What You Should Know Before Deciding to Have Bariatric Surgery

The risks, benefits and costs to consider

A heavyset woman considering weight-loss surgery.

The risks, benefits and costs to consider

For people who struggle with obesity, bariatric surgery can prolong life and is often the best option for substantial and sustained weight loss.

Bariatric surgery is approved for people with a body mass index (BMI) of 35-40 with a weight-related medical condition and for patients with a BMI 40 or greater.

“In addition to improving quality of life, losing weight can reduce the risk of heart attack, stroke, diabetes and cancer,” says Mark Takata, MD, a bariatric surgeon at Scripps Clinic. Weight-loss surgery has also been shown to significantly improve or resolve hypertension, sleep apnea, high cholesterol and diabetes.

There are different types of bariatric surgery. All affect your digestive system. Before proceeding, it is important to understand how the operations work and what to expect.

“Patient education and careful selection of patients is critical for successful outcomes,” Dr. Takata says. “If you are approved for surgery by your doctor and health plan, you’ll work closely with a medical team to make sure you’re healthy enough for surgery, identify any potential challenges and develop specific plans for you to reach and maintain your goal weight.”

When deciding on the best weight loss surgery for you, many factors are considered, including BMI, eating habits and health problems. “It all depends on your specific situation,” Dr. Takata says.

Most weight-loss surgeries today use minimally invasive techniques, which limit the size of incisions, minimize the length of recovery and decrease the risk of complications. Although complications are uncommon, patients should be aware of the specific risks of bariatric surgery.

What are the benefits of bariatric surgery?

Studies show that more than 90 percent of bariatric surgery patients are able to maintain long-term weight loss of 50 percent excess body weight or more, according to the American Society for Metabolic and Bariatric Surgery.

Bariatric surgery is also effective at reducing the impact of or curing many obesity-related conditions, such as type 2 diabetes, sleep apnea, high cholesterol, high blood pressure and heart disease.

“Weight-loss success also depends on many other important factors, such as nutrition, exercise and lifestyle changes to prevent weight gain,” Dr. Takata adds. “This is why a comprehensive approach, such as the one offered at the Center for Weight Management and Bariatric Surgery at Scripps Clinic Del Mar, is critical for success.”

What are the risks?

All operations have risks. “However, it is important to understand that the risks of remaining obese are far greater than the risks of bariatric surgery,” Dr. Takata says.

With the development of minimally invasive techniques, and accreditation standards for medical excellence, the risks associated with bariatric surgery are very low. (Scripps Clinic has met the rigorous standards established by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and is a designated Comprehensive Center for bariatric surgery).

In addition to the low risk of complications, such as infection, bleeding and cardiopulmonary problems — there are risks of complications in all surgeries — bariatric surgery has specific precautions to consider.

For example, after weight-loss surgery, patients are required to take specific supplements to avoid vitamin deficiencies. “Interestingly, most patients take supplements anyway, so this requirement is not a significant change for many patients,” Dr. Takata says.

Weight-loss surgery shrinks the size of the stomach and creates a significant decrease in appetite. This puts patients at risk for dehydration in the first two to three months after a bariatric procedure. “We follow patients very closely to ensure everyone is progressing as expected,” he adds.

Long term, patients can develop intestinal obstructions, “but this is very rare,” he says. “Your medical team will be tracking your nutrition and progress closely.”

Make sure to write down your concerns before going in for your first appointment, Dr. Takata advises. “That way you can get all the information you need and feel good about your decision on weight-loss surgery.”

Is bariatric surgery reversible?

Sometimes people are not comfortable with the changes produced by bariatric surgery and they want to know if the operation can be reversed. This fear often stems from not understanding the operation, Dr. Takata says. “I recommend people come to an orientation session and learn about the operation before turning away from the lifesaving option of bariatric surgery.”

Gastric banding (or the Lap-Band) is a reversible procedure.

“There are many patients with gastric bands that were implanted many years ago who want to get them removed or want a different weight-loss operation,” Dr. Takata says. “Making this type of change is something we frequently perform to help them achieve their weight-loss goals.”

Gastric bypass surgery is also a reversible operation, he says. “But it is rare to have a patient who needs it reversed,” he says.

Laparoscopic sleeve gastrectomy is not a reversible operation, but “we do not encounter situations where we would want it reversed,” he says.

Does insurance cover bariatric surgery?

Bariatric surgery is expensive. This makes health care insurance an important issue. While most major insurance carriers offer bariatric surgery coverage, not all policies include coverage. Medicare currently pays for weight-loss surgery.

It’s important to check with your insurance carrier and ask if your policy covers bariatric surgery. You may also want to call the office of a local bariatric surgeon and ask for help in checking whether you have coverage.

“Most bariatric programs are happy to check and often have someone on staff that does this on a regular basis,” Dr. Takata says.