How Successful Is Bariatric Surgery?

If you choose to have bariatric surgery, you may not lose as much weight as you’d like, stay as thin as your ideal, or solve your current health problems.

To see what a body looks like right after bariatric surgery, look online. It’s not a pretty sight. But surgery may still be attractive compared to obesity.

If, over many years, you’ve been unable to lose weight or maintain a healthy weight, you are probably already suffering some of the consequences of obesity — a long list of risks that includes diabetes, heart disease, sleep apnea, joint problems, and migraines, as well as certain cancers. 

Alongside the health risks, the social stigma attached to obesity can affect your job and marriage prospects. Even teenagers are increasingly having these operations, which aren't risk-free but are safe than being obese over the long run. Studies show bariatric surgery may reduce a patient’s risk of premature death by 30 to 50 percent.

Just be clear: Even after the pain and inconvenience of surgery, you may not reach your weight goal, keep off all the pounds you lose, or solve your current health problems. Some people may even require a second surgery.

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But you are likely to enjoy a dramatic weight loss in the first six months or year and be significantly thinner than you are now after three years. 

Bariatric surgery can bring immediate health benefits. In one study, for example, more than half of patients had a complete remission of their diabetes after the gold-standard Roux-en-Y gastric bypass (RYGB). Remission was most likely in younger patients who lost a great amount of weight and needed the least insulin before the surgery.

There are three popular options. Besides RYGB, you might consider laparoscopic adjustable gastric banding (LAGB) or the “sleeve” procedure. 

In RYGB, your stomach is reduced to the size of a walnut and attached to the middle of your small intestine, bypassing a section of the small intestine. Afterwards, your body won’t be able to absorb as many calories.

There is a slight chance you’ll have a heart attack or stroke during or after surgery; the risks include blood clots in your legs and breathing problems. 

In the first post-surgery week, you’ll experience some pain, and you’ll need to stick to small amounts of soft foods and liquids for a month. If food moves through you too quickly, you could feel faint, shaky, and nauseated, develop diarrhea, and have trouble getting enough nutrients. (You'll also need to take special vitamin supplements for the rest of your life.)

Slowly, you’ll be eating more foods. You’ll need to chew everything well and stop as soon as you feel full; if not, you may get nauseated and vomit. To avoid malnutrition, you may need to plan meals and take vitamins.

Drinking lots of soda or fruit juice will keep the pounds on. If you continually overeat, your stomach could stretch. People begin regaining weight after two years and in some cases earlier. You know what’s coming: The trick is to limit that weight gain. 

Roux-en-Y gastric bypass

In one overview of studies looking out seven years, researchers found an average loss of 28 percent of baseline weight after RYGB and 15 percent after LAGB. People did regain weight but not much, 4 percent and 1.4 percent respectively. They also saw improvements in diabetes, high cholesterol, and high blood pressure.

A separate earlier study identified several paths your weight might take after RYGB. Nearly half of the patients lost weight for two years, getting down nearly 35 percent. In year three, their weight crept up, and they ended up with a 30 percent loss. A quarter did better, losing more than 40 percent of their weight, which crept up only slightly in year three. 

On the other hand, some people lost less and began regaining sooner. Roughly a fifth began regaining weight after a year, ending up with a loss of around 20 percent. About 2 percent began to regain after six months, with weight loss of around only 10 percent after three years. 

Laparoscopic adjustable gastric banding

This study also followed 610 LAGB patients. This procedure is considered safer but usually results in less weight loss, and fewer people see dramatic improvements with other health measures.

In this option, the surgeon wraps a ring or band around your stomach with a thin tube attached. Later, your doctor can tighten the band by adding saline through the tube or take saline away to loosen it.

With this procedure, the majority of patients in the study — 62 percent — lost 15 percent of their weight in the first year and remained stable over the next two. But 19 percent began regaining after six months and ended up not far from where they started after three years.

Compared to RYGB, banding was much less likely to address diabetes, high blood pressure, or heart disease risk factors. People are also likely to undergo another procedure, looking for more weight loss.  

The sleeve procedure

In the “sleeve” procedure, which is older but still the most common, your surgeon divides the stomach and staples it vertically, creating a tube or banana-shaped pouch that can hold much less food than before. The sleeve procedure brings results comparable to an RYGB.  

Any surgery has risks. With these procedures, 10 to 17 percent of patients run into complications, and about 7 percent have a second operation.

What you can do

Weigh the consequences of your obesity against the risks.

Ask yourself if you’ve done everything possible to lose weight and keep it off. If you decide to go ahead with bariatric surgery, you might look online at the wealth of before-and-after shots, showing formerly obese people looking happy and buff.

Now ask yourself if you are committed to changing any habits that could put the pounds back on; you’ll need to be.  

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