Weight loss surgery (WLS) has come a long way since its early introduction. It currently is safer than heart operations, safer than hip operations, and carries a mortality rate no more than a regular laparoscopic cholecystectomy. This is because of dedicated bariatric and minimally invasive surgical training programs, supervision by the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS), and the training of Certified Bariatric Nurses (CBN).

In addition to the improvement in the safety profile of the surgical procedures, so has our understanding of the nature of obesity. It is now implicated in over 65 different medical conditions ranging from sleep apnea to diabetes, from hypertension to hyperlipidemia. In addition, obesity has been found to be a contributing risk in over 11 different malignancies, including breast and colon cancer.

The surgical procedures work in a variety of ways. Some procedures, such as the lap band and gastric balloon, are restrictive in nature. They work by restricting a patient’s eating habits. Other procedures combine a malabsorptive element, such as the gastric bypass and duodenal switch. Still others work with combination of restrictive and hormonal mechanisms, such as the gastric sleeve. Regardless of the surgical procedure chosen, they are all functional tools to facilitate weight loss given the proper follow-up, diet, exercise plan, and lifestyle modification.

All surgical procedures suffer from the risks of bleeding, infection, and reaction to anesthesia. These can be successfully treated with proper identification and early intervention and still lead to successful weight loss. Even a leak can be treated successfully, in a minimally invasive fashion, if recognized early. The leading cause of death in all patients undergoing surgical weight loss is pulmonary embolism. This risk is a 1 in 250 chance, but 1 in 3 patients who suffer an embolism will not survive.

Weight loss surgery is becoming increasingly popular. In 2016, nearly 200,000 procedures are expected to be performed. The numbers of patients in our country alone that have had WLS number in the millions. Every health care practitioner in their career, regardless of their field, is likely to encounter patients who have had weight loss surgery. It is important to understand the procedures performed, their mechanisms of action, the necessary follow-up, and the potential long-term complications.