What to know about weight-loss surgery

The procedure can help some, but poses risks

Published: December 20, 2014 06:00 AM

About 113,000 people get weight-loss surgery every year. And growing research shows that the procedure can help many people lose weight and control weight-related health problems, including type 2 diabetes and high blood pressure.

But the surgery isn’t always appropriate, even for people who are seriously overweight. And when it is a good choice, there are several options to choose from, and your choice of doctor and hospital matters. Here’s what you need to know about weight-loss surgery.

First, it should be reserved for people who really, really need to lose weight. That’s because the procedure comes with all of the risks of any other major surgery, including infections, and recovery can be difficult. Moreover, some research suggests that many people who undergo the operation have to be readmitted to the hospital, either to get the band repaired or removed.  

So experts say that the operations should be limited to people who are “morbidly obese,” that is with a body mass index (BMI) of 40 or above; and those with a BMI above 35 who also have a serious health condition such as type 2 diabetes, severe joint pain, or sleep apnea. And even then, the surgery should be done only if you have seriously tried to lose weight by exercising more and eating less, and if you’re healthy enough to undergo major surgery. So people with a history of heart attack, stroke, kidney failure, or a blood-clotting disorder may not be good candidates for weight-loss surgery.

In the right patients, weight loss surgery is effective. About 80 to 90 percent of patients who undergo the two most common procedures—gastric bypass and sleeve gastrectomy—experience long-term weight loss, according to John Birkmeyer, M.D., chief academic officer of the Dartmouth-Hitchcock Health System in New Hampshire.

Here are descriptions of the most common versions of weight loss surgery.

Roux-en-Y gastric bypass

The surgeon divides the upper part of the stomach to make an egg-sized pouch, then connects it to the lower half of the small intestine. Because your stomach is so small, you feel full soon after eating. This is the most effective of all weight-loss surgeries, with patients losing 62 percent to 68 percent of their excess weight in the first year. But it also has the most adverse incidents. About 10 percent of patients develop diarrhea, cramps, and facial flushing after eating; 3 to 4 percent develop a stomach ulcer or bowel obstruction.

Laparoscopic sleeve gastrectomy

Doctors remove about 85 percent of your stomach, leaving a banana-shaped pouch. That restricts food intake and affects the appetite-related stomach hormone, leaving you feeling less hungry. Within a year, patients lose an average of 33 percent of excess weight.

Laparoscopic adjustable gastric banding (Lap-Band)

An adjustable band placed around the upper part of the stomach limits the amount of food it can hold. The band can be tightened or loosened periodically. After two years, weight loss ranges from 45 to 75 percent of excess body weight. This surgery, unlike the previous two, is reversible.

Endoscopic sleeve gastroplasty

In this new (and reversible) weight loss surgery procedure, doctors place a flexible tube with a suturing device into your stomach. Using stitches, they “sew” your stomach so that it shrinks to a narrow bananalike tube, rendering you unable to eat much. Patients can expect to lose up to 30 pounds in the first six months. Most regain some weight but largely sustain the loss after a year.

What to look for in a surgeon and hospital

When looking for a surgeon and hospital for weight-loss surgery, experience matters.


For example, one study found that patients who were operated on by less experienced surgeons were twice as likely to be readmitted to a hospital or to need a second operation. Birkmeyer recommends look for a surgeon who does at least 50 of the procedures a year.  


For hospitals, it’s worth looking for one accredited by the American College of Surgery and the American Society for Metabolic and Bariatric Surgery. Research suggests that hospitals with that accreditation had better outcomes than non-accredited hospitals.


And use our hospital Ratings to see how hospitals in your community fare in other measures of hospital safety.


Editor's Note:

This article also appeared in the January 2015 issue of Consumer Reports on Health.



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