4 Common Weight Loss Surgeries (& 3 Alternatives)
Weight Loss Surgery: What to Know and If It's Right For You
If you’re struggling with weight, you’re not alone. Around 42 percent of American adults have obesity. In addition to nutrition, exercise and medications, some might explore the idea of weight reduction surgery (or bariatric surgery).
What is bariatric surgery? It’s any surgical procedure that helps a person manage obesity or related health conditions.
But is weight loss surgery safe, and what are the pros and cons?
Whether weight loss surgery is right for you is a personal decision based on things like risk analysis, cost, commitment level and whether you’re a good candidate for stomach surgery for weight loss.
We’ll break down how weight loss surgery works, safety considerations, advantages, potential drawbacks and more to consider to help you make the best decision.
How Weight Loss Surgery Works
Weight loss surgery physically alters your digestive system to promote weight loss over time. The most common types of surgery aim to restrict food intake and/or reduce absorption of macronutrients (carbs, proteins and fats).
Is bariatric surgery safe? Yes! As long as you’re a good candidate and work with an experienced bariatric surgeon.
Bariatric surgeries are usually performed laparoscopically, meaning they involve small incisions in the abdomen and a teeny-tiny camera. Laparoscopic procedures are less invasive than some other surgeries, which helps minimize post-op recovery time and risk of complications.
Weight loss surgeries can be very effective for promoting weight loss and addressing related health problems. However, patients have to be willing to make significant lifestyle changes to support ongoing weight loss and long-term success.
Types of Weight Loss Surgery
There are several types of weight loss surgery, each with a unique approach.
Gastric Bypass Surgery
What is gastric bypass surgery? Also called Roux-en-Y gastric bypass (or RYGB), gastric bypass surgery involves creating a small pouch at the top of your stomach and rerouting part of your small intestine — like a traffic detour for digestion.
How does gastric bypass work? It limits the amount of food you can eat, reducing overall calorie absorption.
Like other weight loss procedures, there are pros and cons of gastric bypass surgery.
Gastric bypass may promote more sustainable weight loss and better blood sugar control than other procedures.
One review of clinical trials with over 65,000 patients in total found that RYGB resulted in more weight loss than gastric sleeve or lap band surgery at one, three and five years post-op. However, gastric bypass side effects are more common in the first 30 days.
Is gastric bypass reversible? Yep. While there are gastric bypass surgery risks (again, like any procedure), reversal is no less effort or risk than having it done in the first place.
Gastric Sleeve Surgery
What is gastric sleeve surgery? Also called sleeve gastrectomy (ectomy means “removal”), the procedure involves removing a large piece of your stomach. A sleeve-shaped pouch remains, hence the name.
This reduces the capacity of your stomach to hold food and tones down hunger hormones. These effects can make you feel fuller after eating a small amount, leading to a lower overall calorie intake.
The stomach sleeve surgery has the lowest likelihood of needing reoperation (when you have to have surgery again to correct a previous one), but it’s not reversible.
Gastric Banding Surgery
Gastric banding (laparoscopic adjustable gastric banding or LAGB) involves placing an inflatable silicone band around the upper part of your stomach, creating a small pouch.
The band can be tightened or loosened (or removed) to regulate food intake.
Biliopancreatic Diversion With Duodenal Switch
Biliopancreatic diversion with duodenal switch (BPD/DS) is a two-step surgery.
First, a small stomach pouch is created, similar to a sleeve gastrectomy. Then, a large portion of the small intestine is bypassed, rerouting food away from the first part of the small intestine. This reduces calorie and nutrient absorption.
Who Can Get Weight Loss Surgery?
Weight loss surgery is typically reserved for folks with a body mass index (BMI) of 35 or higher. BMI is calculated by your body weight in kilograms divided by the square of your height in meters (kg/m²).
That said, those with a BMI of 30 to 34.9 who have weight-related health issues — like high blood pressure or type 2 diabetes — may also be good candidates. Due to their generally smaller stature, people of Asian descent with diabetes might qualify at a BMI of 27.5 or higher.
While BMI isn’t a perfect assessment of body mass composition, it broadly categorizes people as underweight (18.4 and below), normal weight (18.5 to 24.9), overweight (25 to 29.9) or obesity (30 and above).
Typically, people with obesity who’ve been unable to achieve significant weight loss through nutrition, exercise and medications can also be considered for weight loss surgery.
The prerequisites for bariatric surgery don’t stop there, though. Besides comprehensive evaluations of their overall health and psychological readiness, potential candidates have to show a willingness to commit to long-term lifestyle changes.
(Related: Weight Loss Medications: Are They Effective?)
What to Expect From Weight Loss Surgery
Weight loss surgery should be carefully considered — not just because of the long-term commitment to change but also because of the cost, pre-op requirements and post-op process.
Here are some things you can expect:
Variations in cost. Though most insurance policies cover weight loss surgery to a degree, coverage varies by provider.
Extensive pre-op requirements. Preoperative prep is a team approach that calls for effort from the patient and their providers. Once you’re labeled a good candidate, you’ll get directions for nutrition, exercise, medication and mental health evaluations. Your provider might require a certain amount of weight loss prior to your procedure. Also, weight loss surgery recovery times can vary.
Detailed lifestyle changes. Following surgery, you’ll have a very specific lifestyle plan to adhere to. Be sure to communicate with your healthcare team and dietitian so they can support you along the way.
Pros and Cons of Weight Loss Surgery
While these procedures can be worthwhile investments for some, there are also risks of bariatric surgery. Let’s go over the bariatric surgery pros and cons so you have an idea of the benefits and drawbacks.
Potential Benefits
These are some potential benefits of weight loss surgery:
Significant weight loss is possible. Weight loss surgery can be successful at improving health and quality of life. In fact, bariatric surgery can achieve weight loss of 25 to 30 percent, which is more than weight loss injections and behavioral interventions.
Improvement of obesity-related health conditions. Many people find that conditions worsened by their weight — like type 2 diabetes, hypertension, sleep apnea and joint pain — improve after weight loss.
Enhanced mobility. Weight loss might help mobility and stamina, making it easier and more enjoyable to be active.
Reduction in medications. As weight-related health conditions get better, you might not need to take as many medications. (Just don’t stop any medications unless specifically instructed to do so by your provider.)
Improved fertility. Obesity can have a higher risk of fertility problems. So weight loss surgery could help increase the odds of conception and support a healthy pregnancy.
Better sleep. Many report improved sleep quality, reduced sleep apnea and even less snoring after weight loss surgery.
Potential Downsides
Equally important to consider are the cons, including:
Surgical risks. Surgery has risks — that’s just the nature of the beast. Infection, bleeding, blood clots, adverse reactions to anesthesia and gastric bypass complications are possible.
Nutritional deficiencies. Bariatric surgery comes with an increased risk for nutrient deficiencies. The way your digestive system is altered (and often downsized) can make it more difficult to absorb vitamin D, iron, calcium and the B vitamins. (This is one reason it’s so vital to follow your dietitian’s food and supplement recommendations).
Dumping syndrome. Weight loss surgery can cause “dumping syndrome.” This is characterized by nausea, vomiting, diarrhea, sweating and weakness after eating foods high in sugar or fat. It happens because, after the procedure, food can zoom through your digestive system.
Digestive issues. Besides dumping syndrome, some people experience gastrointestinal symptoms like acid reflux, bloating, gas and constipation.
Gallstones. The speed of weight loss after surgery can increase the risk of gallstones (hardened digestive fluid deposits that form in the gallbladder). In some cases, medication or surgery is needed.
Mental health challenges. Weight loss surgery can have many positive effects on a person’s self-esteem. However, some might experience body image issues, adjustment difficulties and disordered eating behaviors.
Weight regain. Some people might regain weight over time. There are many reasons this could happen, like lapses in nutrition, hormonal changes or other lifestyle factors.
What If Weight Loss Surgery Doesn’t Work?
Even the best-laid plans can go awry. While not something to expect, it’s possible that having weight loss surgery won’t yield expected results.
This could happen because of underlying medical conditions, genetic factors, hormonal changes or trouble adhering to the nutrition and lifestyle plan.
If you feel like your progress has stalled, get in touch with your healthcare team. They can assess potential reasons and help you figure out your options.
This might include revisiting your nutrition and exercise plan, consulting additional experts, revisional surgery or exploring other non-surgical interventions, including the addition of weight loss medications.
(Related: Are Diabetes Drugs Safe & Effective For Weight Loss?)
Weight Loss Surgery Alternatives
Weight loss surgery can lead to successful weight loss, but it’s not the only avenue. There are less invasive alternatives if you don’t want to have surgery to lose weight.
Weight Loss Medications
Prescription weight loss medications can be very effective, especially when paired with lifestyle changes. Weight loss drugs work by suppressing appetite, reducing fat absorption or boosting metabolism.
Many weight loss medications are used off-label. This means they’re FDA-approved for something other than weight loss, but providers prescribe them for weight loss because they can work well for that purpose.
Some of the most common options are:
GLP-1s. Glucagon-like peptide 1 (GLP-1) receptor agonists were developed for managing type 2 diabetes. By mimicking the action of the hormone GLP-1, they can reduce appetite, increase satiety and slow digestion. Popular options include liraglutide (Victoza, Saxenda), semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro, Zepbound) exenatide (Byetta, Bydureon), and dulaglutide (Trulicity®). Most are injectables.
Metformin. While its primary benefits are as a type 2 diabetes drug, metformin can improve insulin sensitivity and reduce appetite to support weight loss.
Naltrexone and bupropion (Contrave). Naltrexone is typically used to manage alcohol and opioid dependence, and bupropion is an antidepressant. Combining the two helps regulate appetite and cravings to support weight loss.
Topiramate. Topiramate is an anticonvulsant that can suppress appetite and make you feel fuller.
Nutrition Counseling
Good nutrition is non-negotiable for health and weight loss. It can be tempting to try weight loss trends promising a quick fix (we’re looking at you, celery juice diet), but these probably won’t help your long-term success.
Meet with a registered dietitian who specializes in weight loss. They can help you optimize your nutrition and create a tailored plan based on your health, preferences and goals.
Physical Activity
Experts recommend getting at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous aerobic exercise a week for overall health and disease prevention.
This might seem like a lot, and you definitely don’t need to start with that much exercise. The most important thing is to start where you are, give yourself grace and find things you truly enjoy doing.
Perhaps it’s walking, swimming, biking, dancing, playing a sport or a rotation of activities.
If you’re up for it, consider adding in resistance training. Think lifting dumbbells, using weight machines at the gym, or doing bodyweight exercises at home to strengthen your muscles.
Final Thoughts on Weight Loss Surgery
Weight loss is very personal. The best weight loss surgery or approach for someone else may not be the best for you — and that’s okay! Every surgical procedure and health pursuit requires careful consideration.
When considering weight loss surgery, remember that:
It’s not for everyone. Weight loss surgery can be wildly successful, but it’s not a one-size-fits-all prescription for weight loss. There are plenty of pros and cons to think about.
It’s one piece of the long-term puzzle. If you’re a good candidate for weight loss surgery, preparation and commitment are essential. Just as weight loss medications should be used alongside lifestyle modifications, so is weight loss surgery calls for a long-term nutrition and exercise plan.
There are alternatives. If weight loss surgery isn’t a good fit for you, consider other options, like medications along with nutrition counseling and a fitness plan. Your healthcare provider is there to help!
