the first year or two after surgery, and then regular checkups thereafter with a healthcare provider to monitor for complications.
Summary
Several options are available for weight loss surgery and devices. People must meet certain criteria to be considered candidates for these procedures. Each type of procedure has its own benefits, drawbacks, and risks, which should be carefully considered with the help of healthcare providers.
The surgery and procedures required are not the final step toward weight loss. Also required are changes to diet, lifestyle, and medications or supplements for the rest of the person's life.
Read the original article on Verywell Health.