Obesity: Should I have weight-loss surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Obesity: Should I have weight-loss surgery?

Get the facts

Your options

  • Have weight-loss surgery.
  • Do not have weight-loss surgery.

Key points to remember

  • Being very overweight makes you more likely to have serious health problems, such as heart disease and type 2 diabetes.
  • Surgery may be an option if you haven't been able to lose weight with diet and exercise and if:
  • Most people lose at least a third of their extra weight after surgery. Some people lose almost all of their extra weight.
  • After surgery, you will need to make big, lifelong changes in how you eat—including smaller portions and different foods. Some people gain weight again after a few years because they can't make these permanent changes.
  • Weight-loss surgery has risks, including a risk of death. You need to compare the risks of being very overweight with the risks of surgery.
FAQs

What is surgery for obesity?

The most common surgeries are:

Stomach stapling . Surgical staples and a plastic band are used to create a small pouch at the top of the stomach. You get full much faster, so you don't eat as much.
Adjustable gastric banding . A small band is placed around the upper part of the stomach, creating a small pouch. The band can be adjusted to make the pouch bigger or smaller.
Gastric bypass . Staples or a band are used to create a permanent small pouch in the stomach. The pouch is connected to the middle part of the small intestine so that food bypasses the rest of the stomach and the first part of the small intestine. You get full much faster, and your small intestine absorbs fewer calories.

Most people who have weight-loss surgery are between 18 and 65 years old. But the surgery is often done on people older than 65. And it is sometimes done on people younger than 18.

Surgery can be done two ways:

  • Open surgery.The surgeon makes a large cut in the belly.
  • Laparoscopic surgery. The surgeon makes several small cuts and uses small tools and a camera to guide the surgery. You recover sooner and are less likely to have problems after surgery.1

How will surgery affect what you eat?

After surgery, you'll need to make big, permanent changes in how you eat:

  • Tiny meals.You can eat only a few ounces of food at a time. Your new stomach will only hold a tiny amount of food.
  • Eat slowly.You must eat very slowly and chew your food to mush. Otherwise, you may vomit often and have pain.
  • No liquids with meals.You won't be able to drink for 30 minutes before you eat, during your meal, and for 30 minutes after you eat. There won't be room in your stomach for both drinks and solid food.
  • Vitamin pills.You probably will need to take vitamins and supplements.
  • Avoid candy, ice cream.You may have to avoid foods that contain simple sugars—like candy, juices, ice cream, condiments, and soft drinks. Simple sugars may cause a problem called dumping syndrome. This happens because food moves too quickly through the stomach and intestines. It can cause shaking, sweating, dizziness, rapid heart rate, and often severe diarrhea.

What are the risks of surgery?

People who are very overweight are more likely than other people to have problems from any kind of surgery.

After any weight-loss surgery:

  • There is a risk of death.This is rare, but it does happen sometimes. Fewer than 1 out of 100 people die after weight-loss surgery.2
  • You could get an infection in the area where cuts were made.
  • There can be a leak from the stomach into the belly area, which can cause an infection called peritonitis.
  • A blood clot can form and block blood flow in the lung (pulmonary embolism).
  • About 33 out of 100 people develop one of the following problems, while about 67 out of 100 do not:3, 4

After stomach stapling :3

  • About 20 out of 100 people may need a second operation because the connection between the stomach and the small intestine narrows, leading to nausea and vomiting, or because of an increase of gastroesophageal reflux after eating.5 This means that 80 out of 100 people don't have this problem.
  • The staples pull loose in about 33 out of 100 cases. This means that 67 out of 100 people don't have this problem.
  • The plastic band may slip. Or it may work its way from the outside of the stomach to the inside.

After gastric bypass :5, 3

  • More than 30 out of 100 people have an iron and vitamin B12 deficiency, while about 70 do not. About half of those 30 people with an iron deficiency develop anemia.
  • The connection between the stomach and the small intestine narrows in 5 to 15 out of 100 people, leading to nausea and vomiting after eating. This means 85 to 95 out of 100 don't have this problem.
  • Between 5 and 15 out of 100 people get ulcers. This means 85 to 95 out of 100 don't get this problem.
  • The staples may pull loose.
  • Hernia may develop.
  • The bypassed stomach may enlarge. This causes hiccups and bloating.

After adjustable gastric banding :

  • Many patients need a second operation because the band slips. Or sometimes it works its way from the outside of the stomach to the inside.
  • You won't lose weight as fast as you would with gastric bypass.
  • Although it does not seem to have as many risks as other types of weight-loss surgery, more research is needed.

Another risk of surgery is that, although it helps you lose weight, after a few years you may gain the weight back. Research shows that after 10 years, only 20 out of 100 people who had stomach stapling have kept the weight off. That means that 80 out of 100 people gained weight again after 10 years.5, 4

Why might your doctor recommend surgery?

Your doctor may recommend weight-loss surgery if:

  • Your BMI is at least 40 (35 if you have other health problems related to your weight).
  • You have been obese for at least 5 years.
  • You have tried for at least 6 months to lose weight with diet and exercise.
  • You do not abuse alcohol.
  • You do not have untreated depression or another major mental illness.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have weight-loss surgery Have weight-loss surgery
  • You are asleep during the operation.
  • You stay in the hospital one or more days.
  • You return to normal activities within 3 to 5 weeks.
  • General problems that can occur after surgery include blood clots in the lung and infection.
  • Many people have nutrition problems because they eat so little. That can lead to anemia or weak bones.
  • In the 10 years after surgery, most people gain weight again.
  • There is a risk of death, but this is rare.
Don't have surgery Don't have surgery
  • You keep trying to lose weight with diet and exercise.
  • You may try prescription drugs to help you lose weight.
  • You avoid having surgery and all the risks and side effects.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about having surgery for obesity

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

Weight never used to be a problem for me. But then I had some problems in life and started gaining weight. I tried to lose weight but my problems kept getting in the way. I looked into surgery, but it seemed like a last resort. Instead, I'm working through my problems and feel I can get back to my old weight through less drastic means.

Charlene, age 52

I'm pretty young, but my doctor is worried about my weight problem; I guess my BMI and waist size put me at high risk for complications, especially diabetes. I've tried diet and medications, but have not had any luck. My doctor is now talking to me about a gastric bypass, and I'm going to give it a try. I need to lose the weight and feel I can live with the side effects and risks of surgery.

Mike, age 35

I know I'm obese and that I'm at risk for health problems. But to me, the risk of surgery and side effects are as bad as being obese, especially at my age. I might try diet or medication again, but who knows? I'm happy with who I am and lead a good life. Surgery might make it worse. It's not for me.

Melissa, age 60

I'm tired of being fat. I've had a weight problem since I was a kid and want something different. Diets, drugs, exercise—I've tried them all. I've been talking to my doctor about surgery. We both feel that reducing my risk of heart problems, plus feeling better about myself, is worth the risks of surgery. The surgery sounds effective, and I feel if I can get started, I'll do fine on my own.

Frank, age 48

For more information, see the topic Obesity.

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose weight-loss surgery

Reasons not to choose weight-loss surgery

I have tried diet, exercise, and medicine, and they haven't worked.

I want to keep trying diet, exercise, and medicine to lose weight.

More important
Equally important
More important

My weight bothers me so much that I am willing to have surgery, even though there are risks involved.

My weight doesn't bother me enough to take on the risks of surgery.

More important
Equally important
More important

I feel confident that I can make major diet changes after surgery.

I'm not sure I can handle the diet changes I'll need to make after surgery.

More important
Equally important
More important

I'm not worried about paying for this surgery.

I don't think I can afford to pay for this surgery.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

After weight-loss surgery, I will be able to eat normal amounts of food.

  • True Sorry, but that's wrong. Surgery will make your stomach much smaller than normal, so you will need to eat very small amounts of food and pay very close attention to getting the right amounts of vitamins and minerals.
  • False Correct. Surgery will make your stomach much smaller than normal, so you will need to eat very small amounts of food and pay very close attention to getting the right amounts of vitamins and minerals.
  • I'm not sure It may help to go back and read "How will surgery affect what you eat?" You will need to eat very small amounts of food after surgery.
2.

Having weight-loss surgery can cause problems, but my being very overweight can also cause health problems.

  • True That's right. Surgery has risks, including a risk of death. But being very overweight can lead to serious health problems, such as heart disease and diabetes. You need to compare the risks of being obese with the risks of surgery.
  • False Sorry, that's wrong. Surgery has risks, including a risk of death. But being very overweight can lead to serious health problems, such as heart disease and diabetes. You need to compare the different risks.
  • I'm not sure It may help to go back and read "Key points to remember." Surgery has risks, including a risk of death. But being very overweight can lead to serious health problems, such as heart disease and diabetes. You need to compare the risks.
3.

Surgery may be an option for me because my BMI is higher than 40.

  • True You're right. Surgery is for people who are so heavy that their health is in danger. Those are people whose BMI is at least 40, or at least 35 if they already have other health problems.
  • False Surgery is for people who are so heavy that their health is in danger. Those are people whose BMI is at least 40, or at least 35 if they already have other health problems.
  • I'm not sure It may help to go back and read "Key points to remember." Surgery is for people who are so heavy that their health is in danger. Those are people whose BMI is at least 40, or at least 35 if they already have other health problems.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits and references

Credits
Author Jeannette Curtis
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer Matthew I. Kim, MD - Endocrinology & Metabolism

References
Citations
  1. Schauer PR, Ikramuddin S (2001). Laparoscopic surgery for morbid obesity. Surgical Clinics of North America, 81(5): 1145–1179.
  2. Maggard M, et al. (2005). Meta-analysis: Surgical treatment of obesity. Annals of Internal Medicine, 142: 547–559.
  3. American Gastroenterological Association (2002). AGA technical review on obesity. Gastroenterology, 123(3): 882–932. [Erratum in Gastroenterology, 123(5): 1752.
  4. U.S. Department of Health and Human Services (2008). Bariatric Surgery for Severe Obesity (NIH Publication No. 04-4006). Available online: http://www.win.niddk.nih.gov/publications/gastric.htm.
  5. Brolin RE (2002). Bariatric surgery and long-term control of morbid obesity. JAMA, 288(22): 2793–2796.

Obesity: Should I have weight-loss surgery?

You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

  • Have weight-loss surgery.
  • Do not have weight-loss surgery.

Key points to remember

  • Being very overweight makes you more likely to have serious health problems, such as heart disease and type 2 diabetes.
  • Surgery may be an option if you haven't been able to lose weight with diet and exercise and if:
  • Most people lose at least a third of their extra weight after surgery. Some people lose almost all of their extra weight.
  • After surgery, you will need to make big, lifelong changes in how you eat—including smaller portions and different foods. Some people gain weight again after a few years because they can't make these permanent changes.
  • Weight-loss surgery has risks, including a risk of death. You need to compare the risks of being very overweight with the risks of surgery.
FAQs

What is surgery for obesity?

The most common surgeries are:

Stomach stapling . Surgical staples and a plastic band are used to create a small pouch at the top of the stomach. You get full much faster, so you don't eat as much.
Adjustable gastric banding . A small band is placed around the upper part of the stomach, creating a small pouch. The band can be adjusted to make the pouch bigger or smaller.
Gastric bypass . Staples or a band are used to create a permanent small pouch in the stomach. The pouch is connected to the middle part of the small intestine so that food bypasses the rest of the stomach and the first part of the small intestine. You get full much faster, and your small intestine absorbs fewer calories.

Most people who have weight-loss surgery are between 18 and 65 years old. But the surgery is often done on people older than 65. And it is sometimes done on people younger than 18.

Surgery can be done two ways:

  • Open surgery.The surgeon makes a large cut in the belly.
  • Laparoscopic surgery. The surgeon makes several small cuts and uses small tools and a camera to guide the surgery. You recover sooner and are less likely to have problems after surgery.1

How will surgery affect what you eat?

After surgery, you'll need to make big, permanent changes in how you eat:

  • Tiny meals.You can eat only a few ounces of food at a time. Your new stomach will only hold a tiny amount of food.
  • Eat slowly.You must eat very slowly and chew your food to mush. Otherwise, you may vomit often and have pain.
  • No liquids with meals.You won't be able to drink for 30 minutes before you eat, during your meal, and for 30 minutes after you eat. There won't be room in your stomach for both drinks and solid food.
  • Vitamin pills.You probably will need to take vitamins and supplements.
  • Avoid candy, ice cream.You may have to avoid foods that contain simple sugars—like candy, juices, ice cream, condiments, and soft drinks. Simple sugars may cause a problem called dumping syndrome. This happens because food moves too quickly through the stomach and intestines. It can cause shaking, sweating, dizziness, rapid heart rate, and often severe diarrhea.

What are the risks of surgery?

People who are very overweight are more likely than other people to have problems from any kind of surgery.

After any weight-loss surgery:

  • There is a risk of death.This is rare, but it does happen sometimes. Fewer than 1 out of 100 people die after weight-loss surgery.2
  • You could get an infection in the area where cuts were made.
  • There can be a leak from the stomach into the belly area, which can cause an infection called peritonitis.
  • A blood clot can form and block blood flow in the lung (pulmonary embolism).
  • About 33 out of 100 people develop one of the following problems, while about 67 out of 100 do not:3, 4

After stomach stapling :3

  • About 20 out of 100 people may need a second operation because the connection between the stomach and the small intestine narrows, leading to nausea and vomiting, or because of an increase of gastroesophageal reflux after eating.5 This means that 80 out of 100 people don't have this problem.
  • The staples pull loose in about 33 out of 100 cases. This means that 67 out of 100 people don't have this problem.
  • The plastic band may slip. Or it may work its way from the outside of the stomach to the inside.

After gastric bypass :5, 3

  • More than 30 out of 100 people have an iron and vitamin B12 deficiency, while about 70 do not. About half of those 30 people with an iron deficiency develop anemia.
  • The connection between the stomach and the small intestine narrows in 5 to 15 out of 100 people, leading to nausea and vomiting after eating. This means 85 to 95 out of 100 don't have this problem.
  • Between 5 and 15 out of 100 people get ulcers. This means 85 to 95 out of 100 don't get this problem.
  • The staples may pull loose.
  • Hernia may develop.
  • The bypassed stomach may enlarge. This causes hiccups and bloating.

After adjustable gastric banding :

  • Many patients need a second operation because the band slips. Or sometimes it works its way from the outside of the stomach to the inside.
  • You won't lose weight as fast as you would with gastric bypass.
  • Although it does not seem to have as many risks as other types of weight-loss surgery, more research is needed.

Another risk of surgery is that, although it helps you lose weight, after a few years you may gain the weight back. Research shows that after 10 years, only 20 out of 100 people who had stomach stapling have kept the weight off. That means that 80 out of 100 people gained weight again after 10 years.5, 4

Why might your doctor recommend surgery?

Your doctor may recommend weight-loss surgery if:

  • Your BMI is at least 40 (35 if you have other health problems related to your weight).
  • You have been obese for at least 5 years.
  • You have tried for at least 6 months to lose weight with diet and exercise.
  • You do not abuse alcohol.
  • You do not have untreated depression or another major mental illness.

2. Compare your options

  Have weight-loss surgery Don't have surgery
What is usually involved?
  • You are asleep during the operation.
  • You stay in the hospital one or more days.
  • You return to normal activities within 3 to 5 weeks.
  • You keep trying to lose weight with diet and exercise.
  • You may try prescription drugs to help you lose weight.
What are the benefits?
  • You avoid having surgery and all the risks and side effects.
What are the risks and side effects?
  • General problems that can occur after surgery include blood clots in the lung and infection.
  • Many people have nutrition problems because they eat so little. That can lead to anemia or weak bones.
  • In the 10 years after surgery, most people gain weight again.
  • There is a risk of death, but this is rare.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Obesity.

Personal stories about having surgery for obesity

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"Weight never used to be a problem for me. But then I had some problems in life and started gaining weight. I tried to lose weight but my problems kept getting in the way. I looked into surgery, but it seemed like a last resort. Instead, I'm working through my problems and feel I can get back to my old weight through less drastic means."

— Charlene, age 52

"I'm pretty young, but my doctor is worried about my weight problem; I guess my BMI and waist size put me at high risk for complications, especially diabetes. I've tried diet and medications, but have not had any luck. My doctor is now talking to me about a gastric bypass, and I'm going to give it a try. I need to lose the weight and feel I can live with the side effects and risks of surgery."

— Mike, age 35

"I know I'm obese and that I'm at risk for health problems. But to me, the risk of surgery and side effects are as bad as being obese, especially at my age. I might try diet or medication again, but who knows? I'm happy with who I am and lead a good life. Surgery might make it worse. It's not for me."

— Melissa, age 60

"I'm tired of being fat. I've had a weight problem since I was a kid and want something different. Diets, drugs, exercise—I've tried them all. I've been talking to my doctor about surgery. We both feel that reducing my risk of heart problems, plus feeling better about myself, is worth the risks of surgery. The surgery sounds effective, and I feel if I can get started, I'll do fine on my own."

— Frank, age 48

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose weight-loss surgery

Reasons not to choose weight-loss surgery

I have tried diet, exercise, and medicine, and they haven't worked.

I want to keep trying diet, exercise, and medicine to lose weight.

More important
Equally important
More important

My weight bothers me so much that I am willing to have surgery, even though there are risks involved.

My weight doesn't bother me enough to take on the risks of surgery.

More important
Equally important
More important

I feel confident that I can make major diet changes after surgery.

I'm not sure I can handle the diet changes I'll need to make after surgery.

More important
Equally important
More important

I'm not worried about paying for this surgery.

I don't think I can afford to pay for this surgery.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. After weight-loss surgery, I will be able to eat normal amounts of food.

  • True
  • False
  • I'm not sure
Correct. Surgery will make your stomach much smaller than normal, so you will need to eat very small amounts of food and pay very close attention to getting the right amounts of vitamins and minerals.

2. Having weight-loss surgery can cause problems, but my being very overweight can also cause health problems.

  • True
  • False
  • I'm not sure
That's right. Surgery has risks, including a risk of death. But being very overweight can lead to serious health problems, such as heart disease and diabetes. You need to compare the risks of being obese with the risks of surgery.

3. Surgery may be an option for me because my BMI is higher than 40.

  • True
  • False
  • I'm not sure
You're right. Surgery is for people who are so heavy that their health is in danger. Those are people whose BMI is at least 40, or at least 35 if they already have other health problems.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
Author Jeannette Curtis
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer Matthew I. Kim, MD - Endocrinology & Metabolism

References
Citations
  1. Schauer PR, Ikramuddin S (2001). Laparoscopic surgery for morbid obesity. Surgical Clinics of North America, 81(5): 1145–1179.
  2. Maggard M, et al. (2005). Meta-analysis: Surgical treatment of obesity. Annals of Internal Medicine, 142: 547–559.
  3. American Gastroenterological Association (2002). AGA technical review on obesity. Gastroenterology, 123(3): 882–932. [Erratum in Gastroenterology, 123(5): 1752.
  4. U.S. Department of Health and Human Services (2008). Bariatric Surgery for Severe Obesity (NIH Publication No. 04-4006). Available online: http://www.win.niddk.nih.gov/publications/gastric.htm.
  5. Brolin RE (2002). Bariatric surgery and long-term control of morbid obesity. JAMA, 288(22): 2793–2796.

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Last Updated: April 16, 2009

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