Now the good news: For lots of Americans, weight loss (bariatric) surgery is a safe and effective way to drop weight, send diabetes packing, and otherwise dodge the dangers of severe obesity.
"The surgery requires participation and lifestyle changes on the patient's part, but afterward most people say, 'Look at me now!' " says Noel Williams, MD, director of the bariatric surgery program at the University of Pennsylvania Health System.
Here's what you need to know about weight loss surgery.
1. It's all about shrinking your stomach.
In basic terms, bariatric surgery reduces the size of your stomach in order to lower the amount of food your body can take in, Rosenthal says. "The surgery can also result in metabolic changes, including hormonal shifts that can lower appetite and help improve insulin sensitivity, which often leads to diabetes remission," he explains. There are more than 200,000 bariatric surgeries performed each year, and having one drops your mortality risk by 40%, according to a study in the New England Journal of Medicine.
2. Not everyone's a candidate.
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While body mass index (BMI) can be a flawed measure of your weight and overall health, it's still the first criteria a doctor will look at when determining if bariatric surgery is an option for you. Rosenthal says anyone with a BMI over 40—also termed "severe" obesity—should consider the surgery. He says those with a BMI between 35 and 40 are also likely candidates, and surgery may make sense for some people with BMIs ranging from 30 to 35.
"As physicians, our intent is always not to operate if we can help it," he says. "But when lifestyle changes like diet and exercise fail, those people may be good candidates for surgery."
3. The surgery comes in several flavors.
Bariatric surgery could entail implanting balloons or bands that temporarily restrict the size of your stomach. But Rosenthal says neither of those is recommended these days. "We found that once those measures were removed, the patients tended to regain weight, so we now advise procedures that aren't reversible," he says.
More than 90% of patients now receive one of two different procedures. The first and most common is called a sleeve gastrectomy. "This involves the removal of 80% of the stomach," Rosenthal explains. The procedure restricts the amount of food you can consume and also significantly knocks down appetite-increasing hormones, he says. (Check out how to balance your hormones and lose up to 15 pounds in just 3 weeks!)
The second-most common procedure is gastric bypass, which involves bisecting your stomach and small intestines into two segments. Your surgeon then links the smaller segments together in order to reduce the amount of food you can consume while also lowering the number of calories (and nutrients) your intestines can absorb, Rosenthal says.
4. The perfect procedure for you depends on your weight.
Rosenthal says 60 to 70% of patients now undergo a sleeve gastrectomy, which is usually recommended for those with a BMI between 35 and 40. While similar to gastric bypass, "the sleeve" doesn't touch your intestines, so calorie and nutrient absorption aren't significantly hindered.
Gastric bypass, on the other hand, is often the choice for the severely obese—or those with a BMI above 40, Rosenthal says. Because the surgery separates part of your intestine from your body's digestive processes, your gut absorbs fewer calories but you also have a greater risk for nutrient deficiencies, he says.
5. The surgery itself isn't too rough.
Williams says all these procedures involve general anesthesia, but most patients are in and out of the hospital within 48 hours. Also, most surgeons operate using laparoscopic methods, which involve only small incisions and speedy recoveries. "Most people are more or less back to normal in terms of their daily lives and activities within a week," Rosenthal adds.
6. All these procedures are low risk.
Bariatric surgery is one of the safest surgical procedures in medicine, Williams says. It's also very effective. Lots of research, including one recent study from the Journal of the American Medical Association, finds that these surgeries result in "substantial weight loss" for nearly all the patients who undergo them. Also, 80% or more of patients see their diabetes and related conditions resolve or improve, Rosenthal says.
7. Insurance likely won't cover it.
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Despite the study-backed benefits, Rosenthal says most insurers won't cover bariatric surgeries. The insurers that do often require a patient to have a BMI of at least 35, as well as two other related conditions like heart disease or diabetes. The out-of-pocket costs can be significant—usually somewhere in the range of $11,000 to $26,000, he says. (The good news: Insurance is catching up to help with weight loss.)
8. Surgery is just the start.
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Both Williams and Rosenthal say successful bariatric surgery requires lifelong diet and habit changes. (Here's what life after gastric bypass is like.)
During the first weeks following surgery, you'll have to stick with a tightly restricted, mostly liquid or pureed diet packed with protein, Williams says. (You need the protein to sustain your muscle mass while your body drops lots of weight.)
While you'll be able to start eating "normal" foods after about a month, you'll have to stick with a permanent regimen of nutritional supplements, Rosenthal says. This is necessary because you'll be eating too little food to give your body the vitamins and minerals it needs.
"If you think the surgery will do all the work for you, you're not a good candidate," Williams adds. "But we do a lot to educate patients when they first come in, so people know what's required of them."
