Weight-Loss Surgery: Debunking Common Myths
Weight-loss procedures have been carried out since as early as the 10th century—yes, truly—but it was in the mid-1990s that they became far more prevalent. In fact, recent surveys indicate that over 250,000 bariatric surgeries are conducted annually in the United States—a figure that's quite similar to the number of breast augmentations (the nation’s most popular cosmetic procedure) performed domestically each year.
Despite this, weight-loss surgery appears not only more stigmatized but also prone to more misinformation than many other procedures. These incorrect notions range from relatively minor ones, such as the belief that there's only one type of bariatric surgery, to more detrimental concepts, like it being the most risky form of surgery and potentially shortening your lifespan after recovery.
The reality is that bariatric surgery is a life-altering—and, in certain cases, life-saving—choice for those who are eligible. Here, Dr. J. Timothy Katzen, a board-certified plastic surgeon in Beverly Hills, California, and the president of the American Society of Bariatric Plastic Surgeons (ASBPS), helps us dispel some of the most frequently encountered myths about weight-loss surgery.
Myth #1: Bariatric Surgery is a "Magic Bullet" for Weight Loss
Some individuals believe that weight-loss surgery serves as an antidote for bad habits—for instance, thinking you can eat as unhealthily as you desire because your newly reduced stomach will make overeating more difficult. But bariatric surgery should be regarded as a tool, not a complete solution. “Like any tool, its effectiveness depends on your efforts to maximize it,” says Dr. Katzen. A healthy lifestyle, encompassing nutritious eating and a consistent fitness routine, is crucial for a successful outcome and sustained weight loss. Otherwise, you're merely deceiving yourself. “If you fail to adhere to the appropriate nutrition guidelines or neglect to exercise, you can nullify the benefits of bariatric surgery,” warns Dr. Katzen.
Myth #2: Stomach Stapling is the Sole Kind of Weight-Loss Surgery
“Stomach stapling,” a form of bariatric surgery that physically separates a large portion of the stomach from a smaller section using staples (thus reducing the volume of food it can hold), is an outdated approach. It led to numerous side effects, such as severe acid reflux, so stapling has largely been replaced by gastric banding, also known as the Lap-Band. This band divides the stomach into two sections: A smaller upper stomach, where food is stored (and makes you feel full sooner), and a larger lower stomach for food digestion.
This is a relatively straightforward and safe procedure, with a quicker recovery period and smaller scar compared to more extensive procedures like a gastric bypass. Nevertheless, it comes with two drawbacks. “You will need to have the band adjusted to further restrict your stomach size and, consequently, decrease stomach absorption,” says Dr. Katzen. That's undoubtedly a disadvantage for those not interested in scheduling follow-up procedures. Additionally, the weight loss after the procedure is not as significant as that from other bariatric surgeries, so if you're seeking more substantial change, other forms might be more suitable for you.
One of the most well-known options is gastric bypass, formally referred to as Roux-En-Y surgery. During this operation, a surgeon creates a small pouch from the stomach and directly connects it to the small intestine. Gastric bypass offers substantial and rapid weight loss (within the first six months!) that can persist for up to two years. However, because it alters the way you absorb nutrients, you might become malnourished and experience low levels of hemoglobin and calcium (causing anemia and osteoporosis, respectively). Another concern is the unfortunately, yet appropriately, named dumping syndrome. “Dumping syndrome is a side effect where the stomach dumps an excessive amount of food into the intestines, causing diarrhea,” Dr. Katzen explains.
There are additional surgical choices as well as a non-surgical option—the gastric balloon. Your provider inflates a balloon in your stomach, which remains in place for approximately six months. There are numerous bariatric procedures to consider; your provider will be best able to determine which is most appropriate for your weight-loss goals.
Myth #3: Weight-Loss Surgery is Unattainable Due to Cost
This is incorrect—in fact, Dr. Katzen remarks that the majority of bariatric surgery is covered by health insurance. If you have a high BMI; suffer from obesity-related health problems such as diabetes, hypertension, heart stress, and joint issues; and collaborate with your insurance provider to complete the necessary preoperative weight-loss counseling, the likelihood that your procedure will be eligible for coverage is high.
If you don't qualify, you still have alternatives. Remember, there are numerous factors that can cause the cost of bariatric surgery to vary, so be sure to take those into consideration. And apart from paying in cash, you can also budget carefully and work with lenders like CareCredit to finance your weight-loss surgery. “Remember, this is your life—it is essential that you devote all your efforts and resources to extend your life and enhance the quality of your life and health,” urges Dr. Katzen. “Do whatever is necessary to obtain the funds needed to proceed with your life-saving bariatric surgery.”
Myth #4: You Must Be Morbidly Obese to Be a Candidate for Weight-Loss Surgery
Morbid obesity is an outdated (and offensive) term. Obese BMI levels are now classified as Class 1 (30 to 34.9), Class 2 (35 to 39.9), and Class 3 (40 or higher). This statistic is determined through a height and weight calculation; you can find a BMI calculator here. Prospective patients typically need to have a BMI of 40 or greater—or 35 with a comorbidity—to be eligible for a bariatric procedure.
However, eligibility for insurance coverage for weight-loss surgery falls under different criteria. “Insurance companies have strict requirements for permitting payment and coverage for the procedure,” says Dr. Katzen. While some insurance companies have more rigorous policies, “most insurance companies require an elevated BMI and associated comorbidities, such as diabetes and hypertension,” he adds. Until you go through the submission process, you may not know if you qualify under your insurance provider's plan. You'll have to work with your bariatric surgeon and their team to document your health conditions and file a letter of medical necessity; ultimately, your insurance company makes the final decision.
Myth #5: Weight-Loss Surgery is Hazardous
All major surgical procedures, whether reconstructive, cosmetic, or for weight loss, inherently carry risks; several factors, in particular, increase those risks. “The more obese you are, the more comorbidities you have, the more invasive the procedure, and the less experienced your weight-loss surgeon, the higher the chance that complications can arise,” says Dr. Katzen. Generally speaking, though, the benefits of surgery outweigh the health risks associated with being overweight.
When seeking a surgeon, it's crucial to find one with extensive experience in performing your specific procedure; they should operate in a surgery center that's been accredited as a “center of excellence in bariatric surgery” or in a hospital. And while there are some truly outstanding weight-loss surgeons abroad, most frequently in Mexico, Dr. Katzen still recommends having your surgery in the United States. “The main issue with having bariatric surgery outside the USA is the follow-up,” he cautions.
Due to the complex nature of weight-loss surgery, attending your follow-up appointment is important—and if you're experiencing a complication and your doctor is abroad, it might be impossible to see them. “In an emergency, [it’s possible that] the exact surgery or what was done can’t be determined because it was performed outside the USA,” he adds. It's also worth noting that the majority of insurance providers won't cover the expenses incurred by complications that occur elsewhere.
Myth #6: Bariatric Surgery is Entirely a Cosmetic Procedure
Weight-loss surgery may alter a patient's appearance, but it's by no means a cosmetic surgery. “Cosmetic procedures are carried out on healthy patients,” says Dr. Katzen. They are also elective and, unlike bariatric surgery, typically don't qualify for health insurance coverage (though there are exceptions). “Weight-loss surgeries are performed because patients have a disorder—namely, obesity,” explains Dr. Katzen.
Myth #7: Most People Regain All the Weight They've Lost from Their Surgery
Remember, bariatric surgery is a tool, not an instant fix, and weight regain after the procedure largely depends on the patient's commitment to maintaining a healthy lifestyle. The type of weight-loss surgery performed also plays a role, as do genetics, age, and activity. But ultimately, “the surgery itself will not ensure permanent weight loss,” cautions Dr. Katzen. “Weight-loss maintenance is a collaborative effort between you and your bariatric surgery procedure that requires your constant cooperation.”
That said, the statistics related to weight regain are reassuring. According to Dr. Katzen, regardless of the patient or procedure, only 15–20% of patients regain 20% of their lost weight. “Most patients do not regain all their weight,” he says. If you do, however, you can always have your procedure revised or try a different one.
Myth #8: Apart from Weight Improvement, Bariatric Surgery Has a Negative Impact on Long-Term Health
Some people think that weight-loss surgery makes it impossible to conceive (false) and can shorten your life. That's not the case—what can shorten your life are the health conditions linked to obesity, such as diabetes, high blood pressure, and osteoarthritis. Bariatric procedures lead to weight loss and can completely eliminate some of these dangerous health issues. And beyond the improvement in your health, it can also significantly transform your quality of life and self-esteem for the better. “The benefits far outweigh the side effects achieved through significant weight loss,” notes Dr. Katzen
