All bariatric procedures are effective when:

• Done with the right experts — qualified and experienced to perform these procedures
• Done with the right aftercare programme — diet, physical activity and medication, if any.
• Done with the right patient — dedicated to the weight-loss programme.

To assess which procedure suits you best, various factors are considered — Health condition, BMI, aversion to foreign bodies, aversion to risk, influential behavioural characteristics, personal preferences, etc.

BMI is a factor that affects the results of weight loss surgery. The heavier you weigh the more weight lose and faster. Bariatric surgery is usually performed on persons with a Body Mass Index of 40, or a body Mass Index of 35 with co-morbidities like heart diseases, diabetes, metabolic disorder, etc. Biliopancreatic diversion (with duodenal switch) is performed on super obese persons (BMI of 50 or higher).

How much do you need to lose? Each surgery provides different range of outcomes. Gastric bypass patients lose 70% of their excess weight, gastric sleeve patients lose 60% of their weight, and gastric band patients lose 50% of their weight on average. For example, gastric bypass surgery shows faster weight loss in the first year than gastric sleeve procedure. But in three years post-surgery, the weight loss from both procedures starts to match.

Health conditions affect the choice of procedure. If you have GERD, your surgeon may suggest gastric bypass over gastric sleeve.

Patients who have poorer control overeating patterns might choose the banding procedure as it is reversible. Whereas gastric bypass is typically not. It can be reversed, but it is a challenge. Gastric sleeve is cannot be reversed. However, such patients who choose gastric bypass will be advised that they will experience ‘dumping’ if they consume food that contain excess sugar. It is a kind of negative reinforcement or a checking mechanism that will discourage the patient from inappropriate eating habits.

Gastric bypass is more invasive than gastric sleeve. Hence, gastric sleeve may be recommended to a person who is more ill or averse to risks. Gastric sleeve patient can later chose to undergo gastric bypass as the next step. Persons who have a real fear of needles might have difficulty with gastric banding technique at it involves injecting saline into the lap band to tighten it. This needs to be done multiple times in the first year and fewer injections every year after.

Procedural time, however small a factor, is certainly to be considered. The risk of going under anaesthesia is higher for obese persons. More so, for persons with co-morbidities. Discuss procedural duration with your surgeon and assess your risks.

How fast you want to realise your goals is factor to consider. Gastric bypass surgery produces results in the first year and then slows down. Gastric sleeve procedure sees weight loss over a period or 2-3 years. Outcomes such as loose skin is inevitable with major weight-loss — more with quicker weight loss (gastric bypass), less with slower weight-loss over longer periods (gastric sleeve). The significant boost to health far outweighs the cosmetic outcome of loose skin.

Speak to your surgeon about your weight-loss goals and concerns, current challenges to lose weight, failed attempts at weight loss and why, eating behaviour, how obesity is an obstacle to the quality of life. Choosing the appropriate weight-loss surgery should be only upon the advice of a qualified surgeon. And always remember that drastic measures like weight-loss surgeries are to be resorted to only when traditional approaches to weight loss through diet and exercise over a prolonged period fail.