by David Arterburn, MD, MPH, and Jane Anau
You’ve been wondering about bariatric surgery. When you first heard about it, you thought weight-loss was the only reason to have the surgery, so learning that bariatric surgery can be used to manage and treat your diabetes and hypertension was eye-opening. Treating these chronic health conditions is more important to you than weight-loss but you are worried about the risks of surgery. It’s a big deal, so you’ve taken your time to talk with your primary care doctor, and you’ve read real-life stories from people who had chosen to have or not have bariatric surgery. You’ve imagined the lifestyle changes you might need to make after surgery – will the outcomes be worth it? Is the cost of the surgery worth it? After reflecting on these ideas and talking with your family and friends, you’ve made the decision that surgery is right for you.
Now you face the next step – choosing which type of bariatric surgery to have. You’ve heard some people wish they’d chosen a different surgery, while other people remain happy with their choice.
It’s a big decision and you’re going to need the help of a surgeon to make it. There are so many things to consider with each procedure, it’s hard to know where to even start. Here are some questions you might be asking yourself:
Here’s a really important point to remember when planning your visit – there are no right answers and there is no “right” procedure. You and your surgeon enter the discussion with the same goal – to collaborate and make a decision about which type of surgery is right for you.
Here’s what to expect in an appointment with a surgeon to consider different bariatric surgery procedure types:
One source of new research evidence that might help you in talking with your doctor comes from the PCORnet Bariatric Study (PBS), which is the largest long-term U.S. study on bariatric surgery to date. The study uses real-world data from 41 health organizations around the country to examine bariatric surgery results at 1, 3, and 5 years after surgery. Specifically, based on anonymous medical records from over 46,000 people who had bariatric surgery from 2005 to 2015, PBS compared different bariatric procedures in terms of weight-loss and regain, diabetes risk, and safety.
There are several types of bariatric surgery, but the two most common operations are the gastric bypass and the sleeve gastrectomy.
Other bariatric operations are less commonly performed in the United States, including the adjustable gastric banding operation. Adjustable gastric banding is now less common because research shows better results and fewer long-term complications with gastric bypass or sleeve gastrectomy. For example, the PBS found that adults had more weight-loss with gastric bypass or sleeve gastrectomy than with adjustable gastric banding. Adults also had a higher chance of improvements in type 2 diabetes with gastric bypass or sleeve gastrectomy than with adjustable gastric banding. In addition, patients who had gastric banding had the highest risk of needing another surgery. For these reasons, the evidence below focuses on how sleeve gastrectomy compares to gastric bypass.
The PBS studied how gastric bypass and sleeve gastrectomy compare when it comes to weight-loss, effect on diabetes, and safety. The information below is based on the results of surgeries in adults aged 20 to 79 years old at the time of their surgery.
If your main concern is weight-loss, the PBS study found:
If your main concern is diabetes, our study found:
If your main concern is the safety of the surgical procedure, the PBS found:
As you think about the information presented above, what seems most important to you? Is it the amount of weight-loss, the improvement in diabetes, or the risk of complications? Can you rank these in order of importance for you? Given what is most important to you, which operation appears to be best overall for that particular goal?
These questions can help you get closer to understanding what operation might be right for you, but you should still have a conversation with your surgeon. Every person is different, and your surgeon can help you to understand whether the results from the PBS study apply well to you – your individual health characteristics and your goals. Also, there might be other reasons why another procedure might be a good option. Having a conversation with your surgeon about the benefits and risks of the different operations, including data like those presented above, can help you make an informed choice that is guided by your own preferences, goals, and concerns. This can lead to better confidence in your decision-making and better satisfaction with your care long-term.
Information about weight-loss, diabetes risk, and the safety of the most common bariatric surgery procedures can help guide the conversation on procedure choice between you and your surgeon. Remember, there is no “right” choice. You and your surgeon can make a shared decision on which procedure is best for you. No matter what treatment options you are considering, we encourage exploring shared decision-making with a trusted medical professional.
The PBS used anonymized and completely “de-identified” medical record data to study people who had bariatric surgery, including the following criteria:
To learn more, please visit the following links:
The PCORnet Bariatric Study was conducted in the National Patient-Centered Clinical Research Network, PCORnet. This study was funded by PCORI® via contract OBS-1505-30683. The views expressed in this article are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee. To learn more, please visit pcori.me/3BTbqeJ.
About the Authors:
David Arterburn, MD, MPH, FACP, FTOS, FASMBS (Hon) is a general internist and researcher at the Kaiser Permanente Washington Health Research Institute and Affiliate Professor with the University of Washington’s Department of Medicine in Seattle. He has published over 150 scientific papers on obesity, diabetes, and shared decision-making. The main focus of his current research is on identifying safe, effective, and affordable interventions to reduce the medical and psychosocial burden of obesity, with a special emphasis on the long-term outcomes of bariatric surgery.
Jane Anau, BS is a research project manager at the Kaiser Permanente Washington Health Research Institute. She works on studies related to bariatric surgery, diabetes, and persistent pain.
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