Last year, 177,000 people in the U.S. had weight-loss, or bariatric, surgery. Most were more than 100 lbs. overweight and already had tried slimming down in conventional ways — through dieting, exercise and medication — but couldn’t. So they opted, finally, to have their stomachs reduced “from the size of a football to that of a golf ball,” according to Philip Schauer, M.D., president of the American Society for Bariatric Surgery.

The main goal of this procedure? To make patients feel full after eating much less food, with the big payoff coming weeks and months later as the pounds start melting away.

The Basics

Bariatric surgery is actually a catchall term for several stomach-shrinking procedures. The most common of these is the “Roux-en-Y” gastric bypass (GBP) in which a surgeon permanently alters the stomach so a portion of the intestinal tract is “bypassed” when you digest food. The second most popular procedure, the “laparoscopic adjustable banding system” (LAP-BAND), is less invasive (no cutting into the stomach wall) and reversible.

An inflatable “band” is placed around your stomach to restrict its size, and as you lose weight, a doctor can “tighten” the band, making your stomach even smaller. Expect to spend up to a week in the hospital after a bypass and two or three days following a laparoscopic procedure. After another month or so, you should be able to get back to your regular routine.

The Pros

A 2004 study found that weight-loss surgery improves an obese person’s life expectancy by a whopping 89 percent by easing many serious medical problems, including Type 2 diabetes, hypertension and respiratory ailments. Equally important from a patient’s point of view? A new, vastly improved self-image.

The Cons

“There’s a high risk of complications, such as gastro-intestinal leaks, infections and even death,” says Andrew Wright, M.D., a University of Washington acting assistant professor who is studying the long-term effects of bariatric surgeries. Each year, between 1,400 and 2,800 patients of the surgery die (or about 5 percent within 12 months of the operation, according to a University of Washington study).

Even those who respond well may experience side effects: vitamin deficiencies, numbness in the hands and painful digestion. And you do need to watch what you eat. It’s possible to regain some of the weight you’ll lose in the first few years after surgery, especially if you don’t hold back on easy-to-digest high-cal treats such as puddings and shakes.

Where Do I Find a Top-Notch Doc?

Any licensed surgeon can legally perform these surgeries, but you should find someone who does them routinely. Check out the American Society of Bariatric Physicians (asbp.org) for a list of experienced, board-certified member surgeons. Or if you know of one who’s considered outstanding, work backward: Find out which primary
care doctors the surgeon works with, then make an appointment with one of them to start the process.

Are These Procedures Pricey?

The bill may total anywhere from $15,000 to $50,000, but many insurance companies cover the cost (they’ve done the math: Insured obese people spend 36 percent more on health-care services than the healthy).

But there’s a catch: As these surgeries gain popularity (they’ve risen more than 400 percent since 1999), insurers want to make sure they’re performed on those who really need them. So first check your carrier’s policy, then be ready to get to work, advises Mary P. McGowan, M.D., author of Gastric Bypass Surgery. You’ll likely need to:

• Meet the National Institutes of Health obesity surgical eligibility guidelines of a BMI of 40 or higher.

• Document all failed previous attempts at weight loss through dieting, counseling or medications.

• Have no history of alcohol or drug abuse.

• Have a letter of support from your primary care doctor that lists all your obesity-related illnesses.

• Have a letter of support from your bariatric surgeon. This letter is crucial and should include the same medical history as your primary doctor’s letter.

Another Option
Check out clinicaltrials.gov, where National Institutes of Health-supported studies are posted. Search “gastric bypass” and you’ll find nationwide studies recruiting new patients. If you’re willing to be a guinea pig, you just might be able to get a free procedure.