Loss Surgery Factsheet
• Metabolic and bariatric surgery, the treatment of morbid obesity and
obesity-related diseases and conditions, limits the amount of food the
stomach can hold, and/or limits the amount of calories absorbed, by surgically
reducing the stomach’s capacity to a few ounces
• Candidates for bariatric surgery have a body mass index (BMI) of 40
or more, or a BMI of 35 or more with an obesity-related disease, such
as type 2 diabetes, heart disease or sleep apnea
• An estimated 205,000 people with morbid obesity in the U.S. had bariatric
surgery in 2007
• About 15 million people in the U.S. have morbid obesity; only 1% of
the clinically eligible population is being treated for morbid obesity
through bariatric surgery
• Bariatric surgery costs an average of $17,000 - $25,000; Insurance coverage
varies by provider
• Bariatric surgery can improve or resolve more than 30 obesity-related
conditions, including type 2 diabetes, heart disease, sleep apnea, hypertension
and high cholesterol
TYPES OF BARIATRIC SURGERY
• Gastric Bypass
o Stomach is reduced from size of football to size of golf ball
o Smaller stomach is attached to middle of small intestine, bypassing
the section of the small intestine (duodenum) that absorbs the most calories
o Patients eat less because stomach is smaller and absorb fewer calories
because food does not travel through duodenum
• Laparoscopic Adjustable Gastric Banding
o Silicone band filled with saline is wrapped around upper part of stomach
to create small pouch and cause restriction
o Patients eat less because they feel full quickly
o Size of restriction can be adjusted after surgery by adding or removing
saline from band
• Bilio-Pancreatic Diversion with Duodenal Switch
o Similar to gastric bypass, but surgeon creates sleeve-shaped stomach
o Smaller stomach is attached to final section of small intestine, bypassing
o Patients eat less because the stomach is smaller and absorb fewer calories
because food does not travel through the duodenum
• Vertical Sleeve Gastrectomy
o Emerging procedure
o Approximately 85% of the stomach is removed, leaving a sleeve-shaped
o No published studies on long-term results
SURGERY: RISKS VS. BENEFITS
- The federal
government (AHRQ) and studies report significant improvements in safety
- Risk of
death from bariatric surgery is about 0.1%
obese individuals who have bariatric surgery increase their longevity,
as compared to those who do not have surgery
can improve life expectancy by 89% 8
can reduce their risk of dying by 30% - 40% 9,10
obese patients who have surgery dramatically reduce their risk of dying
from an obesity-related disease, as compared to those who do not have
- Risk of
death from diabetes down 92%, from cancer down 60% and from coronary
artery disease down 56% 10
EFFECTIVENESS OF BARIATRIC SURGERY
- In general,
bariatric surgery patients experience their maximum weight loss 1-2
years after surgery and maintain a substantial weight loss, with
in obesity-related conditions, for years
may lose 30% - 50% of their excess weight 6 months after surgery and
77% of their excess weight as early as 12 months after surgery 11
• Long-term studies show up to 10-14 years after surgery, morbidly obese
patients who had surgery maintained a greater weight loss and more favorable
levels of diabetes, cholesterol and hypertension, as compared to those
who did not have surgery 3,12
ADOLESCENTS AND BARIATRIC SURGERY
• As obesity rates rise in the U.S., an increasing number of adolescents
(12-17 years old) are receiving bariatric surgery, an estimated 349
in 2004 7
• Bariatric surgery has been performed on morbidly obese adolescents
for more than 10 years; doctors are gaining more experience with surgery
for this age group
• Long-term efficacy and impact remains unknown, but is a topic of ongoing
• Bariatric surgery is considered a tool to help morbidly obese patients
lose weight, to be used in conjunction with changes in eating and exercise
• Research shows that bariatric surgery patients who keep all doctors
appointments for at least 3 years after surgery lost an average of 24%
more weight, as compared to those who skipped appointments 13
• Studies show that bariatric surgery patients who attend support groups
maintain about 20% - 30% greater excess weight loss as compared to patients
who do not attend support groups 14,15,16
1 Dixon, JB et al. Adjustable Gastric Banding and Conventional Therapy
for Type 2 Diabetes. JAMA 2008; 299(3): 316-323.
2 Schauer, PR et al. Effect of Laparoscopic Roux-en-Y Gastric Bypass
on Type 2 Diabetes Mellitus. Nutrition in Clinical Practice. 2004: Vol.
19, No. 1, 60-61.
3 Pories, WJ et al. Who Would Have Thought It: An Operation Proves to
Be the Most Effective Therapy for Adult-Onset Diabetes Mellitus. Ann
4 Torquati, Alfonso, MD, MSCI, FACS, Wright, Kelly, MD, FACS, Melvin,
Willie, MD, FACS, and Williams, Richard, MD, FACS. “Effect of Gastric
Bypass Operation on Framingham and Actual Risk of Cardiovascular Events
in Class II to III Obesity.” Journal of the American College of Surgeons.
Vol 204, No. 5, May 2007.
5 Rasheid, Sowsan et al. Gastric Bypass is an Effective Treatment for
Obstructive Sleep Apnea in Patients with Clinically Significant Obesity.
Obes Surg 2003; 13, 58-61.
6 Buchwald H, et al. Bariatric Surgery: A Systematic Review and Meta-analysis.
JAMA 2004; 292 (14): 1724-38.
7 Agency for Healthcare Research and Quality (AHRQ). Statistical Brief
#23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. January
8 Christou, NV et al. Surgery Decreases Long-term Mortality, Morbidity,
and Health Care Use in Morbidly Obese Patients. Ann Surg 2004;240: 416–424.
9 Sjöström, Lars. Effects of Bariatric Surgery on Mortality in Swedish
Obese Subjects. N Engl J Med 2007; 357:741-52.
10 Adams TD. Long-Term Mortality after Gastric Bypass Surgery. N Engl
J Med 2007; 357:753-61.
11 Wittgrove, AC, et al. Laparoscopic Gastric Bypass, Roux-en-Y: Technique
and Results in 75 Patients With 3-30 Months Follow-up. Obesity Surgery
1996: 6, 500-504.
12 Sjöström, Lars, et al. Lifestyle, Diabetes, and Cardiovascular Risk
Factors 10 Years after Bariatric Surgery. N Engl J Med 2004; 351: 2683-2693.
13 Gould JC. Impact of routine and long-term follow-up on weight loss
after laparoscopic gastric bypass. Surg Obes Relat Dis 2007 Nov-Dec;
14 Song Zirui, et al. Association between support group attendance and
weight loss after Roux-en-Y gastric bypass. SOARD 2008 (4): 100-103.
15 Orth, WS. Support Group Meeting Attendance is Associated with Better
Weight Loss. Obes Surg 2008 (18): 391-394.
16 Elakkary, Ehab, et al. Do Support Groups Play a Role in Weight Loss
After Laparoscopic Adjustable Gastric Banding? Obes Surg 2006; 16, 331-334.
Society for Metabolic and Bariatric Surgery - http://www.asbs.org
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