How Safe Is Weight Loss Surgery and Is It Worth the Risk?

Weight loss surgery, also called “bariatric surgery,” has been performed since the 1950s. Like other fields, it has evolved significantly over the many decades. This evolution has included numerous changes in the operative technique, anesthesia, and post-operative care.

All of these changes have served the purpose of making the surgery safer and reducing the burden of recovery afterward while still helping patients have long-term weight loss that will significantly improve their overall health and well-being.

Despite these advancements, the safety of modern bariatric surgery is still sometimes questioned either by prospective patients and their loved ones or the media. There were recent headlines regarding the unfortunate passing of Lisa Marie Presley. Although the American singer-songwriter had passed away months earlier, new reports had surfaced that a “small bowel obstruction” caused by scar tissue after bariatric surgery years ago had caused her death. The deputy medical examiner for Los Angeles County described this as a “known long-term complication of this type of surgery.”[1]

Since this report, many media outlets have been discussing the potential risks of developing these complications and even re-directing patients towards alternative weight loss treatments such as prescription medication like the popular Ozempic and Wegovy.

The truth is that bariatric surgery is no different than most other surgeries performed today. There is a non-zero percent risk associated with all surgery, whether discussing a hernia repair, appendectomy, or gastric bypass. Good surgeons will always have a thorough discussion with their patients before proceeding with surgery that involves “informed consent” and a shared decision-making. It is at this time that all potential risks, benefits, and alternatives to the procedure being recommended are discussed.

The most common risks to any surgery include those relating to bleeding and infection. The risk of a serious complication resulting from bariatric surgery is around 1 percent.[2] Good surgeons will carefully weigh the potential risks with the projected benefits following bariatric surgery and use this projection to determine the most appropriate type of surgery. Also, any necessary testing may be added during the pre-operative process to ensure all risks are minimized to the greatest extent possible.

There are indeed some risks of bariatric surgery unique to this field. For example, patients must take vitamin and mineral supplements following the procedures to prevent any deficiencies. Patients who follow these recommendations have an overall low likelihood of developing any problems relating to this.

Patients who opt for the gastric sleeve may have an increased risk of acid reflux post-operatively, although in most cases, these symptoms are controlled through dietary change and occasionally medication. Lastly, patients who undergo the gastric bypass procedure must be educated regarding their new anatomy.

The sudden onset of severe abdominal pain, nausea, and vomiting should prompt a visit to the emergency room, as this can be a sign of internal hernia, which involves a twisting of the small intestine. This can be a life-threatening problem in rare cases but can be rather easily treated by an experienced bariatric surgeon when diagnosed early. Referring back, this is the complication said to have been experienced by Ms. Presley. It is notable that she was said to have had pain, nausea, and vomiting in the months leading up to her unfortunate passing. Although hindsight is perfect, a prompt evaluation by a bariatric surgeon at the onset of these symptoms might have altered the outcome.

Bariatric surgery remains the single most effective tool available to combat severe obesity, defined as a body mass index or BMI higher than 35. This tool in combination with a healthy diet and exercise, can result in a loss of approximately 30 percent of one’s body weight. The surgery can literally cure chronic medical conditions associated with increased body weight, such as diabetes, sleep apnea, high cholesterol, and high blood pressure. It can also improve conditions that might otherwise require additional surgery, such as degenerative spine disease and arthritis of the hips, knees, and ankles. In fact, data from more than 30 years ago supported the use of these surgeries, which, even at that time, were shown to significantly extend patients’ lives (not to mention improve their life quality).

While there have been some notable recent advancements in anti-obesity medications, the truth is that these medications simply do not stack up when compared with the benefits of surgery. The current most popular and effective medications, Ozempic and Wegovy, are the same medication marketed for diabetes and weight loss, respectively.

Weight loss on these medications averages between 10-15 percent of total body weight (about half that of surgery). The medications, which are once weekly subcutaneous injections, induce weight loss by acting on a hormone called GLP-1, which slows how the stomach empties, thereby reducing one’s appetite.

The medications can potentially have side effects which include stomach upset, nausea, vomiting, and diarrhea. Also, importantly, if patients ultimately decide to stop the medication, there is a high likelihood of regaining the previously lost weight. Cost is another issue. Depending on the individual health insurance plan, the cost can range up to $1,500 per month. That is a high cost compared to surgery, which is almost universally covered by most major plans, given its long track record of lasting success.

These medications still have a role to play and can be an excellent tool for patients in need of more short-term or mild weight loss. They are also approved for patients who are not candidates for surgery based on weight and have a BMI between 30 and 35.

The medications are a fantastic tool for patients who have already had surgery as well and are looking to augment their weight loss results to reach their goals.

The bottom line is that patients who are looking to lose weight should discuss all of their options with a physician experienced in weight loss treatment. An individualized treatment strategy can then be developed based on the patient’s weight, BMI and chronic medical conditions. Experienced practitioners understand that an informed patient makes for a satisfied patient and will only proceed once they are confident the patient understands the risks and benefits and is set up for success moving forward.

Be wary of practitioners who only offer one option or are willing to over-promise regarding weight loss results. Providers with FASMBS (Fellow of the American Society of Metabolic and Bariatric Surgery) and DABOM (Diplomat of the American Board of Obesity Medicine) credentials have undergone specialized training in weight loss surgery and medical treatment, respectively, and must adhere to certain standards to maintain their credentialing. Patients should ideally seek out such providers to ensure the quality of any recommendations.

For additional information, visit ASMBS.org, which has an excellent section for patient resources or feel free to contact the bariatric services program at Lompoc Valley Medical Center.

[1] Medina, Eduardo, and Matt Stevens. “Lisa Marie Presley Died from Bowel Obstruction, Officials Say.” The New York Times, 14 July 2023, www.nytimes.com/2023/07/13/arts/music/lisa-marie-presley-death-cause.html.

[2] Birkmeyer NJO, Dimick JB, Share D, et al. Hospital Complication Rates with Bariatric Surgery in Michigan. JAMA. 2010;304(4):435–442. doi:10.1001/jama.2010.1034