PCOS and weight loss surgery

Question
Dr. Pilcher,

I am 21 years old female with polycystic ovarian syndrome.  I have exercised, eaten right, and am currently taking metformin for my condition, but cant get the weight off.  I currently weigh approximately 220 with a BMI of 34.  I am in my senior year of college and was recently accepted to medical school.  I want to lose weight before I begin my medical training.  In your experience, would lap  band surgery work for me?  I want to do the least invasive, yet effective surgery.  Can you help answer my question?  thanks very much!

Answer
Taylor,
Your BMI of 34 puts you just a shade below the level of 35 at which it is widely agreed that the risk/benefit ratio weighs in favor of surgical intervention for weight.  Having said that, many experienced bariatric surgeons (including myself) believe that well-informed individuals who are in the BMI range of 30-35 are appropriate to consider for surgery as well.

I believe I could support Band surgery in a case like yours, and I believe it would help improve the PCOS by breaking the usual spiral of increasing weight and medical problems.  I note that the Band is a relatively high maintenance procedure (including Band adjustments) and it does not directly address the internal hormone imbalance (which is poorly understood) at the root of PCOS and other metabolic disorders.  I would not fully rule out the gastric bypass because it would help re-balance the metabolic hormones more directly and it is lower maintenance.

In summary, I think it would be very reasonable for you to visit with an experienced bariatric surgeon in your area, and discuss the options with him/her.  You may find a bariatric Center of Excellence on the web here:
https://www.surgicalreview.org/locate.aspx

Best of luck!
Dr JP

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