The prevalence of overweight and obese adults is increasing dramatically and is associated with chronic diseases such as type 2 diabetes, cardiovascular disease (CVD), hypertension, osteoarthritis, gallbladder disease, and some cancers. In Canada, 36 per cent of adults are overweight, and 23 per cent are in one of the obese categories.

Gastric bypass and laparoscopic band surgery are the most common forms of bariatric surgery procedures.

Surgery may be considered if:

  • Patient's BMI is = 40, or = 35 with a related condition (e.g., hypertension, type 2 diabetes, hyperlipidemia, or CVD); and
  • All appropriate non-surgical measures have been tried for at least six months without adequate success.

According to a review article in the CMAJ (CMAJ June 12, 2012 vol. 184 no. 9 ) surgical intervention is an option for carefully selected patients with clinically severe obesity (BMI = 40 kg/m2, or BMI = 35 kg/m2 with comorbid conditions) who have been unable to lose weight using other methods and who are at high risk for obesity-associated illness or death. It may be of particular benefit to those patients with diabetes

In a review article on surgical management (.pdf) surgical procedures for morbid obesity are typically categorized by their impact on overall food intake (restrictive) or absorption (malabsorptive).

The current mainstream surgical options for weight loss include vertical banded gastroplasty and adjustable gastric banding (restrictive procedures); biliopancreatic diversion (malabsorptive procedure); and roux-en-Y gastric bypass  other bypass surgeries.

The laparoscopic approach has virtually eliminated the wound complications associated with surgery in the obese patient (wound infection and incisional hernia) and thereby dramatically reduced the burden of illness. Laparoscopy has also affected the surgical management of morbid obesity by driving the adjustable gastric band to the forefront of surgical management, based not only on its favourable clinical outcomes but also its technical simplicity.

Compared with conventional (nonoperative) strategies, surgery achieves dramatically improved weight loss.  

Although ordinarily safe and effective, bariatric surgery is a major operation. Leakage and pulmonary embolism have been the main causes of death. Incisional hernias have been much more common after open than after laparoscopic procedures.

Early mortality following weight loss surgery ranges from 0.4 per cent to 1 per cent.

As this review article points out-weight loss alleviates many of the conditions associated with obesity. Bariatric surgery dramatically improves quality of life because of the significant weight loss .

Bariatric surgery does work and is safe in appropriately selected patients.