What are the weight loss expectations after each procedure?
Success following bariatric surgery is determined by both weight lost and improvement in obesity-related comorbidities. Most surgical studies report outcome as % excess weight loss (excess weight = preoperative weight – ideal weight). Gastric banding typically produces 40% to 50% excess weight loss over 2 to 3 years, but has at least a 20% failure rate. The gastric bypass has long-term data showing a 50% loss of excess body weight maintained over 14 years. Most current laparoscopic literature shows up to 5-year excess weight loss in the 60% to 80% range. There is typically some recidivism after 2 years and it has a 10% failure rate. The biliopancreatic diversion is the most effective weight loss procedure and results in the loss of 80% excess weight maintained over the long term. The sleeve gastrectomy is currently being studied for long-term success and 5-year data shows excess weight loss in the 50% to 60% range with a 20% failure rate.
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Are these weight loss procedures just cosmetic operations?
No. Depending on the procedure, with the gastric band being the least effective but the safest and the biliopancreatic diversion carrying the greatest risks but the most efficacy, nearly all of the patient’s obesity-induced comorbid conditions are improved or resolved within 1 year.
Do surgical weight loss procedures translate to improved long-term survival?
Yes. Recent studies have shown up to a 40% reduction in long-term mortality in a surgical group compared with a nonsurgical group.
Which comorbidity can have the most dramatic improvement?
Type 2 DM shows the most dramatic improvement. In fact, there is much discussion about the surgical treatment for type 2 DM given the very impressive results after the gastric bypass and biliopancreatic diversion. Approximately 90% of diabetics are resolved of their hyperglycemia after these two operations even prior to weight loss. In fact, three recent prospective randomized studies comparing surgery to intensive medical therapy have confirmed that the biliopancreatic diversion is the most effective operation for type 2 diabetes followed by the Roux-en-Y gastric bypass and then the sleeve gastrectomy.
