Surgery always carries with it some risk.  The risk of anesthesia is fairly minimal, but it is not zero.  In addition, any time you must cut healthy tissue, you run the risk of infection and other complications that go along with cutting into healthy tissues.  To balance out these kinds of risks, the benefit of the surgery must be clear or it would not be worth it.  Several kinds of weight loss surgery offer a strong enough advantage in promoting long term weight control that they definitely far outweigh the risks.

Because of the risks involved with surgery, I usually try all the non-surgical options first.  This is just good medicine.  People must be carefully screened if weight loss surgery is to have a reasonable chance of success.  I try to go through all the screening and treatment options I discussed in the first twelve articles of this series before I even consider surgery as a possibility.  I say “try” because sometimes people resist what are medically the best choices and in other cases, enough time is not available.  If I have enough time with someone, though, to complete a thorough evaluation and to try the best non-invasive approaches, I am then in an excellent position to advise them about the benefits of surgery.

One of the possibilities that can result is that I can help steer them away from surgery if they are not a good candidate.  Who might not be a good candidate?  Someone who thinks the surgery will completely compensate for a lack of self control concerning food is one example.  To be effective after a surgical procedure for weight loss, the patient must follow guidelines and attend follow-up visits with their management team.  Remember the article about the emotional drivers of overweight?  A person who has emotional compulsions to maintain a certain degree of overweight, as I discussed in that article, will find a way to eat around the procedure’s limitations or otherwise sabotage themselves.  Many programs require psychological evaluations to screen out these types of situations – and for good reason.  Also, many of the skills learned in diet and lifestyle modification approaches will help someone be more successful after weight loss surgery.

Assuming that all the non-surgical options have failed and someone is a good candidate for surgery, is there a best choice?  I divide the procedures into two categories.  The most potent surgeries are the more invasive ones.  These require cutting and often stapling the stomach and sometimes even a portion of the small intestines.  While they are the most effective in terms of percentage weight loss, they are also not completely reversible and carry a higher risk than the second category: the laparoscopic banding procedures.  The “lap band” procedures are becoming more and more popular because of their reversibility and lower risk.  In general, if I am recommending surgery for weight loss, it will usually be a lap band.  All of the really severe complications from weight loss surgery I have seen have been from the more invasive gastric bypasses and partial stomach resections.

The good news is that when a surgical procedure is successful (this is the majority of patients who undergo the procedures), there can be dramatic changes in their medical condition.  Some patients are able to stop all of their diabetes and blood pressure medicines.  Sometimes sleep apnea resolves and arthritic joints usually improve with significant weight loss.  It is generally the cost of the procedures that prevent good candidates from getting the surgery.  Many insurance plans will not cover the costs.  Unfortunately, if their insurance won’t cover it, the cost is out of reach for many who would benefit.

In the next and final article in this series, I will provide a summary of what I have presented so far and provide a few insights about weight control in general that deserve more emphasis.

As always, any questions or comments are welcome.

Chuck