Exploring bariatric operations: Which weight loss surgery is right for you?  

Bariatric surgery, also known as weight-loss surgery, can be a life-changing decision. If you’re considering weight-loss surgery, it's smart to explore your options to help you make an informed choice.

What is bariatric surgery?

Bariatric surgery is a medical procedure designed to help you lose weight by changing how your digestive system works. 

How do you know if weight loss surgery is right for you? It’s usually recommended for people with a body mass index (BMI) of 40 or higher, or a BMI of 35 with at least 1 obesity-related health condition, like diabetes or high blood pressure. 

Bariatric surgery is different from other weight-loss methods, such as medications, because it’s a more permanent solution with a single procedure. It still requires lifelong commitment to healthy nutrition and lifestyle. 

Because of this commitment, the best bariatric programs provide you with the support and guidance you need to succeed. “You can’t just decide on a whim — you need to be able to make an informed choice that you’re ready to commit to these changes,” says Anthony Petrick, MD, division chief of Geisinger esophageal and bariatric surgery. 

He adds, “Surgery is just one part of the treatment we offer. Nutritional guidance and lifestyle education are also key to a long-term weight management plan.” 

And you don’t have to worry about figuring it out by yourself. “Patients considering bariatric procedures go through a thorough medical, dietary, behavioral and surgical assessment to find the best approach for them,” says Dr. Petrick.

Types of bariatric surgery: Pros and cons

If you’ve ever looked into bariatric surgeries in the past, it’s time to look again.

“This field has evolved rapidly, even in the last 10 years,” says Dr. Petrick. “All bariatric operations are routinely performed as minimally invasive procedures. Newer procedures are tailored specifically to the patient’s needs and some patients can even go home the same day as surgery.” 

Here are the most current weight-loss surgery options, along with the pros and cons of each: 

Gastric sleeve (SG or VSG)

In a gastric sleeve procedure (SG), also known as vertical sleeve gastrectomy (VSG), about 80% of the stomach is removed. By leaving just a small tube or sleeve, it reduces the amount of food you can eat and helps you feel full faster. 

• Benefits:
• Leads to lasting weight loss of about 25% total body weight
• Most of the stomach is removed, but there’s no rerouting of the intestines.
• Leads to remission of obesity-related diseases, including diabetes, high blood pressure (hypertension), sleep apnea and hyperlipidemia
• Complication risks are the lowest of all the bariatric procedures

• Risks:
• Requires lifetime vitamin and calcium supplements to avoid nutritional deficiencies  
• Higher incidence of acid reflux requiring treatment

Gastric bypass (RNY) 

Gastric bypass, or Roux-en-Y gastric bypass (RNY), involves creating a small pouch from the upper part of the stomach and connecting it directly to the small intestine. Bypassing much of the stomach and small intestine reduces the amount of food you can eat and the number of calories your body absorbs. 

• Benefits:
• Leads to rapid, lasting total body weight loss of 35% or more
• None of the stomach is removed
• Provides effective treatment of acid reflux
• Compared to SG/VSG, slightly better remission of obesity-related diseases, including diabetes, high blood pressure (hypertension), sleep apnea and hyperlipidemia

• Risks:
• Slightly higher risk of complications than sleeve gastrectomy
• Requires lifelong vitamin and calcium supplements to avoid nutritional deficiencies

Biliopancreatic diversion with duodenal switch (BPD-DS) 

This procedure removes about 80% of the stomach and connects the remaining stomach to the lower part of the small intestine. It reduces the amount of food you can eat and the number of calories your body absorbs. 

• Benefits:
• Leads to lasting total body weight loss of 40% or more
• Has the highest rate of remission of obesity-related diseases and the highest rate of diabetes remission 

• Risks:
• Higher risk of complications than other bariatric procedures
• Highest risk of vitamin and mineral deficiencies, requiring lifelong comprehensive vitamin and mineral supplements
• Small risk of chronic loose bowel movements (dumping syndrome) 

Single anastomosis duodeno-ileostomy (SADI)

SADI is a less complex version of BPD-DS that creates a small stomach pouch and connects it to the ileum (the last part of the small intestine). 

• Benefits:
• Similar weight loss as BPD-DS, about 40% or more
• Similar rate of remission of obesity-related disease as BPD-DS
• Lower risk of complications than BPD-DS 

• Risks:
• Intermediate risk of vitamin and mineral deficiencies, requiring lifelong comprehensive vitamin and mineral supplements
• Lower risk of loose bowel movements than BPD-DS (dumping syndrome) 

Endoscopic sleeve gastroplasty 

The endoscopic sleeve gastroplasty procedure uses an endoscope to place stomach sutures, creating a smaller stomach pouch, like SG. 

• Benefits: 
• Leads to loss of about 15% total body weight
• No incisions
• Lowest risk of complications 

• Risks:
• Effectiveness in producing long-term weight loss and reducing obesity-related diseases is less well-studied than in the surgical procedures
• Potential for suture failure 

Procedures that are not recommended 

Some bariatric procedures offered in the past are now considered dated because the failure rate is too high. “These procedures do not provide durable weight loss and are no longer considered a first-line weight-loss therapy,” says Dr. Petrick.

These include:

• Gastric balloon: A balloon inserted into the stomach and filled with saline to create a feeling of fullness
• Laparoscopic adjustable gastric bands (lap bands): A band placed around the upper part of the stomach that creates a small pouch, used to control food intake

Gastric sleeve vs. gastric bypass: A closer look

So what are the main differences between the 2 most common bariatric procedures, gastric sleeve (SG) and gastric bypass (RNY)? Factors to consider include surgical complexity, weight loss, nutritional impact, recovery time, reversibility and lifestyle changes.  

	Gastric sleeve (SG)	Gastric bypass (RNY)
Surgical complexity	Less complex, shorter surgery time	More complex, longer surgery time
Weight loss	Effective weight loss, but less overall and may not be as durable as RNY	More substantial and durable weight loss than SG
Nutritional impact	Lower risk of nutritional deficiencies, but requiring lifelong supplements	Higher risk of nutritional deficiencies, requiring lifelong supplements
Recovery time	Average hospital stay of 1 night with rapid recovery	Average hospital stay of 1 night with rapid recovery, but could be slightly longer than SG
Complications	Risk of GERD that may be difficult to treat medically	Risk of bowel obstruction
Reversibility	Not reversible	Reversible, but it’s a complex procedure
Lifestyle changes	No long-term activity restrictions Requires significant changes in eating habits and portion sizes	No long-term activity restrictions Requires significant changes in eating habits and portion sizes

 

Choosing the best bariatric operation for you

Deciding on the right bariatric operation depends on your individual health, lifestyle and goals. Here are some questions to consider: 

• What’s your health status? If you have multiple obesity-related conditions, RNY might offer more long-term benefits. 
• Are you committed to long-term lifestyle changes? Both procedures require you to stop smoking and change your diet, but RNY may lead to more nutritional deficiencies if you don’t stick with it. 
• What’s your tolerance for risk? SG is generally considered less risky, but both procedures have potential complications. 
• What are your weight-loss goals? If greater weight loss is a priority, RNY might be the better choice. 

Bariatric surgery can be a transformative journey when you choose the right procedure for your needs. Whether you opt for a gastric sleeve, gastric bypass or another procedure, working closely with your healthcare team and your own support system will lead to the best possible outcome. 

“This is a significant step, and your health and well-being are the top priorities. You should think of your healthcare team as your lifelong weight-loss partners. That’s why it’s crucial to select not only an experienced surgeon, but a reputable bariatric program for your treatment,” says Dr. Petrick.  

Find the best bariatric surgery program for you

Many programs prioritize only your procedure. Instead, look for a program that is recognized nationally for safety and success. Quality bariatric programs go beyond surgery by offering comprehensive nutrition training, lifestyle education and compassionate support — integral parts of your weight-loss journey.  

When selecting a bariatric program for your weight-loss surgery, look for those with:  

• Plenty of experience and a strong record of excellent patient outcomes 
• External recognition through awards and accreditations such as: 
• Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Accreditation
• Accreditation as an American College of Surgeons’ Quality Program
• Designation as a bariatric surgery center of excellence 
• Designation as a destination center for bariatric surgery
• Surgeons who have bariatric surgical leadership positions or who have received quality awards 
• Educational leadership – offering learning opportunities and educational programs, such as a specialty fellowship training program 

Next steps

Ready to make an informed decision about your weight-loss surgery options? Here’s what to do next:  

• Consult a specialist: Schedule a consultation with a bariatric surgeon to discuss your options. 
• Attend a support group or information session: Others who have had bariatric surgery can offer insights and encouragement. 
• Prepare for surgery: Follow pre-surgery guidelines including the pre-surgery diet, mentally and emotionally prepare yourself for the lifestyle changes and make a plan for post-surgery care.  

If you’re considering bariatric surgery, take your time to research, ask questions and seek support. Having the right knowledge empowers you to make the best decision for yourself. It’s a big step toward a healthier future — and to a healthier, happier you!  

See also:

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Get started with the Mediterranean diet
Explore the risks and benefits of weight loss medications