Gastric bypass surgery may be the best surgical option for extremely obese patients, according to a recent study by George S. Ferzli and a team of researchers from the State University of New York, Health Science Center of Brooklyn and Lutheran Medical Center. They found that the popular procedure, which connects an apricot-size portion of the upper stomach to a lower portion of the small intestine, bypassing the upper portion and thus limiting food absorption, is “superior” to adjustable gastric bands. The band procedure is a less popular alternative that places a snug, saline-filled silicone ring around the stomach to limit food intake.

The study reports that supermorbidly obese patients—for example, a man who is 5'8" and weighs at least 340 pounds, or 225 percent more than he should—who have the Roux-en-Y gastric bypass surgery experience fewer complications, lose more weight, and are more satisfied with results than patients who get the other stomach procedure, even though the bypass operation lasts longer and requires a lengthier hospital stay. Gastric bypass patients are also more likely to note decreases in conditions like diabetes and sleep apnea that often coexist with excess weight.

"The band requires behavior changes on the part of the patient, in terms of what they eat," says Ferzli. "They can really sneak by a lot of liquid high-calorie stuff." With gastric bypass, food and drink are processed quickly and not readily absorbed, which can sometimes lead to malnutrition.

But it may be too soon to make a beeline for the operating table. The study, which was published in the July issue of Archives of Surgery, relied on a small sample of people who were not randomly selected and evaluated them for only a short period after surgery, cautions Philip Schauer, director of bariatric surgery at the Cleveland Clinic and president of the American Society for Bariatric Surgery. He advises patients to discuss all their options with a doctor before selecting treatment.