A Comprehensive Guide to Weight Loss Surgery: Types, Effectiveness, and Suitable Candidates

Weight Loss Surgery

One day, the young nurse at our center's reception desk was frantically looking for me, her face flushed with anxiety. She said a 38-year-old woman had come to the front desk and, after only a brief conversation, was insisting on having weight loss surgery, and that she absolutely had to have it. The nurse was completely bewildered and didn't know how to respond, so she came to find me.

When I went over, I immediately understood the nurse's confusion. Although the woman was a little overweight, her appearance and attire were quite pleasant; she didn't seem to be at a point where she needed surgery to lose weight. However, after carefully inquiring about her BMI and weight loss history, especially after learning that she had diabetes, I immediately knew that she was indeed a suitable candidate for weight loss surgery.

When people think of weight loss surgery, many probably think of liposuction. Imagine a water tank model: since being overweight is due to too much water in the tank, wouldn't simply draining some of the water lead to weight loss? That's the logic behind liposuction.

While it sounds appealing, I have to tell you:

Liposuction is almost entirely invented for local body contouring and cosmetic purposes; it neither leads to weight loss nor improves health. Therefore, in medicine, liposuction belongs to plastic surgery, which is in the realm of medical aesthetics.

Why can't liposuction lead to weight loss?

Firstly, liposuction only removes subcutaneous fat, not visceral fat. Subcutaneous fat is actually quite useful; the real threat to health is visceral fat. Only by reducing visceral fat can true weight loss be achieved. Liposuction cannot do this.

Secondly, if you don't change your lifestyle, the fat removed will likely grow back in about three months. Moreover, it won't grow back to the original areas where the liposuction was performed (thighs, buttocks, waist, back), but is more likely to accumulate in the internal organs, resulting in a body shape with thin limbs and a large belly. This is even more harmful to health.

Therefore, liposuction is not included in the weight loss surgeries we are discussing. You must understand this.

The principle of true weight loss surgery is actually very simple. Since being overweight is due to overeating and energy accumulation, wouldn't it be better to simply reduce the size of the stomach so that people eat less? That's right, weight loss surgery reduces the size of the stomach through different methods. There are three classic methods:

The first is gastric bypass surgery, which involves creating a bypass around the stomach using a section of the small intestine, effectively rendering the stomach unused.

The second, simpler and more direct method, involves directly removing a portion of the stomach.

The third involves placing an inflatable balloon in the stomach to reduce its volume.

It was this incredibly simple weight-loss surgery that topped the list of medical innovations in the United States in 2013 and ranked third among medical innovations over the past 10 years in 2015.

This is because, after tracking patients for 10 years following weight-loss surgery, the medical community discovered that nearly 90% of diabetic patients were miraculously cured. Yes, truly "cured," no longer requiring any medication, dietary management, or exercise; they could live like normal people.

Therefore, this type of weight-loss surgery is also used in the treatment of diabetes. This is why the woman mentioned at the beginning was a suitable candidate for weight-loss surgery.
All three surgeries are quite effective. However, although the third method sounds less invasive, the first and second methods have more stable and lasting results, making them the current classic surgical procedures.

A long-term follow-up study found that 12 years after undergoing the first two types of surgery, 93% of people were still 10% lighter than before the surgery, and 40% were even 30% lighter. The results are even better when combined with lifestyle interventions.

Why do the first two methods, which also reduce stomach size, have better results?

This is because the surgery doesn't just physically alter the stomach's volume; its magic lies in the chemical changes it induces.

The first two surgeries, by bypassing a section of the stomach wall, alter the chemical environment of the gastrointestinal tract. For example, it increases bile acids in the intestines, affecting our gut microbiota, which in turn adjusts our taste system, making us less fond of sugar and fat and more receptive to fruits and vegetables. It also reduces ghrelin, the hormone that makes you feel hungry, thus reducing the desire to eat transmitted to the brain.

After reading this, you're probably tempted. So, while the effects are significant, it is still a surgical procedure. Are there any risks and side effects?

Currently, according to data from established institutions, bariatric surgery has the lowest mortality rate among all general surgical procedures – no higher than 0.4% within 30 days and afterward.

Therefore, after decades of clinical observation, bariatric surgery has become a mature weight-loss treatment option. Given its efficacy and side effects, there are clear medical guidelines for its application:

(1) Recommended for diabetic patients with a BMI greater than 32.5.

(2) For diabetic patients with a BMI less than 32.5, due to a lack of effective research data spanning more than 10 years, you should consult with your doctor.

(3) Recommended for individuals without diabetes but with a BMI greater than 40.

Regardless of the type of bariatric surgery, it is not a permanent solution. Lifestyle interventions are still necessary after surgery. Only in this way will the weight loss effects be maintained stably.