The surgery itself has become quite safe. New surgical procedures, improved techniques, and greater experience with the operation have cut the mortality associated with this operation to less than 1 percent. Common complications include nutritional deficiency, gallstones, and hernia.
Along with the epidemic of obesity, the number of people having bariatric operations has also risen dramatically, to nearly 180,000 last year in the U.S. However, the guidelines for deciding who should have this surgery are still quite restrictive.
The current guidelines recommend that people be considered only when they have failed to lose weight through other weight-loss measures. Candidates must also be "morbidly obese"— that is, having at least 100 extra pounds or a BMI over 40. (The guidelines do state, however, that surgery may be undertaken with a BMI over 35 in those people who have medical conditions stemming from their obesity, such as diabetes or high blood pressure.)
The National Institutes of Health has scheduled an expert panel to evaluate whether to make changes in the present guidelines, so as to make more people eligible for this lifesaving surgery.
Obviously, it is best not to become obese in the first place, or to lose extra weight through diet and exercise. However, it is hard for most of us to stay slim, and weight loss is especially difficult for extremely obese individuals. The cited improvements in mortality may encourage doctors to recommend bariatric surgery more often.
