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Weight Loss Surgery vs. Diet and Exercise: Which Has Better Long-term Results?

By  Michael LoRe
The answer may be "both."

There is no one-size-fits-all plan for healthy weight loss. With so many options available, it's up to you and your doctor to decide what is right for you based on your current health and health care coverage. But is diet and exercise better for your long-term health than weight loss surgery? Let's explore. 

Proper diet and exercise are things you can take on yourself in order to maintain a healthy body weight. If you are unable to maintain healthy weight through diet and exercise or have a BMI of 35 or greater — a BMI of 40 or higher is referred to as "severe" or "extreme" obesity — your doctor may recommend weight loss surgery.

Popular bariatric procedures include gastric bypass, sleeve gastrectomy, and adjustable gastric band. These procedures cause weight loss by either restricting the amount of food the stomach can hold or changing how the body absorbs nutrients.

"It is important to point out that weight-loss surgery is not the magic bullet," says Dr. Scott A. Cunneen, Director of Metabolic and Bariatric Surgery at Cedars-Sinai Medical Center in Los Angeles. "Long-term success following weight-loss surgery includes proper diet and exercise in order to sustain the weight loss and health benefits that surgery provides."

The aim of weight-loss surgery is for patients to lose 70-80% of their excess body weight, Dr. Cunneen says, but a 40-50% decrease can result in significant improvement on overall health, including combatting comorbidities. A 2018 study in the Journal of the American Medical Association (JAMA) found that the  mortality rates of patients who underwent bariatric surgery compared to those who didn't were 1.3% percent versus 2.3% over a 4.5-year span. 

"If a bariatric patient complies with the lifestyle changes that are required to make these procedures work, their efforts will be rewarded with long-term success and greatly improved health," Dr. Cunneen says. "Statistics show that a regimen of diet and exercise alone has about a 95% fail rate when it comes to keeping the weight off long term. Weight-loss surgery gives patients a fighting chance to beat those odds and live longer, better and healthier."

While diet and exercise alone are more difficult to sustain over time, those lifestyle changes coupled with weight loss surgery seem to have the best overall result.