People living with severe obesity may see the greatest weight loss and quality-of-life improvements after gastric bypass surgery compared to two other types of bariatric surgery, according to a major clinical trial.

Researchers in the United Kingdom (U.K.) studied more than 1,300 adults who underwent either Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding. After three years, those who received a gastric bypass had the best overall outcomes — losing more weight and reporting a higher quality of life compared to people who had the other procedures.

What Is Bariatric Surgery?

Bariatric (or metabolic) surgery refers to a range of procedures that help people lose weight by changing how the stomach and digestive system function. It’s typically considered for people with severe obesity who haven’t had success with lifestyle changes or medications, and whose weight is affecting their health or quality of life.

The By-Band-Sleeve trial followed more than 1,300 adults in the U.K. who underwent one of three types of bariatric surgery:

• Roux-en-Y gastric bypass — Creates a small pouch at the top of the stomach and connects it directly to the small intestine, reducing how much food a person can eat and absorb
• Sleeve gastrectomy — Removes a large portion of the stomach, leaving behind a smaller, sleeve-shaped section that limits food intake
• Adjustable gastric banding — Places a silicone band around the upper part of the stomach to create a small pouch, restricting how much food can be eaten at one time

How Did the Types of Bariatric Surgery Compare?

Among people who had Roux-en-Y gastric bypass, 68 percent lost at least half of their excess weight. That compares with 41 percent for sleeve gastrectomy and 25 percent for gastric banding. Quality-of-life scores were also higher for people who underwent gastric bypass compared to sleeve gastrectomy and gastric banding.

Although sleeve gastrectomy showed solid benefits, it led to less weight loss and slightly lower quality of life than gastric bypass. Gastric banding showed the least benefit overall.

All procedures carried some risk of side effects, including gastrointestinal issues and surgical complications. Gastric banding had slightly fewer reported adverse events overall, but it was also the least effective at achieving sustained weight loss.

What This Means for People Considering Weight Loss Surgery

Based on these findings, the study’s researchers concluded that Roux-en-Y gastric bypass is the most effective of the three surgeries for supporting weight loss and daily quality of life. They recommend that doctors and people with severe obesity who are thinking about bariatric surgery should consider gastric bypass as the first option, when appropriate. When gastric bypass isn’t suitable, due to medical reasons or individual preferences, sleeve gastrectomy may be a good alternative.

Researchers also suggested that adjustable gastric banding should no longer be considered a standard treatment for severe obesity due to its lower effectiveness.

If you’re living with obesity and considering bariatric surgery, talk with your doctor about the pros and cons of each procedure. This study may help inform those conversations as you explore options that align with your health goals.

Learn more about surgeries for obesity, how they may help, and what to expect.

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Have you had bariatric surgery — or are you thinking about it? What questions or insights do you have about the different procedures? Share your experiences in a comment below, post to your Activities page, or connect with others in Groups.