Bariatric Surgery Options: Types, Eligibility, and Considerations for Weight Loss

One of the most widely performed bariatric procedures today is the laparoscopic sleeve gastrectomy, a minimally invasive surgery that removes a large portion of the stomach to create a narrow gastric "sleeve." This significantly reduces stomach capacity, helping patients feel full faster and consume fewer calories. Another common surgical option is the Roux-en-Y gastric bypass, which not only reduces stomach size but also reroutes the small intestine to limit both food intake and nutrient absorption.

Outdated and Less Common Procedures

In the past, adjustable gastric banding was a popular choice for weight loss surgery. However, this method has largely been phased out due to complications such as band slippage, erosion into the stomach wall, and relatively poor long-term outcomes. While it was once seen as a reversible and less invasive option, its effectiveness pales in comparison to modern techniques.

Specialized Surgeries for Extreme Cases

For individuals with super obesity (a BMI over 50) or those struggling with severe, insulin-resistant type 2 diabetes, more complex procedures like biliopancreatic diversion (BPD) or duodenal switch surgery may be considered. These operations combine restrictive and malabsorptive elements, leading to significant weight loss. However, they come with higher risks of nutritional deficiencies, including deficiencies in vitamins A, D, E, K, calcium, and protein, requiring lifelong supplementation and close medical monitoring.

Who Is a Candidate for Bariatric Surgery?

Bariatric surgery isn't suitable for everyone—it's reserved for individuals who meet specific medical criteria. Generally, surgery is strongly recommended for patients with a body mass index (BMI) exceeding 37.5. Those with a BMI between 32.5 and 37.5 are typically good candidates, especially if they have obesity-related health conditions such as hypertension, sleep apnea, or type 2 diabetes.

Expanded Criteria Based on Health Profile

For patients with a BMI between 27.5 and 32.5, surgery may still be an option if metabolic syndrome is present—this includes conditions like high blood sugar, elevated triglycerides, low HDL cholesterol, and increased waist circumference. Central obesity, identified through imaging studies showing excess visceral fat, is another key factor. Men with a waist measurement greater than 90 cm (about 35 inches) and women with a waist over 85 cm (about 33 inches) may qualify for surgery after a multidisciplinary team evaluation.

Age and Safety Guidelines

The generally accepted age range for bariatric surgery is between 16 and 65 years. Adolescents may be considered if they've reached physical maturity and suffer from severe obesity with comorbidities. On the other end, older adults must undergo thorough cardiovascular and overall health assessments to ensure surgical safety. Decisions are always made on a case-by-case basis, involving input from surgeons, endocrinologists, dietitians, and mental health professionals to optimize long-term success.