SHAH ALAM – Bariatric surgery has become one of the most effective medical treatments for obesity, offering long-term weight loss and improved overall health for those who struggle with severe weight issues.
Yet, it continues to be misunderstood, often dismissed as a cosmetic shortcut rather than a life-saving medical intervention.
Hospital Canselor Tuanku Muhriz (HCTM) Universiti Kebangsaan Malaysia (UKM) and UKM Specialist Centre’s Head and Senior Consultant in Upper Gastrointestinal, Metabolic and Bariatric Surgery, Professor Datuk Dr Nik Ritza Kosai Nik Mahmood breaks down what bariatric surgery really entails, who qualifies and why it is far from an easy way out.
What Is Bariatric Surgery?
Bariatric surgery is a medical procedure designed to treat obesity, particularly when lifestyle changes such as diet and exercise have failed to produce sufficient results.
Dr Nik Ritza said that the International Federation for the Surgery of Obesity now refers to it as bariatric metabolic surgery because of its dual role in weight reduction and metabolic improvement, particularly for conditions like diabetes.
“This surgery is not cosmetic. The World Health Organisation (WHO) classifies obesity as a disease and bariatric surgery aims to treat or even completely resolve it. Therefore, it is a medical treatment for a recognised condition, not a shortcut to losing weight,” he said in an interview with Sinar Daily.
Is Bariatric Surgery an Easy Way Out?
According to Dr Nik Ritza, bariatric surgery is far from an easy solution. He descried that conventional methods such as diet and exercise typically only result in a three to five per cent total body weight reduction, which is often insufficient for those suffering from severe obesity.
“Patients considered for bariatric surgery must have already tried to lose weight naturally for at least six months,” he said.
Other treatments, such as medication or endoscopic procedures, may lead to five to 20 per cent weight loss, while bariatric surgery offers a much greater average of 30 to 40 per cent.
For those battling obesity-related medical issues, bariatric surgery remains the most effective and sustainable solution.
Who Qualifies for Bariatric Surgery?
Eligibility for the procedure follows Malaysia’s Clinical Practice Guidelines for Obesity and Type 2 Diabetes, in line with international standards. The general criteria include:
- A BMI (body mass index) of 37.5 or higher with no underlying health conditions.
- A BMI of 32.5 with comorbidities such as diabetes or hypertension.
- In special cases, a BMI of 27.5 for patients with severe, uncontrolled conditions like diabetes despite maximum medical treatment.
However, Dr Nik Ritza cautioned that patients with serious psychiatric illnesses such as severe depression, schizophrenia, or bipolar disorder are not suitable candidates.
“A psychological evaluation is required before surgery to ensure mental readiness,” he added.
What Are the Risks Involved?
Although all surgical procedures carry some degree of risk, bariatric surgery is generally very safe, particularly for patients who need it most.
“There are two main types: sleeve gastrectomy, which reduces stomach size, and gastric bypass, which alters the digestive tract to limit absorption,” he said.
Potential risks include leaks, strictures, or bleeding, but these complications are rare, occurring in only one to two per cent of cases.
Nutritional deficiencies such as low iron, Vitamin B12, folic acid, calcium and protein can occur after gastric bypass, so patients are encouraged to take multivitamins, eat high-protein meals and limit carbohydrates after surgery.
How Safe Is the Procedure?
“Bariatric surgery is one of the most carefully planned and studied procedures,” Dr Nik Ritza emphasised.
Before surgery, patients undergo comprehensive medical assessments, including blood tests, heart scans, chest X-rays, hormonal evaluations, lung function tests and endoscopies, to minimise potential complications.
Because all underlying conditions are optimised before surgery, the risk of major complications is very low, comparable to that of gallbladder removal.
“Mortality within 30 days is extremely rare, at less than 0.001 per cent. With modern surgical techniques and structured postoperative diet plans, from liquids to soft and then solid foods, recovery is faster and safer.
“Overall, bariatric surgery is a very safe and effective procedure,” he said.
Why Do Some Patients Regain Weight?
Weight regain occurs when caloric intake once again exceeds what the body burns, negating the effects of surgery.
“While bariatric surgery helps patients lose weight through restriction and reduced absorption, consuming excess calories over time can reverse these effects,” he said.
Weight regain is typically defined as a rise in BMI above 35 after initially successful weight loss. Causes can be patient-related, such as poor diet or inactivity, or surgical-related, such as stomach pouch dilation.
Treatment may involve medications like Saxenda, Ozempic, Mounjaro, or revisional surgery in certain cases.
“Patients who experience weight gain should consult their doctor for assessment and management,” he advised.
What Are the Other Weight Loss Options?
For those not ready for surgery, less invasive medical options are available. Medications can lead to five to 10 per cent weight loss, while intragastric balloons such as Elurion or Spatz can achieve 10 to 15 per cent.
“Endoscopic gastric plication, which folds the stomach lining to reduce its size, can result in around 20 per cent weight loss,” Dr Nik Ritza added.
However, he maintained that bariatric surgery remains the gold standard, providing the most significant and sustainable results.
With proper evaluation, advanced surgical techniques, and adherence to medical guidance, patients can achieve safe, long-term success.