Now, there's a third choice.
It is called sleeve gastrectomy.
Action News spoke to Jennifer Warburton who had it done in mid-September.
"I feel great," says Warburton, a visiting nurse.
Over the past 4 months, she's lost 70 pounds.
"These were my skinny jeans," she says, holding up the size 20 denims she used to wear.
She's gone from a size 22 to a size 12,and she's still losing weight. That is a big turnaround for a woman who has struggled with her weight since she was a teenager.
Jennifer tried every commercial program out there and anytime she lost some weight, she would gain it back.
"I tried doing it on my own - that was a bigger disaster," Jennifer says.
And after she had kids, it got even worse.
"I actually gained more weight after the pregnancy. I was nursing both my kids, and my appetite was tremendous," she says.
As Jennifer's weight ballooned, her energy to be an active mom dwindled.
"They (her son Liam and daughter Caitlin) wanted to run around, and run around with Mommy, and Mommy just wants to sit down and take a rest," she says.
She consulted with a doctor about the Lap Band, but didn't feel it would help enough. She also considered gastric bypass, in which doctors staple the stomach, making it a smaller pouch. They cut the small intestine and re-attach a lower part to the new stomach pouch. Food then bypasses an area that absorbs many calories.
However, she didn't like some of the side effects, including "dumping syndrome," and vitamin deficiencies.
After she learned she had diabetes, she took a second look at surgery, and discovered the sleeve gastrectomy. It is being done at a growing number of local hospitals.
Like gastric bypass, doctors laproscopically staple off some of the stomach. But this time -
"Instead of having a small pouch, the stomach now looks like a tube, more or less the size of two fingers," says Dr. Ramsey Dallal, a bariatric surgeon with Einstein Healthcare.
Dr. Dallal was part of the early studies testing sleeve gastrectomy 10 years ago.
Now, at Einstein, he's doing them every week.
He says the sleeve procedure is less complicated, and takes less time than traditional bypass.
Plus, because the intestines are kept intact, sleeve patients are less likely to have vitamin deficiencies.
Many also believe because the part of the stomach that produces hunger hormones is removed, sleeve patients' appetites drop more significantly.
"They don't crave food as much. They don't feel deprived, even though they're only eating a fraction of what they've eaten before," Dallal says.
Jennifer says, "I had no appetite. The first two weeks, I was forcing myself to take in the clear liquids."
Jennifer says that made adjusting to a healthier diet easier.
She is now off diabetes medications, and she's got her energy back, to live the life she wants to with her family.
"When I go to the park, I actually play soccer with my son. I actually run around and kick the ball," she says with a smile. Her kids are beaming, too.
And Jennifer's husband likes the way she looks.
We don't have long term results on the new operation, but the short-term studies are promising. Weight loss and complications are both said to be similar with sleeve gastrectomy compared to gastric bypass.
Dr. Dallal says iron and calcium deficiencies appear to be minimal, compared to the stomach bypass.
Among the hospitals now offering it are Einstein, Temple University Hospital, Our Lady Of Lourdes, Penn Medicine, Cooper University Hospital,Jefferson University Hospital.
Insurers began paying for it last year, helping drive the current popularity.
