Surgery for morbid obesity: why? and for whom?
Who should be evaluated for surgery?
Who needs ‘surgery’ to treat obesity?
Are there any new medicines or hormones that might work?
What are the reliable operations for morbid obesity?
Is the operation a 'keyhole' one?
Which operation will I be advised to have?



These guidelines have been produced for patients who are due to have an operation for the treatment of morbid or severe obesity. It is important that you understand the principles of the treatment, and that you follow these guidelines so as to get the maximum benefit from surgery.


To get the full benefit from the procedure, the operation should mark the start of a healthier way of life for you. The operation should be regarded as just one of a number of permanent changes that can help you to achieve a healthier, happier and longer life. Although some patients might have been badly misunderstood and poorly treated in the past, they remain motivated to change their lives and most readily accept what we ask of them in exchange for the benefits to their health and appearance.

This guide has been produced for patients who are due to have an operation for the treatment of morbid or severe obesity. It is important that you understand the principles of the treatment, and that you are prepared to follow these guidelines so as to get the maximum benefit from surgery.




Surgery for morbid obesity: why? and for whom?

Most of us realise that our weight is controlled by a variety of factors including diet, exercise, and illness. Scientists have begun to show that certain people are fatter than others even with the same diet. We suspect that in these individuals weight is controlled as much by genes or hormones as by how much they eat. Another example: clinically severe obesity is much more common in women than in men.

Typically we gain weight as we age. This weight gain aggravates many medical problems such as arthritis or diabetes. Most mild obesity –10, 20 or even 50 pounds overweight – is best controlled by changes in the diet and exercise. While overweight is to be avoided, mild obesity is rarely life threatening.

Severe obesity is life threatening. Severe obesity means your weight is twice the normal desirable body weight. In general a 5'4" women who weighs more than 300 pounds or a 5'10" man who weights more than 350 pounds is severely obese: Studies indicate the death rate is more than 10 times higher in patients with this type of obesity. Put simply: there are many mildly overweight senior citizens, but very few severely obese patents live to age 65.

In the UK, the National Institute for Clinical Excellence (NICE) has endorsed the role of surgery for the correction of morbid obesity. Click on the following link to read NICE guidance on Surgery for Morbid Obesity.


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Who should be evaluated for surgery?

Only patients that have clinically severe obesity are the candidates for surgery. This degree of overweight is called morbid obesity and refers to patients who weight twice the desired body weight corrected for height and sex. Selected patients who are only 100 pounds overweight but also have diabetes or heart disease may also be candidates for surgery. Current studies estimate clinically severe morbid obesity occurs in 1-2% of the UK population. However, the vast majority of patients has only mild obesity and should be managed by diet, exercise and medical therapy.


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Who needs ‘surgery’ to treat obesity?

Surgery is the treatment of choice for most patients whose body mass index (BMI) exceeds 40 kg/m2. In selected patients, especially diabetics, a body mass index of 35 kg/m2 is the threshold for surgery.

BMI is a formula for correlating body weight with body height [BMI=weight (kg) ¸ (height2 (m2)].

Click on the following links to:

Calculate your BMI.
Convert your weight and height to metric measurements.

To work out your body mass index, follow these steps:

1: Find out your weight in kilograms
2: Find out your height in metres
3: Divide your weight (in kilograms) by your height (in metres)
4: Then divide your answer by your height in metres again

For example, someone who weighed 120kg (19 stone) and was 1.65m tall (5' 5") would have a body mass index of 44.

A body mass index of more than 27.5 is considered overweight.

A body mass index of more than 30 is considered obese.

A body mass index of more than 40 is considered morbidly obese.


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Are there any new medicines or hormones that might work?

There are two drugs licensed by the National Institute for Clinical Excellence (NICE) for use in the medical correction of obesity, which include:

1: Sibutramine (Reductil), licensed by NICE for up to 12 months only
2: Orlistat (Xenical), licensed by NICE for up to 2 years only

However, these drugs have their considerable side effects, which include diarrhoea, offensive oily stool, bloating, dry mouth, headache and hypertension, and many patients cannot tolerate them. Furthermore, the weight loss that might be achieved with medications is limited, and many patients tend to put the weight back on after 1-2 years.


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What are the reliable operations for morbid obesity?

There are two types of operations that have stood the test of time and are performed safely. These include:

The gastric (stomach) bypass operation
The gastric (stomach) banding operation (LapBand)


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Is the operation a 'keyhole' one?

Both operations are carried out by the keyhole method, which involves making a few small skin cuts and inflating the abdomen with gas. However, there is always a small possibility (less than 5%, one in 20 patients) of having to convert to an open operation making a larger wound if there are difficulties.


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Which operation will I be advised to have?

The gastric bypass operation is suitable for all patients and achieves excellent results. However, the gastric banding operation is suitable for the lighter patients (BMI less than 45 kg/m2). Heavier patients (BMI of more than 45 kg/m2), and patients who are sweet-eaters are best treated with a gastric bypass operation.

For more details click here

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