Does metabolic surgery work for overweight people?

Question

Hi doctor,

I have been struggling with my weight for years now, and it is taking a toll. I am 44, my BMI is at 33, and my blood pressure stays high no matter what I try. It feels like I am always tired, even after sleeping a full night. My doctor mentioned metabolic surgery as an option, but I am not sure if I am even a candidate. I have tried diets, going to the gym, and even those fancy meal plans, but nothing sticks. My knees are starting to hurt, too, probably from the extra weight. Is surgery a good idea for me, or should I try something else first? Would it also help with my hypertension or just the weight? Any risks I should be worried about?

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

Metabolic surgery could be a viable option, especially since your hypertension remains uncontrolled despite lifestyle changes. While most guidelines recommend bariatric surgery for a BMI of 35 or 30-plus with obesity-related conditions, some centers perform it at a BMI of 30-plus if metabolic issues (like hypertension) are present.

How would surgery help?

Significant weight loss – You could lose 20 to 35 percent of your body weight, easing the strain on your knees.
Hypertension improvement – Studies show that 60 to 80 percent of patients see better blood pressure control, sometimes eliminating the need for medication.
More energy and metabolism boost – Surgery affects gut hormones, helping with hunger, energy levels, and insulin sensitivity.

Surgical options:

1. Gastric sleeve (sleeve gastrectomy) – Removes part of the stomach to reduce hunger.

Pros: Lower complication risk, great for metabolic issues.

Cons: May not be as effective for severe hypertension as bypass.

2. Gastric bypass – Reroutes digestion to change hormone signaling and absorption.

Pros: Best for metabolic diseases (hypertension, diabetes).

Cons: More risk of nutrient deficiencies and dumping syndrome.

Are you a good candidate?

You might qualify, especially with hypertension and knee pain affecting your quality of life. But if you are hesitant, GLP-1 medications (like Semaglutide or Tirzepatide) could be a less invasive option to try first. These medicines work similarly to bypass surgery’s effects on hormones.

Risks to consider:

Nutrient deficiencies (iron, B12, and calcium) – Requires lifelong supplements.
Surgical risks (leaks, infections, strictures) – Higher for bypass than sleeve.
Loose skin – This can be managed with strength training or surgery later.

I hope this information will help you.

Thanks.