Metabolic and Bariatric Surgery


  • Metabolic/bariatric surgery is the most effective and long-lasting treatment for severe obesity resulting in significant weight loss and the improvement, prevention or resolution of many related diseases including type 2 diabetes, heart disease, hypertension, sleep apnea and certain cancers.
    • Studies show bariatric surgery may reduce a patient’s risk of premature death by 30-50%.
  • Bariatric surgery is as safe or safer than some of the most commonly performed surgeries in America including gallbladder surgery, appendectomy and knee replacement.


  • Studies show patients typically lose the most weight 1-2 years after bariatric surgery and see substantial weight improvements in obesity-related conditions.
    • Patients may lose as much as 60% of excess weight six months after surgery, and 77% of excess weight as early as 12 months after surgery.
    • On average, five years after surgery, patients maintain 50% of their excess weight loss.
  • Majority of bariatric surgery patients with diabetes, dyslipidemia, hypertension, and obstructive sleep apnea experience remission of these obesity-related diseases.
Condition/Disease Remission Rate
Type 2 Diabetes 92%
Hypertension 75%
Obstructive Sleep Apnea 96%
Dyslipidemia 76%
Cardiovascular Disease 58%

Safety and Risks

  • The risks of severe obesity outweigh the risks of metabolic/bariatric surgery for many patients.
    • The risk of death associated with bariatric surgery is about 0.1% and the overall likelihood of major complications is about 4%.

Economics of Bariatric Surgery

  • The average cost of bariatric surgery ranges between $17,000 and $26,000.
  • Because of the reduction or elimination of obesity-related conditions and associated treatment-costs:
    • Estimates suggest third-party payers will recover bariatric surgery costs within 2 to 4 years.
    • Healthcare costs are reduced by 29% within five years of bariatric surgery.

Estimate of Bariatric Surgery Numbers, 2011-2019

  2011 2012 2013 2014 2015 2016 2017 2018 2019*
TOTAL 158,000 173,000 179,000 193,000 196,000 216,000 228,000 252,000 256,000
RYGB 36.7% 37.5% 34.2% 26.8% 23.1% 18.7% 17.8% 17.0% 17.8%
Band 35.4% 20.2% 14% 9.5% 5.7% 3.4% 2.7% 1.1% 0.9%
Sleeve 17.8% 33% 42.1% 51.7% 53.6% 58.1% 59.4% 61.4% 59.4%
BPD/DS 0.9% 1% 1% 0.4% 0.6% 0.6% 0.7% 0.8% 0.9%
Revisions 6% 6% 6% 11.5% 13.6% 14.0% 14.1% 15.4% 16.7%
Other 3.2% 2.3% 2.7% 0.1% 3.2% 2.6% 2.5% 2.3% 2.4%
Balloons         0.03% 2.6% 2.8% 2.0% 1.8%

The ASMBS total bariatric procedure numbers are based on the best estimate from available data (BOLD, ACS/MBSAQIP, National Inpatient Sample Data and outpatient estimations).

*New methodology for estimating outpatient procedures done at non-accredited centers.

ASMBS Approved Procedures and Devices

Roux-en-Y Gastric Bypass

  • Stomach reduced to size of walnut and then attached to middle of small intestine, bypassing a section of the small intestine (duodenum and jejunum) and limiting absorption of calories
  • Risks include allergic reactions to medicines, blood clots in the legs, blood loss, breathing problems, heart attack or stroke during or after surgery and infection

Sleeve Gastrectomy

  • Stomach divided and stapled vertically, removing more than 85%, creating tube or banana-shaped pouch restricting amount of food that can be consumed and absorbed by the body
  • Risks include gastritis, heartburn, stomach ulcers; injury to the stomach; intestines, or other organs during surgery; leakage from the line where parts of the stomach have been stapled together; poor nutrition, scarring inside the belly that could lead to a future blockage in the bowel; and vomiting

Gastric Banding

  • Adjustable silicone band filled with saline wrapped around upper part of stomach, creating small pouch that restricts food intake
  • Risks include the gastric band eroding through the stomach, the gastric band slipping partly out of place, gastritis, heartburn, stomach ulcers, infection in the port, injury to the stomach, intestines, or other organs during surgery, poor nutrition, and scarring inside the belly

Duodenal Switch

  • The majority of the most stretchable portion of the stomach is permanently removed and roughly twothirds to three-fourths of the upper small intestines are bypassed.

Intragastric Balloon

  • Saline-filled silicone balloons temporarily placed in the stomach, limiting amount of food one can eat.


View attached PDF for a full list of References