For many people who struggle with their weight, trying yet another diet can feel like an exercise in futility. Indeed, the Centers for Disease Control and Prevention found that nearly half of adults tried to lose weight in the previous year.
That doesn’t surprise Farah Husain, M.D., FACS, FASMBS, Division Chief of Bariatric and Metabolic Surgery at the University of Arizona College of Medicine in Phoenix. “Only a very small percentage of people are able to lose weight and maintain that loss with diet and exercise alone,” she says.
For certain people, bariatric surgery may be an option worth considering. “These days, the surgeries are done laparoscopically and robotically—that is, they’re minimally invasive,” says Dr. Husain. She likens them to commonplace procedures such as gallbladder surgery.
And while surgery may seem like a risky move, untreated obesity can be even riskier. Following bariatric surgery, “we see improvements in type 2 diabetes, renal function, fatty liver disease, sleep apnea, heart disease, lung disease and inflammatory conditions like arthritis,” says Dr. Husain. All of that can add up to a 30% to 50% reduction in premature death.
With the new weight-loss medications on the market it might seem that there’s an easier alternative: Give yourself a weekly shot and watch the pounds fall away. But patients need to stay on these medications long-term to keep the weight off. A study published in 2022 in Diabetes, Obesity and Metabolism found that a majority of people who take one of these drugs gain most of the weight back within a year of stopping the medication. In contrast, five years after bariatric surgery, most patients are able to maintain at least 25% of their weight loss.
The most common procedure is sleeve gastrectomy, done in 60% of cases. “That’s where we remove around two-thirds of the stomach, changing its shape from a kidney bean to a banana,” explains Dr. Husain. With gastric bypass, the second most popular option, “we reroute the intestines and attach them to a new, much smaller stomach pouch that is about the size of a walnut.”
Both techniques are remarkably effective: Patients typically lose at least 60% of their excess weight within six months after surgery and 77% after a year, according to the American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders. “There aren’t many other treatments that produce that kind of weight loss, where the weight actually stays off,” says Dr. Husain.
Keep reading to find out what we now know about the procedure, plus how Johnson & Johnson is innovating to improve outcomes for the millions who could benefit from this weight-loss solution.
1.
Bariatric surgery does more than just shrink the stomach.
It also causes hormonal changes that lead to eating less over the long run. “Early on, we believed that weight-loss surgery was effective because we reduced the size of the stomach, which meant that people could eat only small amounts,” says Dr. Husain. It turns out that’s only part of the equation.
Surgery also affects hormones related to appetite and satiety. Right after surgery, even before a patient starts to lose weight, levels of the hormone ghrelin—sometimes called the “hunger hormone”—drop, while levels of a hormone called GLP1 (short, for glucagon-like peptide-1 agonists) increase, helping patients feel full longer by boosting satiety. “These hormonal changes reduce insulin resistance, leading to weight loss and other beneficial health changes,” says Dr. Husain.
2.
Only a small percentage of people who could benefit from weight-loss surgery end up getting it.
Despite the fact that 20% of Americans are eligible for bariatric surgery—meaning they have a body mass index (BMI) of more than 35 or a BMI of 30 with a weight-related condition such as high blood pressure or type 2 diabetes—only 200,000 to 300,000 of these surgeries are performed each year. “That’s about 1 percent of the people who qualify,” says Dr. Husain. That may be because people perceive weight-loss surgery as riskier than it is. “But for the right candidates, the medical benefits far outweigh the risks,” she notes.
A recent review of studies published in the British Journal of Surgery found that the risk of death associated with bariatric surgery is about 0.08% and the overall likelihood of major complications is about 4%, both similar to other common surgeries.
Complications can include post-surgery bleeding, bowel obstruction and perforation; malnutrition; and chronic nausea and vomiting.
3.
A common side effect of gastric sleeve surgery now has a promising treatment that can make recovery easier.
Patients who undergo gastric sleeve surgery often develop gastroesophageal reflux disease (GERD), a painful condition that causes stomach acid to flow back up into the esophagus, causing heartburn, coughing and hoarseness, among other symptoms.
Now, a device known as the Linx™ Reflux Management System, marketed by Ethicon, a Johnson & Johnson MedTech company, treats GERD.
The device is a ring of titanium beads with magnetic cores, connected by independent titanium wires, and is implanted laparoscopically around the lower esophagus. During swallowing, the beads slide away from each other to allow the esophageal sphincter to open as food passes through, then the beads come together to prevent stomach acid from flowing up through the esophagus.
“Older devices to treat reflux didn’t have much mobility and could erode tissue and cause scarring,” explains Dr. Husain. “Linx is the first device for GERD that accommodates and moves with the tissue. It seems really promising for our gastric sleeve patients.”
4.
Technological advances are making bariatric procedures easier for surgeons to perform.
“Compared with when I started practicing 20 years ago, the tools we now use for bariatric surgery have really evolved,” says Dr. Husain. Case in point: A surgical stapler called the Echelon™ 3000, developed by Ethicon, makes it easier for surgeons to maneuver in tight spaces with more precision. Approved by the Food and Drug Administration in 2022, the Echelon 3000 is designed to be used in multiple minimally invasive procedures, including thoracic, colorectal and bariatric surgeries.
“The device is designed to work around the various physical constraints in the body—and to be used by a variety of surgeons, all of whom have different hand sizes and preferences,” says Richard L. Leimbach, Senior Principal Design Engineer at Ethicon Johnson & Johnson Surgical Technologies.
Unlike older surgical staplers, the Echelon 3000 has a wider aperture, meaning that the jaws of the stapler open more widely. It also features powered articulation for a variety of angled positions of the jaw. “The new design really improves access for surgeons, so they can position the instrument exactly where they need to without pulling or tugging on tissue or having to take out the device and put it in again,” says Leimbach.
Another big advantage: While previous staplers required two hands to use, the Echelon 3000 requires only one hand and is operated with the push of a button. “When we were developing the device, we paid a lot of attention to ergonomics and to making sure surgeons with different glove sizes were able to operate it effectively,” he explains. As a result, surgeons can choose to press the button with their index finger (easier for those with smaller hands) or with their thumb (for larger hands), doing what comes naturally for them.
5.
Weight-loss surgery isn’t a “one and done” solution.
It’s important to also make lifestyle changes that support the weight loss. That means diet and exercise, of course, but that’s not all.
“There are so many factors that can cause weight gain, including certain medications,” says Dr. Husain. That’s why patients need to stay in touch with their treatment team, she emphasizes. “Our job is to monitor patients and help with treatments and behavioral changes that can counter possible weight gain, so people can keep the weight off for life.”
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