What to know about weight loss surgery and other options

In the United States, nearly 1 in 3 adults is overweight, and more than 2 in 5 are obese. For some, weight loss can be a lifelong challenge. If you or a loved one has struggled to lose weight and keep it off through diet and exercise, you should look into other options such as weight loss surgery.

What are common weight loss options?

Many people with a high body mass index (BMI) can't lose enough weight to normalize their BMI without medical intervention. Here are a few common options.

Surgical procedures

Surgery is one of the most common — and most effective — options for weight loss. According to the American Society for Metabolic and Bariatric Surgery, more than 279,000 weight loss procedures were performed in 2022. Gastric sleeve surgery (or vertical sleeve gastrectomy) was the most popular procedure, followed by Roux–en-Y gastric bypass (RYGB).

Gastric sleeve surgery reduces stomach capacity by removing about 80% of the stomach. The remaining stomach is shaped like a shirt sleeve. In addition to restricting food capacity, the procedure improves the metabolic hormones responsible for appetite, satiety and blood sugar stability. The metabolic benefits of this surgery are as important as the restricted stomach capacity.

Nonsurgical procedures

Surgery isn't the best option for everyone who wants to lose weight. Nonsurgical weight loss options can be just as effective and come with fewer risks.

For example, endoscopic sleeve gastroplasty is an alternative to gastric sleeve surgery. During this procedure, the surgeon places sutures along the inside of the stomach through a scope. As with gastric sleeve surgery, the goal is to reduce stomach capacity. Shortcomings of this approach include the possibility of suture disruption and failure to maintain a healthy weight long term. There is no long-term data on the procedure at this time.

Intragastric balloons are another nonsurgical option. These soft silicone balloons are usually inserted into the stomach through the esophagus. This happens during a procedure known as endoscopy. Once it’s inside the stomach, the balloon is expanded with air or liquid. This reduces the amount of available space in the stomach and helps limit food intake. However, since the balloon cannot stay in the stomach permanently, patients are at risk of regaining weight after removal. For that reason, intragastric balloons do not deliver sustainable weight loss when compared with weight loss surgery.

Medications

Medications can also be effective for weight loss. These medications are available as injectables or pills. Most work by increasing the sense of satiety and slowing the emptying of the stomach. While weight loss drugs are a noninvasive option, they're designed to be taken long term. Stopping use comes with a high risk of regaining weight.

Are weight loss drugs safe?

Weight loss drugs are generally safe, but they can have side effects. Studies have shown that some weight loss drug users stop using them because of these side effects which can include nausea, vomiting and diarrhea. In fact, some weight loss pills have been removed from the market due to health concerns. Also, weight loss drugs can interact with other medications. It’s important to consult with your doctor before deciding whether to take them.

Who's a good candidate for weight loss surgery?

Depending on your circumstances, surgery can be an excellent alternative to weight loss drugs, providing significant outcomes at around 50% to 70% loss of excess weight. You may be a good candidate for surgery if you have:

• A BMI of 30 or more and obesity-related health problems such as Type 2 diabetes
• A BMI of 35 or more

What are the benefits of weight loss surgery?

Improves quality of life

If you have severe obesity, weight loss surgery can extend your life, as well as enhance your quality of life. It can reduce the number of prescription medications you have to take, increase physical function and mobility, and improve self-esteem, body perception and social interaction.

Reduces the risk of weight-related health concerns

Surgery can significantly improve or lower your risk of weight-related health conditions such as high blood pressure, Type 2 diabetes, heart disease and sleep apnea. It may also reduce your risk of some common cancers, including lung, kidney and liver cancer.

Supports long-term weight management

Surgery can provide long-term weight loss in combination with lifestyle changes such as eating healthily and exercising regularly. One study showed that most people maintained their weight loss seven years post-surgery.

Risks and recovery

Thanks to enhanced delivery of care and the advent of minimally invasive surgery, weight loss surgery is generally safe. The current mortality risk from sleeve gastrectomy is less than 0.1%. However, there are potential risks around the need to adjust food consistency, especially in the early recovery period. Also, side effects can include bleeding, blood clots and changes in bowel function.

If you decide surgery is right for you, then you may have to follow a liquid diet for one to two weeks and slowly transition to eating solid foods. Returning to normal unlimited activities post-surgery can take up to four weeks.

Talk to your doctor about your options

If you're interested in exploring weight loss surgery, talk to your doctor. Any surgery comes with a certain degree of risk, but when compared with the risks of excess weight and associated health problems, surgery is an excellent option. Ask your doctor for guidance. If you both decide surgery is the right path for you, your surgeon can help you prepare. Whatever method you choose for weight loss, taking the step toward better health is essential.