Weight Loss Surgery
Weight loss (bariatric) surgery is generally considered an extreme measure, and the NHS does not perform it lightly: there are a number of risks associated with the procedure, but it has been found to be effective in patients with or without diabetes.
Permanent procedures are more effective in the long-term. However, because they rely on the performance of open surgery, the risks are significantly higher.
Temporary options are comparatively safe, and, unlike permanent procedures, they can be reversed.
Almost all of these procedures rely on strict, disciplined dietary improvements to be successful in the long-term.
What bariatric surgery options are available?
There are a number of bariatric surgery opens available. They include:
- Gastric band surgery
- Gastric bypass surgery
- Sleeve gastrectomy
- Gastric balloon
Read through a comprehensive list of bariatric surgery options, including descriptions and comparisons of each option.
Do I qualify for weight loss surgery?
Guidelines proposed by the National Institute for Health and Care Excellence (NICE) suggest that the NHS:
- Offer an expedited assessment for bariatric surgery to people with a BMI of over 35 or over 30 who have recent-onset type 2 diabetes, as long as they are also receiving or will receive assessment in a tier 3 service (or equivalent)
- Consider an assessment for bariatric surgery for people with a BMI of 30-34.9 who have recent-onset type 2 diabetes as long as they are also receiving or will receive assessment in a tier 3 service (or equivalent)
- Consider an assessment for bariatric surgery for people of Asian family origin who have recent-onset type 2 diabetes at a lower BMI than other populations (see recommendation 1.2.8) as long as they are also receiving or will receive assessment in a tier 3 service (or equivalent)
What follow-up care do the guidelines recommend?
Regarding follow-up care, NICE recommends that the NHS "offer people who have had bariatric surgery to people with a BMI of 35 or over who have recent-onset type 2 diabetes as long as they are also receiving or will receive assessment in a tier 3 service (or equivalent)".
This should include:
- Monitoring nutritional intake (including proteins and vitamins) and mineral deficiencies
- Monitoring for comorbidities (the presence of one or more additional disorders occurring along with a primary disease or disorder)
- Medication review
- Dietary and nutritional assessment, advice, and support
- Physical activity advice and support
- Psychological support tailored to the individual
- Information about professionally-led or peer-support groups 
These guidelines have been in place since November 2014: previously, bariatric surgery was considered to be very much a "last resort". The threshold changes themselves were not huge, but the new guidelines represented a change in how bariatric surgery was viewed.
By including weight loss surgery as part of a carefully considered, long-term weight control plan, NICE rejected the view of weight-loss surgery as an extreme, desperate measure.
The guidelines do not suggest that weight loss surgery should replace healthy eating and exercise for overweight people: quite the opposite, in fact. One of the biggest misconceptions about weight loss surgery is that it is a desperate measure that deals with the problems of being overweight entirely.
When in fact, weight loss surgery is only effective if coupled with lifestyle changes.
The new guidelines from NICE suggest that more emphasis should be placed on the lifestyle changes that come with weight loss surgery as part of a general healthcare package.
Is weight loss surgery safe?
Weight loss surgery is considered an extreme option: each procedure carries the risk of complications and side effects. Permanent surgery is the most dangerous option, but any kind of weight loss surgery needs to be seriously considered.
What are common complications of weight loss surgery?
Common complications of weight loss surgery include:
- Acid reflux (in procedures which shrink the stomach)
- Loose or nasty smelling stools
- Lack of energy
- Nutritional deficiencies
- Stomach complaints
Procedures involving open surgery carry additional complications such as wound infection and even death.