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Weight-Loss Surgery: It's Not for Everyone

Bariatric surgery, also known as gastric bypass, has increased ten-fold over the past decade, with more than 150,000 Americans getting the procedure every year. Most insurance companies, as well as Medicare, pay for it. Most patients have successful outcomes, but there are still significant risks, and the surgery is not for everyone.

Dr. Paul Shekelle directs the Evidence-based Practice Center at the Rand Corporation. He says there's no question gastric-bypass surgery "works." Patients lose on average about 100 pounds or more, in just one year. And, in so doing, they also lower their risk of obesity-related diseases, such as hypertension, diabetes and high cholesterol.

But Shekelle worries that the surgery may be too appealing to patients who don't need it. And to surgeons who aren't expert at it.

"Just in our own newspaper in the city, you can open it up and there's ads for bariatric surgery. So this is being marketed directly to the public. The ads generally ask, 'Are you overweight? Tried everything? Consider coming to our bariatric surgery center.'"

Not All Surgery Centers are Equal

But not all bariatric surgery centers are equal, says Shekelle. Some have better results than others. These outcomes are important because complications can be significant. Dr. Ed Livingston is chief of gastrointestinal surgery at the University of Texas Southwestern Medical School. He's performed gastric bypass for the past 13 years, with extremely positive results for most patients, he says. In fact, when he first started performing the surgery, he was surprised at what he calls the "stunning" results. Patients were extremely positive and even "euphoric" about the results, he says.

But you have to remember this is surgery, Livingston warns. And there can be problems. One major complication is leaking, he says.

"We put all these parts together, and if the intestinal contents leak into the abdominal cavity, people can get infected," Livingston says. "And they have a very very difficult time recovering from that. They can be bed bound for months."

One out of every 200 patients dies as a result of the surgery. Patients can get blood clots in their legs or lungs. They can get hernias at the site of incision, as well as "dumping" syndrome, where they get physically ill, nauseous and sweaty if they eat foods high in fat or sugar.

"Patients that get gastric bypass have to know they are getting a permanent change in the way their body is going to absorb food," Shekelle says. "This means they can become bloated and gaseous with certain foods. And, because food is not completely absorbed, patients may also become deficient in certain nutrients and vitamins."

Not a Diet Substitute

While bypass surgery might be the right answer for certain severely obese individuals, it's clearly not for everyone. The surgery is more risky for those who are over 55 and suffer problems, such as hypertension and diabetes.

Shekelle also worries that people with a lower body mass index, a calculation of body fat based on height and weight, may want to get the surgery.

"Initially, it's people with a BMI of 40 or over," Shekelle says. "Then it's people with a BMI of 35 and over." Soon, it's people who aren't that overweight, but want the surgery instead of dieting, he says.

Unfortunately, Shekelle says, there may be a surgical center or doctor willing to help them do that. Bariatric specialists are now trying to figure out how to evaluate results from various surgical centers, hospitals and doctors in order to make that information public and help patients make decisions about where to get surgery, if it's decided they are good candidates for the procedure.

Copyright 2023 NPR. To see more, visit https://www.npr.org.

Patti Neighmond
Award-winning journalist Patti Neighmond is NPR's health policy correspondent. Her reports air regularly on NPR newsmagazines All Things Considered, Morning Edition, and Weekend Edition.