In short: Weight-loss surgery began in 1954 with the jejunoileal bypass, an operation that skipped most of the small intestine and was later abandoned because of severe diarrhea, kidney stones and liver damage. In 1966 Edward Mason at the University of Iowa performed the first gastric bypass, and the Roux-en-Y version became the standard by the late 1970s. The 1980s and 1990s added stomach-stapling, adjustable bands and the duodenal switch; in 1994 surgeons first did a gastric bypass through small keyhole cuts. The sleeve gastrectomy began in the early 2000s as the first step of a two-stage operation and became the most common procedure in the U.S. by 2013. Today about 270,000 procedures are done a year, and in 2022 the specialty replaced the 1991 rules on who should be offered surgery.
This page tells that story from the original surgical papers, FDA approval records, Medicare’s coverage history and the American Society for Metabolic and Bariatric Surgery (ASMBS). It is history, not advice: for today’s options side by side, see every weight-loss procedure compared, and for how surgery works now, our bariatric surgery guide. The wider story of diets, drugs and programs is in our history of weight loss.
Seven decades of weight-loss surgery in four numbers
- 1954the first published intestinal bypass work, the start of metabolic surgeryKremen AJ et al., Annals of Surgery 1954
- 1966Edward Mason performs the first gastric bypass at the University of IowaFaria GR, Porto Biomedical Journal 2017
- 1994first laparoscopic (keyhole) Roux-en-Y gastric bypass reported, in five patientsWittgrove AC et al., Obesity Surgery 1994
- 58.2%share of 2023 U.S. procedures that were gastric sleeves, up from 17.8% in 2011ASMBS estimates
Checked on October 6, 2026
1954 to the 1970s: intestinal bypass (ABANDONED)
Modern weight-loss surgery started with the intestine, not the stomach. In 1954, surgeons A. J. Kremen, J. H. Linner and C. H. Nelson published an experimental study in the Annals of Surgery on how much of the small intestine the body needs to absorb food. A 2017 history in the Porto Biomedical Journal credits Kremen with the first metabolic operation, the jejunoileal bypass, which joined the start of the small intestine to its end and bypassed most of it in between. In 1963, J. H. Payne and colleagues reported on patients who had a “jejunocolic shunt”, connecting the small intestine directly to the colon, in the American Journal of Surgery.
Many versions followed in the 1960s and 1970s, but the Porto review notes that none gained wide acceptance, because patients developed severe diarrhea and dehydration. A 1977 randomized trial in the Annals of Surgery, led by W. O. Griffen Jr., compared the jejunoileal bypass with a gastric bypass in 59 patients: after the intestinal bypass, 56% had significant diarrhea, kidney stones and gallstones appeared that were not seen after gastric bypass, and fatty liver worsened at one year in 75% of the intestinal-bypass group, while it improved or stayed stable in everyone after gastric bypass. Results like these ended the jejunoileal bypass. Medicare’s national policy today lists intestinal bypass as not covered.
1966 to 1977: the gastric bypass
Edward E. Mason was a surgeon at the University of Iowa. According to the Porto review, he proposed the first gastric bypass in 1966, building on observations of weight loss in patients who had had part of the stomach removed; he and C. Ito described it in “Gastric bypass in obesity” in 1967. The first version used a horizontal division of the stomach with a loop of intestine. Surgeons later rebuilt it with a Roux-en-Y limb, a Y-shaped connection that keeps bile away from the stomach and esophagus. ASMBS’s profile of Mason says that W. O. Griffen Jr.’s Roux-en-Y gastric bypass became the bypass of choice for most surgeons in 1977, when Griffen published his experience.
The basic idea has lasted: a small stomach pouch connected further down the small intestine. Today’s gastric bypass uses an egg-sized pouch joined 3 to 4 feet down the intestine, according to ASMBS, and it is still the second most common operation in the U.S.
1979 to 1998: diversion and the duodenal switch
In Italy, Scopinaro and colleagues reported the biliopancreatic diversion in the British Journal of Surgery in 1979, after studies in dogs. In their first 18 patients, average weight loss was 33.7% of body weight at 12 months, and the authors suggested it as an alternative to the jejunoileal bypass. In 1993, Marceau’s team at Laval Hospital in Québec reported a version that replaced the partial stomach removal with a long, narrow “parietal” gastrectomy and kept the valve at the stomach’s outlet, which reduced loose stools and protein malabsorption. In 1998, D. S. Hess and D. W. Hess at Wood County Hospital in Bowling Green, Ohio, reported their first 440 patients with “biliopancreatic diversion with a duodenal switch”, the operation now called the duodenal switch. Its stomach portion is essentially a sleeve, which became important later.
The duodenal switch is still done, along with a simpler variant with one connection, SADI-S. ASMBS says it produces the most weight loss of the approved operations but carries the greatest risk of vitamin and mineral deficiencies.
1982 to 2001: stapling and bands
Some surgeons tried restricting the stomach without bypassing anything. In 1982, Mason described the vertical banded gastroplasty (VBG) in the Archives of Surgery: a row of staples created a pouch of less than 50 mL, with a mesh collar around its outlet. He reported fewer complications and more weight loss in 42 patients than with any other operation he knew of. VBG and gastric bypass were the dominant procedures by the time of the 1991 NIH consensus conference, according to the 2022 ASMBS/IFSO guideline. Medicare’s national policy now lists open and laparoscopic VBG as not covered, and it has largely disappeared.
The adjustable gastric band came next. The Porto review credits Kuzmak with introducing it in 1986, adjustable without another operation, and says Cadière placed the first band by laparoscopy in 1992; Belachew’s team reported their laparoscopic series in 1994. The FDA approved the Lap-Band on June 5, 2001, for adults with a BMI of 40 or more, or 35 or more with a severe related condition, and expanded it in 2011 to a BMI of 30 to 34 with an obesity-related condition. The band was briefly very popular: it made up about 35% of U.S. procedures in 2011. Use then fell sharply, to 773 operations in 2023, as ASMBS lists slower weight loss and a high reoperation rate among its disadvantages. Our Lap-Band guide covers where it stands today.
1991: the NIH sets the rules
In March 1991, a National Institutes of Health consensus panel met on gastrointestinal surgery for severe obesity. Its statement recommended that people first be offered a non-surgical program combining diet, exercise, behavior change and psychological support; that surgery could be considered for well-informed, motivated patients with acceptable risk; that candidates be evaluated by a multidisciplinary team with medical, surgical, psychiatric and nutritional expertise; that surgeons be experienced and well supported; and that patients have lifelong medical follow-up after surgery. The thresholds that grew out of it, a BMI over 40, or over 35 with related conditions, were used by surgeons, hospitals and insurers for three decades, according to the 2022 guideline that replaced them.
1994 to 1995: keyhole surgery and a diabetes surprise
In 1994, Alan Wittgrove, G. W. Clark and L. J. Tremblay in San Diego reported the first laparoscopic Roux-en-Y gastric bypass, in five patients, with comparable weight loss and less morbidity and disability than the open operation. Laparoscopy changed the field: today most bariatric operations are done this way, according to the National Institutes of Health.
A year later, W. J. Pories and colleagues at East Carolina University published a 14-year follow-up of 608 gastric bypass patients in the Annals of Surgery with a title that captured the field’s surprise: “Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus.” Among patients with adequate follow-up, 121 of 146 (82.9%) with type 2 diabetes kept normal blood sugar, HbA1c and insulin levels. The society’s current name, the American Society for Metabolic and Bariatric Surgery, reflects that focus on metabolism, and later randomized trials such as STAMPEDE tested the diabetes effect formally.
2003 to 2013: the sleeve takes over
The gastric sleeve began as a safety step. For patients with very high BMIs, a full bypass or duodenal switch in one sitting carried more risk, so surgeons began removing most of the stomach first and doing the second operation later. In 2003, Regan, Gagner and colleagues at Mount Sinai in New York reported seven patients with a BMI of 58 to 71 who had a laparoscopic sleeve gastrectomy followed by a gastric bypass about 11 months later; patients had lost about a third of their excess weight after the sleeve alone. The Porto review notes that the sleeve was then increasingly used as a stand-alone operation. Medicare allowed its regional contractors to cover stand-alone laparoscopic sleeve gastrectomy from June 27, 2012.
The change in practice was fast. ASMBS estimates show the sleeve at 28,124 operations (17.8%) in 2011, ahead of the band and bypass by 2013, and at 157,254 (58.2%) in 2023.
| Item | Sleeve | Bypass | Band | Revision |
|---|---|---|---|---|
| 2011 | 17.8% | 36.7% | 35.4% | 6% |
| 2014 | 51.7% | 26.8% | 9.5% | 11.5% |
| 2017 | 59.4% | 17.8% | 2.8% | 14.1% |
| 2020 | 61.4% | 20.8% | 1.2% | 11.1% |
| 2023 | 58.2% | 23.4% | 0.3% | 11.9% |
Shares computed from ASMBS best estimates (totals 158,000 in 2011 to 270,089 in 2023). 'Other' includes duodenal switch, SADI-S, one-anastomosis bypass, ESG, balloons and other procedures.
Source: ASMBS, Estimate of Bariatric Surgery Numbers, 2011-2023 (checked on October 6, 2026)
2004 to 2013: coverage and quality rules
As operations multiplied, the profession built quality programs. The society Mason helped found in 1983 as the American Society for Bariatric Surgery (now ASMBS) released accreditation standards for Bariatric Surgery Centers of Excellence in 2004, and the American College of Surgeons released its own in 2005. In 2012 the two merged into one program, MBSAQIP, which today covers nearly 1,000 sites in the U.S. and Canada.
Medicare’s coverage followed a similar arc. On February 21, 2006, it began national coverage of open and laparoscopic gastric bypass, laparoscopic adjustable banding and the duodenal switch for qualifying people at certified facilities. In 2009 it confirmed type 2 diabetes as a qualifying condition, in 2012 it allowed contractors to cover the sleeve, and from September 24, 2013, facilities no longer had to be certified. The same policy still lists gastric balloons, intestinal bypass and VBG as not covered.
| Year | Milestone | Status today |
|---|---|---|
| 1954 | Kremen, Linner and Nelson’s intestinal studies; jejunoileal bypass begins | ABANDONED |
| 1963 | Payne’s jejunocolic shunt report | ABANDONED |
| 1966-1967 | Mason’s first gastric bypass; published with Ito | Evolved into Roux-en-Y bypass |
| 1977 | Griffen’s trial; Roux-en-Y bypass becomes the bypass of choice | Second most common operation |
| 1979 | Scopinaro’s biliopancreatic diversion | Evolved into the duodenal switch |
| 1982 | Mason’s vertical banded gastroplasty | Largely abandoned; not covered by Medicare |
| 1983 | American Society for Bariatric Surgery founded (now ASMBS) | Active |
| 1986 | Kuzmak’s adjustable gastric band | Rare (773 in 2023) |
| 1991 | NIH consensus statement on surgery for severe obesity | Replaced in 2022 |
| 1992-1994 | First laparoscopic band (1992) and laparoscopic bypass (1994) | Laparoscopy is standard |
| 1993-1998 | Marceau’s and the Hesses’ duodenal switch | In use, with SADI-S |
| 1995 | Pories: “Who would have thought it?” diabetes paper | “Metabolic surgery” |
| 2001 | FDA approves the Lap-Band | Approved; rarely used |
| 2003 | Sleeve gastrectomy as the first stage of a two-stage operation | Most common operation |
| 2006 | Medicare national coverage | Updated 2009, 2012, 2013 |
| 2012 | MBSAQIP accreditation program formed | Nearly 1,000 sites |
| 2015, 2021 | FDA approves ORBERA and Spatz3 balloons | Approved; not covered by Medicare |
| 2022 | FDA authorizes endoscopic sleeve gastroplasty; ASMBS/IFSO update who should be offered surgery | Current |
| 2026 | FDA approves the Allurion balloon, the first swallowable balloon placed without endoscopy | Approved; first U.S. patients April 2026 |
2007 to today: long-term evidence, devices and new rules
Long-term studies answered the question critics had asked for decades. The Swedish Obese Subjects study, published in the New England Journal of Medicine in 2007, found lower long-term death rates after surgery than with usual care, and people who had a bypass were about 25% lighter after 10 years. The STAMPEDE trial reported in 2017 that, five years on, 29% of people with type 2 diabetes who had a bypass and 23% who had a sleeve had an HbA1c of 6.0% or less, compared with 5% on medical therapy alone.
Less invasive options arrived through the FDA’s device pathway: the ORBERA gastric balloon was approved on August 5, 2015, the Spatz3 adjustable balloon on October 15, 2021, and endoscopic sleeve gastroplasty, which folds the stomach with stitches from the inside, was authorized on July 12, 2022. The newest device is the Allurion balloon, approved on February 20, 2026, for “short-term limited weight loss” in adults aged 22 to 65 with a BMI of 30 to 40: it is swallowed as a capsule, filled through a thin tube without endoscopy or anesthesia, and empties and passes on its own after about four months. Not every approved device lasted: our overview of FDA-authorized weight-loss devices shows which are still sold. Also in 2022, ASMBS and IFSO published new indications, describing them as major updates to the 1991 NIH guidelines: surgery is recommended from a BMI of 35 regardless of other conditions and can be considered from 30 with metabolic disease, there is no upper age limit, and insurer-required diets before surgery were called “scientifically unfounded”. The guideline puts the risk of dying around the operation at 0.03% to 0.2%.
The newest chapter is medicines. U.S. procedures fell from an estimated 279,967 in 2022 to 270,089 in 2023, while GLP-1 medicines came into wide use, and revisions of earlier operations now make up about 12% of all procedures. Surgery and medicines are increasingly discussed together; our GLP-1 vs bariatric surgery comparison and history of weight-loss drugs pick up that story.
Five lessons from 70 years of surgery
- Side effects decide what lastsThe intestinal bypass worked for weight but harmed too many people, so it was dropped.
- Simpler often winsThe sleeve spread fastest because it was simpler and safer for many people.
- Long-term follow-up mattersProblems such as deficiencies and reflux show up years later, so lifelong care is part of every operation.
- Weight is not the only outcomeDiabetes and other conditions changed how surgery is judged.
- Rules change with evidenceThe 1991 thresholds were replaced in 2022 after decades of new data.
If you are considering a procedure today, start with our procedures hub, read about life after bariatric surgery, and use our guide to finding a bariatric surgeon to check accreditation. Your own decision belongs with you and a qualified bariatric team.