Bariatric Treatment Options,
Bariatric Weight Loss & Bariatric Medicine

Bariatric treatment could drastically improve the health, happiness and lifespan of over 18 million Americans… could you or someone you love be one of them?

• Bariatric Surgery Table of Contents (start here if you know what you're looking for... otherwise, read this entire page before proceeding)
• Is bariatric weight loss safe?
• Why bariatric weight loss is the only option for many of us
• Is bariatric surgery right for you?
• Why you're thinking about moving forward (or why you already did)
• Why other visitors to this page had surgery
• What you should do next

We’ll let a few major studies sum up the medical community’s consensus about bariatric treatment...

• “Only bariatric surgery can provide substantial and maintained weight loss, which in turn results in improvement of obesity-related co-morbidities and quality of life.”
  
  Journal of the American Medical Association1
• “We count these [study] results as a milestone in our understanding of the benefits of bariatric surgery for obesity. We are confident in the results and believe this will lead to an acceptance that bariatric surgery is a viable, life-saving option for severely obese patients.”
  
  Pennington Biomedical Research Center2
• “The [quality of life] score for the obese group was much lower, suggesting a substantially lower quality of life. The researchers concluded that nearly 3 million quality years are lost in this country each year from obesity and associated conditions.”
  
  American Journal of Preventive Medicine3

Reading this entire page will summarize our collection of bariatric treatment-related content and help guide you through it in a way that is most meaningful to your situation. As you come across a topic of interest, click a link in that section to dive deeper.  Click here to get started.

If you know what you’re looking for, click one of the links below...

• Obesity United States statistics
• Cause and Effect of Obesity
• Treatments for Obesity
• How to calculate BMI (body mass index)
• How to calculate body fat percentage
• Overview & Comparison of Established Types of Bariatric Surgery or click one of the following links for more elaborate information about each procedure:
  • Bariatric surgery video for the established procedures (computer-animated and actual procedure videos for each procedure - videos are also included on each of the follow procedure pages)
  • Analysis & cost of laparoscopic gastric bypass surgery
  • Analysis & cost of lap band surgery
  • Gastric sleeve surgery (Vertical Sleeve Gastrectomy)
  • Duodenal Switch (DS)
  • Vertical Banded Gastroplasty
  • Mini gastric bypass surgery
  • Lap band vs gastric bypass
• Gastric bypass revision procedures:
  • ROSE Procedure
  • StomaphyX Procedure
  • Conversion to lap band surgery
  • Lengthen the Roux limb
  • Conversion to duodenal switch
• Experimental Weight Loss Surgery Procedures
  • EndoBarrier Gastrointestinal Liner
  • Implantable Maestro System
  • TOGA bariatric surgery system
  • Transoral Gastric Volume Reduction (TGVR)
• Risks & Complications
  • Bariatric surgery risks (mortality risks)
  • Bariatric surgery complications (all risks, complications & side effects)
  • Dumping syndrome
  • Blood clot symptoms, prevention and treatment
• Financial Topics
  • Cost of bariatric surgery
  • Bariatric surgery insurance ( DS, VBG, gastric bypass and lap band insurance )
  • Health insurance appeal letter & the appeals process (how to appeal a denial)
  • Financing bariatric surgery & getting the costs down
  • Weight loss surgery Mexico & abroad (also called Medical Tourism or Medical Travel)
  • Free weight loss surgery (charity care and government assistance)
• Finding, Interviewing and Choosing a Surgeon
  • Choosing the right bariatric doctors and bariatric weight loss center
  • Find a bariatric surgeon in my area (search by city and state)
• Life After Surgery
  • Life after weight loss surgery
  • Diet after bariatric surgery
    
  • Weight gain after bariatric surgery
  • Pregnancy after weight loss surgery
• Weight Loss Surgery Support
  • In-person weight loss surgery support
  • Online weight loss support
• Obesity in Teens & Teen Weight Loss Surgery
  • Teenage obesity statistics
  • Teen obesity and adolescent bariatric surgery

Is bariatric weight loss safe?

"Morbidly obese patients who have bariatric surgery are 89% less likely to die over any 5 year period than morbidly obese patients who don't have the surgery."

Surgery of any kind carries risk, and bariatric treatment is no exception. But the answer to any safety question is always relative… 

• What is the risk of NOT having the surgery compared to the risk of having it?
• What is the risk of death from bariatric surgery?
• What is the risk of complications?

Risk of NOT Having Surgery

Before reviewing the risks and complications of bariatric treatment, let’s consider the implications of being morbidly obese and NOT having the surgery. Factors explored in our Cause and Effect of Obesity section include the following… 

• Obesity discrimination
• Depression
• Quality of life – According to a study by the Mercer University School of Medicine, individuals who were obese had a significantly lower health-related quality of life than those of normal weight.
• Obesity health problems ranging from minor to severe 

Bariatric surgery may be the best (or only) treatment for those who are morbidly obese.4 For example, following bariatric surgery…

• Quality of life improved in 95% of patients
• Asthma – 82% improved or resolved
• Cardiovascular disease – 82% risk reduction
• Depression – 55% improved or resolved
• Dyslipidemia hypercholesterolemia – 63% resolved
• Gastroesophageal reflux disease – 72 – 98% resolved
• Hypertension – 52 – 92% resolved
• Metabolic syndrome – 80% resolved
• Migraines – 57% resolved
• Non-alcoholic fatty liver disease – 90% improved steatosis; 37% resolution of inflammation; 20% resolution of fibrosis on repeat biopsy
• Orthopedic problems or degenerative joint disease - 41-76% resolved
• Polycystic ovarian syndrome – 78% resolution of hirsuitism; 100% resolution of menstrual dysfunction
• Pseudotumor cerebri – 96% resolved
• Sleep apnea – 74 – 98% resolved
• Stress urinary incontinence – 44 – 88% resolved
• Type 2 diabetes – 83% resolved
• Venous stasis disease – 95% resolved

In addition, morbidly obese patients who received bariatric treatment were 89% less likely to die over any 5 year period than morbidly obese individuals who didn’t have the surgery.5

Risk of Death from Bariatric Treatment 

The risk of dying from bariatric treatment does exist, but advances in medicine have made its safety equal to that of any other routine surgical procedure. Here’s a comparison of bariatric surgery to heart surgery and common causes of death in the U.S…

See our Bariatric Surgery Risks page for additional details about mortality risks. 

Risk of Complications

The risk of complications both during and after surgery range from minor to severe. About 10% of bariatric surgery patients (1 in 10 people) have some sort of complication, with the most common being nausea and vomiting.

Our Bariatric Surgery Complications page will take you through the complete list and compare complications relating to each bariatric surgery procedure.

Summary

If you qualify for bariatric treatment, from a safety standpoint you should feel comfortable moving forward for a few reasons:

1. The risk of death resulting from bariatric surgery is relatively low at less than 1/2 a percent
2. Bariatric surgery complications occur in 1 out of 10 people but generally classify as minor
3. The health problems stemming from obesity appear to pose a significantly higher risk than having bariatric surgery, and bariatric treatment cures or improves many of those health issues.

Why bariatric treatment is the only option for many of us

According to the Centers for Disease Control, one out of every three people are considered obese in the United States, with over 18 million people qualifying as “morbidly obese”.

And despite the uneducated viewpoints and offensive weight discrimination that run rampant in American, obese people are NOT lazy, are NOT ignorant and DO NOT lack willpower. In short, obesity is not your fault. 

The confluence of several factors has led to the rise of obesity in America. They include… 

• Obesity and genetics: hunger-inducing hormones along with the weight our bodies naturally “want” to be, also known as the Metabolic Set Point Theory
• The prevalence and marketing of unhealthy food choices
• Our demanding, time-strained lifestyle
• Our choices (intentionally last on the list)

Long story short, we have millions of years of evolution working against us. We have a constant bombardment of negative influences. And many of us have a packed and exhausting life that makes finding time to eat healthy and exercise seem nearly impossible.

Bariatric treatment is not for everyone and does carry risks. But with the factors above pulling so hard in the opposite direction, surgery may be the only way to significantly improve your long-term physical and mental health.

See our Cause and Effect of Obesity section for more about obesity. 

Is bariatric treatment right for you?

You’re here, which says that you’re sick and tired of the effects that obesity can have...

• Obesity health problems
• Depression
• Out of breath quickly
• Obesity discrimination
• Relationship problems
• Poor self-image
• Failed diet and exercise programs

As discussed above, bariatric surgery will most likely eliminate or improve each of these. But before we learn together whether surgery is right for you, it is important to understand that bariatric surgery is not for everyone. Even if you fit the profile below, surgery should always be the treatment of last resort. 

If you and your bariatric doctors decide that it makes sense to move forward, be prepared to do a LOT of work both before surgery and for the rest of your life. Bariatric surgery should be thought of as one of the most effective tools available, but in order to succeed you must be ready to completely change your life. 

Ready to figure this out? Okay, let’s get started… 

1. Have you thoroughly explored other treatments?
2. Are you morbidly obese?
3. How do you plan to pay for surgery?
4. Do your expectations match reality?
5. Does your doctor agree that surgery is a good option?
6. How supportive will your friends and family be?
7. Are you really willing to do whatever it takes?

1.  Have you thoroughly explored other treatments for obesity, including diet and exercise plans? 

Look through our healthy bariatric diet plan and weight loss surgery exercise program information and recommendations. There’s a good chance that we’ll have at least a few programs that you haven’t considered. 

If you’re convinced that additional attempts at weight loss on your own will be unsuccessful, professional help could be the answer. A study published in the Journal of the American Medical Association found that most patients are more open to losing weight under a doctor’s supervision.9

In addition, many insurance companies require that you have gone through a medically supervised weight loss program before they will agree to pay for bariatric surgery. 

2.  Are you morbidly obese?

According to the National Institutes of Health guidelines, you could be a good candidate for bariatric treatment if one of the following applies…

• You have a body mass index (BMI) of 40 or more (about 80 pounds overweight for women and 100 pounds overweight for men), or
• Your BMI is between 35 and 39.9 and you have a serious obesity-related health problem

Take a look at our How to Calculate BMI page to see where your body mass index falls. As a good “before and after” exercise, you can also calculate body fat percentage (on a different page), although this measurement will not be used for any other purpose relating to your bariatric treatment. 

3.  How do you plan to pay for surgery?

Bariatric surgery financing is another big consideration.

If you have insurance, there are many obstacles to overcome before surgery will be approved.  If you don’t have insurance, you’ll either need to use your savings or borrow the money. 

See the following pages for more information:

1. Cost of bariatric surgery
2. Bariatric surgery insurance, including how to determine whether you’re covered and ways you may be able to get coverage added to your plan
3. Financing bariatric surgery and the 7 options you should consider

4.  Do your expectations of life after weight loss surgery match reality?

You should work with your bariatric doctors and their team to set realistic post-surgery goals.  You should also gain a solid understanding of the changes you'll experience during life after weight loss surgery.

In general, here’s what to expect…

On the positive side:

• Depending on the type of bariatric surgery you choose, your percentage of excess weight lost could be as high as 80% or more.
  
  As a guideline, your initial goal should be to get your body mass index below 30 (to figure out how many pounds getting to a BMI of 30 will equal for you, see our How to Calculate BMI page).
  
  A BMI of 25 is possible, but 30 should be the real target as that’s where many of the obesity-related health conditions begin to show significant improvement.  (By the way, your body doesn’t want you too thin. Moderately overweight people actually live longer than those at “normal” weight.11)

"Moderately overweight people actually live longer than those at 'normal' weight."

• Your obesity health issues will go away entirely or be greatly improved. For example, a study by the Cleveland Clinic showed that 83% of type II diabetes patients had complete resolution of the disease after bariatric surgery.
• Pregnancy after weight loss surgery will be also much safer than it would be if you didn’t have the surgery. In many cases, the surgery completely cures infertility. 

On the challenging side:

• As we’ll discuss further down the page, this will not be an easy process. Your new bariatric diet and weight loss surgery exercise program will require a lifelong commitment. 
• You won’t see bariatric treatment results overnight. Your lowest weight typically will not be reached until 1 to 3 years out. 
• Once you reach your low point, you are likely to experience some weight gain after bariatric surgery. 
  
• While bariatric treatment has become much safer over the last several years – the mortality rate is only 0.135%, while the mortality rate for all national hospital stays is 2.04% - you should still review and understand the possible bariatric surgery risks and bariatric surgery complications.
• Relationships with family and friends may change. (more on this further down the page) 
• Unhealthy food cravings may or may not go away after surgery (malabsorptive surgeries tend to reduce food cravings more than purely restrictive procedures).  If you give into the cravings, you will reduce your chances for hitting your goal weight and increase the risk of complications.

As mentioned above, bariatric treatment may be the best tool to make you happier and healthier, but that’s all it is… a tool. You will be the key to making it successful. 

See our Life After Weight Loss Surgery page for more information about the changes to expect in each area of your life.

5.  Does your doctor agree that bariatric treatment is a good option? 

Bariatric Surgery Source is your eyes and ears for bariatric treatment-related research and updates, but you should always follow the advice of your doctors when determining what’s best. 

In addition to the NIH and insurance company guidelines mentioned above, your doctor may have their own requirements. For example, your doctor may insist that you… 

• Can move around well. Being bed-ridden or confined to a wheelchair will increase the chance of blot clot symptoms and complications following surgery.
• Have a BMI below 50 or lose 10% of your weight before surgery. The higher your BMI, the higher your risk for complications. However, many surgeons don't require any weight loss prior to approving surgery.
• Be under a certain age, as the risk of complications may increase as you get older. If you are over 50, your doctor will most likely require cardiac clearance before approving surgery.11
• Be old enough so that your growth plates have fused. Teen weight loss surgery may or may not be appropriate. Surgery will not be an option for children until their growth plates fuse, but even afterwards there are several factors to consider.
• Do not suffer from certain medical conditions
• Do not take certain medications that could increase your bariatric surgery risks.
  

If your surgeon says no, don’t be too quick to give up, especially if you are confident that this is right for you.

First, ask if there’s another bariatric treatment that they consider to be safe.

If the answer is still no, ask if they know of another doctor who may be willing to operate on you. Some bariatric doctors specialize in higher-risk patients.

6.  Will your family and friends be supportive of your bariatric treatment? 

Making sure you have a good support network before and after surgery has been shown in several studies to help you heal faster and to increase the likelihood that you will keep the weight off over the long term.12

You’ll need help from family, friends and dedicated groups such as in-person weight loss surgery support groups or online weight loss support groups in order to be successful. 

For example, is your family willing to grocery shop differently to keep the wrong foods out of the house? Will they consider your new diet limitations when ordering at a restaurant to help keep temptation away?

Will there be feelings of jealousy from your partner or your friends if you start to attract new or different types of attention when out in public?

Is your family willing to exercise with you to help keep you on track?

Even if your family is already supportive, they need to be educated to understand why your new habits are so important. Sit down with them and review the relative information on our site, especially the following pages...

• Life after weight loss surgery
• Bariatric diet (what you eat)
• Bariatric eating (how you eat)

7.  Are you willing to do whatever it takes to make your bariatric treatment successful? 

Here's an important exercise that will help you answer this question thoroughly and honestly.

Download and print our "Is Bariatric Surgery Really Right for Me?" document (by clicking the link).  In it you will find a series of questions that require careful thought.

When responding to each question, be as honest and reflective as possible.  This will be for your eyes only.

In addition to helping you be sure that this life-changing procedure is right for you, your responses will help you get more out of your bariatric doctor, dietitian and psychologist visits.  Countless patients have also said that when post-bariatric surgery life gets tough, reviewing their responses to these questions has helped them get back on track. 

Complete the questionnaire, then return here...

Now that you've completed the questionnaire and have a clearer or renewed understanding of your personal struggles with weight loss, it's time to consider the changes that are required after weight loss surgery.

You will have to commit to the following FOR THE REST OF YOUR LIFE…

• Bariatric diet
• A new weight loss surgery exercise routine
• Bariatric vitamins
• Follow-up doctor visits (as a part of life after weight loss surgery)

So you don’t lose your spot on this page, the above links will open in a new window. Click on each and read through them to get an understanding of how they will affect your life. 

Summary of Whether Bariatric Treatment is Right for You

Despite what many people think, bariatric treatment is not an “easy way out”. Complying with the many  requirements can be very difficult, especially when you’re just getting used to the new routine. Plus, it can be tempting to slip back into your old habits as time goes on. 

Do you still feel that bariatric weight loss surgery is right for you? If so, put your work from this section in a safe place for future reference and make your way through the next steps further down the page.

First, the next two sections are for feedback from you and from other visitors to this page.

If you are seriously considering surgery, have decided to move forward with it or already had surgery in the past, please share your decision making process. It'll really help other visitors, as many who visit this page are struggling with the same issues.

Also take time to review the contributions from other visitors... their experiences may help in your decision-making process.

If you want to skip those sections and jump straight to "Next Steps", click here.

Is bariatric treatment for you?

Your thought process leading up to your decision to have bariatric treatment is extremely valuable to other visitors who are also considering it.

Please include any or all aspects of your decision, including...

1. What is/was your weight/BMI when you made the decision?

2. What were the deciding factors for you (i.e. health problems, self-image, obesity discrimination, etc.)?

3. What was the biggest hurdle you faced in deciding to move forward? How did you overcome it?

4. Did you try other treatments/diets first?

5. Anything else that was an important consideration.

Bariatric Treatment Decision-Making Process of Other Visitors

Click below to see contributions from other visitors...

What you should do next

If you are still on the fence or are ready to move forward with bariatric treatment, there are 3 things you need to do next… 

1. Learn about and decide which types of bariatric treatment fit your situation.
   
   You’ll want to do your research on each procedure and have questions ready for step 3.  Either start on our Types of Bariatric Surgery page for an overview and comparison of all surgeries or go directly to the details of each major procedure via the following links:
• Information about & cost of lap band surgery
• Laparoscopic gastric bypass surgery
• Lap band vs gastric bypass
• Gastric sleeve surgery
• Duodenal Switch (DS)
• Vertical Banded Gastroplasty ("Stomach Stapling")
• Mini gastric bypass surgery
• Experimental weight loss surgery
2. Figure out who’s going to pay for your bariatric treatment
   
   Your total bariatric surgery cost could range anywhere from $3,000 to over $35,000 depending on the surgery you choose and where you receive treatment. Fortunately, weight loss surgery can be made more affordable by partnering with insurance companies, your surgeon and other resources:

• Bariatric surgery insurance ( including VBG, DS, gastric bypass and lap band insurance )
• Bariatric surgery financing (if you don't have insurance or if insurance won't cover it)

3. The final and most important next step is to interview doctors and choose the one that is right for you. Choose one of the following:
   1. See our Bariatric Doctors and Bariatric Weight Loss Center page to get started or.
   2. Most surgeons offer free seminars and/or free one-on-one consultations that teach you about your options. Click here to find and schedule a free in-person seminar or one-on-one consultation with a qualified weight loss surgeon in your area.

References

1. For the Media - JAMA and Archives. Study Examines Outcomes of Gastric Bypass Surgery in Morbidly Obese and Superobese Patients.  April 2009.  Available at: http://pubs.ama-assn.org/media/2009a/0420.dtl. Accessed August 10, 2009.
2. Pennington Biomedical Research Center. Weight loss surgery extends lifespan. August 2007. Available at: http://www.pbrc.edu/News/News_Story.asp?id=73. Accessed: August 12, 2009.
3. Groessl, Kaplan, Barrett-Connor, Ganiats. Obese older adults tend to have lower quality of life than normal or overweight individuals. Am J Prev Med 2004;26(2):126-9 (AHRQ grant HS09170)
4. Cleveland Clinic Journal of Medicine.  Risks and benefits of bariatric surgery:
   Current evidence.  November 2006.  Available at: http://www.ccjm.org/content/73/11/993.full.pdf+html?sid=3e4e601f-6d3a-4175-
   98af-d04e64e1409b.  Accessed August 8, 2009.
5. Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean AP, MacLean LD.  Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004 Sep;240(3):416-23; discussion 423-4.
6. National Safety Council. Report on Injuries in America Highlights from Injury Facts, 2009 Edition.  Available at: http://www.nsc.org/news_resources/injury_and_death_
   statistics/Pages/HighlightsFromInjuryFacts.aspx. Accessed: August 13, 2009.
7. DukeHealth.org. Duke Medicine News and Communications. Large-Scale Analysis Finds Bariatric Surgery Relatively Safe.  Available at: http://www.dukehealth.org/HealthLibrary/
   News/large_scale_analysis_finds_bariatric_surgery_relatively_safe. Accessed: August 10, 2009.
8. University of Wisconsin School of Medicine and Public Health. 30-day Surgical Mortality Rate (All Major Cardiac Surgery Procedures). December 2007. Available at: http://www.uwhealth.org/qualityreports/surgicalmortality/14489. Accessed: October 31, 2009.
9. E. Logue, K. Sutton, D. Jarjoura and W. Smucker Department of Family Practice, Summa Health System, Akron, OH. Obesity management in primary care: assessment of readiness to change among 284 family practice patients. Jour Am Board of Fam Medicine. Vol 13, Issue 3 164-171, 2000.  
10. Mary Anne McCaffree, MD, Chair. The clinical utility of measuring body mass index and waist circumference in the diagnosis and management of adult overweight and obesity. June 2008.  Available at: http://www.ama-assn.org/ama1/pub/upload/mm/
    38/a08csaphreports.pdf.  Accessed: August 15, 2009.
11. American Heart Association Task Force on Practice Guidelines. ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery. February 2002. Available at: http://www.circ.ahajournals.org/cgi/content/full/105/10/1257. Accessed: August 11, 2009.
12. LeMont D, Moorehead, MK, Parish, MS, Reto, CS, Ritz SJ.  American Society of Metabolic and Bariatric Surgery. SUGGESTIONS FOR THE PRE-SURGICAL PSYCHOLOGICAL ASSESSMENT OF BARIATRIC SURGERY CANDIDATES. October 2004.  Available at: http://www.asbs.org/html/pdf/PsychPreSurgicalAssessment.pdf.  Accessed: August 12, 2009.

[Last editorial review/modification of this page: 11/8/2011]