Obesity doctors now consider bariatric surgery to be the most effective and durable treatment for obesity, a disease that’s erupted into a full-blown epidemic in America since the 1970s.
The argument in favor of the most effective bariatric procedures, the gastric sleeve and gastric bypass, is that on average, they help people lose about 30 percent of their original bodyweight and keep most of it off — a far better outcome than a regimen of diet and exercise. They also have lower rates of obesity-related diseases, such as diabetes and cancer, compared to people with obesity who don’t get the surgery.
The trouble is that doctors still can’t predict who will succeed with bariatric surgery and who will be the one in 10 patients for whom the procedure fails. (To learn more about bariatric surgery, read our explainer.)
Individuals, even in the same family, can respond differently to the surgeries. For nine months, I followed a teenager named Jewel Francis-Aburime, and her mom, Justina, who both got the gastric sleeve, one of the two most popular procedures, around the same time. Justina’s hunger and cravings were dramatically reduced, making her weight loss rapid and somewhat effortless. Jewel, on the other hand, remained hungry and struggled to lose weight even after losing 80 percent of her stomach.
Over that same year, I talked to a dozen other bariatric surgery patients, and heard about the myriad ways surgery affected their lives — for better and worse. Some people lost all the weight they had hoped to, but others barely lost any. There were patients who experienced no complications following surgery, while others needed additional operations to fix problems or more rounds of weight loss surgery. Some people felt their appetite fade away; others simply replaced their food addiction with other addictions or found ways to eat more food.
Jewel’s story: how one teen battled obesity with medicine’s best — and most underused — tool
We wanted to capture some of that variation with people’s personal stories, to show how differently the surgery can affect people. Here’s how surgery changed the lives of 11 Americans.
On surprises, harms, and complications of surgery
Nanette Adams, a 38-year-old professional counselor in New Orleans, Louisiana
Weight pre–surgery in 2009: 353 pounds
Weight today: 180 pounds
My first surgery was a lap band [which involves placing an inflatable band around the upper portion of the stomach to create a small pouch]. Within about three to four years, I got food poisoning from oysters. For five days, I wasn’t able to keep food down. At the hospital, I found out the lower portion of my stomach protruded through the band to the top, so I was basically choking on my stomach. My doctor didn’t want to [do another bariatric procedure]. So my band was taken out, and I gained weight. I couldn’t fit into my wedding dress.
I did pretty well with the band — I had lost 180 pounds. Then I had it out for 14 months and gained five pounds a month. My highest weight was 300 pounds.
By 2013, I had a gastric sleeve operation, but I had a lot of acid reflux after that and stopped losing weight around 220 pounds. I went to Mexico for another weight loss surgery because my insurance wouldn’t cover it here. The surgeon gave me the gastric bypass for $5,800 to $6,000. That’s half the cost in the US.
[To lose weight,] my approach was quality over quantity. In a typical day now, I try to eat four to five small meals. In the morning, I get up and have coffee and whole milk and a granola bar. I get to work and have a protein shake. At noon, I get whatever the healthy choice meal is that day — fish, protein, vegetables. Around 3 pm, I’ll have a protein bar or fruit. At dinner, I cook. Two nights a week, we have fish and vegetables.
[To this day] I can’t eat really dry chicken. Certain textures are uncomfortable. Sometimes I get woozy from sugar. I notice I’ve had a change in my taste buds. The things I used to like I don’t gravitate toward anymore, like sugar. But the metabolic changes gastric bypass has given me makes me less prone to overeating and having food cravings. The only issue I’ve had now is low iron, so I take iron supplements on a regular basis.
I’m very happy with [bariatric surgery]. No regrets, not even that it took me three surgeries to get to a maintenance weight.
Kevin Brown*, a 63-year-old retiree in Seattle, Washington
Weight pre–surgery in 2013: 358 pounds
Weight today: 247 pounds
When you lose 150 pounds, it takes a lot less alcohol to get drunk. Secondly, because of the short-circuiting of your plumbing [digestive tract], alcohol gets to the intestines faster, so the speed of absorption increases. So two drinks equals six drinks.
Those of us that were overweight obviously had impulse control issues. You can replace a food addition with alcohol addiction, drug addiction, or, in my case, a news addiction. The same compulsive instinct can shift to other crutches. I drink less beer than I used to, but I drink a little more rum than I used to.
If I were talking to somebody who was considering the surgery, I’d warn them that you’re going to smell really bad [from farting]. This is going to be pretty gross, but you don’t burp anymore. I don’t know why. I don’t think I’ve burped more than two to three times since my surgery. All of the gas goes out the south end, not the north end.
Natalie Laforce, a 52-year-old medical office coordinator in Baltimore, Maryland
Weight pre–surgery in 2015: 270
Weight today: 150
When you have this surgery, you have to mentally prepare for the fact that you’re not going to be able to eat as much. I used to love milk and yogurt. After surgery, I couldn’t eat it. I was probably one of the luckier ones — I was craving vegetables. Some people don’t have hunger at all. These days, I notice I crave chips and pretzels. But sugar, I can’t do a whole lot of it. It makes me sick.
My digestion is different [since the surgery]. Sometimes it’s uncontrollable. I get up and pass gas and don’t know where it came from. I notice I go to the bathroom more frequently, which is a good thing. I also have a lot more energy.
Barbara McGraw, a 71-year-old retired teacher in Santa Cruz Redwoods, California
Weight pre–surgery in 2005: 300 pounds
Weight today: 155 pounds
I had a lap band surgery, and it had to be removed after six years. The tubing on the band kinked, so the fluid in my stomach got in my lungs in the surgery.
After that, the surgeons did a gastric bypass. Since then, I have also had eight plastic surgeries. They did my breasts, arms, face, thighs, because you have loose skin hanging all over. It’s almost as bad as being obese. My legs were rubbing together and hurting. My chin was hanging.
[Surgery will] totally change your life, but it’ll take a lot of work on your part. You need the right surgeon and right support group. My mantra is: Bariatric surgery is a journey, not a destination.
Neely Williams, a 67-year-old independent consultant in Nashville, Tennessee
Weight pre–surgery in 2011: 406 pounds
Weight today: 250 pounds
About one and a half years after surgery, I had hernia repair. Once I lost the weight, herniated areas in my stomach became an issue. Seven months after that surgery, I had to have an emergency gallbladder surgery. Weight loss surgery changed the digestive system and caused gallbladder problems for me.
On the benefits of surgery
Chloe Greenlee, a 22-year-old trivia and karaoke host in Columbus, Ohio
Weight pre–surgery in 2015: 322 pounds
Weight today: 192 pounds
I met a friend at Ohio University in my first semester there, and she had had the bariatric sleeve when she was in high school. It worked amazingly well for her. I had been trying to lose weight for about two years by that point, and got the surgery when I was 20.
After the surgery, I went back to the restaurant where I was working and started working there again. It was so much easier to maneuver around. I didn’t feel I was taking so much space. It felt easier to walk around and provide good service. I also went back to the day care where I had been working and noticed a big change in how I could play with the kids.
In the past, I didn’t really date at all. I think it had something to do with my weight. But I can tell you since I lost weight, it’s been a completely different story.
I get asked out often, and I’m not usually the one who instigates anything. I’ve never had that kind of experience before, where I’d be walking down the street and someone would be asking for my number. It’s really weird. Nobody really prepares you for that kind of attention. And I got a lot of it especially now that I’m getting closer to my goal weight.
Before [gastric bypass] surgery, I weighed over 350 pounds. I had Type 2 diabetes, and it was progressing to having to do insulin shots. I was on two kinds of diabetes medications and a blood pressure medicine.
Since my surgery, I’ve had no prescriptions at all.
Surgery was the scariest thing I ever did, but it was easily the best choice I ever made. It’s been embarrassingly easy to adjust. When you go into it, you have all these fears about what you were going to give up. I always tell people I can still eat three bites of just about anything, but I can’t put a whole bag down anymore. It’s remarkable; you’re really not hungry. Both my ability to eat a lot of food and, more importantly, my interest in eating a lot of food has gone away.
Carlos Martinez, a 20-year-old in Fort Worth, Texas
Carlos lost 100 pounds with surgery but did not provide his pre– and post–surgery weights
I had my gastric bypass surgery on June 24, 2016, about a month after college graduation, and it’s going well.
Before the surgery, doctors told me I was pretty healthy but I was on the verge of being prediabetic and having high blood pressure. They attributed that to all the weight I had gained in college.
Once my weight started going down, those issues normalized, and I haven’t had any medical complications.
The likes on Tinder are also exponentially higher. It’s a lot easier — you’re a lot more confident and more willing to go out.
Bypass surgery is the best thing I ever did. I had really bad sleep apnea and severe arthritis in my neck, back, and feet. I got to the point where I couldn’t walk.
Once I had my surgery, I could jog. I climbed up a mountain. I still have pain here and there, but it’s nothing like it used to be.
My legs are not as swollen. My thyroid has leveled out. My sugars are level. My blood pressure is low to normal. My cholesterol is good. The only thing for me is my iron. Because I’m a bypass patient, my iron level is low, so I have to take extra supplements.
On weight stigma
There’s so much stigma [around obesity]. Society wants people to lose weight. When we go through that surgery, it doesn’t please anybody either. I was like that first too: I was a little ashamed to be going through surgery. It’s seen as the easy way out, but it’s not. It’s involved a drastic change in my diet, working out and going to the gym.
I’m so glad [I did the surgery early in life]. My mother is hoping to get the surgery herself soon. She hasn’t told anybody else either because of the stigma.
I wish obesity didn’t really happen for young people or anybody. And I think that with the society we live in, with such fast and accessible ways of getting such unhealthy food — from the corner stores or a McDonald’s passing your house — it seems all this stuff is more accessible than any healthy food. I understand where obesity comes from, that it’s a key problem for youth now. If that’s not going to change, teens will continue to be obese. I feel like surgery should be an option especially if they don’t have any other real way of losing weight and maintaining that weight loss.
I tell people before their surgery to think about this: You have this weight problem, and it’s physical, psychological, and emotional. You’re stigmatized. Now, you have this surgery and phenomenal things happen: The weight goes away; you look good.
All of a sudden, 18 months pass, 24 months pass, and if you haven’t been able to get into new ways of living your life, and you’re back to doing things you were doing before you had the surgery, so is the weight. If that happens, you have a double problem: You had extra weight, lost it, and now you have it again — and you’re going to be doubly stigmatized.
On eating, then and now
Cheri Janning, a 57–year–old retired researcher in Durham, North Carolina
Weight pre–surgery in 2004: 256 pounds
Weight now: 180 pounds
I used to love to eat three pieces of fried chicken. And now maybe a wing is all I can do. Things that are very heavily fatty don’t process well in your stomach. It gives you the feeling of an overwhelming nausea.
The things I eat more now that I wouldn’t have eaten before are cheese, eggs, nuts. I wasn’t so focused on protein. I don’t eat a whole bag of candy now like I would way back then. I don’t even buy candy in big bars. I buy more in Halloween sizes because a bite of that is all I want or feel good with. I don’t ever pick up a piece of pie or something at a restaurant. I might take a bite of my husband’s, whereas before, I would have liked to eat dessert first.
By the end of college, I had developed really bad eating habits where I would basically eat one meal a day and that consisted of eating an entire large pizza by myself.
[After surgery,] I was working as a field organizer on the Hillary Clinton campaign. As you might be aware, the one thing that campaigns are never short on is pizza. We would start work at 9 am and not finish until 11 at night. So we are always doing something, and it’s kind of hard to factor in the 15 to 20 minutes to sit there and chew my food. Trying to learn how to eat on the go was my biggest challenge. And trying to navigate eating healthy. If I tried to eat a slice of pizza, I would throw up immediately and start getting cold sweats. So I would try to prepare for the day and make sure nothing like that happened.
Every day, I have lattes in the morning. At noon, I have a piece of toast with butter or a cookie, or I’ll have a hot dog with cream cheese. That fills me up for half the day. I’m a big fan of frozen burritos, so I’ll have that with a little sour cream for dinner. That’s my day. That’s all I eat.
After surgery, I was craving vegetables. Roasted vegetables. These days, I notice I crave chips and pretzels. But sugar — I can’t do a whole lot of it, it makes me sick. I used to love coconut cream cake, and I can’t look at that anymore.
Now I drink a protein shake in the morning and a hardboiled egg. I eat every couple of hours. I might be able to get a yogurt in or some fruit, like an apple, by 10 o’clock.
At lunch, I have a Lean Cuisine with a vegetable or meat and a little bit of mashed potato.
Then I go home and have dinner. It’s usually really light: a tuna fish salad with spinach, tomatoes, and I eat it with no bread.
When surgery fails
Lindsay Green*, a 27-year-old corporate wellness executive in Seattle, Washington
Weight pre-surgery in 2008: 215 pounds
Weight today: 210 pounds
I had the lap band in the spring of 2008, when I was 17. I had struggled weight with my whole childhood, but I was by no means obese. I am 6 feet tall and weighed 215 pounds. We paid $16,000 for the band out of pocket.
I was a senior in high school and went off to college that fall. The way the band works, even if you follow all the rules — eat slow, the right kinds of foods, and those types of things — there are still occasions where you get sick, food gets stuck, and you throw up. I thought if I’m going to throw up no matter what, I might as well eat what I want, and eat as much as I want. [That would often include bags of Goldfish crackers or bowls of cereal.] That’s the opposite of what you’d hope of trying to create someone with healthy eating habits.
It turned into bulimia. I had never struggled with an eating disorder before and never struggled since. I have some binge tendencies and worked through most of that. It really was the result of the band. I’d get a lot of heartburn when I was throwing up food.
I’m still settling back in to a normal body that doesn’t have a weird plastic contraption in there fouling everything up. I take a balanced approach to food and activity focused on low stress, self-acceptance, and self-compassion.
Josephine Adams*, a 67-years-old retiree in Lethbridge, Alberta
Weight pre–surgery: 280 pounds
Weight today: 125 pounds
After gastric bypass surgery, junk food went down way easier than regular food, and I didn’t have to chew it as well, I guess. The surgery made me bulimic. As soon you eat too much from having your stomach done, it just comes out. I would get this awful pain in my chest, burp, and up would come what I ate.
Even to this day, I have to puree a lot of my food to keep it down. I don’t eat junk food any more — I haven’t for 18 years, since I joined Food Addicts Anonymous. I now weigh 125 pounds. It’s wonderful. I love it.
The surgery didn’t solve a thing [but Food Addicts did help me]. If people think surgery is going to fix their whole life, it’s not going to. They still have to change their life, change what they eat; they have to change their mindset.
I used to think [my food addiction] was because we were deprived as children. My mom never put bowls of food on the table. I used to sneak extra food. I also was molested as a child. And they say sometimes you put on weight to protect yourself. And so who knows, that could’ve been a factor of why I started eating like I did.
Colette Smith*, a 50-year-old psychotherapist in Maryland
Weight pre–surgery in 2002: 340 pounds
Weight today: 150 pounds
I used lots of alcohol at certain periods in my life, as well as cigarettes, and an addiction to food. I have been diagnosed with things like anxiety and depression and bipolar.
When I got the bypass surgery, my weight had gone up to 340 pounds. I was working in a place where I had a few co-workers who had [bypass] surgery and they had started losing weight. So I jumped on that too, and got approved to have it also.
I lost about 70 pounds, and I still had a tremendous amount of weight to lose. And to get to my current weight, I had to lose another 120 pounds. But I stopped losing weight and started gaining weight. I’d eat late at night, and within a couple of years, I could eat 8,000 calories in one sitting. I’d sit there with my TV tray at night and eat cookies, chocolate, ice cream, chips — things that went down easy.
I thought the bypass surgery would let me eat what I wanted and not gain weight. The surgery limited what would fit inside initially, but it didn’t change my craving to get it down.
The weight started coming back up and the depression got worse, and that’s when I found Food Addicts in Recovery Anonymous. I went into the surgery at 340. Went down to 250 or so, and then regained to 270 pounds when I found FA. It worked better than surgery.
Even now, I haven’t had flour, sugar, or lots of quantities of food for almost seven years. I’ve been 150 pounds for six years.
I elected to physically alter my body to control my weight. I don’t know what else that is except an eating disorder. I have physically mutilated my insides to control my weight. That’s pretty serious. For me, we call it food addiction. That’s an eating disorder.
*These names have been changed to protect the identities of those involved.