Is Bariatric Surgery Underutilized?

Close-up of surgeon putting on surgical gloves in operating theater
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A number of surgical weight-loss procedures are available for the treatment of certain patients with obesity. But recent data indicates that these procedures may be underutilized, as the vast majority of eligible patients are not being referred for them.

What Is Bariatric Surgery?

The term “bariatric surgery” applies to a number of surgical procedures that have been developed to treat obesity and surgically induce weight loss.

These include gastric bypass, gastric banding, and gastric sleeve (sleeve gastrectomy) procedures, among others, which have been developed for the surgical treatment of obesity.

Who Is a Candidate for Bariatric Surgery?

According to the latest obesity guidelines released by the American Heart Association (AHA), the American College of Cardiology (ACC), and The Obesity Society (TOS), bariatric surgery may be an option for adult patients who meet certain criteria.

These criteria include a body mass index (BMI) of 40 or greater, or a BMI of 35 or greater in a patient who has other medical conditions (known as “comorbid conditions”) caused by obesity.

The obesity guideline writing committee did not find sufficient evidence to recommend bariatric surgery for patients who have BMIs that fall below these cutpoints.

The guideline further advises primary care doctors and others caring for patients with obesity with high BMI to try “behavioral treatment with or without pharmacotherapy” first, and then if this has not worked along with other diet and lifestyle measures to achieve sufficient weight loss, bariatric surgery may be considered.

Most Eligible Patients Are Not Being Referred

According to a 2013 report in the International Journal of Obesity, the prevalence of morbid or clinically severe obesity, defined as a BMI of 40 or greater, increased by approximately 70% from 2000 to 2010, including 6.6% of the U.S. population. But fewer than 2% of eligible candidates for bariatric surgery actually undergo weight-loss surgery each year.

Why is this? Some have postulated that internists are not referring enough patients who are candidates for bariatric surgery. It may be that these physicians don’t believe that particular patients have tried long enough or hard enough at lifestyle changes to treat obesity.

Other physicians may still believe that bariatric surgery carries too many risks of short-term and long-term complications. While mortality rates for bariatric surgery have dropped significantly over the past decade, complications and subsequent long-term conditions, such as vitamin deficiencies, are still possible and require long-term follow-up.

Keys to Success With Bariatric Surgery

For the right patient, bariatric surgery can be a successful and life-changing weight loss option. Some keys to success with these operations include having an informed and supportive health care team, following up with your physicians and nutritionist or dietician as scheduled, and continuing to exercise to maintain weight loss following the surgery.


Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society [published online November 27, 2013]. J Am Coll Cardiol.

Jensen MD, Ryan DH. New obesity guidelines: promise and potential. JAMA 2014; 311:23-24.

Durkin M. Weighing the options for bariatric surgery. ACP Internist 2016;36(1):1.

Physical Activity Guidelines for Americans. United States Department of Health and Human Services. Accessed online at on June 12, 2014.

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