Gallstones

WHAT YOU NEED TO KNOW

Many people with gallstones are told they must lose weight before receiving proper treatment. Despite what healthcare providers might suggest, effective gallstone management is possible regardless of your size, and weight loss requirements are not evidence-based.

What Are Gallstones?

Gallstones (cholelithiasis) are solid deposits that form within the gallbladder. Think of your gallbladder like a storage pouch for bile – when stones form, they can block the flow of bile and cause pain or complications.

Main Symptoms Include:

  • Right upper quadrant or epigastric pain lasting 30 minutes to 8 hours
  • Pain that may radiate to the back or shoulder
  • Intolerance to fatty foods in some cases
  • Nausea or vomiting during pain episodes
  • Rarely, jaundice (yellowing of skin or eyes)

Important Facts About Gallstones

What Actually Causes Gallstones?

Gallstones have many contributing factors:

  • Genetics (strongest risk factor)
  • Family history
  • Age (most common after 40)
  • Hormonal influences (2-3 times more common in women)
  • Medical conditions (Crohn’s disease, diabetes)
  • Certain medications (especially GLP-1 agonists like Ozempic or Wegovy)
  • Rapid weight loss or weight cycling (a significant risk factor)

 

The Truth About Weight and Gallstones

Despite what you might have been told:

  • Gallstones affect people of all sizes
  • The old “fat, female, forty” stereotype is inaccurate and stigmatizing
  • Rapid weight loss is actually a significant risk factor for gallstone formation
  • Research shows no evidence that weight loss improves surgical outcomes
  • The C-GALL trial (2025) found no difference in quality of life outcomes between surgical and non-surgical management regardless of weight

 

What About Weight Loss as Treatment?

The evidence for weight loss as a treatment approach is surprisingly weak:

  • No studies show that pre-surgical weight loss improves outcomes
  • Rapid weight loss significantly increases gallstone risk
  • A small study (only 46 participants) found that extreme calorie restriction before surgery only reduced operating time by 6 minutes
  • No difference was found in complications, length of stay, or conversion to open surgery
  • There was no benefit to the patient, only potential convenience for the surgeon

How Weight Stigma Affects Your Care

Weight stigma in healthcare can seriously impact gallstone treatment:

  • Effective treatments may be delayed by focusing unnecessarily on weight loss
  • Blanket BMI limits for surgery have no scientific basis
  • The Royal College of Surgeons opposes mandatory bans on surgery based on weight
  • Important symptoms might be dismissed or attributed to weight
  • Complications might progress while waiting for weight loss that won’t improve outcomes

Evidence-Based Treatment Options

Conservative Management

  • Appropriate pain management (NSAIDs and opioids when needed)
  • Dietary modifications based on symptom triggers, not weight
  • Avoidance of medications that worsen symptoms
  • Management of underlying conditions
  • Regular monitoring

 

Surgical Management

  • Laparoscopic cholecystectomy (keyhole removal of gallbladder)
  • Usually a day case procedure with 1-2 weeks recovery
  • Equally safe for people of all sizes (confirmed in multiple studies)
  • Low conversion rate to open procedure (about 1.6%) regardless of BMI
  • Similar complication rates across weight categories

 

Research from the C-GALL Trial (2025)

  • Half of patients with conservative management remained symptom-free without surgery after two years
  • No difference in quality of life between surgical and non-surgical groups
  • Similar outcomes regardless of patient size
  • Individual factors, not weight, should guide treatment decisions

Weight Inclusive Treatment

Your Rights as a Patient

You deserve healthcare that:

  • Treats your symptoms effectively without weight loss requirements
  • Considers all available treatment options regardless of size
  • Bases surgical decisions on individual health factors, not BMI
  • Provides appropriate pain management
  • Respects your autonomy and right to informed consent

 

Getting Good Care

If your healthcare provider focuses on weight loss:

  1. When Told “Surgery Isn’t Safe at Your Weight”

Research shows day case laparoscopic cholecystectomy is equally safe regardless of weight. A 2018 study found no significant difference in complications, hospital admissions, or readmission rates between higher and lower weight patients.

2. When Told “You’re at Higher Risk of Converting to Open Surgery”

A meta-analysis of 19 studies found that the majority (11 vs 8) showed no relationship between BMI and conversion risk. The overall conversion rate is very low (1.6%) for all patients, and a Cochrane Review found no difference in safety between laparoscopic and open procedures.

3. When Told “You Must Lose Weight Before Surgery”

There is no evidence that pre-surgical weight loss improves outcomes for gallstone treatment. In fact, rapid weight loss increases gallstone risk. The only study on this subject (with just 46 participants) found caloric restriction only shortened operating time by 6 minutes with no benefit to patient outcomes.

4. When Denied Surgery Due to BMI Limits

The Royal College of Surgeons explicitly states: “Blanket bans that deny or delay patients access to surgery are wrong.” There is no clinical guidance from NICE or surgical associations supporting mandatory bans based on weight.

 

Template Response for Surgical Denials

When told to lose weight before surgery, you can say:

“I understand this is your recommendation, but I need to point out that research shows:

  1. Pre-surgical weight loss does not improve gallstone surgery outcomes
  2. Rapid weight loss actually increases gallstone risk
  3. Evidence demonstrates no significant difference in outcomes following day case laporoscopic cholecystectomy in people who are higher weight
  4. The Royal College of Surgeons opposes blanket bans based on weight

I do not consent to weight loss attempts as a prerequisite for care. Please document in my medical record that you are denying me evidence-based treatment, along with your specific medical justification for this denial.”

Remember

  • Gallstones are not your fault
  • You couldn’t have prevented them
  • Rapid weight loss is a risk factor, not a treatment
  • Effective gallstone management is possible without weight loss
  • You deserve evidence-based care regardless of your size
  • Treatment decisions should be individualized, not based on arbitrary BMI limits

This information is provided by Dr. Asher Larmie, The Fat Doctor. For more detailed information and resources, check out his masterclass. This information is provided for educational purposes and should not replace professional medical advice. Always consult with healthcare providers for personal medical decisions.

References:

  1. CholeS Study Group, & West Midlands Research Collaborative. (2016). Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases. British Journal of Surgery, 103(12), 1704-1715. https://doi.org/10.1002/bjs.10287
  2. van Dijk, A. H., Wennmacker, S. Z., de Reuver, P. R., Latenstein, C. S. S., Buyne, O., Donkervoort, S. C., Eijsbouts, Q. A. J., Heisterkamp, J., Hof, K. I., Janssen, J., Nieuwenhuijs, V. B., Schaap, H. M., Steenvoorde, P., Stockmann, H. B. A. C., Boerma, D., Westert, G. P., Drenth, J. P. H., Dijkgraaf, M. G. W., Boermeester, M. A., & van Laarhoven, C. J. H. M. (2019). Restrictive strategy versus usual care for cholecystectomy in patients with gallstones and abdominal pain (SECURE): a multicentre, randomised, parallel-arm, non-inferiority trial. The Lancet, 393(10188), 2322-2330. https://doi.org/10.1016/S0140-6736(19)30941-9
  3. Hernández, R. A., Ahmed, I., Edwards, K., Hudson, J., Gillies, K., Bruce, R., Bell, V., Avenell, A., Blazeby, J. M., Brazzelli, M., Cotton, S., Croal, B. L., MacLennan, G., Murchie, P., & Ramsay, C. (2025). Laparoscopic cholecystectomy versus conservative management for uncomplicated symptomatic gallstones: economic evaluation based on the C-GALL trial. British Journal of Surgery, 112(1), znae293. https://doi.org/10.1093/bjs/znae293
  4. Gurusamy, K. S., Davidson, C., Gluud, C., & Davidson, B. R. (2013). Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database of Systematic Reviews, 6, CD005440. https://doi.org/10.1002/14651858.CD005440.pub3
  5. Gregori, M., Miccini, M., Biacchi, D., de Schoutheete, J. C., Bonomo, L., & Manzelli, A. (2018). Day case laparoscopic cholecystectomy: Safety and feasibility in obese patients. International Journal of Surgery, 49, 22-26. https://doi.org/10.1016/j.ijsu.2017.11.051
  6. Goonewardene, M., Fang, J., Rasiah, R., Jaunoo, S., & Martin, I. (2015). Predicting conversion from laparoscopic to open cholecystectomy presented as a probability nomogram based on preoperative patient risk factors. The American Journal of Surgery, 210(3), 492-500. https://doi.org/10.1016/j.amjsurg.2015.04.003
  7. Hu, A. S. Y., Menon, R., Gunnarsson, R., & de Costa, A. (2017). Risk factors for conversion of laparoscopic cholecystectomy to open surgery – A systematic literature review of 30 studies. The American Journal of Surgery, 214(5), 920-930. https://doi.org/10.1016/j.amjsurg.2017.07.029
  8. Keus, F., de Jong, J., Gooszen, H. G., & van Laarhoven, C. J. (2006). Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database of Systematic Reviews, 4, CD006231. https://doi.org/10.1002/14651858.CD006231