Bariatric surgery is winning respect. "There's been deep skepticism about surgery for weight loss, in part because obesity hasn't been officially viewed as a disease," says surgeon David R. Flum, M.D., a professor at the University of Washington School of Medicine. "But type 2 diabetes is widely accepted as a disease, and one that can lead to blindness, kidney failure, amputations. Since surgery can reliably reverse diabetes in people who are seriously overweight or obese, we should be offering them that option."
With the astonishing reversal of type 2 diabetes in many patients, some experts say the bariatric procedures should be an option even for people who aren't morbidly obese.
Experts use body mass index, or BMI — a combined measure of height and weight — to determine who should be considered for bariatric surgery. A BMI of 30 or more is obese. Guidelines from the National Institutes of Health say bariatric surgery is an option for anyone with a BMI of 40 or higher. (A woman 5 feet 4 inches weighing 235 has a BMI of 40.3, for example.) People with a BMI of 35 to 39 and a medical condition related to obesity, such as type 2 diabetes, also are candidates.
Besides gastric bypass, the other common weight-loss surgery and the least invasive is gastric banding, the option chosen by reality TV star Sharon Osbourne. Surgeons place a hollow silicon band around the upper stomach, creating a small pouch, which drastically restricts the amount of food that can be eaten at one time. The Food and Drug Administration recently approved the use of gastric bands for patients with a BMI between 30 and 34 and medical complications related to obesity.
Some bariatric centers require patients to go on a weight loss and exercise regimen before the operation, to prove they're willing to make lifestyle changes. A growing number of insurers require prospective patients to go on supervised liquid diets and to lose some weight before they'll cover the costs. But critics say some insurers set increasingly strict requirements to discourage people from getting bariatric operations. "There's no evidence that dieting and losing weight before surgery improves outcome," says Michael Jay Nusbaum, M.D., chief of bariatric surgery at Morristown Memorial Hospital in New Jersey.