• What procedure is offered?
• Is it reversible?
• What are the benefits?
• Who is eligible?
• Will insurance pay?
• What are the risks?
• How much weight can I expect to lose?

What procedure is offered?

The Palo Alto Medical Foundation (PAMF) offers the Roux-en-Y (roo-en-wy) gastric bypass procedure. Roux was named for the Swiss surgeon who developed this technique joining the stomach pouch to the small intestine and creating a “Y” shaped intestinal junction. This surgery was first performed for weight loss by Edward Mason, M.D. in the early 1970s at the University of Iowa.

It is considered a last resort for people who are more than 100 pounds overweight, and who have not been successful in permanently reducing their weight through other methods.


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Is it reversible?

Gastric bypass surgery should not be considered reversible. The decision to have this procedure must be made in consultation with a qualified surgeon, and after careful consideration of the potential benefits, risks and lifelong consequences.


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What are the benefits?

The emotional and physical benefits of achieving a healthy weight are significant. People who lose at least 50 percent of their excess body weight report they have more energy, endurance, ability to enjoy physical activities and a significant improvement in back and joint pain. Research on the effects of major weight reduction surgery has demonstrated a significant decrease in the risk of heart disease, and often improved blood pressure in patients with hypertension.

Many people with obstructive sleep apnea or respiratory problems enjoy marked improvement. The majority of significantly overweight people who have diabetes enjoy tremendous improvement in blood sugar control following major weight reduction, and many no longer require medication. Skin problems related to obesity usually resolve and acid reflux (indigestion) symptoms often improve or disappear.

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Who is eligible?

You must be at least 100 pounds over your clinical ideal body weight and have a body mass index (BMI) greater than 40. Calculate your body mass index.

However, if your BMI is 35 or above you may be eligible for this surgery. If your score is below 35, you are not eligible for this surgical procedure. However, PAMF’s Education Division offers classes for weight management, nutrition and fitness.

People with a BMI greater than 35 may be eligible if they have two or more diseases associated with their obesity, such as diabetes, obstructive sleep apnea, heart disease or arthritis.

The age range for this surgery is generally 18 to 65 years of age. However, in extreme situations obesity surgery may be appropriate for some people over the age of 60. People with substance abuse issues are not appropriate candidates.

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Will insurance pay?

Many health plans cover this surgery if the person meets all requirements. For example, you must be able to document that you have seriously tried to lose weight multiple times through more conventional methods without lasting results.

If you have an HMO or POS insurance plan, your insurance company will require a six month trial of medically supervised weight loss attempts before you can begin the screening for bariatric surgery or make an appointment with a surgeon.

We encourage patients to speak with their primary care physician, and to call their insurance provider and familiarize themselves with their respective plan.


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What are the risks?

Weight loss surgery has a mortality rate of .5 percent or less. However, significant obesity itself increases the risk for many life-threatening diseases, including diabetes, heart disease, respiratory problems and liver dysfunction.

Complications which may occur during surgery, or soon after, include bleeding, a leak or narrowing of the anastomosis (where the loop of bowel is attached to the stomach pouch), abscesses inside the abdomen, wound infection, blood clots developing in the legs (deep venous thrombosis) or blood clots traveling to the lungs (pulmonary embolism). Between 5 to 10 percent of patients experience a post-operative problem that requires medical attention.

Some patients may require up to 24 hours on the breathing machine (ventilator) following surgery, particularly those with existing respiratory problems such as sleep apnea.

Complications which may occur later include incisional hernia, narrowing or stricture of anastomosis, small bowel obstruction, gallstone formation, anemia and diarrhea. Some complications may require additional surgeries.

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How much weight can I expect to lose?

Weight loss after surgery depends on how successful you are in making significant dietary and lifestyle changes. PAMF’s program is designed to support you in making those changes.

Most patients lose 10 pounds a month during the first year and continue to lose weight, usually at a slower rate for another year.

Successful habits include eating three small, well-balanced meals, and a maximum of two low-fat snack each day. Avoid carbonated or sugary beverages and alcohol. Carbonated bubbles over-fill the stomach pouch. Sugar and alcohol add empty calories.

A program of regular exercise is very important for promoting and maintaining weight loss. Patients tend to gain weight if they start eating larger portions, consume high fat or "junk" foods, or drink high-calorie beverages. In about 6 percent of cases, surgery cannot produce the physical changes required to achieve the expected weight loss.

Last Reviewed: April 2005


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