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Obesity: Should I Have Weight-Loss Surgery?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Obesity: Should I Have Weight-Loss Surgery?
Get the facts
- Have weight-loss surgery.
- Do not have weight-loss surgery.
Key points to remember
- Being very overweight makes you more likely to have serious health problems, such as heart disease and type 2 diabetes.
- Surgery may be an option
if you haven't been able to lose weight with diet and exercise and if:
- You are an adult with a BMI (body mass index) of 40 or higher.
- You are an adult with a BMI of 35 or higher and you also have another health problem related to your weight, such as type 2 diabetes or arthritis.
- In adolescents, these surgical procedures are not typically recommended unless the BMI is over 50 or the child has severe health problems and a BMI over 40. Surgery is considered only after changes have been made to increase physical activity, eat the right range of calories, and possibly use medicine for weight loss, under the direction of a doctor.
- Most people lose at least a third of their extra weight after surgery. Some people lose almost all of their extra weight. Weight loss varies with the type of surgery and how closely people follow the recommendations for lifestyle changes, check-up appointments, and counseling as instructed by the doctor.
- Weight-loss surgery is not cosmetic surgery. It will not remove fatty tissue. And after a lot of weight loss, you may have excess skin. Some people choose to have more surgery to remove skin from the belly, thighs, upper arms, or breasts.
- After surgery, you will need to make big, lifelong changes in how you eat—including smaller portions and different foods. Some people gain weight again after a few years because they can't make these permanent changes.
- Weight-loss surgery has risks, including a risk of death. You need to compare the risks of being very overweight with the risks of surgery.
Surgeries for weight loss use these surgical procedures: restrictive and/or malabsorptive.
The restrictive procedures make the stomach smaller (restricting the size and the amount of food that can be in the stomach). Examples of restrictive surgeries include:
- Adjustable gastric banding. A band is placed around the upper part of the stomach, creating a pouch. The band is adjustable, so the size of the opening between the pouch and the stomach can be adjusted.
- Gastric sleeve. More than half of your stomach is removed, leaving a thin sleeve, or tube, that is about the size of a banana. Because part of your stomach has been removed, this is not reversible. Sometimes this surgery is part of an approach to weight loss done in several steps. If you need to lose a lot of weight before you have duodenal switch surgery, gastric sleeve surgery may help you.
In the malabsorptive procedures, part of the intestine is bypassed. Since nutrients are normally absorbed in the intestine, bypassing a part of it reduces how much it can absorb, which can cause weight loss.
Combination procedures are both restrictive and malabsorptive. Examples include:
- Roux-en-Y gastric bypass. A small part of the stomach is used to create a new stomach pouch, roughly the size of an egg. The smaller stomach is connected to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine. This reduces the amount of food you can eat at one time. Bypassing part of the intestine reduces how much food and nutrients are absorbed. This leads to weight loss.
- Biliopancreatic diversion. A biliopancreatic diversion changes the normal process of digestion by making the stomach smaller. It allows food to bypass part of the small intestine so that you absorb fewer calories. There are two biliopancreatic diversion surgeries:
- In a biliopancreatic diversion, a portion of the stomach is removed. The remaining portion of the stomach is connected to the lower portion of the small intestine. The food you eat then bypasses much of the small intestine, resulting in fewer calories absorbed and weight loss.
- In a biliopancreatic diversion with duodenal switch, a portion of the stomach is removed, but the pylorus remains intact. The pylorus controls food drainage from the stomach. The pylorus is connected to a lower segment of the intestine. The duodenum is connected to the lower part of the small intestine. The food you eat then bypasses much of the small intestine, resulting in fewer calories absorbed and weight loss.
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 done two ways:
- Open surgery. The surgeon makes a large cut in the belly.
- Laparoscopic surgery. 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 pain or problems after surgery. Not all weight-loss surgeries can be done this way.
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. You'll also want to be careful about drinking alcohol. You may become intoxicated much more quickly, and alcohol can also cause ulcers in your stomach and/or intestines.
- Vitamins. You will need to take vitamins and supplements, because you won't get enough nutrition from the small amounts of food you eat. If you have surgical changes to your intestines, your body won't be absorbing all the nutrition from the food.
- Avoid fatty, sugary foods. 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. It can also cause belly pain, cramping, and nausea.
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 a risk of any surgery.
- You could get an infection in the area where cuts were made.
- A blood clot can form and block blood flow in the lung (pulmonary embolism).
- Some people have problems after surgery, such as:
After gastric bypass:
- You may have a deficiency in vitamin B12, which can cause anemia.
- The connection between the stomach and the small intestine can become narrow. This can cause nausea and vomiting after eating.
- You can get ulcers.
- Hernia may develop.
- The bypassed stomach may enlarge. This causes hiccups and bloating.
- There can be a leak from the stomach into the belly area, which can cause an infection called peritonitis.
After adjustable gastric banding:
- You are more likely to need another surgery to fix complications than you would be after gastric bypass. For example, some patients need a second operation, because the band slips or it works its way from the outside of the stomach to the inside. This complication is called an erosion.
- You won't lose weight as fast as you would with gastric bypass.
Another risk of surgery is that, although it helps you lose weight, after a few years you may gain the weight back if you don't follow the changes in your eating and lifestyle.
Weight-loss surgery is not cosmetic surgery. It will not remove fatty tissue. And after a lot of weight loss, you may have excess skin. Some people choose to have more surgery to remove skin from the belly, thighs, upper arms, or breasts.
Your doctor may recommend weight-loss surgery if:
- Your BMI is at least 40 (or your BMI is at least 35 and you have other health problems related to your weight, such as type 2 diabetes that is difficult to control with diet, exercise, and medicine).
- 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.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You are asleep during the operation.
- You stay in the hospital one or more days.
- You return to normal activities within 2 to 5 weeks.
- Weight-loss surgery helps most people lose a lot of weight.
- If you lose weight, you're less likely to have
related health problems. And if you already have these health problems, some may get better. Examples are:
- Heart disease.
- Type 2 diabetes.
- High blood pressure.
- High cholesterol and triglycerides.
- Sleep apnea.
- General problems that can occur after surgery include blood clots in the lung and infection.
- Many people have nutrition problems because they eat so little. That can lead to anemia or weak bones.
- In people who do not follow the changes in eating and lifestyle, weight gain is much more likely.
- There is a risk of death.
- You keep trying to lose weight with healthy eating and exercise.
- You may try prescription drugs to help you lose weight.
- You avoid having surgery and all the risks and side effects.
- If you don't lose weight, you are more likely to have related health problems, including heart disease and type 2 diabetes.
Personal stories about having surgery for obesity
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
Weight never used to be a problem for me. But then I had some problems in life and started gaining weight. I tried to lose weight but my problems kept getting in the way. I looked into surgery, but it seemed like a last resort. Instead, I'm working through my problems and feel I can get back to my old weight through less drastic means.
Charlene, age 52
I'm pretty young, but my doctor is worried about my weight problem. I guess my BMI and waist size put me at high risk for complications, especially type 2 diabetes. I've tried diet and medicines, but have not had any luck. My doctor is now talking to me about a gastric bypass, and I'm going to give it a try. I need to lose the weight, and feel I can live with the side effects and risks of surgery.
Mike, age 35
I know I'm obese and that I'm at risk for health problems. But to me, the risk of surgery and side effects are as bad as being obese, especially at my age. I might try diet or medicine again, but who knows? I'm happy with who I am and lead a good life. Surgery might make it worse. It's not for me.
Melissa, age 60
I'm tired of being fat. I've had a weight problem since I was a kid and want something different. Diets, drugs, exercise—I've tried them all. I've been talking to my doctor about surgery. We both feel that reducing my risk of heart problems, plus feeling better about myself, is worth the risks of surgery. The surgery sounds effective, and I feel if I can get started, I'll do fine on my own.
Frank, age 48
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to choose weight-loss surgery
Reasons not to choose weight-loss surgery
I have tried diet, exercise, and medicine, and they haven't worked.
I want to keep trying diet, exercise, and medicine to lose weight.
My weight bothers me so much that I am willing to have surgery, even though there are risks involved.
My weight doesn't bother me enough to take on the risks of surgery.
I feel confident that I can make major diet and exercise changes after surgery.
I'm not sure I can handle the diet and exercise changes I'll need to make after surgery.
I'm not worried about paying for this surgery.
I don't think I can afford to pay for this surgery.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
NOT having surgery
What else do you need to make your decision?
Check the facts
After weight-loss surgery, I will be able to eat normal amounts of food.
- TrueSorry, but that's wrong. Surgery will make your stomach much smaller than normal, so you will need to eat very small amounts of food and pay very close attention to getting the right amounts of vitamins and minerals.
- FalseCorrect. Surgery will make your stomach much smaller than normal, so you will need to eat very small amounts of food and pay very close attention to getting the right amounts of vitamins and minerals.
- I'm not sureIt may help to go back and read "How will surgery affect what you eat?" You will need to eat very small amounts of food after surgery.
Having weight-loss surgery can cause problems, but my being very overweight can also cause health problems.
- TrueThat's right. Surgery has risks, including a risk of death. But being very overweight can lead to serious health problems, such as heart disease and type 2 diabetes. You need to compare the risks of being obese with the risks of surgery.
- FalseSorry, that's wrong. Surgery has risks, including a risk of death. But being very overweight can lead to serious health problems, such as heart disease and type 2 diabetes. You need to compare the different risks.
- I'm not sureIt may help to go back and read "Key points to remember." Surgery has risks, including a risk of death. But being very overweight can lead to serious health problems, such as heart disease and type 2 diabetes. You need to compare the risks.
Surgery may be an option for me because my BMI is higher than 40.
- TrueYou're right. Surgery is for people who are so heavy that their health is in danger. Those are people whose BMI is at least 40, or at least 35 if they already have other health problems.
- FalseSurgery is for people who are so heavy that their health is in danger. Those are people whose BMI is at least 40, or at least 35 if they already have other health problems.
- I'm not sureIt may help to go back and read "Key points to remember." Surgery is for people who are so heavy that their health is in danger. Those are people whose BMI is at least 40, or at least 35 if they already have other health problems.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Ali Tavakkolizadeh, MD, FRCSC - General Surgery, Bariatric Surgery|
Last Updated:August 16, 2012