For the vast majority of patients today, there is no operation that will control weight to a "normal" level without introducing risks and side effects that over a lifetime may raise questions about its use for surgical treatment of obesity.
-- Edward Eaton Mason MD, Ph.D

Bariatric surgery is expensive, often costing in excess of $25,000 for a typical operation. Some HMOs and medical insurance plans are beginning to provide coverage for the procedure. Clinics and hospital chains specializing in this surgery are springing up all over the country. It is highly profitable for the institutions and surgeons involved. Everyone benefits . . . except perhaps the patients.

Bariatric surgery works by, in effect, creating an artificial condition -- a surgically induced illness that impairs the digestive system's ability to absorb food. It diminishes the capacity of the stomach, either by stapling or by strategic placement of a constricting band that prevents expansion of the stomach. After a "successful" operation, overeating does not result in absorption of "excess" nutrients, but rather in either vomiting or diarrhea, depending on the type of procedure chosen. The excess food is purged, rather than digested.

After surgery, the patient must stay on a rigorous diet that restricts types and especially the quantity of food ingested. Attempting to eat more than the reconstructed stomach can hold results in unpleasant consequences, as noted above, and may even cause the stomach to stretch, effectively negating the operation and possibly leading to weight gain. Bariatric surgery cannot guarantee weight loss.

Bariatric surgery is usually irreversible, which means that the patient must live with its effects for the rest of her life. She must, therefore, stay on a strict diet the rest of her life. Changing one's mind is not an option after the operation. Bariatric surgery may result in a shortened lifespan.

Bariatric surgery is dangerous -- a small, but significant percentage of patients die and there is always the risk of complications.

Possible complications include abdominal hernias, hemorrhaging, infections, ulcers, damage to the spleen, pulmonary embolism from blood clots, adhesions and bowel obstruction, leakage at the staple line, dumping or diarrhea, gallstones, and nutritional deficiencies. There are, in addition, all the usual risks associated with a major surgical procedure and undergoing anesthesia.

• Find out about alternatives to surgery, such as diet and exercise programs.
• If your family physician has recommended that you undergo bariatric surgery, ask him whether he receives a referral fee from the surgeon and/or clinic.
• Ask the hospital or clinic offering bariatric surgery how much profit they make from the procedure.
• Ask the surgeon how many medical malpractice claims have been filed against him for the bariatric procedures he has performed.
• Talk to persons who have had the procedure done. Ask them how satisfied they are with the results. Ask about after-effects and complications.
• Get a second opinion.

• If you are a victim of bariatric surgery, do not hesitate to file lawsuits against all parties involved, including the surgeon(s), clinic, and referring physician.
• If you are being pressured to undergo bariatric surgery, switch doctors and complain to the local professional medical society.

According an article in the May 27, 2005 New York Times, medical insurance companies are dropping surgeons' coverage for malpractice insurance because of the high risk of post-operative complications and the resulting lawsuits.

Quoting from the article:

Most malpractice lawsuits are settled without publicity, but $1.6 million was awarded to the family of Tracey Mayes, a 39-year-old school district employee in a California case that went to trial two years ago. She died from complications 62 days after a stomach-stapling surgery procedure in a Pasadena hospital, said Bruce Fagel, a physician who was her lawyer.