Candidates for Bariatric Surgery
Any surgical candidate must have failed consistently in losing weight through less invasive methods. Experts recommend bariatric surgery only for the following:
- Those whose BMI is above 40 (about 100 pounds overweight)
- Those with a BMI of over 35 who have type 2 diabetes or serious obesity-related medical problems
- Those with severe obesity that interferes with employment, normal physical activity (such as walking), and important relationships
Patients with binge eating disorder should be identified before surgery and treated. A full evaluation, including a psychological evaluation, should be performed on all candidates for surgery.
Depending on insurance coverage and which procedure is performed, the cost of bariatric surgery may be up to $35,000
Patient considering bariatric surgery should be well-informed regarding the procedure, its efficacy, side effects, and complications. They should also understand the following:
- Lifestyle and behavioral changes will still be needed after surgery, including:
- The continued need to focus on weight
- The need to chew food well
- The need for dietary restrictions
- The need for vitamin and mineral supplementation
- Patients will be unable to eat large meals.
- Surgery may not be successful in achieving significant weight loss.
Restrictive Banding Procedures
About a third of people who undergo these procedures achieve normal weight, and 80% experience some weight loss. They are less successful than the bypass procedures, but carry a lower risk of nutritional deficiencies.
Laparoscopic Gastric Banding. Laparoscopic gastric banding (the Lap-Band) usually does not require a major incision and avoids some of the major complications of gastric bypass. Patients lose almost one third to one half of their excess weight after this procedure. Some smaller trials have shown remission of type 2 diabetes in over 70% of patients having the surgery, compared to around 10% treated medically. Death during or after the surgery occurs in fewer than 1/1000 of these procedures.
The Lap-Band procedure restricts the amount of food a person can eat and gives the feeling of fullness. It employs an adjustable silicone band that is placed around the upper part of the stomach. A small balloon-like reservoir attached to the band under the abdominal skin contains saline, which can be added or removed to tighten or loosen the band.
Review Date: 04/14/2010
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital (4/14/2010).