How we compare bariatric procedures.

Weight-loss evidence

Different studies report total weight loss, excess weight loss or BMI change. We avoid pretending those measures are interchangeable. The 0–10 weight-loss rating is therefore a relative editorial scale rather than a pooled percentage forecast.

Reflux

Reflux can materially alter procedure choice. Sleeve may worsen reflux in some people, while Roux-en-Y bypass can be attractive in selected patients with significant reflux. No website can replace endoscopy/history/surgeon assessment.

Diabetes and metabolic effect

Bypass procedures score highly because of extensive metabolic-surgery evidence. A score does not mean every person with diabetes should have a bypass.

Nutritional burden

All bariatric procedures require long-term follow-up. Bypass procedures generally carry greater risk of micronutrient deficiency and malabsorption; band, balloon and ESG avoid intestinal bypass but still require good nutrition and clinical follow-up.

Reversibility

“Reversible” is used cautiously. Bands and balloons can be removed. ESG can sometimes be revised. Bypass can be surgically revised. None of that means the body simply returns to exactly its previous state without consequence.

NHS relevance

This reflects how established the procedure is within UK bariatric pathways, not a promise that a local NHS service offers it.

NICE referral criteria

NICE NG246 recommends referral for comprehensive bariatric assessment at BMI 40+, or BMI 35–39.9 with a significant weight-related condition that could improve with weight loss, subject to the complete guideline and ethnicity-adjusted thresholds where relevant.

Endoscopic procedures

The NHS now describes ESG in its weight-loss procedure information. ESG and balloon are included because users compare them with surgery, but their invasiveness, durability and evidence are different.

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