Bariatric surgery is weight-loss surgery. To understand which is the safest weight-loss surgery, it is worth understanding how bariatric surgery works and when it is an appropriate solution for patients.
Obesity can lead directly to serious health risks like heart disease, stroke, diabetes, cancer, and even premature death. According to the World Health Organization (WHO), 39% of the world population is obese.
With this in mind, weight-loss surgery is a safe and effective life-saving measure for obese and extremely obese patients who have been unsuccessful at losing weight and have been diagnosed with—or are at risk of developing—one or more of the health conditions mentioned above.
Which is the safest weight-loss surgery?
Bariatric and weight-loss surgeries are one and the same; they carry a minimal risk of post-op complications. That said, there are different types of bariatric surgery, and the specific procedure that may be best for you will depend on your weight, underlying health conditions, and other risk factors.
How bariatric surgery works is by making changes to your digestive system to facilitate weight loss. It consists of reducing your stomach size, thereby curbing your appetite and maximizing weight loss.
A study by the US National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) compared three common forms of weight-loss surgery: gastric banding, gastric sleeve (gastrectomy), and gastric bypass.
Though bariatric surgery is quite safe, the procedures vary in risk and potential complications. An evaluation led by your doctor, surgeon, and nutritionist can help determine the most appropriate bariatric option for you.
Every surgery has its pros and cons, and even bariatric surgery isn’t 100% risk-free. However, the risks of early death and chronic disease increases with obesity and extreme obesity.
Main Types of Weight-loss Surgery
There are four main types of bariatric (or weight-loss) surgeries.
- The Gastric Sleeve — Patients stand to lose around 60–65% of excess body weight, on average, in the first year following the surgery. The procedure creates a much smaller stomach in the form of a sleeve, thus, its more technical name: laparoscopic sleeve gastrectomy.
- The Gastric Bypass — Of the three main bariatric surgeries, this bypass procedure is perhaps the least invasive. It essentially separates the stomach into a smaller pouch and a larger sac. Food is channeled through the pouch to the small intestine, bypassing the rest of the stomach. Patients lose about 70–75% of excess weight within 12 months of the surgery.
- The Gastric Band — This minimally invasive surgery aims to reduce food intake by wrapping an adjustable inflatable band around part of the stomach. Patients report feeling satiated with less food. That said, weight-loss varies widely from person to person.
- The Duodenal Switch — Patients stand to lose about 80–85% of excess weight in the first year following this surgery. As this procedure combines elements of both the gastric sleeve and the gastric bypass, it is the most delicate, reserved for the most appropriate cases.
By reducing the stomach size, these procedures allow food to pass more slowly, making the patient feel full in a shorter amount of time, which results in significant post-surgical weight loss.
Other procedures worth mentioning include:
● Vagal blockade
● Biliopancreatic diversion
● Gastric balloon/intragastric balloon system
● Aspire Assist
Weight-loss surgeries can take many forms. Which procedure is best for you will depend on the evaluation process and determination made by a team of medical professionals led by your surgeon.
Which is the least invasive surgery for weight loss?
Apart from the question regarding the safest weight loss surgery, many people are more specifically interested in the least invasive surgery. Weight-loss surgeries range from invasive to minimally invasive to completely non-invasive. Some, including the gastric band surgery mentioned above, are reversible.
Most bariatric surgeries are performed with a laparoscope—a thin, minimally invasive surgical instrument with a built-in camera that allows the surgeon greater operational precision, therefore bypassing the need for larger, more intrusive incisions.
Here are some examples:
- Gastric Balloon — This restrictive weight-loss surgery is non-invasive with no hospitalization and a fast recovery. However, side effects may include nausea and vomiting, and the procedure may not be suitable if you have bowel disease or liver problems.
- Laparoscopic Band — Also known as gastric band surgery, this is another minimally invasive option that involves fastening a lap band inside the stomach wall. The procedure facilitates weight loss by reducing appetite and curbing hunger.
- Endoscopic Sleeve Gastroplasty — This is a newer, minimally invasive surgery that involves an endoscopic technique to reduce stomach size. It features a faster recovery and shorter healing time. Some drawbacks are nausea, vomiting, and abdominal pain.
Gastric sleeve and gastric bypass procedures are commonly performed, minimally invasive, and some of the safest weight-loss surgeries available. Since the surgery involves the use of relatively small laparoscopic instruments—a thin fiber-optic camera system being one of them—, potential complications are greatly minimized.
How to choose the best surgery for you?
When considering which is the safest weight-loss surgery, your medical team needs to analyze the specifics of your case.
As a guideline, bariatric surgery is for patients with a body mass index (BMI) of 35 or greater plus two or more underlying health conditions. For patients without underlying health conditions, a BMI of 40 or greater is the general criteria. In either case, your doctor will need to perform a detailed assessment that analyzes the following:
● Physical health, including eating habits, lifestyle patterns, and underlying health conditions
● Alcohol and tobacco use
● Mental state, to determine commitment and readiness for surgery
● Other potential risk factors for surgery.
So, how do you choose the best surgical option for your body? This decision is best made in consultation with your team of medical professionals, including your doctor, surgeon, and dietitian.
Also, consider that the pre- and post-bariatric surgery diets are very specific, and your recovery will depend on how well you follow them.
Important Things to Know Before the Procedure
- Weight-loss surgery is not for everyone. You need to meet specific criteria and requirements before being approved for surgery.
- Preoperative work is required. Preparation begins weeks, or even months, before the surgery. It includes weight reduction, protein and vitamin supplements, and a preoperative diet to get your body ready for surgery.
- Weigh the risks and benefits.
- Be prepared for lifestyle changes. Bariatric surgery requires you to modify your eating habits. Alcohol and tobacco use is restricted to safeguard your wellbeing and reduce the chance of complications.
- Emotional support and counseling are essential. Create a support network that includes not just your medical professionals but also family, friends, and people with similar weight-loss goals.
To summarize, bariatric surgery is weight-loss surgery, and your surgeon and medical team will work with you to determine the best and safest option for you.
The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) recorded over 800,000 bariatric surgeries performed globally in 2019. In their report, they state the following: Obesity is not a behaviour. It’s not a choice, but a chronic progressive heritable neuro-behavioural disorder that is highly sensitive to environmental conditions.
If anything, the analysis conducted by the IFSO stresses the importance of helping people battle obesity. Not just because it, along with smoking, is one of the primary causes of early death, but because obesity can complicate so many other health conditions. So, it is worth emphasizing the greater need for lifestyle changes to support bariatric surgery and ensure long-term, successful weight-loss.
Every medical procedure carries a risk, but it is important to maintain perspective. Remember that bariatric surgeries are life-saving procedures for patients with life-threatening obesity. There can be complications, as with any medical intervention, but they are far outweighed by the risks of not doing something about extreme obesity.