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Massachusetts Medical Society's Physician Focus

July 2013

Weight-Loss Surgery: Myths and Realities


  • The obesity epidemic in America has fueled an increasing patient demand for weight-loss surgery; about 220,000 operations now occur each year.

  • Besides shedding excess pounds, weight-loss surgery can also help to reduce conditions such as diabetes, hypertension, and sleep apnea.

  • Three types of operations are most common: gastric bypass, adjustable gastric banding, and laparoscopic sleeve gastrectomy.

  • For the best outcomes, patients undergoing weight-loss surgery must make a commitment to change lifestyle habits and have follow-up medical exams for the rest of their lives.

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Weight-loss surgery is rapidly increasing as a treatment for obesity, but for those patients who may think such an operation can readily solve the problems of being excessively overweight, Rick Buckley Jr., M.D. has some advice – and a caution.

“Weight-loss surgery is a tool,” Dr. Buckley says about operation, “and it’s one of many that we have to get people healthier. But it’s not a quick fix, and it never has been a quick fix. It’s a life-long process.”

Dr. Buckley, former chief of bariatric surgery at North Shore Medical Center in Salem, Mass., and Mitchell Gitkind, M.D., director of the UMass Memorial Weight Center in Worcester, Mass., appear as guests on the July episode of Physician Focus to discuss the myths and realities of weight loss surgery. Hosting the program is primary care physician Bruce Karlin, M.D.

With obesity being a major public health concern today - 36 percent of adults and 17 percent of children and adolescents are now considered obese, according to the U.S. Centers for Disease Control and Prevention – one might suggest that plenty of candidates exist for weight-loss surgery. But not everyone can meet the criteria.

The first step to determine if a patient is eligible is calculating Body Mass Index, a number based on a person’s weight and height that indicates body fat. Examples: Patients with a BMI of 30 are considered obese; 35 would be about 80 pounds overweight; 40 would be about 100 pounds overweight. Patients with higher BMIs are considered more suitable candidates for surgery.

BMI, however, is just the beginning of the process.

“We start with the mathematical criteria,” says Dr. Gitkind, “and then help people understand the type of work that needs to get done to put them into a position to succeed with the surgery.” He notes the process includes a multidisciplinary approach, including a physician, dietician, psychologist, and exercise physiologist, as well as the surgeon and nurses.

“We bring patients through a process of preparation,” Dr. Gitkind continues, “that improves their approach to eating and physical activity and builds a foundation that we can put the surgery on top of and expect a great long-term result.” Some steps in the process – like quitting smoking – may be required right from the start.

Simply put, say the doctors, it’s an approach to weight loss with multiple aspects. “The operation can give you a jump-start,” says Dr. Buckley, “but the patient still has to modify behavior, get into exercise, and eat the right foods.”

Three common operations are performed for weight-loss surgery - gastric bypass, adjustable gastric banding, and laparoscopic sleeve gastrectomy. Each is quite safe and low risk, the physicians say, and which one a patient will undergo depends on several factors, one of the most important being the patient’s physical condition.

While weight-loss surgery can be an effective treatment for excessive obesity and success rates are high, the physicians are quick to re-emphasize that an operation is not a quick fix to extreme obesity. “It’s a lot of work,” Dr. Buckley stresses, “probably more work than anyone has ever done before. You really have to commit to a life-long process.”

But for those patients willing to make that commitment, the benefits can be great indeed. The feedback from some of Dr. Gitkind’s patients, for example, is telling.

“They’ve told me,” he says, “‘I got my life back and I’m doing things I’ve never been able to do before.’”

Watch the above video for the full discussion, including conversation about the importance of Body Mass Index and its link to mortality, the details of the three kinds of operations, the risks and success rates for weight-loss surgery, and the impact the surgery can have on such conditions as diabetes, cancer, heart disease and stroke.

MMS/Richard Gulla

American Society for Metabolic and Bariatric Surgery

National Institutes of Health Weight Control Information Network

Obesity Action Coalition

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"Weight Loss Surgery" PSA

From left, Bruce Karlin, M.D.; Rick Buckley Jr., M.D.; Mitchell Gitkind, M.D.
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