Can’t seem to lose the weight. What is that all about?

Q. My wife has tried every diet in the world but can’t seem to lose the weight she should. Now she says she wants weight-loss surgery. What is that all about?

A. For people who are extremely obese, diets are frequently use-less for long-term weight loss. If your wife is diagnosed as obese, the best bet may, indeed, be surgery. Known as bariatric surgery, it has shown impres-sive long-term results. Ten years after surgery, 90% of people who have had gastric bypass—the most common type of bariatric procedure—have kept off about half of their excess weight. The health benefits can be significant, with improvements in blood pressure, choles-terol levels, joint pain, type 2 diabetes, and sleep apnea. And two recent long-term studies show that bariatric surgery dramatically reduces the chances of dying in the 7 to 10 years following the operation.

Different surgical techniques work differently to produce weight loss. For example, gastric banding restricts food intake by making the stomach smaller. Roux-en-Y gastric bypass restricts intake but also changes the absorption of some fats and other nutrients. In both cases, people eat less and feel full sooner—in part due to hormonal changes caused by the surgery.

These procedures come with varying degrees of risk. In addition, people who have had bariatric surgery must be medically monitored for the rest of their lives. They must also make significant
changes in diet and lifestyle. According to National Institutes of Health guidelines, bariatric surgery is
indicated for people with a body mass index (BMI) of 40 or more who have not been successful with other weight-loss methods. (For someone 5 foot 6, a BMI of 40 would mean weighing 247 pounds.) People with a BMI between 35 and 40 who have a significant weight-related medical condition may also be considered. If your wife fits that profile and is interested, she should look for a surgeon who has performed at least 100 of the type of procedure she chooses.