Weight loss surgery options

Weight loss surgery, also known as bariatric surgery, is one of the most effective tools for weight loss for people with a BMI above 40. The best operation to lose weight depends on a variety of factors but gastric bypass and gastric sleeve are two clear frontrunners.
Weight loss surgery, also known as bariatric surgery, is one of the most effective tools for weight loss for people with a BMI above 40. The best operation to lose weight depends on a variety of factors but gastric bypass and gastric sleeve are two clear frontrunners.

Weight loss surgery, also known as bariatric surgery, is one of the most effective tools for weight loss for people with a BMI above 40. If you're considering weight loss surgery, you'll learn there are several types of procedures available. While there's no single best operation to lose weight, you can choose the one that's best suited to you. 

If you and your doctor have determined that weight loss surgery is your next step toward better health, you'll need to carefully consider your options. Not all weight loss surgeries are right for everyone. 

Broadly, weight loss surgeries fall into one of two categories ­­– restrictive or malabsorptive. Restrictive surgeries restrict your food intake and help you eat less. By eating less, you lose weight. Malabsorptive surgeries are restrictive as well, but they also alter how your body absorbs food. Your body will process fewer calories and nutrients from your meals.

Here are some options you might consider:

  • Gastric bypass – Malabsorptive
  • Gastric sleeve – Restrictive
  • Duodenal Switch (“BPD-DS”) – Malabsorptive
  • SADI – Malabsorptive
  • Gastric Band – Restrictive
  • Gastric balloon – Restrictive

As research on safer and more effective techniques continues, the list of available weight loss surgeries is ever-changing. The gastric band was one of the most common surgeries for weight loss over a decade ago, but it's now largely fallen out of favor. Currently, only about 1% of weight loss surgeries performed in the US are gastric bands.

When it comes to popular weight-loss surgeries, today there are two clear frontrunners – the gastric sleeve and the gastric bypass. These two procedures make up about 92% of all bariatric surgeries performed today. Evidence has shown they are safe and effective options. Since they are the options your surgeon will likely offer to you, it's a good idea to become familiar with both. 

Gastric sleeve

The sleeve gastrectomy, or "gastric sleeve," is the most popular weight loss surgery performed today. About 60% of bariatric surgeries performed in the US are gastric sleeve surgeries. 

This surgery has become so popular for a reason. It's safe and easy to perform, and the weight loss results are similar to those achieved with more invasive malabsorptive surgeries. The surgeon removes 75% of your stomach, leaving it shaped like a banana or sleeve. Your sleeved stomach limits the amount of food you can eat in one sitting, which helps you to lose weight. 

The sleeve surgery also reduces the amount of the hormone called ghrelin that your body produces. Producing less ghrelin helps to reduce feelings of hunger and might improve blood sugar metabolism.

Pros:

  • 60% average loss of excessive weight
  • Reduced ghrelin can help reduce feelings of hunger
  • Lowered ghrelin can decrease the need for oral diabetes medications
  • Doesn't re-route the digestive system
  • Doesn't require the implantation of any devices (such as bands)

Cons:

  • Non-reversible - a portion of the stomach is removed permanently
  • Chance of surgical complications (as with any surgery)
  • Chance of long-term nutritional deficiencies 

Gastric bypass

Before the rise of the gastric sleeve, the gastric bypass was the most common weight loss surgery. Currently, it's the second-most-common procedure and accounts for 18% of all weight loss surgeries. 

The gastric bypass is a malabsorptive procedure. In a gastric bypass operation, the surgeon sections off a portion of your stomach to create a pouch. This small pouch is the restrictive component of the surgery and limits your food intake to just a few ounces at a time. 

In addition to having a small pouch for a stomach, your digestive tract is re-routed so the food you eat bypasses a portion of your small intestines. This re-routing means that some of the calories and nutrients you eat won't be absorbed. The intestinal bypass makes this surgery highly effective in resolving diabetes and is often the first choice of surgery for people with Type 2 diabetes.

Pros:

  • A wealth of data and experience support this procedure, which has been performed for over 50 years
  • Between 50% and 67% average loss of excessive weight
  • Very effective for treating diabetes
  • Doesn't require the implantation of any devices (such as bands)

Cons:

  • Chance of surgical complications (as with any surgery)
  • Higher chance of long-term vitamin deficiency
  • High sugar or high-fat foods can cause you to become ill (“dumping syndrome”)

QUESTION

What is weight loss surgery? See Answer

Other surgery options

While gastric sleeve and gastric bypass make up the vast majority of bariatric surgeries today, they aren't the only options. Some newer developments in weight loss surgery include the SADI and the gastric balloon.

SADI

The single anastomosis duodeno-ileostomy, or SADI, is a simplified version of the older duodenal switch. The older version of the duodenal switch is a malabsorptive procedure that is rarely performed today due to its complicated nature and higher risk of nutrient deficiencies. The SADI, though, bypasses less of the small intestines than the original surgery and has a single connection rather than two.

The SADI has become especially popular as a revision option for patients who completed the gastric sleeve and either didn't meet their weight loss goal or who gained weight back again. The SADI starts with a sleeved stomach, so gastric sleeve patients already have the restrictive component of the operation complete. 

As the operation is still relatively new, many insurers don't cover it, but some believe it'll soon increase in popularity.

Gastric balloon

The gastric balloon is another relative newcomer to the world of weight loss surgery options. The gastric balloon is a temporary device that's placed in your stomach. This is a nonsurgical outpatient procedure that takes about 30 minutes. Gastric balloons can remain in place for up to 6 months, and preliminary studies show you can lose up to 15% of your excess weight in that time.

Choosing the best surgery for you

Fortunately, you do not need to make this decision alone. Your surgeon will offer valuable insight into which procedure will suit you best based on your medical history and weight loss goals. If you have Type 2 diabetes, your doctor may recommend gastric bypass because of its high success rate in resolving diabetes. If you want to avoid the downsides of a malabsorptive procedure (such as dumping syndrome) the gastric sleeve could be a better choice.

It's important to remember, though, that you can be successful in reaching your goals with any surgery you choose if you remain committed to the program your doctor establishes for you. 

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Medically Reviewed on 7/12/2022
References
SOURCES:

American Society for Metabolic and Bariatric Surgery: "Estimate of Bariatric Surgery Numbers, 2011-2019."

Columbia Center for Metabolic and Weight Loss Surgery: "Gastric Balloons," "Gastric Bypass," "Sleeve Gastrectomy."

NIH National Institute of Diabetes and Digestive and Kidney Diseases: "Types of Weight Loss Surgery."

Obesity Action Coalition: "Single Anastomosis Duodenal Switch (SADI) – What Can You Expect from the New Bariatric Surgery Device?"

University of Iowa Hospitals and Clinics: "How effective is bariatric surgery?"