Obesity: Should I have weight-loss surgery?

The most common surgeries are:

Stomach stapling. Surgical staples and a plastic band are used to create a small pouch at the top of the stomach. You get full much faster, so you don't eat as much.

Adjustable gastric banding. A small band is placed around the upper part of the stomach, creating a small pouch. The band can be adjusted to make the pouch bigger or smaller.

Gastric bypass. Staples or a band are used to create a permanent small pouch in the stomach. The pouch is connected to the middle part of the small intestine so that food bypasses the rest of the stomach and the first part of the small intestine. You get full much faster, and your small intestine absorbs fewer calories.

Most people who have weight-loss surgery are between 18 and 65 years old. But the surgery is often done on people older than 65. And it is sometimes done on people younger than 18.

Surgery can be donetwo ways:

• Open surgery.The surgeon makes a large cut in the belly.
• Laparoscopicsurgery. The surgeon makes several small cuts and uses small tools and a camera to guide the surgery. You recover sooner and are less likely to have problems after surgery.¹

After surgery, you'll need to make big, permanent changes in how you eat:

• Tiny meals.You can eat only a few ounces of food at a time. Your new stomach will only hold a tiny amount of food.
• Eat slowly.You must eat very slowly and chew your food to mush. Otherwise, you may vomit often and have pain.
• No liquids with meals.You won't be able to drink for 30 minutes before you eat, during your meal, and for 30 minutes after you eat. There won't be room in your stomach for both drinks and solid food.
• Vitamin pills.You probably will need to take vitamins and supplements.
• Avoid candy, ice cream.You may have to avoid foods that contain simple sugars—like candy, juices, ice cream, condiments, and soft drinks. Simple sugars may cause a problem called dumping syndrome. This happens because food moves too quickly through the stomach and intestines. It can cause shaking, sweating, dizziness, rapid heart rate, and often severe diarrhea.

People who are very overweight are more likely than other people to have problems from any kind of surgery.

After any weight-loss surgery:

• There is a risk of death.This is rare, but it does happen sometimes. Fewer than 1 out of 100 people die after weight-loss surgery.²
• You could get an infection in the area where cuts were made.
• There can be a leak from the stomach into the belly area, which can cause an infection called peritonitis.
• A blood clot can form and block blood flow in the lung (pulmonary embolism).
• About 33 out of 100 people develop one of the following problems, while about 67 out of 100 do not:^{3, 4}
  • Gallstones
  • Anemia
  • Osteoporosis

Afterstomach stapling:³

• About 20 out of 100 people may need a second operation because the connection between the stomach and the small intestine narrows, leading to nausea and vomiting, or because of an increase of gastroesophageal reflux after eating.⁵ This means that 80 out of 100 people don't have this problem.
• The staples pull loose in about 33 out of 100 cases. This means that 67 out of 100 people don't have this problem.
• The plastic band may slip. Or it may work its way from the outside of the stomach to the inside.

Aftergastric bypass:^{5, 3}

• More than 30 out of 100 people have an iron and vitamin B12 deficiency, while about 70 do not. About half of those 30 people with an iron deficiency develop anemia.
• The connection between the stomach and the small intestine narrows in 5 to 15 out of 100 people, leading to nausea and vomiting after eating. This means 85 to 95 out of 100 don't have this problem.
• Between 5 and 15 out of 100 people get ulcers. This means 85 to 95 out of 100 don't get this problem.
• The staples may pull loose.
• Hernia may develop.
• The bypassed stomach may enlarge. This causes hiccups and bloating.

Afteradjustable gastric banding:

• Many patients need a second operation because the band slips. Or sometimes it works its way from the outside of the stomach to the inside.
• You won't lose weight as fast as you would with gastric bypass.
• Although it does not seem to have as many risks as other types of weight-loss surgery, more research is needed.

Another risk of surgery is that, although it helps you lose weight, after a few years you may gain the weight back. Research shows that after 10 years, only 20 out of 100 people who had stomach stapling have kept the weight off. That means that 80 out of 100 people gained weight again after 10 years.^{5, 4}

Your doctor may recommend weight-loss surgery if:

• Your BMI is at least 40 (35 if you have other health problems related to your weight).
• You have been obese for at least 5 years.
• You have tried for at least 6 months to lose weight with diet and exercise.
• You do not abuse alcohol.
• You do not have untreated depression or another major mental illness.