Finances and fear deter many morbidly obese patients from having stomach-reducing bariatric surgery, but it's steadily becoming more common.
Surgical techniques have improved, and the number of obese people keeps rising. Meanwhile, research shows benefits go far beyond looking better, because obesity reduces life span by two to 10 years.
Bariatric surgery reverses or improves dozens of disorders, including expensive, life-threatening ones such as Type 2 diabetes. Research shows eliminating those conditions reduces patient care costs by about 30 percent within five years, and insurers recover their costs within two to four years by averting hospitalizations and other medical expenses.
Patients can keep working longer as well, said Dr. Raul J. Rosenthal, president of the American Society for Metabolic and Bariatric Surgery. The society estimates 193,000 procedures were done in 2014, up 22 percent since 2011.
Given the high costs, patients must weigh risks and advantages to pick the best procedure for them. Here's a primer:
WHAT IT IS
Bariatric surgery comprises five stomach-reducing procedures that limit food intake and make people feel full quickly. Some methods also reroute the path of food leaving the stomach, to bypass most of the intestines, slashing calories and nutrients absorbed.
After debuting in the 1950s, bariatric surgery didn't take off until 1994, when minimally invasive surgery made operations easier and cut recovery time to a couple weeks. Now only about 4 percent of patients suffer major complications.
"This is safe surgery," Rosenthal said.
The surgery is generally appropriate for people more than 100 pounds overweight, with a body mass index of 40 or higher, or 30 if they have related diseases.
Most patients lose and keep off substantial weight, often 100 pounds or more. And after surgery, Type 2 diabetes, high blood pressure, cholesterol problems and sleep apnea vanish in 60 percent to 80 percent of patients, while others improve somewhat, one recent study found.
Possible complications include injury to internal organs during surgery, infections, diarrhea, stomach pain, ulcers and heartburn. Other risks are specific to the procedure, such as gastric bands eroding stomach tissue.
All patients risk osteoporosis and other malnutrition-related conditions, so they take daily nutritional supplements.
-Gastric bypass, the first widespread surgery, has been done for a half-century. The surgeon reduces the stomach to walnut size, attaching what's left to the middle of the small intestine.
-Gastric banding is easily reversible, but many patients regain weight. An adjustable silicon band, filled with saline, is wrapped around the stomach's top, leaving a small food pouch.
-Sleeve gastrectomy, much newer, already comprises half of bariatric surgeries because it's an easy procedure. The stomach is stapled vertically, creating a banana-shaped food pouch; the other 85 percent is removed.
-Duodenal switch, or BPD-DS, is the most complex, longest surgery at 2 hours. It involves reducing the stomach, removing the gall bladder and rerouting other parts of the digestive system. It generally brings the most weight loss - and the most complications, including severe diarrhea.
-Gastric balloon is mainly used for patients shedding pounds before procedures such as hip replacements. A balloon is inserted in the stomach via the mouth, then inflated to reduce space for food. It must be replaced every six months.