The Basics

No. The causes of obesity can be complex. Despite conventional wisdom, morbid obesity is not simply a result of overeating.

Research has shown that, in many cases, underlying causes of obesity are genetic, environmental, and social. Studies have demonstrated that, once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief. The yo-yo diet phenomenon describes patients who lose weight with a diet and regain it back plus more after a few months.

The weight-loss experts with Keck Medicine of USC’s Bariatric Surgery program understand the many factors that contribute to lasting weight loss. That’s why we offer surgical, nutritional, and social support to help our patients achieve long-term success.

BMI is an abbreviation for Body Mass Index

It is calculated as a measure of a person’s weight in relation to their height. BMI allows health care professionals and patients to better understand health issues associated with a specific weight classification, such as obesity or morbid obesity.

  • BMI 20-25: Ideal
  • BMI 25-30: overweight
  • BMI over 30: obesity
  • BMI over 40: morbid obesity

View BMI chart.

Bariatric surgery, also called weight-loss surgery, is a procedure designed to make the stomach smaller. It also results in hormonal changes that affect metabolism and appetite. The combined effect is a better sense of satisfaction after eating less food.

With a little work and a good support system, it can be a life-changing step towards developing positive habits and taking charge of your health.

Bariatric surgery intended for people who have a body mass index (BMI) of 40 or greater. This condition is also called morbid obesity.

A person with a body mass index of 35 or greater and one or more co-morbid conditions such as high blood pressure, sleep apnea, or type 2 diabetes, may qualify for bariatric surgery.

Bariatric surgery is generally reserved for people who have not had success with other weight loss therapies such as diet, exercise, and medications.

Remember:

  • Bariatric surgery is not cosmetic surgery.
  • Bariatric surgery does not involve the removal of fat by suction or surgical removal.
  • Bariatric surgery works alongside long-term lifestyle changes, including diet and exercise, which are key to long-term success.
Morbid obesity interferes with basic physical functions such as breathing and walking. Long-term effects of the disease include:

  • Shorter life expectancy
  • Serious health consequences in the form of weight-related health problems (co-morbid conditions) such as Type 2 diabetes and heart disease
  • A lower quality of life with fewer economic and social opportunities
A co-morbid condition is a second health problem that is related to morbid obesity. For example, common co-morbidities of obesity are type 2 diabetes or high blood pressure.
  • Sleeve gastrectomy: This is currently the most common bariatric procedure. It transforms the stomach into a banana shape. Patients lose weight because they eat smaller portions and feel less hungry.
  • Gastric bypass: This prodcedure transforms the stomach into a smaller pouch and attaches it to a lower part of the intestine. Patients lose weight because they eat smaller portions and absorb less fat while feeling less hungry.
  • Revisions: This procedure is for patients who have had previous weight loss surgery but are experiencing weight regain, too much weight loss, or any other complication. Revisions for past lap band surgeries are common.
Every patient has unique needs. At Keck Medicine of USC, we believe in tailoring a personalized action plan for each patient who comes to us. We recommend making a consultation appointment to talk with a surgeon about both surgical and non-surgical options. You can also learn more by attending one of our no-cost seminars.
Yes. Bariatric surgery has the potential to improve or resolve more than 40 obesity-related co-morbidities.

Statistically, bariatric surgery results in:

  • 92% reduction in mortality from type 2 diabetes
  • 60% reduction on mortality from cancer, with the largest reductions seen in breast and colon cancers.
  • 56% reduction in mortality from coronary artery disease

There is also a 40% overall reduction in mortality after weight loss surgery.

More good news:

  • More than 70% of patients who had sleeve or gastric bypass surgery experienced a complete resolution of type 2 diabetes symptoms. The rest had significant improvements.
  • Patients who had bariatric surgery had lower insulin resistance and decreased risk for metabolic syndrome, high blood pressure, and high amounts of fats in the blood.
  • 4% of patients who had gastric bypass surgery experienced complete resolution of high blood pressure. Sleeve gastrectomy achieved similar results.
  • 95% of patients who had gastric bypass surgery showed improved cholesterol health. Sleeve gastrectomy achieved similar results.
  • 6% of patients who had gastric bypass surgery experienced complete resolution of sleep apnea. Sleeve gastrectomy achieved similar results.
  • 98% of patients who had gastric bypass surgery experienced complete resolution of acid reflux/GERD. Sleeve gastrectomy achieved similar results.
  • 47% of patients who had gastric bypass surgery experienced Improvement of depression symptoms. Sleeve gastrectomy achieved similar results
  • 41% of patients who had gastric bypass surgery experienced complete resolution of osteoarthritis. Sleeve gastrectomy achieved similar results.
  • 44% of patients who had gastric bypass surgery experienced complete resolution of stress urinary incontinence. Sleeve gastrectomy achieved similar results.
  • 100% of patients who had gastric bypass surgery experienced complete resolution of menstrual dysfunction due to PCOS. Sleeve gastrectomy achieved similar results.
  • 100% of patients who had gastric bypass surgery experienced complete resolution of menstrual dysfunction due to PCOS. Sleeve gastrectomy achieved similar results.
  • 79% of patients who had gastric bypass surgery experienced complete resolution of excess hair due to PCOS. Sleeve gastrectomy achieved similar results.
  • Patients who had bariatric surgery also experienced restored ovulation and fertility.

 

The Benefits

For people suffering from morbid obesity, bariatric surgery can be a powerful tool. For the surgery to be effective long term, the patient must be an active participant in getting healthier. Through lifestyle changes, such as regular exercise and a healthy food plan, many patients are able to make a long-term change for better health.

Results of five-year follow-up:

Treatment Weight Loss Success
(Percentage of Patients)
Diet and exercise* 2 to 5 percent
Medication** 0 percent
Bariatric surgery*** 50 to 90 percent

* Success measured as a loss of 10 percent of initial body weight.
** Weight loss is not maintained once treatment ends.
*** Success measured as a loss of 50 percent of excess body weight (equivalent to loss of approximately 20 to 25 percent of initial body weight).

 

Qualifying for bariatric surgery

Qualified patients have:

  • BMI of 40 or greater OR
  • A BMI of 35 or greater with one or more co-morbid conditions

Other common guidelines include:

  • Understanding the risks of bariatric surgery
  • Committing to dietary and other lifestyle changes as recommended by the surgeon
  • Having a history of failed weight loss treatments
  • Undergoing a complete examination, including medical tests
  • At Keck Medicine, we also ask patients to attend or watch our bariatric surgery seminar to make sure they are aware of our full program and all their options

The best way to determine if you qualify for bariatric surgery is to make an appointment to discuss your options with one of our bariatric surgeons.

Because every insurance policy is unique, it’s important that you thoroughly understand your insurance provider’s Certificate of Coverage to know exactly what is and isn’t covered through your plan. Our administrative team can help you understand your policy’s level of coverage.

As you think about paying for surgery, it’s important to ask about hidden “program fees” or “supplemental fees.” These are common at some bariatric programs in Southern California. At Keck medicine of USC, we never charge hidden or supplemental fees. Our staff will fully explain your costs at the outset.

The qualification process includes a series of tests with your bariatric surgeon. You also will meet with a nutritionist, psychologist and other support staff members in sessions leading up to surgery. Each health care professional will help you prepare for the changes and challenges that lie ahead.

 

Success after surgery

Bariatric surgery is not a quick fix. It’s an ongoing journey toward transforming your health through lifestyle changes. After surgery, you will feel satisfied and fuller with less food. Positive changes in your body, your weight, and your health will occur if you maintain the diet and exercise routines recommended by your bariatric program.
At Keck Medicine, our bariatric surgery team offers continued support after your surgery, from ongoing check-ins with your nutritionist and surgeon to regularly scheduled patient support meetings. We believe that providing ongoing emotional, nutritional, and medical support to our patients is critical to their long-term weight loss success.
Ongoing support after surgery helps to achieve the greatest level of success for their patients. Support groups give you a great opportunity to talk about any difficulties you’re having after surgery with people who understand because they’re on the same journey. The members of your support group will also help keep each other motivated, celebrate small victories together, and provide perspective on the successes and challenges that patients generally experience.
At first, you will be on a special liquid diet. After several weeks, you will transition to a soft-food diet. Most patients are able to move to a diet of vegetables, lean proteins, and whole grains about two months after surgery.
Your ability to resume presurgery levels of activity depends on your physical condition, the nature of the activity and the type of bariatric surgery you had. Many patients return to normal levels of activity within two to six weeks of surgery.
Exercise is an important part of success after surgery. You may be encouraged to begin exercising, limited only by discomfort, about three weeks after surgery. The type of exercise depends on your overall condition, but the long-term goal is to get 30 minutes of exercise three or more days each week.
That’s up to you. However, we highly recommend an exercise regimen that is completely free: Walking. It’s one of the best ways to support your weight loss and take advantage of the beautiful Southern California weather year-round. It also has the advantage of being something you can fit into your day anytime, anywhere.
Most pills or capsules are small enough to pass through the new stomach pouch. At first, your doctor may suggest that medications be taken in crushed or liquid form. As a general rule, ask your surgeon before taking any medication.

 

Further thinking

Bariatric surgery is a low-risk procedure. In Centers of Excellence, published data show that the mortality risk is lower than gallbladder surgery (0.7%) or hip replacement surgery (0.93%).

Clinical evidence indicates that morbid obesity itself carries a greater risk of mortality than bariatric surgery. That said, any surgery carries an inherent risk.

The Bariatric Surgery program at Keck Medicine of USC has achieved an outstanding record for safety, including one of the lowest complication rates in the nation. Our emphasis on clinical excellence and patient safety have earned our program recognition as a Metabolic and Bariatric Surgery Accreditation Quality Improvement Program Accredited Comprehensive Center and as a Blue Distinction Center by Blue Shield and Blue Cross.

For more reading on the risks and benefits of bariatric surgery, visit https://asmbs.org/resources/metabolic-and-bariatric-surgery.

Complications from bariatric surgery are rare but they are similar to any other procedure. We do want our patients to be fully informed about the possibility. Possible side effects include:

  • Nausea or Vomiting
  • Nutritional deficiencies if vitamins are not taken after a gastric bypass
  • Dehydration
  • Gallstones
  • The need to avoid pregnancy for the first year

We take every precaution to prevent these complications. Should they arise, your support team will work with you to treat and resolve them.

The fear of surgery is not irrational or abnormal; in fact, it’s very common. If you have concerns, consider the following:

  • Share your concerns and fears with your surgeon.
  • Attend a support group and speak with patients who likely share the same fears.
  • Learn about the complication rates and mortality rates of surgery.
  • Listen to bariatric surgery patients share their own fears and concerns.
  • And remember, you’ll have a team of health care professionals dedicated to your best possible care.
  • Remember that in the vast majority of cases, the sensation of discomfort disappears after a few days and a positive experience is the norm.
Surgery initially changes your body by creating a smaller stomach pouch. As you develop new eating and exercise patterns, most people see steady and substantial weight loss. For people who have spent years living with morbid obesity, bariatric surgery can transform their lives.
It varies from person to person. Generally, the hospital stay is one night.
Most doctors recommend that you wait at least one year after the surgery before a pregnancy. Approximately one year after the operation, you should be able to carry a normally nourished fetus. Consult your surgeon as you plan for pregnancy.
Many people think bariatric surgery will be followed by a long and painful recovery period. However, most patients report experiencing only discomfort and soreness rather than pain. Recovery does, however, vary from patient to patient. Learn more about recovering from bariatric surgery.
As with any major surgery, there will be a recovery period. Remember that this is a necessary step, and the better care you take during recovery, the more quickly you’ll return to normal activity. We typically recommend two weeks of from work or school. Some patients are able to return to normal activities sooner, while some need a little more time.