Bariatric surgery is no simple thing. It requires preparation and an understanding of post-operative realities. Still, it can be an effective, safe, and enduring therapy for weight loss — but only for the right patients.

Explaining What Bariatric Surgery Entails

The two most common procedures are sleeve gastrectomy and gastric bypass.

“These procedures are as safe as joint replacement or removal of a gallbladder,” said John Morton, MD, system lead for surgical quality and bariatric services in the Yale New Haven Health System and professor in the Department of Surgery at the Yale School of Medicine in New Haven, Connecticut. He’s also a former president of the American Society for Metabolic and Bariatric Surgery.

Studies show that the majority of patients keep their weight off and reduce their long-term mortality by 50% after having surgery. Procedures take 1-2 hours, requiring a hospital stay of 1-2 days, said Morton.

In a sleeve gastrectomy, 75% of the stomach is removed to create a tubular and smaller stomach, whereas in a gastric bypass, a small gastric pouch is divided from the stomach, said Morton. The gastric pouch is then connected to a divided portion of intestine, which is in turn reconnected to another portion of the intestine, he added.

What Are the Benefits of Bariatric Surgery? 

Beyond helping patients lose weight, there are benefits including improvement in heart disease, type 2 diabetes, obstructive sleep apnea, and hypertension, and metabolic surgery also lowers the risk for 13 obesity-related cancers, said Richard M. Peterson, MD, MPH, president, American Society for Metabolic and Bariatric Surgery, Newberry, Florida. He is also a professor of surgery and division chief of general and minimally invasive surgery at UT Health San Antonio.

What Are the Eligibility Standards?

The criteria for eligibility of metabolic and bariatric surgery were updated in 2022 with a joint guideline by the American Society of Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders. The criteria say that a patient is eligible for surgery if they have a BMI of greater than 35 or a BMI between 30 and 34.9 with an obesity-related comorbidity.

While psychological evaluation is required by most insurers, only untreated mental illness or current substance abuse is a contraindication, said Peterson. Also, accredited programs work with trained professionals who are familiar with patients undergoing these treatments.

Diabetes Is Not Disqualifying for Surgery

Yes, patients with diabetes can have the procedures, and in fact, metabolic and bariatric surgery is the most effective treatment for type 2 diabetes, Peterson said.

“Most patients that have been diagnosed with diabetes for less than 5 years will have their diabetes go into complete remission, with most going home from surgery without needing to be on any diabetes medications,” he said. “Those with the diagnosis for longer have a very good chance of their diabetes going into remission or at least significantly better controlled.”

Morton consults for Olympus, Novo Nordisk, Teleflex, Medtronic, and Boehringer Ingelheim. Peterson is a consultant for Teleflex/Standard Bariatrics, Intuitive, and Medtronic.