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?
1Get the |
2Compare |
3Your |
4Your |
5Quiz |
6Your Summary |
Get the facts
Your options
- 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.
- How much weight people lose after surgery varies. It depends on the type of surgery you have and how well you follow your plan for lifestyle changes and follow-up appointments. Some people lose almost all of their extra weight.
- 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. Regular exercise is also important for losing weight and keeping it off. Some people gain weight again after a few years because they don'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.
What is surgery for obesity?
Surgeries for weight loss can be restrictive or a combination of restrictive and malabsorptive.
- Restrictive: This type of surgery makes the stomach smaller. It limits the amount of food the stomach can hold.
- Malabsorptive: This surgery changes the path of the intestine. Food goes around (or bypasses) part of the intestine. Since nutrients are normally absorbed in the intestine, bypassing a part of it reduces how much it can absorb. This can lead to weight loss.
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 surgery can't be reversed.
Examples of restrictive and malabsorptive combined 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.This surgery 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, part of the stomach is removed. The remaining part of the stomach is connected to the lower part of the small intestine. The food you eat then bypasses much of the small intestine. This results 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. This results in fewer calories absorbed and weight loss.
Two ways surgery is done
- 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 may be less likely to have pain or problems after surgery. This is the type of surgery done most often for weight loss.
How will surgery affect what you eat?
After surgery, you'll need to make lifelong changes in how you eat and drink.
- Eat small meals. You can eat only a few ounces of food at a time. Your new stomach will hold only 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.
- Don't drink 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.
- Use alcohol with care. Be careful about drinking alcohol. After gastric bypass or gastric sleeve surgery, you may become intoxicated much more quickly. Alcohol also can cause ulcers in your stomach and intestines.
- Take vitamins as recommended. 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 absorb 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. Dumping syndrome may occur after gastric bypass surgery, but is unlikely after gastric band or gastric sleeve surgery.
What are the risks of surgery?
People who are very overweight are more likely than other people to have problems from any kind of surgery.
After any weight-loss 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).
- You may not get enough of certain vitamins and minerals. This can lead to problems such as anemia and osteoporosis.
- Some people get gallstones.
- You may gain the weight back a few years after surgery if you don't follow your eating and lifestyle plan.
- There is a risk of death. This is a risk of any surgery.
Risks of each surgery
Each type of surgery also has its own risks. Here are a few examples:
- Gastric bypass and gastric sleeve surgeries can cause a leak from the stomach into the belly area. The leak can cause an infection called peritonitis.
- With gastric bypass, the connection between the stomach and the small intestine can get narrow. This can cause nausea and vomiting after eating.
- After adjustable gastric banding, you are more likely to need another surgery to fix problems than you would after gastric bypass. For example, some people need a second operation because the band slips or it works its way from the outside of the stomach to the inside. This is called an erosion.
Extra skin after weight loss
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.
Why might your doctor recommend surgery?
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).
- 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.
Weight-loss surgery for teens
Most people who have weight-loss surgery are 18 to 65 years old. It is sometimes done on people younger than 18.
In adolescents, as in adults, these types of surgery are not usually suggested unless the child's BMI is over 40 or the child has severe health problems and a BMI over 35.
Younger children may not be considered for surgery unless their BMI is even higher. Your child's doctor can help you decide if the health risks of severe obesity outweigh the risks of surgery. 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.
Compare your options
Compare
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What is usually involved? |
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What are the benefits? |
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What are the risks and side effects? |
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- You are asleep during the operation.
- You stay in the hospital for 1 or more days.
- You return to normal activities within 2 to 5 weeks.
- You need to make lifelong changes in how you eat and drink.
- 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.
- It may help you live longer.
- 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 the risks of surgery.
- You may be able to lose some weight and improve your health with healthy eating and activity.
- 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 I 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 I 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.
Having surgery
NOT having surgery
What else do you need to make your decision?
Check the facts
Decide what's next
Certainty
1. How sure do you feel right now about your decision?
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you're leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits
| Author | Ignite Healthwise, LLC Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
Obesity: Should I Have Weight-Loss Surgery?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the Facts
Your options
- 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.
- How much weight people lose after surgery varies. It depends on the type of surgery you have and how well you follow your plan for lifestyle changes and follow-up appointments. Some people lose almost all of their extra weight.
- 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. Regular exercise is also important for losing weight and keeping it off. Some people gain weight again after a few years because they don'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.
What is surgery for obesity?
Surgeries for weight loss can be restrictive or a combination of restrictive and malabsorptive.
- Restrictive: This type of surgery makes the stomach smaller. It limits the amount of food the stomach can hold.
- Malabsorptive: This surgery changes the path of the intestine. Food goes around (or bypasses) part of the intestine. Since nutrients are normally absorbed in the intestine, bypassing a part of it reduces how much it can absorb. This can lead to weight loss.
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 surgery can't be reversed.
Examples of restrictive and malabsorptive combined 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.This surgery 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, part of the stomach is removed. The remaining part of the stomach is connected to the lower part of the small intestine. The food you eat then bypasses much of the small intestine. This results 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. This results in fewer calories absorbed and weight loss.
Two ways surgery is done
- 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 may be less likely to have pain or problems after surgery. This is the type of surgery done most often for weight loss.
How will surgery affect what you eat?
After surgery, you'll need to make lifelong changes in how you eat and drink.
- Eat small meals. You can eat only a few ounces of food at a time. Your new stomach will hold only 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.
- Don't drink 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.
- Use alcohol with care. Be careful about drinking alcohol. After gastric bypass or gastric sleeve surgery, you may become intoxicated much more quickly. Alcohol also can cause ulcers in your stomach and intestines.
- Take vitamins as recommended. 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 absorb 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. Dumping syndrome may occur after gastric bypass surgery, but is unlikely after gastric band or gastric sleeve surgery.
What are the risks of surgery?
People who are very overweight are more likely than other people to have problems from any kind of surgery.
After any weight-loss 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).
- You may not get enough of certain vitamins and minerals. This can lead to problems such as anemia and osteoporosis.
- Some people get gallstones.
- You may gain the weight back a few years after surgery if you don't follow your eating and lifestyle plan.
- There is a risk of death. This is a risk of any surgery.
Risks of each surgery
Each type of surgery also has its own risks. Here are a few examples:
- Gastric bypass and gastric sleeve surgeries can cause a leak from the stomach into the belly area. The leak can cause an infection called peritonitis.
- With gastric bypass, the connection between the stomach and the small intestine can get narrow. This can cause nausea and vomiting after eating.
- After adjustable gastric banding, you are more likely to need another surgery to fix problems than you would after gastric bypass. For example, some people need a second operation because the band slips or it works its way from the outside of the stomach to the inside. This is called an erosion.
Extra skin after weight loss
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.
Why might your doctor recommend surgery?
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).
- 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.
Weight-loss surgery for teens
Most people who have weight-loss surgery are 18 to 65 years old. It is sometimes done on people younger than 18.
In adolescents, as in adults, these types of surgery are not usually suggested unless the child's BMI is over 40 or the child has severe health problems and a BMI over 35.
Younger children may not be considered for surgery unless their BMI is even higher. Your child's doctor can help you decide if the health risks of severe obesity outweigh the risks of surgery. 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.
2. Compare your options
| Have weight-loss surgery | Don't have surgery | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
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 I 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 I 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
3. 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:
4. 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.
Having surgery
NOT having surgery
5. What else do you need to make your decision?
Check the facts
1. After weight-loss surgery, I will be able to eat normal amounts of food.
- True
- False
- I'm not sure
2. Having weight-loss surgery can cause problems, but my being very overweight can also cause health problems.
- True
- False
- I'm not sure
3. Surgery may be an option for me because my BMI is higher than 40.
- True
- False
- I'm not sure
Decide what's next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I'm ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
| By | Ignite Healthwise, LLC Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Current as of: April 30, 2024
Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
