The Numbers Task Force of the American Society for Obesity and Metabolic Surgery (ASMBS) has released its most recent numbers on the most common types of weight loss surgery in the U.S. The “ASMBS Bariatric Surgery Numbers Estimation 2016” shows figures for total procedures, plus a breakdown of each type. You can compare the values annually going back to 2011.

How many surgeries were done?

The data show that there were 215,666 total bariatric procedures done in 2016. That is a lot if you compare to 2011 – it is an increase of 36.5% over the course of 5 years, but it is not much if you compare it to the over 20 million Americans who are eligible for bariatric surgery based on criteria of a BMI over 40 or a BMI over 35 plus a related condition. In fact, only 1% of eligible Americans get weight loss surgery.

Why is the gastric sleeve taking over?

The gastric sleeve is gaining momentum, and quickly. It has leaped from 28,124 procedures in 2011 to 125,318 in 2016. It has jumped from making up 17.8% in 2011 of the total to 58.1% in 2016. Why has the gastric sleeve become so popular, so quickly?

There is a lower risk of nutrient deficiencies and dumping syndrome compared to gastric bypass.

It helps fight hunger by lowering levels of the hormone ghrelin.

It is relatively safe for higher-BMI patients.

It has similar weight loss as gastric bypass, and lower reoperation and complication rates than gastric band.

Why would anyone not choose the gastric sleeve?

The gastric sleeve may appear to be the choice du jour according to the numbers, but even so, not everyone chooses it. These are some hesitations with the gastric sleeve.

It is so new that there is no long-term research on it. We just do not know if it stays effective for years and decades.

It is permanent. Done. There is no going back, even if the patient really, really begs.

Some patients have trouble getting enough calories and protein and continue to depend on supplements for a long time post-op.

What are the non-sleeve choices?

While 58.1% of patients opt for the sleeve, the other 39.9% do not. In fact, nearly 1 out of 5 patients opt for gastric bypass, and biliopancreatic diversion/duodenal switch (BPD-DS) has held steady at 0.6%. These are some reasons to consider other types.

The gastric bypass has a long history. It can be successful long-term with weight loss, and it is famous for its ability to resolve diabetes quickly.

The lap-band is reversible. Even though the band has dropped 86.93% since 2011 , there were still 7,310 new bands in 2016 .

, there were still . The BPD-DS may still be the best for higher-BMI patients.

What does the research say?

Good news – weight loss surgery works! At least, that is what the majority of the research studies conclude, whether they are looking at the sleeve, bypass, band, or another method. All surgery types have a risk of complications, and all have a risk of mortality of under 1%. BMI can drop 7 to 14 or more kg/m2, and diabetes, sleep apnea, hypertension, and other obesity-related conditions can get better.

Is the gastric balloon going to be a factor?

Time will tell whether the gastric balloon is going to be a factor in the overall bariatric surgery statistics. The FDA approved it only in 2015, and it jumped from 0 in 2011-2014 to 0.3% (700 procedures) in 2015 to 2.7% (5,744 procedures) in 2016. The balloon is not a true bariatric surgery; it is not permanent, it leads to less weight loss, and it is intended for lower-BMI patients. This means that it may not be in competition with the true bariatric surgery procedures, although it is likely to become more common as it becomes better known.

What is the deal with so many revision surgeries?

If weight loss surgery techniques are always advancing, why are revisions becoming so much more common? They comprised 6% (9,480) of the total in 2011, but 13.9% (30,077) in 2016. It could be because some of the previous (failed) surgeries were done using older techniques, and are now ready for serious help – a revised procedure.

Why are 99 out of 100 eligible Americans not getting Weight Loss Surgery?

There are a lot of reasons eligible Americans are not getting Weight Loss Surgery. They include:

Cost.

Fear of complications or death.

Not knowing where to start.

Lack of support from family, friends, and healthcare providers.

Fear of failure.

Lack of long-term commitment to lifestyle changes.

What can health professionals and patients do to help eligible patients get the Weight Loss Surgery they need?

Surgeons and other bariatric professionals can help by making sure they reach out to eligible patients. They can explain their options, and promise to provide the nutritional and psychological support patients need for success and to feel confident in their success. They can organize support groups and provide additional resources for patients to get advice and encouragement anytime.

What can health professionals and patients do to help eligible patients get the Weight Loss Surgery they need?

Patients can do their part by asking questions to learn about their best options. They can express their doubts and fears to surgeons to come up with strategies for success. They can reach out to friends, acquaintances, and online groups for support.