Types of Weight Loss Surgery: Choosing the Best Course of Action

Weight loss surgery -- also called bariatric surgery -- has come a long way in recent years. New procedures are less risky and less expensive, but it's still a major procedure that might not be right for everyone. You'll want to carefully consider the pros and cons of the different types of weight loss surgery before making your decision.

Considerations for Weight Loss Surgery

Excess weight can lead to or worsen a variety of health conditions, especially Type 2 diabetes, sleep apnea, heart disease, and bone and joint damage. Mounting evidence shows that losing weight can improve health, reduce the need for some medications, and even extend life. Although the most commonly accepted guidelines indicate surgery as an option for patients with a body mass index (BMI) of 40 or greater, people with certain health conditions may be candidates at much lower BMIs.

If you're considering weight loss surgery, start by talking to your primary care provider, who may refer you to a bariatric surgeon, obesity medicine clinician, or a weight management program that specializes in medical interventions. Together, you and your provider should consider your age and weight, as well as any medical problems, desired weight loss, and any other goals and issues. For example, if your goal is to lose 30 to 50 pounds, medical weight management -- perhaps with the assistance of a removable lap band -- may be the best choice. If you have diabetes and/or acid reflux, you'll want to consider how each procedure may affect those conditions.

Cost is another consideration. Surgery can run as high as $25,000, not counting the cost of hospital stays, anesthesia, or follow-up care, and not all insurance policies will cover it.

Weight Loss Surgeries

Bariatric surgeons use four main types of procedures for weight loss, two of which are much more common. Here's the rundown of types of weight loss surgery, from simplest to most complicated.

• Laparoscopic adjustable gastric band: This is the simplest weight loss surgery. It involves placing a ring around the top of your stomach to create a feeling of fullness after eating only small amounts. The band is adjustable and removable. Patients can lose up to 50 percent of excess weight.
• Vertical sleeve gastrectomy (VSG): VSG is the most common procedure for weight loss. It has better results than a lap band and is less invasive than the other two procedures. VSG results in reduced hunger and some improvement in type 2 diabetes. However, there's evidence that it may worsen acid reflux in some patients. VSG usually requires 1-2 days in the hospital and 2-4 weeks of recovery.
• Roux-en-Y gastric bypass: This procedure has a long track record of success and has been shown to increase two hormones in the gut that deal with hunger and diabetes. It may also significantly reduce acid reflux.
• Biliopancreatic diversion or duodenal switch: This is the most complicated type of weight loss surgery. The procedure reduces the body's ability to absorb fat and reduces appetite, but it may make it difficult for people to get the nutrients they need through their food. However, it's associated with the greatest amount of weight loss (70 to 80 percent of excess weight).

Before making your decision, ask your doctor the following questions: Am I a candidate for bariatric surgery? Which procedure would be best for me? Where should the surgery be done and who should do it? What is the follow-up like? Do you have an established program to support patients through follow-up? The last question is especially important because patients continue to need support long after their surgery as they negotiate getting the necessary nutrients from just 3 to 4 ounces of food per meal (which is about enough to fill a cupped hand). That support will include nutritional advice, lifestyle support, medication management, and more, preferably from a team who understands the challenges of living with a smaller stomach and the implications of major weight loss.

It's important to keep in mind that weight loss surgery isn't always the first, or best, option. Talk to your doctor, consider your options, and make an informed decision about which surgery, if any, is right for you.