Weight Loss Surgery in 2024: What You Need to Know


Until recently, the most buzzed about injectable used to be Botox. Now it’s taken a back seat to weight loss drugs.

“Weight loss injections may not help people who need to lose a great deal of weight,” says Dr. Felix Spiegel, MD, general and bariatric surgeon with Memorial Hermann's NewStart Surgical and Medical Weight Loss®.

Dr. Spiegel discusses the latest about weight loss drugs, weight loss surgery and other ways to lose weight—permanently.

How do injectables work?

These drugs slow the emptying of the stomach so that you stay fuller longer. They do this by imitating a chemical that the small intestine creates to target gut hormone receptors. As a result, these copycats, such as glucagon-like peptide-1 (GLP-1), slow food’s transit.

Who should be using them—and what results can they attain?

One prominent medication, semaglutide, is used to treat type 2 diabetes. 

But semaglutide is not recommended for those hoping to shed their last five to 10 pounds. Instead, it’s FDA-approved for those with a body mass index of 30 or higher, and those with a BMI of 27 or higher if they have weight-linked medical issues such as hypertension, type 2 diabetes or cardiovascular disease.   

The ideal candidates for injectables need to lose 20-30 pounds. “They see the benefit,” Dr. Spiegel says. “They feel better and can breathe better, and their medical conditions improve.”

He said that after taking weight loss medications for a while, patients may want their health to improve even more, “so they come in for a weight loss surgery consultation.”

What about people who require a more rigorous weight loss solution than drugs can provide? 

Those who need to lose 50 pounds or more, potentially benefit from weight loss surgery, he says. “Weight loss medications are not replacing surgery. They’re complementary to it.”

How much weight can you lose?

With surgery, on average you’ll lose up to 70% of your extra weight. Coupled with lifestyle changes, you can keep it off long-term, Dr. Spiegel says.

“You may still be 30 pounds overweight, but the weight you’ve lost will make all the difference in the world,” he says. “You’ll feel better and sleep and function better. “Losing weight also makes it easier to exercise. It’s about wellness and quality of life.”

And if you have up to 150 pounds to lose, such surgery can save your life, Dr. Spiegel says.

As for fears of losing “too much weight,” he says that is unlikely. “In the ‘60s and’70s, those things did happen,” he says. But the techniques have been worked out. If you go to a qualified surgeon, you won’t lose too much weight.”

What kinds of weight-related ailments can weight loss surgery remedy?

There are many obesity-related comorbidities, including type 2 diabetes, hypertension, high cholesterol and sleep apnea as well as heart, lung and liver disease. You also are likely to have less heartburn and joint pain after weight loss surgery.

What are the keys to sustainable weight loss?

Weight loss medicines or surgeries are a solid start, but keeping weight off requires a multifaceted approach involving portion control, exercise and a diet rich in fruits, vegetables and low-fat foods. “A combined approach is what makes the surgery and drugs most effective,” Dr. Spiegel says.

Some health care systems provide personal trainers, registered dietitians, support groups and therapists to help with your weight loss journey as a whole.

“Keeping weight off is a lifelong journey,” Dr. Spiegel says. “Typically, patients who follow up long-term with their bariatric surgeon or weight-management doctor tend to have much higher weight loss, keep it off longer and have less incidence of side effects.”

What message do you have for people who are considering seeing a physician about weight loss?

You should seek a surgeon who is board certified by the American Bariatric Society and who performs multiple types of bariatric surgery, he says. Also, see a bariatric surgeon who is qualified and experienced, is part of a major medical center and does follow-ups.

“Don’t go to a small center, or outside of the country,” he says. “They may offer the wrong surgery and most likely will do minimal follow-up.”

“If your surgery is done by a qualified bariatric surgeon, and if you’re committed to proper lifestyle changes, you can experience excellent results,” Dr. Spiegel says. “These are gold-standard, approved operations because they are very effective.”

If you choose injectables: will the weight loss last?

As long as you continue to take the drug, the weight tends to stay off. But it comes at a cost, and not just financial. If you stop taking injectables, the weight may return. “What happens with most people who take shots or pills is they stop taking them due to side effects and costs, and then they regain most of the weight they lost–or even more,” Dr. Spiegel says.

Most people do, in fact, quit using weight loss medications, generally after six months. “Often their quality of life after using the drugs isn’t great. They are nauseous and bloated and have acid reflux, and they don’t enjoy eating,” he says. “These drugs can paralyze your digestive system—unlike weight loss surgery.”

What are the surgical options for weight loss

Weight loss surgeries are done laparoscopically, with minimal discomfort.

Gastric bypass reroutes the digestive tract by creating a small, pinky-sized pouch approximately the size of a third of a banana, then connecting it to the small intestines. This reroutes food, which bypasses the stomach.

“Nothing is removed, and no blood vessels are severed,” he says. “We separate a little wedge from the rest of the stomach. The majority is left in place, and it’s done through tiny incisions or laparoscopy. This greatly decreases your hunger sensation.”

The result, on average, is losing 70% of excess weight. “More importantly, 20-year and 30-year studies show that most people keep that weight off long term.”

Such gastric bypass surgery is the best weight loss surgery for those who have type 2 diabetes, hypertension and other comorbidities.

Another popular surgery is a gastric sleeve, or vertical sleeve gastrectomy. Surgeons remove 70% of the stomach, leaving only a sleeve the size and shape of a banana.

“That surgery is more invasive but is really simple for a surgeon to perform,” Dr. Spiegel says.

“The stomach becomes a vertical sleeve looking like a long banana,” he says. “The left side and 70% of gastric volume are removed, which is not reversible. But the entrance and exit from the stomach are not involved in the surgery.”

On average people lose 60% of excess weight, and most patients maintain that weight loss after 10 years.

Gastric sleeve surgery is a better option for big-portion eaters and is more common, and more effective, for men. “But men still lose more weight with a bypass than with a sleeve,” Dr. Spiegel says. “The sleeve has a stronger hormonal effect. The hunger hormone is reduced more than with the bypass.” 

Another option is lap-band or gastric band surgery, which is the least effective, though it can have permanent results for people who need to lose 40 to50 pounds. “They usually keep it off.”

It’s done by surgeons placing an adjustable silicone belt, or band, around the upper portion of the patient’s stomach, dividing it into two segments.

“It’s really decreased in popularity in the last 10-15 years and isn’t done that much anymore,” Dr. Spiegel says.

Then there’s a duodenal switch, which has the highest average loss of extra weight at 80% to85%. “It’s perfect for people who need to lose well over 100 to150 pounds,” Dr. Spiegel says.

“It’s doing the sleeve plus making the intestine shorter, reducing it from 30 feet to 10 feet, which decreases your calorie absorption. The rest of the intestine is not removed. It’s just bypassed. And it’s reversible, like all other bypasses.”

He recommends it for patients according to their diet history, medical conditions and the weight they need to lose and maintain. 

“Ultimately, I let the patient choose,” he says. “Different surgeries all can have excellent results if the patient is committed to lifestyle changes.”

How long is the recovery after weight loss surgery?

Usually, you’ll stay in the hospital overnight for observation. Most people return to office work within one to two weeks. If you perform heavier labor, you’ll be able to return within three weeks.

“My patients return to a soft diet in two weeks and a normal one in less than a month,” Dr. Spiegel says. “Portions are tiny, at least for the first year, but patients report they enjoy their food, sleep better and have more energy.”                 

Overall, the rewards of bariatric surgery are “phenomenal,” he says. “Before, they may have been short of breath going up stairs or were unable to keep up with their kids or grandkids. After surgery, they can be active, improve their fertility, restore their confidence and lower depression.

Weight loss success is a team effort

The best results come from a group effort.

A weight-management doctor may prescribe medication to control hunger. Registered dietitians can teach you portion control. And trainers may help you get moving without hurting yourself. Ideally, you should get 30 minutes of physical activity daily, Dr. Spiegel says. But as with injections, you’ve got to pace yourself after surgery.

Keeping weight off is a lifelong journey – but a journey worth the effort, Dr. Spiegel says. “With dramatic weight loss, everything changes. People are amazed how good they feel.”

Learn more about hospital-linked weight-management programs such as Memorial Hermann NewStart Surgical and Medical Weight Loss®.

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