Is Weight Loss Surgery Safe? – All You Need to Know

Below are official position statement excerpts from several of the most trusted obesity and obesity-related conditions organizations in the world… (links will take you directly to published statements about bariatric treatment)…

American Diabetes Association (ADA) Official Position: Is Weight Loss Surgery Safe?

• Bariatric surgery should be considered for adults with BMI 35 kg/m2 and type 2 diabetes, especially if the diabetes is difficult to control with lifestyle and pharmacologic therapy.
• Patients with type 2 diabetes who have undergone bariatric surgery
  need life-long lifestyle support and medical monitoring.
• Although small trials have shown glycemic benefit of bariatric surgery in patients with type 2 diabetes and BMI 30–35 kg/m2, there is currently insufficient evidence to generally recommend surgery in patients with BMI <35 kg/m2 outside of a research protocol.
• The long-term benefits, cost effectiveness, and risks of bariatric surgery in individuals with type 2 diabetes should be studied in well-designed randomized controlled trials with optimal medical and lifestyle therapy as the comparator.

American Heart Association (AHA) Official Position: Is Weight Loss Surgery Safe?

Substantial long-term successes of lifestyle modifications and drug therapy have been disappointing in [the obese] population…

…When indicated, surgical intervention leads to significant improvements in decreasing excess weight and comorbidities that can be maintained over time. These include diabetes mellitus, dyslipidemia, liver disease, systemic hypertension, obstructive sleep apnea, and cardiovascular dysfunction. Recent prospective, nonrandomized, observational, or case-control population studies have also shown bariatric surgery to prolong survival in the severely obese.

Different types of bariatric procedures are being performed. Historically, operative mortality was between 0.1% and 2.0% with more recent data not exceeding 1%.
Early complications include pulmonary embolus (0.5%), anastomotic leaks (1.0% to 2.5%), and bleeding (1.0%). Late complications include anastomotic stricture, anastomotic ulcers, hernias, band slippage, and behavioral maladaptation.

The number of bariatric operations being performed is increasing tremendously as a result of increasing medical need and the evolution of safer surgical techniques and guidelines. Currently, bariatric surgery should be reserved for patients who have severe obesity in whom efforts at medical therapy have failed and an acceptable operative risk is present.

Centers for Medicare and Medicaid (CMS) Official Position: Is Weight Loss Surgery Safe?

“The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is adequate to conclude that open and laparoscopic Roux-en-Y gastric bypass (RYGBP), laparoscopic adjustable gastric banding (LAGB), [laparoscopic sleeve gastrectomy (gastric sleeve surgery – added to covered bariatric surgeries in 2012)], and open and laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS), are reasonable and necessary for Medicare beneficiaries who have a body-mass index (BMI) > 35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity.”

International Diabetes Federation (IDF) Official Position: Is Weight Loss Surgery Safe?

• In addition to behavioural and medical approaches, various types of surgery on the gastrointestinal tract, originally developed to treat morbid obesity (“bariatric surgery”), constitute powerful options to ameliorate diabetes in severely obese patients, often normalising blood glucose levels, reducing or avoiding the need for medications and providing a potentially cost-effective approach to treating the disease.
• Bariatric surgery is an appropriate treatment for people with type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially when there are other major co-morbidities.
• Surgery should be an accepted option in people who have type 2 diabetes and a BMI of 35 or more
• Surgery should be considered as an alternative treatment option in patients with a BMI between 30 and 35 when diabetes cannot be adequately controlled by optimal medical regimen, especially in the presence of other major cardiovascular disease risk factors.
• In Asian, and some other ethnicities of increased risk, BMI action points may be reduced by 2.5 kg/m2.
• Strategies to prioritise access to surgery may be required to ensure that the procedures are available to those most likely to benefit.
• Available evidence indicates that bariatric surgery for obese patients with type 2 diabetes is cost-effective.

National Heart Lung and Blood Institute (NHLBI) Official Position: Is Weight Loss Surgery Safe?

Weight-loss surgery might be an option for people who have extreme obesity (BMI of 40 or more) when other treatments have failed. Weight-loss surgery also is an option for people who have a BMI of 35 or more and life-threatening conditions, such as: Severe sleep apnea (a condition in which you have one or more pauses in breathing or shallow breaths while you sleep) Obesity-related cardiomyopathy (KAR-de-o-mi-OP-ah-thee; diseases of the heart muscle) Severe type 2 diabetes

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Official Position: Is Weight Loss Surgery Safe?

Bariatric Surgery for Adults

Currently, bariatric surgery may be an option for adults with severe obesity. Body mass index (BMI), a measure of height in relation to weight, is used to define levels of obesity. Clinically severe obesity is a BMI > 40 or a BMI > 35 with a serious health problem linked to obesity. Such health problems could be type 2 diabetes, heart disease, or severe sleep apnea (when breathing stops for short periods during sleep).

Bariatric Surgery for Youth

Rates of obesity among youth are high. Bariatric surgery is sometimes used to treat youth with extreme obesity. Although it is becoming clear that teens can lose weight after bariatric surgery, many questions still exist about the long-term effects on teens’ developing bodies and minds.

The Obesity Society Official Position: Is Weight Loss Surgery Safe?

Over the past ten years a consensus has emerged that surgery can produce substantial weight loss and may markedly improve a number of health outcomes. This consensus is supported by the findings of the National Heart, Lung and Blood Institute (NHLBI) in 1998, the AHRQ 2003 Technology Assessment, and the CMS MCAC panel in November of 2004, among others. NAASO supports these conclusions, and believes that surgery does have its place in the obesity treatment continuum.