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For achieving weight loss in severely obese patients, the most effective treatment is surgery. For example, studies show that with one approach, gastric bypass surgery, patients can lose 50% of their excess weight and keep it off for more than 14 years.

Currently there are three general surgical approaches for weight loss:

1. Stomach restriction procedures

These procedures include "gastric stapling" and "vertical banded gastroplasty." The stomach is partitioned into a small upper pouch that reduces the effective size of the stomach from a football to the size of an egg (less than 1-ounce capacity). The upper pouch empties into the rest of the stomach through a narrow channel.

2. Gastric bypass procedure (also known as a Roux-en-Y gastric bypass)

This procedure involves placing staples across the top of the stomach to form a small pouch. This pouch is then attached to a loop of small intestine. Therefore, food enters the small intestine directly from the small gastric pouch, bypassing most of the stomach and all the duodenum (the 11-inch long part of the small intestine that is directly connected to the stomach).

3. Biliopancreatic bypass procedure

This procedure is used to treat patients who are more than 225% above ideal body weight and is designed to reduce the digestion and absorption of food. Three-fourths of the stomach is resected, leaving a 200-ml (6-7 ounce) pouch, which empties into the end of the small intestine. This procedure prevents ingested food from mixing with digestive enzymes (chemicals that break down food) until the food is far down in the small intestine. Therefore, absorption is greatly reduced.

Most surgical procedures for obesity are performed by gaining access to the stomach and intestine through a large abdominal surgical incision. However, some surgeons are now performing some of the procedures by laparoscopy. The laparoscopic technique requires a minimal incision, permits a shorter hospital stay, and a speedier recovery after surgery. However, the laparoscopic procedures are technically impossible in some patients and should only be performed in appropriately selected patients by an experienced surgeon.

The indications for the surgical treatment of obesity were established by a National Institutes of Health Development Conference Panel in 1991. Patients considered eligible for surgery are those who are unlikely to lose weight with non-operative therapy, have acceptable operative risks, and are able to comply with long-term treatment and follow-up. Moreover, patients should have a body mass index (BMI) >40 kg/m² or a BMI between 35 and 40 kg/m² along with life-threatening lung problems or severe diabetes. BMI is calculated as body weight (in pounds) multiplied by 704, divided by height (in inches), divided by height (in inches) again. Therefore, surgery should only be performed in severely obese patients whose health is being compromised by their weight problem