Overcoming Severe Obesity

Overcoming Severe Obesity: The Evolving Role of Bariatric Surgery

August 18, 2025

Overcoming Severe Obesity: In the realm of weight management, the landscape has shifted dramatically in recent decades. Prior to the 1950s, severe obesity, characterized by individuals weighing 400 or 500 pounds, was a rarity. However, as the obesity epidemic gained momentum, it became increasingly apparent that traditional methods of diet and exercise were often insufficient for achieving sustainable weight loss in these cases.

A Game Changer

The evolution of bariatric surgery has been a game-changer. In 1994, a pioneering surgeon, Dr. Alan Wittgrove (Alan Wittgrove), performed the first minimally invasive bariatric procedure, marking a significant turning point (1). Since then, the number of bariatric surgeries performed annually in the United States has skyrocketed, with over 250,000 operations now conducted each year.

Understandably, the prospect of undergoing major surgery for weight loss can be daunting. However, the safety profile of these procedures has improved considerably, with bariatric operations now being almost as safe as gallbladder removal (2). This shift has made these interventions a viable option for a growing number of individuals struggling with severe obesity.

The Decision To Pursue Bariatric Surgery

The decision to pursue bariatric surgery is a complex one, often involving a careful analysis of the individual's degree of obesity and associated medical conditions. For those with a Body Mass Index (BMI) under 35 or in need of losing less than 50 pounds, modern weight loss medications like Wegovy and Zepbound may be the preferred approach (3). However, for those with a BMI exceeding 40, 50, or even 60, the likelihood of achieving a healthy weight through diet, exercise, and medication alone becomes increasingly slim (3). There are people who lost more than 100 pounds through lifestyle modification, but this is a rare phenomenon, and unfortunately, many of them may begin to regain most of the lost weight (4).

In such cases, the combination of medical and surgical interventions can play a crucial role. Patients may opt to take weight loss medications prior to surgery, as this can help reduce the risks associated with the procedure. Conversely, for those who have undergone bariatric surgery but have hit a plateau or experienced weight regain, medication can serve as a valuable adjunct to their weight management plan.

Ultimately, the path to sustainable weight loss is a complex and highly personalized one. Maintaining an open mind, conducting thorough research, and engaging in close collaboration with medical professionals are key to achieving the best possible outcomes. By embracing the advancements in both medical and surgical weight management techniques, individuals dealing with severe obesity can take meaningful strides towards reclaiming their health and well-being.

Stay Healthy, Stay Strong
- Dr. Leon Katz

This material is for educational purposes and should be discussed with a medical professional.

Sources:

  1. Laparoscopic Gastric Bypass, Roux-en-Y: Preliminary Report of Five Cases. Wittgrove et al. Obesity: 01, Volume 4, pages 353–357, (November 1994)
  2. Bariatric surgery is as safe as other common operations: an analysis of the ACS-NSQIP. Benjamin Clapp, MD, FACS et al. Surgery for Obesity and Related Diseases. Volume 20, Issue 6, June 2024, Pages 515-525
  3. Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records. Alison Fildes PhD et al. Am J Public Health. 2015; 105(9). https://bit.ly/4dSkWCC
  4.  Maintenance of Lost Weight and Long-Term Management of Obesity. Kevin D. Hall, Ph.D.1 et al. Med Clin North Am. 2018 Jan; 102(1): 183–197. https://bit.ly/3yAY9fD

Dr. Katz currently practices at Dr. Leon Katz Medical Weight Loss Center.

Leon Katz

ABOUT THE AUTHOR

Dr. Leon Katz MD, FACS, FASMBS, is a bariatrician specializing in non-surgical, medically supervised weight loss. He focuses on patients seeking alternatives to surgery and those needing care after bariatric procedures. Dr. Katz was recently the director of a major medical weight loss program. With extensive experience in establishing successful weight management programs, he now concentrates exclusively on non-surgical weight loss solutions. Dr. Katz is a Diplomate of the American Board of Obesity Medicine and Fellow of American College of Surgeons. Dr. Katz currently practices at Dr. Leon Katz Medical Weight Loss Center.
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