Bariatric Surgery...Opinions?

[sidonia]

Sounds like something I should maybe watch...

[realcdn]

I should say that I've never personally considered it (thought about it, but with no real intention). I've also seen far too many women on the diet boards who lose a fair amount fast, but then it slows down. I've also seen many come to the boards 5 years after, having gained the weight back. It is a tool when used at it's best. Just not for me.

Originally Posted by sidonia

When they tell you in the office that you have to lose weight, I have never been given ANY kind of materials. Never...no diet plans...no exercise routines...nothing. I've never even been referred to a nutritionist! They referred me to a Bariatric surgeon...! That scares me because it make me feel like they gave up!

This is my big pet peeve in Canada (or at least Ontario, I can' speak for other provinces). We have socialized medicine (paid for through taxes, everyone gets it). Doctor visits are paid for, but not nutritionists. This makes no sense to me. I've known at least two woman who were told they were obese - go home and lose weight. One was at a height (4'11) that I think the difference between high acceptable and obese is something like 25 pounds. I just checked 123 is just under BMI of 25, 149 is over 30 and considered obese. I think she was 150, and although carrying a bit of fat, had a lot of muscle as well. I felt her smoking was a truly bigger deal.

And I hear of some women at my weight told to eat 1200 calories a day and exercise for an hour 3 times a week. And yes, from doctors - what book are they reading from? I'm trying to think of the last time I was offered any help. One was a referral to a nutritionist (which I would have had to pay for), and the second was to put me into a drug trial that the doctor's practice was running. One look at the side effects was enough to turn me off.

The one thing about some of the gastric bypass operations though is that I've seen some information that it literally appears to cure diabetes almost immediately. I forget the specific type of bypass, but I can see this being a reasonable solution for some people. In the end I have to get the weight off by lifestyle changes and finding exercises I enjoy doing. If I don't, there is no way I'll keep any lost weight off.

[sidonia]

Originally Posted by realcdn

If I don't, there is no way I'll keep any lost weight off.

That's exactly how I feel... And the fact that my docs asked me if I would look into it...it what made me wanna do it myself!

I wasn't aware that the nutritionist referral would be extra where you are...that's so weird! It's always interesting what they consider extra or not. Even with insurance companies in NY.

[realcdn]

Originally Posted by sidonia

I wasn't aware that the nutritionist referral would be extra where you are...that's so weird! It's always interesting what they consider extra or not. Even with insurance companies in NY.

I've always considered it odd because of our provincial health care (where everyone is covered). If the obese are such a drain on the system (I keep hearing this in the paper every now and then) it would make sense to try and do as much as they could to improve that. Interesting point that I only ended up in the hospital while trying to lose weight though. Most larger companies have extended health care plans (eye glasses, dentist, non-hospital prescriptions, etc.) that might cover it. I've had some that cover lots of extras, just never looked into it. If I'd wanted to visit a nutritionist I'd have likely paid for it. The only time I've even talked to one was when I was in the hospital, and couldn't eat what they were giving me. Pretty much pure carb/fat breakfasts, pudding/cakes as a lunch/dinner desserts. Don't get me wrong, in my bad days I'd have probably eaten them, but they weren't good. One of the nurses on the first day suggested I talk to the nutritionist, and although we argued, I got my way. The best part of the meals were the oranges I got substituted for desserts.

[SpacecityPaula]

And you point out something that happens often in the Hospital Anne.

Even tho someone might be on a strict diet, the hopsital doesn't follow the Rules.

Bob's dad had Duhring's disease, which is like celiac's but in addition to the gut problems, he would get clear watery blisters all over his skin and itch all over. His orders said GLUTEN FREE on them, but inevitably there would be somethings with wheat, oats, etc on his plate. It's like the hospital was out to get him.

[yksin]

I saw a 60 Minutes about bariatric surgery in April. They had several people on it who had all had gastric bypass surgery, & the interviewer asked them, how many of you had diabetes prior to your surgery? Every person raised their hand. How many of you have diabetes now? No one raised their hand. About three quarters had sleep apnea prior to surgery; none have it now. The surgery also appears to significantly lower rates of cancer, which is closely correlated with obesity.

Furthermore, they said that diabetic symptoms such as high blood sugars went away almost immediately after surgery, even before the weight loss. So there does appear to be a relationship between diabetes & the portions of the stomach/duodenum that the bypass passes by. This has been confirmed in studies on diabetic rats: give them the bypass surgery, & their diabetes disappears; reverse the surgery, & the diabetes comes back. Apparently they are now doing a control study on a group of non-obese Type 2 diabetics, I believe in Brazil, to see if the surgery will relieve their diabetes. Normally, at least in the U.S., the only people who can get approval for this kind of surgery are people who are considered morbidly obese.

After seeing that show -- well. I will admit to previously having had a residual prejudice about the surgery, I think because of internalized judgments about all that crap about "fat people lacking willpower to control their eating" that is all over the culture, that has hit me too. And has also had affect on my feelings about my mom, who died in November 2005 of heart-related complications of diabetes. In her later years, all of us kids felt helpless & at the same time angry due to the perception that she wasn't doing enough to help herself, that she wasn't controlling what she ate. And the logical conclusion to that is that all the health problems she suffered at the end, & ultimately her death, was her fault. I've been struggling with that ever since -- blaming her for her own death. But now I know, without question, that that's not so. From what I understand now, yes, there is a metabolic problem that leads to obesity, over which the obese person has no control. It appears to be related to the metabolism of carbohydrates in particular (& hence, blood sugars & insulin), particularly refined carbs. Which are also implicated in cancer, cardiovascular disease, & other conditions. (Yes, & sleep apnea.) But what are you going to do in a society in which the government, all the major health organizations, & most doctors & nutritionists are insisting that high-carb diets are what we should be eating, & the entire food industry is geared for that? It makes it difficult to, as they say, "eat clean," even if one knows what, or what not, to eat. I don't think it will become "easy" if ever until the entire society takes a big huge paradigm shift.

I’m not saying that “low carb is the answer for everyone” – but it is becoming increasingly clear that diets high in carbs, especially refined carbs, are bad news for people who are insulin resistant/prediabetic/diabetic . And yet, the American Diabetes Association continues to recommend high-carb diets to diabetics – in my opinion, only making them sicker. There is also continued blame cast at the obese for being obese, & at obesity as the “cause” of insulin resistance & Type 2 diabetes, when recent research seems to be showing that it just might be the other way around: that people (or many people) become obese because they are insulin resistant. With related metabolic affects which have an impact on appetite & satiety: it's not just "emotional" eating, but also metabolically-driven hunger (affects of leptin & ghrelin, insuiln, & blood sugar volatility) that makes obese people eat. Let's also not forget the affect that wacked out blood sugars & related metabolic problems have on mood, which also can lead to hunger & the desire for "comfort food."

So was it my mom's fault that she died before her time of Type 2 complications? No. As much as I wish we'd known enough to support her in her early endeavors to eat low carb back in the '70s, I also wish we'd known about gastric bypass in the ‘80s & ‘90s. It might have saved her life too.

That said, I don’t believe that gastric bypass is really a “cure” for diabetes. I think it hits symptoms, not causes. Although followup studies I’ve looked at in PubMed indicate positive longterm outcomes for weight loss surgery, I’ve also seen references to people who’ve had the surgery still being obese – just not as obese. It doesn’t lead to lifestyle changes, though undoubtedly some individuals who have the surgery make changes on their own. In the end, it seems a typical Western medicine way of putting a bandaid on a problem with drugs or surgery, when we need to go a lot deeper than that – such as persuading our public health agencies & nonprofits like the ADA & American Heart Association to pay attention to health in their nutritional recommendations, instead of to which lobbyists from Big Agriculture or Big Pharma are lining their pockets.

I am prediabetic myself, & have been working pretty darn hard ever since my mom’s death awakened me to my own danger, to change my health including getting rid of my excess bodyfat. I’m doing it with diet (moderate or, currently, low carbs) & exercise. It’s really not as hard as “they” say it is, when one has the right information. Just don’t go to the ADA, the AHA, the USDA, or most medical doctors for it. My own experts (thus far) have been Diana Schwarzbein, Tom Venuto, John Berardi, & Lyle McDonald.

-- Mel

[Bytsi]

Just saw this thread, and I wanted to chime in (if anyone's still interested)...

I work with bariatric patients, pre- and post-op. I do their fitness assessments and then teach them their exercise program (walking pre-op, more extensive including some strength and flexibility post-op). The people I work with must pass a psych assessment (but I don't know the details or how extensive it is).

For at least one month before surgery (sometimes more, if surgery dates change), the patients are on a meal-replacement program (bars and shakes). I've seen them lose 50# in a month following this plan and doing their walking program. BEFORE their surgery.

So... if you know you CAN do this, why would you opt for dangerous surgery? I'm not saying it'd be pleasant to stay on the bars for months on end, but... I wonder if any of the patients have an A-ha moment and say "I can comply with a diet - maybe I should try some kind of diet plan for a while longer and see what happens." Haven't met one yet...

There is also a great deal of resistance to the idea that they will have to exercise to lose and maintain their loss, that exercise has to become a part of their life forever. I can usually tell who's just nodding along, and every once in a while I meet someone who actually seems motivated and learns to enjoy exercise... but that's rare.

I often hear "I've lost weight before (many times), but it always comes back. This time it will stay off because of the surgery." Well, uh, not necessarily. As mentioned in this thread, the relapse rate is pretty high - you CAN stretch out a stomach, even after the bypass... I've met 2 women who had bands put on AFTER they had bypass and restretched their stomachs.

I think WLS can be a helpful tool, but education and support could probably do as much or more for many people (which goes back to doctors not having the time or tools to support or educate). For people with severe comorbidities or lack of mobility, maybe it can be the major jumpstart they need... but without constant vigilance (just like is necessary for ANYONE who's ever had a weight problem), the surgery is just another tool that only works as hard as the person works, and only lasts as long as you continue to work the program.

[realcdn]

I think the concern I have is that people seem to think it really is a no effort solution. From what I understand about 60% of a person's excess weight drops quickly. That still leaves them with 40% to lose through diet and exercise. I'm sure nobody enters into the decision lightly, but it does seem that way at times. One of the women on the weight loss board I post on has lost about 55lbs since February (I don't know if it was early or late). Lately she's slowed with her loss, regained a few pounds, lost them again, and is now talking about WLS.

I find the whole process scary, even though I was (and probably still would be) considered a good candidate for it. I mean, I know losing weight is hard. I just don't think I could have done it (or would ever). It just seems such a drastic solution. And when I hear women barely over 200lbs considering it that makes me really question the doctors doing it.

[russ]

Originally Posted by tkinsley

Be very careful, Sidonia. I would, personally, only opt for a lap band if anything (reversible), since rerouting the innards is FULL of problems--malabsorption, dumping syndrome, bad ju-ju in general, and surgical complications to include infection and death. Worst case, obviously, but it definitely happens!

HTH

Tina

I'm late to this thread, but it's worth mentioning that dumping syndrome is actually a desired consequence of the procedure (to an extent). Dumping syndrome is part of what decreases the patient's desire for sugary snacks, i.e., seems to decrease the desire for high carb foods.

The surgeons where I work perform, I believe, the largest number of gastric bypass operations in Canada, so I've become quite familiar with the complications. I've seen lots of post-op infections, a number of bowel obstructions due to internal hernias, and a handful of deaths. There is also an increased risk of colon cancer long term. That side of it is not pretty at all.

OTOH, one of the clerical workers in my department had the operation last fall and she's practically melting. She's lost 100lbs, I would guess. She used to be almost spherical in shape, but she's practically unrecognisable now. She's still overweight, but well on her way to a healthy weight.

The facts seem to suggest that if patients are carefully selected for this operation, there is a significant improvement in long term health.

It really does need to be the last choice after all other avenues have been exhausted, and any ethical surgeon would agree (the group here is not doing these for their own financial benefit----it pays well, but they could make the same money doing easier procedures).

[buggin_out]

I'm coming to this really late, but I'll throw in my $0.02 anyway.

I think that in almost every case, getting bariatric surgery is a mistake that's, over time (usually far less time than the people who've opted for it could have imagined) doomed to failure.

Most fat people aren't that way because they overeat. Let me clarify; I'm not saying that some fat people don't overeat, but that that isn't the reason for their fat in most cases. After all, plenty of thin people over overeat all the time. The difference between the thin overeater and the fat one is not what they're eating, but the way they're processing it.

Thin overeaters are less efficient at energy (calorie) storage than fat overeaters.

Outside of being extremely diligent about diet and exercise every day of their lives, the key to people who are prone to fatness becoming and maintaining thinness isn't food restriction via surgery, but discovering a way to cause a fat person's body to process food like a thin person's body.

Bariatric surgery flat out doesn't do that; as of yet, nothing does.

It simply doesn't matter how little food you take in after you've been cut, the way the calories are processed will still remain the same as they do with anyone prone to fatness.

This is why practically everyone who gets that surgery ends up regaining most or all of their weight over a long enough time line.

I have a billion other reasons why I think bariatric surgery is unwise, but I'll stop here.

[russ]

Originally Posted by buggin_out

This is why practically everyone who gets that surgery ends up regaining most or all of their weight over a long enough time line.

While it would be correct to say that most available studies of various bariatric procedures assess a relatively short interval due to the fact that the procedures have become common only in recent years (i.e., many studies assess weight loss at 1 year post-operatively), I have seen no systematic evidence to support what you have written. If you believe what you have written to be the case, then I would appreciate if you could post references from indexed scientific journals to support your contention, as just saying it doesn't make it so.

[realcdn]

Originally Posted by buggin_out

Most fat people aren't that way because they overeat. Let me clarify; I'm not saying that some fat people don't overeat, but that that isn't the reason for their fat in most cases. After all, plenty of thin people over overeat all the time. The difference between the thin overeater and the fat one is not what they're eating, but the way they're processing it.

Thin overeaters are less efficient at energy (calorie) storage than fat overeaters.

Honestly, the longer I'm at this the less I agree with what you've said. I used to think that I had a low metabolism, but I'm beginning to think that's untrue. My mother is one of those thin people who can pretty much eat what she wants (at 80yrs and 120 lbs she's technically a little over what she should weigh, but marginally). She eats 1800 - 2000 cals a day... plus candy and chocolate that's not counted in that. On those numbers she should gain, however, she's never at rest. I call her the poster child for NEAT. At my heaviest I maintained a substantial weight (over 400 pounds) with way more intake (ie. I should have been heavier), although I was still relatively active with a day job that kept me moving all day.

Originally Posted by russ

While it would be correct to say that most available studies of various bariatric procedures assess a relatively short interval due to the fact that the procedures have become common only in recent years (i.e., many studies assess weight loss at 1 year post-operatively), I have seen no systematic evidence to support what you have written. If you believe what you have written to be the case, then I would appreciate if you could post references from indexed scientific journals to support your contention, as just saying it doesn't make it so.

I waver on this one. On a weight loss board I hang out on I see an occasional post from someone who had the surgery (various kinds) years ago and eventually gain some (even all) of the weight back. I suspect the surgeries make it harder, but not impossible to do so. Interesting point is that most of the current women undergoing (current or just planning) don't want to discuss failures with these women. If it were me I'd want to find out why they failed in order to avoid it myself. I suspect that the doctor's performing the surgeries have no vested interest in tracking long-term success. I mean, if the success rate is 80% 1 year out and even 60% 2 years out it might stop some people from signing up.

The numbers used there are ficticious, just used for an example. I do think sometimes it's an acceptable tool for people, however, I do think some people think it's a quick fix. That's what I find most concerning.

[Bytsi]

Originally Posted by buggin_out

Most fat people aren't that way because they overeat. Let me clarify; I'm not saying that some fat people don't overeat, but that that isn't the reason for their fat in most cases. After all, plenty of thin people over overeat all the time. The difference between the thin overeater and the fat one is not what they're eating, but the way they're processing it.

Thin overeaters are less efficient at energy (calorie) storage than fat overeaters.

Outside of being extremely diligent about diet and exercise every day of their lives, the key to people who are prone to fatness becoming and maintaining thinness isn't food restriction via surgery, but discovering a way to cause a fat person's body to process food like a thin person's body.

It simply doesn't matter how little food you take in after you've been cut, the way the calories are processed will still remain the same as they do with anyone prone to fatness.

This is why practically everyone who gets that surgery ends up regaining most or all of their weight over a long enough time line.

I have a billion other reasons why I think bariatric surgery is unwise, but I'll stop here.

Hmmmmm... ok. I think that some (I might even say many) who have bariatric surgery don't lose "enough" (whatever that is) and many regain some or most of their weight. BUT many also have success. I've met plenty of people whose lives turned around after the surgery.

The main difference I see in the people who have long-term success is that they changed their lives. They didn't break their diet rules, they didn't restretch their stomachs, and they became much more active.

Were they more active because they lost weight and can move more easily / lessened their comorbidities, or did the activity lead to more weight loss? Probably an interaction of the two.

The ones who were more successful also changed their mental attitudes, through therapy and self-examination and an ongoing committment to make this life change. The ones who felt it was a magic cure are the ones who I've seen struggle the most.

My "issue" with surgery is that lifestyle change isn't emphasized enough. People who DO have great success (with surgery and lifestyle change) might have achieved the same results without risky invasive surgery if they'd simply stuck to the changes they made anyway along with the surgery.

So... having said all that - I'm very curious as to HOW you feel the body processes calories differently and thus dooms people to failure. What is this "different" process? How do thin people who eat a lot digest, store and utilize energy differently than fat people? How do you account for those who do lose weight and maintain their loss, either through diet/exercise/lifestyle changes or bariatric surgery?

Originally Posted by russ

I have seen no systematic evidence to support what you have written. If you believe what you have written to be the case, then I would appreciate if you could post references from indexed scientific journals to support your contention, as just saying it doesn't make it so.

^^ X2