Mercy's Kuldeep Singh, M.D., FACS, Discusses Weight Loss Surgery vs. Diet and Exercise: Which Has Better Long-term Results?

Kuldeep Singh, M.D., FACS, MBA, FASMBS, is a top weight loss surgeon in Maryland, serves as Director of The Maryland Bariatric Center at Mercy. In a recent response to questions posed by WEBMD.com, Dr. Singh explores the issues of weight loss surgery, diet, and exercise, in achieving long-lasting results for patients:

According to American Society of Metabolic and Bariatric Surgery, the surgical options for weight loss surgery are Sleeve Gastrectomy (done around 60% of all surgeries), Gastric bypass (17% of all surgeries), Revision of Sleeve and Bypass (15%) and to less than 3% are Lap Band, and Intragastric Balloons (not actually a surgical Procedure). Another surgery that has been done less than a percent but does deserve mention is called Duodenal switch or Single anastomosis versions of it. All these surgeries are done laparoscopically i.e. through small incisions and more than 85% of patients will go home next day. 

Weight loss surgeries has huge impact of health of an individual and improves the life span by about 10 years. A person with BMI (Body Mass Index) of 40 (Morbid Obesity) is twice likely to die from any cause as compared to someone with BMI of 25. Adult onset Diabetes is expected to be in remission in 80% of patients who undergo weight loss surgery. No other medicine or intervention can claim even 1% remission. Weight loss surgery leads to mark improvement in Sleep Apnea, High blood pressure, cholesterol disorders. It also decrease chances of twelve different types of cancer such as breast, colon and uterine cancer. Weight loss surgery also helps to restore fertility in young women and leads to resolution of fatty liver (non-alcoholic) and heartburn. The list of conditions that are helped by weight loss surgery is long. In 2013, Society of Bariatric Surgeons added Metabolic surgery to their name to underscore the importance of this type of surgery on health. 

Diet and exercise alone seldom leads to sustained weight loss. A substantial  weight loss (more than a year) with diet and exercise alone, is seen in less than 1-2% of all adults. Surgical weight loss is sustained in over 50% percent of patient over 10 years. Surgery is indicated in Patients with BMI of 35 or above with health conditions. Diet and exercise is indicated in all levels of obesity. Surgery alone is not sufficient enough to get long term weight loss. Both Diet and exercise along with surgery will lead to long term weight loss and good health in patients with BMI of 35 or above. 

Both the approaches complement each other and are not to be seen as either /or. Patients with lower levels of obesity should start with diet and exercise. If someone has BMI of 35, they can explore surgical options depending on their health. One more important but less mentioned approach is stress reduction. Stress worsens all levels of health and obesity. 

-- Kuldeep Singh, M.D., FACS, MBA, FASMBS 

A Board Certified general surgeon, Dr. Singh is Fellowship trained in Advanced Laparoscopic Surgery and Bariatric Surgery. Dr. Singh has been named a “Top Doctor” in Bariatric Surgery by Baltimore magazine for multiple years and a “Health Care Hero” by The Daily Record.