Gastric bypass remains the most popular form of bariatric surgery, followed by gastric banding, according to Bruce M. Wolfe, M.D., president of the American Society for Metabolic & Bariatric Surgery.
"Patients typically choose gastric banding because it's less complicated and because the band can be removed, so it's also reversible," says Wolfe, who also serves as chairman of the National Institutes of Health's research consortium on weight-loss surgery. People who are at high risk for complications from surgery may be candidates for banding, as are patients who have had abdominal surgery and may have scarring that makes a bypass difficult. "But while bands pose the least risk, they're also less effective than gastric bypass in terms of weight loss and diabetes control," says Wolfe.
In a recent study of 82 gastric banding patients who were followed for 12 or more years, nearly half had to have the bands removed because of complications. Osbourne had hers removed after she lost weight.
Some patients try gastric bands and, if they don't work, go on to have gastric bypass surgery, although doctors discourage that as an option. "If we're going to do a band, we want to make sure the patient is fully committed to making it work," says Wolfe.
Like any operation, banding and bypass surgery pose risks, including infection and leakage of stomach contents into the abdomen. Yet studies show the procedures have become far safer since first introduced in the late 1980s. "At this point, we can say that the risks of being morbidly obese far exceed any risks from the surgery," says Guilherme M. Campos, M.D., associate professor of surgery at the University of Wisconsin-Madison. He points to research showing that many people denied coverage of bariatric surgery by their insurance companies later develop serious complications, including type 2 diabetes and heart disease.
Although bariatric surgery can cure obesity-related diabetes, it doesn't work for everyone. The longer people have had type 2 diabetes, experts say, the less likely they are to see it resolve after surgery. And not everyone loses dramatic amounts of weight. "It's still possible to 'eat through' a gastric band or a bypass," says Nusbaum. "If people go on consuming high-calorie foods and snacking all the time, they'll stay fat."