March 12, 2024

What to know about weight loss surgery and other options

In the United States, nearly 1 in 3 adults is overweight, and more than 2 in 5 are obese. For some, weight loss can be a lifelong challenge. If you or a loved one has struggled to lose significant weight and keep it off through diet and exercise, you should look into other options such as weight loss surgery.

We reached out to Dr. Jamie Loggins, bariatric (weight loss) surgeon at Mission Health for his expert advice on weight loss surgery and other weight management options.

What are common weight loss options?

Many people with a high body mass index (BMI) can’t lose enough weight to normalize their BMI without medical intervention. Here are a few common options.

Surgical procedures

Surgery is one of the most common — and most effective — options for weight loss. According to the American Society for Metabolic and Bariatric Surgery, more than 279,000 weight loss procedures were performed in 2022. Gastric sleeve surgery (or vertical sleeve gastrectomy) was the most popular procedure, followed by Roux–en-Y gastric bypass (RYGB).

Gastric sleeve surgery reduces stomach capacity by removing about 80% of the stomach. The remaining stomach is shaped like a shirt sleeve. In addition to restricting food capacity, the procedure improves the metabolic hormones responsible for appetite, satiety and blood sugar stability. The metabolic benefits of this surgery are as important as the restricted stomach capacity.

Nonsurgical procedures

Surgery isn’t the best option for everyone who wants to lose weight. Nonsurgical weight loss options can be just as effective and come with fewer risks.

For example, endoscopic sleeve gastroplasty is an alternative to gastric sleeve surgery. During this procedure, the surgeon places sutures along the inside of the stomach through a scope. As with gastric sleeve surgery, the goal is to reduce stomach capacity. Shortcomings of this approach include the possibility of suture disruption and failure to maintain a healthy weight long term. There is no long-term data on the procedure at this time.

Intragastric balloons are another nonsurgical option. These soft silicone balloons are usually inserted into the stomach through the esophagus. This happens during a procedure known as endoscopy. Once it’s inside the stomach, the balloon is expanded with air or liquid. This reduces the amount of available space in the stomach and helps limit food intake. However, since the balloon cannot stay in the stomach permanently, patients are at risk of regaining weight after removal. For that reason, intragastric balloons do not deliver sustainable weight loss when compared with weight loss surgery.

Medications

Medications can also be effective for weight loss. These medications are available as injectables or pills. Most work by increasing the sense of satiety and slowing the emptying of the stomach. While weight loss drugs are a noninvasive option, they’re designed to be taken long term. Stopping use comes with a high risk of regaining weight.

Are weight loss drugs safe?

Weight loss drugs are generally safe, but they can have side effects. Studies have shown that some weight loss drug users stop using them because of these side effects which can include nausea, vomiting and diarrhea. In fact, some weight loss pills have been removed from the market due to health concerns. Also, weight loss drugs can interact with other medications. It’s important to consult with your doctor before deciding whether to take them.

Who’s a good candidate for weight loss surgery?

Depending on your circumstances, surgery can be an excellent alternative to weight loss drugs, providing significant outcomes at around 50% to 70% loss of excess weight. You may be a good candidate for surgery if you have:

  • A BMI of 30 or more and obesity-related health problems such as Type 2 diabetes
  • A BMI of 35 or more

 

We asked Dr. Jamie Loggins to provide more detail about who might be a good candidate for weight loss surgery.

 

“The guidelines that have traditionally been followed to determine when someone becomes a candidate for bariatric surgery were created by the National Institutes of Health back in 1991,” said Dr. Loggins. “To come up with these guidelines, a consensus panel of experts got together and looked at all the severe obesity and bariatric surgery outcomes data available at the time. They analyzed this data to figure out at what point did living with the disease become a greater risk than undergoing a procedure. What they determined is that if a person’s BMI was 40 or greater, that in and of itself was enough to make that person considered an eligible candidate. That number dropped down even lower, meaning even more favorable for surgery, to 35 if people already had certain obesity related medical issues, including diseases such as Type 2 diabetes, high blood pressure or obstructive sleep apnea.”

 

“What is very interesting about these guidelines, which are now over 30 years old, was that when they were created, they were largely looking at outcomes from people who had these procedures done using the more traditional “open” technique, meaning a large incision right down the middle of the abdomen,” Dr. Loggins said. “Even with this much more invasive approach, this is when the data indicated that surgery was a lower risk than living with the disease. Now, we use much more sophisticated technology and are able to perform these operations through only a few small incisions, and as such, surgery has become much safer! Yet, many insurance companies have continued to use these 30+ year old guidelines! Can you imagine if we were using clinical guidelines from 30+ years ago to decide how we treat people say for colon cancer, or maybe breast cancer? It would be unthinkable.”

 

“Finally, in 2022, the American Society for Metabolic and Bariatric Surgery (ASMBS), along with the International Federation for the Surgery of Obesity (IFSO), released new guidelines, based on analysis of outcomes using MODERN bariatric surgery techniques,” said Dr. Loggins. “These new guidelines recommend that patients with a BMI 35 or greater be considered for surgery without the need for co-existing medical conditions, and patients with BMIs of 30 or greater be considered for surgery in the setting of coexisting obesity-related medical conditions.”

 

What are the benefits of weight loss surgery?

Improves quality of life

If you have severe obesity, weight loss surgery can extend your life, as well as enhance your quality of life. It can reduce the number of prescription medications you have to take, increase physical function and mobility, and improve self-esteem, body perception and social interaction.

Reduces the risk of weight-related health concerns

Surgery can significantly improve or lower your risk of weight-related health conditions such as high blood pressure, Type 2 diabetes, heart disease and sleep apnea. It may also reduce your risk of some common cancers, including lung, kidney and liver cancer.

Supports long-term weight management

Surgery can provide long-term weight loss in combination with lifestyle changes such as eating healthily and exercising regularly. One study showed that most people maintained their weight loss seven years post-surgery.

What are some concerns that patients have regarding weight loss surgery?

 

“I believe one of the largest concerns is the belief that bariatric surgery is “dangerous,” said Dr. Loggins. “Certainly, there is always going to be some inherent risk with any type of surgery. That being said, modern bariatric surgery, with the evolved techniques and the advanced technology, is not what it was 50 years ago. Today, we do these operations using minimally invasive techniques that often times get the patients back home after just a single night in the hospital, sometimes even sooner. In fact, bariatric surgery done in an accredited bariatric surgery program is as safe, if not safer, than other very common types of surgery such as gallbladder removal. With these advancements in bariatric surgery, what is now really irrefutable, is however every risky people think bariatric surgery might be, the disease of untreated severe obesity is riskier. BY FAR!”

 

How does a patient prepare for weight loss surgery?

 

“Preparing for bariatric surgery will be a unique process for each patient that will be determined after the patient undergoes an initial consult with the bariatric surgery team,” said Dr. Loggins. “Together, we figure out a plan for the patient that includes both physiologic and psychologic evaluations and education to help the patient best position themselves for a safe and successful outcome from surgery. The process generally starts by attending a free information session to learn more about bariatric surgery and the disease of severe obesity, and if people are interested in taking that next time, they would undergo a one-on-one consultation with myself or one of our mission weight management providers. That is when we formulate a preoperative program tailored for the specific needs of the patient. The patient will continue to work with the members of the Mission Weight Management team throughout this process, and once all the evaluations on education is complete, the team meets to review the patient’s progress/results and if everything looks good, we submit the request for surgery to the patient’s insurance and schedule them for their procedure. They will have a final preoperative visit with their surgeon prior to the operation for us to review the procedure, logistics of the hospital stay and also address any remaining questions the patient may have, if any.”

 

Risks and recovery

Thanks to enhanced delivery of care and the advent of minimally invasive surgery, weight loss surgery is generally safe. The current mortality risk from sleeve gastrectomy is less than 0.1%. However, there are potential risks around the need to adjust food consistency, especially in the early recovery period. Also, side effects can include bleeding, blood clots and changes in bowel function.

If you decide surgery is right for you, then you may have to follow a liquid diet for one to two weeks and slowly transition to eating solid foods. Returning to normal unlimited activities post-surgery can take up to four weeks.

Talk to your doctor about your options

If you’re interested in exploring weight loss surgery, talk to your doctor. Any surgery comes with a certain degree of risk, but when compared with the risks of excess weight and associated health problems, surgery is an excellent option. Ask your doctor for guidance. If you both decide surgery is the right path for you, your surgeon can help you prepare. Whatever method you choose for weight loss, taking the step toward better health is essential.

Learn more about the weight management and weight loss surgery options at Mission Health.