Dr. Kulmeet Sandhu
For people who are overweight or obese, the ticket to better health is often losing weight. Although many people view bariatric surgery as a cosmetic procedure, the truth is surgical weight loss saves lives. In fact, bariatric surgery has made major strides over the past decade, and it can be a blessing for the 40% of Americans who are obese.
"People often feel like it's their fault and they should be able to lose weight on their own. But obesity is not about overeating and lack of self-control," says Dr. Kulmeet Sandhu, a surgeon at Cedars-Sinai. "It's a complex medical condition with metabolic changes that can sometimes make losing weight nearly impossible."
"People often feel like it's their fault and they should be able to lose weight on their own. But obesity is not about overeating and lack of self-control. It's a complex medical condition with metabolic changes that can sometimes make losing weight nearly impossible."
What people get wrong about weight loss surgery
Surgical weight loss can be a lifesaving solution for many overweight Americans. Yet only 1% of people who qualify for bariatric surgery get the procedure, in part because of misconceptions surrounding weight loss surgery. Here, Cedars-Sinai experts set the record straight about seven common bariatric surgery myths:
MYTH #1: All weight loss surgeries are the same.
There are many approaches to weight loss surgery. In the early days, doctors often performed gastric band surgery, which sections off the stomach with an adjustable band. Today, the most common procedures are sleeve gastrectomy, a procedure that reduces the stomach to roughly the size of a banana, and laparoscopic gastric bypass, a procedure that connects a tiny section of the stomach to a later section of the small intestine so that food bypasses the majority of the stomach and some of the small intestine. The duodenal switch surgery combines a sleeve gastrectomy with a bypass of much of the small intestine.
Dr. Sergey Lyass
MYTH #2: Weight loss surgeries are risky.
For most people, the risks of obesity are much greater than the risks of bariatric surgery. Studies report a nearly 90% reduction in premature death from all causes after surgical weight loss, as well as dramatic drops in deadly diseases such as diabetes, hypertension and heart disease. And while every surgery comes with risks, bariatric procedures are among the safest on the operating table. The mortality rate (0.1%) of bariatric surgery is less than that of commonplace procedures such as gallbladder removals and hip or knee replacements.
"Over the past decade, doctors have refined their techniques, and most procedures are performed laparoscopically through tiny incisions," says Dr. Sergey Lyass, a bariatric surgeon at Cedars-Sinai. "Many patients are out of the hospital within the same day or the next day."
MYTH #3: Weight loss surgery is a quick fix.
You'll lose weight quickly with weight loss surgery, but bariatric surgery is only one component of a multipronged treatment for obesity. In addition to undergoing physical and psychological tests, surgical candidates meet with a dietitian to be equipped to make the necessary lifestyle changes to help their weight loss stick after surgery. The entire process typically takes four to six months. The goal is to help patients develop healthier habits over the long haul.
"If you don't change your relationship with food and watch your portion sizes, you're likely to regain the weight a few years down the road," says Dr. Carson Liu, a bariatric surgeon at Cedars-Sinai Marina del Rey Hospital.
MYTH #4: Bariatric surgery is all cosmetic.
While losing weight can dramatically enhance your appearance, the real benefits of weight loss surgery are health and longevity. Obesity is linked with more than 40 chronic health conditions, and weight loss surgery can help minimize the impact of all of them.
"Nearly 90% of people with sleep apnea end up with complete resolution of their disease after bariatric surgery, and patients with diabetes end up with lower blood sugar and fewer diabetes-related complications than those who don't undergo the procedure," says Dr. Lyass. In fact, up to 80% of people with Type 2 diabetes go into remission following bariatric surgery, meaning their blood sugars fall within the normal range and they can stop taking medication.
MYTH #5: Most insurance companies won't cover surgical weight loss.
Many insurance companies do cover weight loss surgery for patients who haven't successfully lost weight with other methods. Plans differ by state and which types of procedures they'll cover, but most companies approve surgical weight loss for patients who meet the following criteria:
- A body mass index (BMI) of 35 or more, coupled with a weight-related health condition such as diabetes, hypertension, sleep apnea or arthritis
- A BMI over 40
To calculate your BMI, take your weight in kilograms and divide it by your height in meters squared. If you want to use pounds and inches, divide your weight in pounds by your height in inches squared, and then multiply the answer by 703. If your BMI is over 30, you fall into the obese category.
MYTH #6: Bariatric surgery is for people who have hundreds of pounds to lose.
Many people think weight loss surgery is not for them and that it's only for severely obese people.
"In reality, the people who benefit most from surgery are not only obese, but they have coexisting conditions that impact their health and quality of life," Dr. Liu says.
So, if you have a BMI of 35 and you're taking medications for diabetes or high blood pressure, being treated for sleep apnea, or experiencing chronic low-back or knee pain due to excess pressure on the joints, you're probably a candidate for bariatric surgery.
MYTH #7: Most people who have the surgery gain the weight back.
About 30% of weight loss surgery patients regain much of the weight they lost within five years of surgery. That means an estimated 70% maintain their weight loss.
Most weight loss happens in the first eight to 12 months after surgery, regardless of the patient's lifestyle habits. That's what Dr. Lyass calls the honeymoon period. Unfortunately, the hormonal effects of surgery diminish over time. So, if you plant yourself on the couch after surgery and return to unhealthy eating patterns, you'll regain the lost weight after the honeymoon period ends.
Moving bariatric surgery up the line
Many people consider weight loss surgery to be a last resort. Yet, according to a National Institutes of Health (NIH) expert panel, long-term weight loss is nearly impossible without surgery for people who are severely obese. So, if you've tried and failed to lose weight with diet and exercise or medication, surgical weight loss may help you reclaim your health.
Just keep in mind that bariatric surgery isn't a miracle cure. Instead, it's a powerful tool that can help you pave a path to a healthier lifestyle. And studies suggest that intervening with weight loss surgery within five years of developing a weight-related condition such as diabetes leads to better outcomes over the long haul.
"In fact, one of the most common things I hear patients say is, 'I wish I'd done the surgery sooner,'" says Dr. Sandhu.