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It is the dream of most who have been struggling with overweight: getting surgery and, within hours, removing excess weight off. However, not all surgeries are recommended for all people. In fact, the dream can become a nightmare: the Journal of the American Medical Association published an article reporting that the mortality rate of patients 30 to 40 years reaches 5% in men and 3% for women.

Who Can Have Surgery?
According to the National Institute of Diabetes and Digestive and Kidney Disease, gastric surgeries are indicated in cases with at least 100 pounds (45 Kg) of overweight in men and 80 pounds (36 Kg) in women.
While many people lose weight with these surgeries, it is important to follow several diet and exercise recommendations. There are always certain risks and complications, like infections, hernias, and blood clots.

The Most Common Surgeries
In the United States, four types of surgeries are the most common. To choose the most appropriate type of surgery, both the patient and the physician should discuss the benefits and risks of each, according to body mass index, dietary habits, health problems related to obesity and previous surgeries:

• Adjustable gastric band:Decreases the amount of food that can be ingested by reducing the size of the opening from the esophagus into the stomach through the placement of a small bracelet or band around the upper stomach. After surgery, the doctor may adjust or reduce the size of the opening through the band, which can be removed at any time.
Prognosis: Since it can be performed through laparoscopy, it offers certain advantages, such as reduced trauma and post-operative pain, shorter hospital stays, and overall faster recovery. Furthermore, it is a reversible surgery (through another surgical intervention). The success of the procedure depends to a large extent on the patient’s consistency with the indicated change of habits.

• Roux-en-Y Gastric Bypass:This is the most frequent surgery. It decreases the amount of food that can be ingested, using a small bag. It also reduces food absorption in the digestive system, excluding most of the stomach, duodenum, and upper intestine from direct contact with foods, sending them directly from the bag to the small intestine.
Prognosis: Through this surgery, patients usually lose between 10 and 20 pounds (4.5 to 9 Kg) during the first month, but then weight loss depends on the patient’s perseverance with diet and exercise. Half of more of the excessive weight can be lost during the first two years.

• Biliopancreatic diversion:It is a complex surgery that reduces food intake and absorption through a procedure in which portions of the stomach are removed. The small “pouch” that remains is connected directly to the final segment of the small intestine. Patients lose weight because the calories and nutrients are routed into the colon, where they are not absorbed. And this leads to the greatest risk of the surgery: it reduces the absorption of nutrients, vitamins, and minerals.
Prognosis: Most people lose 10 to 20 pounds (4.5 to 9 Kg) per month after the surgery and up to half the extra weight or more within the first two years.

• Vertical Sleeve Gastrectomy:This surgery was developed only as a first step of the biliopancreatic bypass surgery in patients at high risk of complications for more extensive surgical interventions. It reduces food intake, but doesn’t affect absorption. Most of the stomach is removed, thus reducing the production of a hormone, ghrelin. By producing less ghrelin, appetite is decreased more than in other surgeries, such as the gastric band.
Prognosis: Less weight is lost in comparison to gastric diversion and the process is slower. Patients lose weight over two or three years. 

Like all surgeries, these procedures are serious. Therefore, the decision cannot be taken on the run, but requires taking time to analyze the pros and cons. And, of course, they should only be considered if there are important health problems or if after several attempts, diet and exercise haven’t shown results.

Sources: MedlinePlus