Many people assume that bariatric surgery is something you turn to only after trying everything else. This belief is common, but outdated. Today, we understand that obesity is not a personal failure. It is a complex, chronic medical condition caused by changes in hormones, metabolism, and brain chemistry. Bariatric surgery, including procedures like gastric sleeve and gastric bypass, should not be seen as a last resort. Instead, it should be considered an effective treatment option that is offered early enough to make a real difference.
Obesity Is a Chronic Disease, Not a Lifestyle Choice
Modern medical research has redefined the way we look at obesity. It is now classified as a chronic disease that can lead to serious health problems such as type 2 diabetes, sleep apnoea, fatty liver, and heart disease. The 2025 Lancet Commission introduced the term “clinical obesity” to describe situations where excess body fat causes measurable harm to organs and overall health.
We no longer rely on body mass index (BMI) alone. Other measurements such as waist circumference or waist-to-hip ratio help us better understand body fat distribution and related risks. In many cases, especially when the BMI is over 40, the presence of harmful levels of body fat can be assumed.
Why Dieting Alone Often Fails
One of the most frustrating parts of living with obesity is how hard the body fights to hold on to weight. When someone loses weight through diet alone, the body often responds by:
- Reducing satiety signals (due to leptin resistance)
- Increasing hunger hormones such as ghrelin
- Lowering metabolism more than expected, which makes it harder to keep the weight off
These changes can persist for years, making it incredibly difficult to maintain weight loss through willpower alone. This is not a matter of laziness or poor motivation. It is a biological defence system trying to return the body to a higher weight set point.
How Bariatric Surgery Changes the Game
Procedures such as gastric sleeve and gastric bypass do more than just reduce the size of the stomach. They also produce powerful changes in hormones and metabolism that help counteract the body’s defences against weight loss.
For example:
- Ghrelin (the hunger hormone) drops after a gastric sleeve or gastric bypass, which reduces appetite
- GLP-1 and other gut hormones increase, helping you feel full sooner and longer
- Insulin sensitivity improves, which can lead to rapid improvement in diabetes even before much weight is lost
These changes can help reset the body’s internal weight regulation system in a way that diet alone cannot.
Surgery Is a Proven and Safe Treatment
Gastric sleeve and gastric bypass have been performed for decades. They are backed by strong evidence showing long-term safety and effectiveness. These surgeries:
- Help people lose a significant and sustained amount of weight
- Improve or resolve conditions such as type 2 diabetes, high blood pressure, and sleep apnoea
- Can increase life expectancy in people with severe obesity
Updated international guidelines (IFSO and ASMBS) now recommend offering bariatric surgery earlier, rather than waiting for patients to fail repeated diet attempts or reach extreme BMIs.
We would never delay chemotherapy until cancer is advanced or withhold an inhaler from someone with asthma. So why delay life-saving treatment for obesity?
Early Treatment Is Better Than Late Treatment
Waiting too long can make things harder. As weight increases and complications set in, surgery becomes more technically challenging and health risks rise. Offering surgery earlier allows people to avoid years of suffering and improves long-term outcomes.
This does not mean surgery replaces healthy eating or exercise. Rather, it gives the body a fighting chance to respond to those efforts. It is one part of a long-term care plan that also includes lifestyle support, psychology, and sometimes medication.
An Integrated Approach to Obesity Care
Obesity, like cancer or heart disease, is best managed with a team approach. This might include:
- Bariatric surgery
- Medications before or after surgery
- Nutritional counselling
- Exercise support
- Mental health care
- Long-term follow-up
People respond differently to treatment. Some may regain some weight years after surgery. Others may need additional support with medications or psychological help. This is normal. Managing obesity is a lifelong journey, and it is okay to need different strategies at different stages.
Let’s End the Stigma
Many patients delay seeking help because of shame or fear of judgement. Unfortunately, stigma around obesity is still widespread, including in the healthcare system. This can lead to delayed care, poorer outcomes, and unnecessary suffering.
It is time to stop viewing gastric sleeve and gastric bypass as drastic or desperate measures. They are legitimate medical treatments with decades of evidence behind them. Choosing surgery is not giving up. It is choosing to take control using the most effective tools available.
Final Thoughts
If you are living with obesity, know this: you deserve care that is timely, respectful, and based on science, not outdated beliefs.
Bariatric surgery is not a last resort. It is a powerful, proven option that can help you reclaim your health and quality of life.
If you are wondering whether gastric sleeve or gastric bypass might be right for you, talk to your GP or a bariatric specialist. We are here to guide you, without judgement, towards the treatment plan that suits you best.
