For patients living with obesity, bariatric surgery continues to play a central role in long-term health, even as new weight-loss medications reshape treatment options. According to Dr. Emily Watters, a bariatric and general surgeon at Greater Baltimore Medical Center, surgery is increasingly viewed as one option within a broader, individualized approach to weight management.
“Anyone whose BMI is over 35 with another medical condition associated with obesity is considered a candidate,” Watters said. Those conditions include high blood pressure, diabetes, acid reflux and chronic joint pain. Patients with a body mass index over 40 may qualify regardless of other diagnoses.
BMI, or body mass index, is a calculation based on height and weight that insurers have long used to determine eligibility. “It’s kind of an old way to calculate true health,” Watters said, “but that’s what they’ve been using for decades.”
The two most common bariatric procedures today are the gastric sleeve
and the gastric bypass. Both carry similar safety profiles, with serious complications occurring in about 2% of cases nationwide.
During a gastric sleeve procedure, surgeons remove approximately 70-80% of the stomach, leaving behind a smaller, tube-shaped organ. “There’s less room for food to go into,” Watters explained, helping patients feel full more quickly.
Gastric bypass surgery is more complex, altering how food moves through the digestive system. Surgeons create a small stomach pouch and reroute part of the small intestine.
“Everything stays in the body, nothing comes out,” Watters said. In addition to restricting intake, bypass surgery affects hormone signaling, which helps decrease hunger.
Success rates are strongest in the early years. Watters estimates that up to 80% of patients experience good results during the first one to three years after surgery. Some patients — about 10-15% — regain weight over time. “That happens because over time you may get used to that restriction,” she said, or because a major life event interrupts healthy routines.
Beyond weight loss, bariatric surgery can also play an important role in improving heart health, Watters said. By reducing obesity-related conditions such as high blood pressure and Type 2 diabetes, surgery can lower strain on the cardiovascular system. As weight decreases and metabolic health improves, patients often see better blood pressure and blood sugar control — changes that reduce long-term cardiovascular risk.
The rise of GLP-1 weight-loss medications initially led to fewer people pursuing bariatric surgery. “We did see a drop in bariatric surgery, especially over the past year and a half,” Watters said. That trend is now reversing, driven by cost, insurance coverage and medication side effects.
When counseling patients, Watters focuses on medical history, past weight-loss efforts and personal goals. “Whether that’s using GLP-1s or pursuing surgery, or both,” she said, “it’s important to work with the patient and help meet their goals.”
Misconceptions persist. “You usually only hear the really bad stories or the really, really good stories,” Watters said. Another stigma is the belief that surgery represents failure. “It’s not a failure.
It’s another tool in our toolbox.”
Long-term follow-up and nutrition education remain critical. Patients are monitored for weight changes and vitamin deficiencies and learn portion control and protein intake before surgery. “When they’re ready for surgery,” Watters said, “they’re really ready.”
Ultimately, she emphasizes flexibility and support. “Both the GLP-1 medications and bariatric surgery are tools for weight loss,” Watters said. “Sometimes it’s one or the other, and sometimes it’s a combination that helps someone reach their goals.”