Which surgery gives the best weight loss?

July 15, 2021



Surgery Comparison - Gastric Banding Sleeve Gastrectomy and Roux-en-Y Gastric Bypass (rygb)

By Dr Caroline Lloyd (Bariatric Physician)

This is a great question and one which we are asked often. There are a few ways to answer the question and I will start with the factual, evidence based answer, which is that the bypass shows the ‘best’ weight loss in most of the research*. The sleeve comes next, and the lap band follows close behind. The long term difference between the bypass and the sleeve tends to be in the vicinity of 5% excess weight loss (EWL). The sleeve tends to beat the band by about 10% EWL. So in real terms, for example, if you take a patient with a starting weight of 120kg, whose excess weight is 60kg, the person with the band could reasonably expect to lose about 30kg, the sleeve could result in 36kg and the bypass in 39kg. So this is one factor to be taken in to account when making your decision.

However, there is a bit of a fault in the actual question, and this is that none of the operations ‘give’ weight loss. Each of them is a tool, an amazing, exceptional and powerful tool for weight loss, but none of them are a guarantee. Each operation works slightly differently, and each client will be encouraged to carefully consider each of the operations before making a choice. We can’t decide for you, but we can give you all the information and the benefit of our experience. Each new client will generally see a Bariatric Physician first, have a good chat about each of the options we offer, and then see the surgeon to go over the information in a bit more detail. We like to think you will be well informed! Once you have had the operation, using the tool is the next step. Commitment to choosing your foods wisely, commitment to exercising at a level appropriate to you, and coming in for regular review and support will ‘give’ you the best results in kilos lost and health gained. There is no doubt that bariatric surgery results in significantly more weight loss than lifestyle measures alone, but people who do best overall, are those who combine the benefits of their chosen surgery with a dedication to changing their lifestyle and committing to healthy food choices (most of the time) and regular activity. Our team is there to help you with this long term, encourage and support you, and we delight in all of our clients successes – it is such a great job, helping people achieve their goals, regain their health and mobility and flourish in life.

*Reference Obesity Surg 2019 Jan;29(1):3-14, P. O’Brien et al “Long-Term Outcomes After Bariatric Surgery: a Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding.”

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