Bariatric Surgery...Opinions? - JP Fitness Forums

sidonia · 06-09-2008, 01:18 PM

I'm just curious what everyone's thoughts are on Bariatric surgery. I am talking the permanent kind, where they re-route your insides.

Since last year pretty much every one of my doctors has discussed it with me as an option. I am always kind of taken aback. I guess I'm not ready to surgically alter my body when I feel can change it myself with some hard work...I'm not willing to give up just yet and go that route. I understand it for someone who may be a little older, and has more health concerns like diabetes or high blood pressure...and is maybe over 400lbs...but for me? No way!

Anyone have experiences with it...know anyone who has? I am just curious on a fitness board...how you all feel about this option?

tkinsley · 06-09-2008, 02:04 PM

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

sidonia · 06-09-2008, 02:13 PM

I am in NO way thinking of doing this!

I was shocked that they would even offer it to me at my age, being fully capable of taking care of this myself. Their answer was that it was something more...something that was not my fault...something genetic. All I was thinking was...really? Unconsciously stuffing food in my mouth wasn't my fault? Whose was it then???!!!

I don't think I could ever permanently alter the natural state of my body unless it was truly a life or death situation...that's the part of this that really irks me! THREE of my doctors, my general, my endo and my gastro guy...all THREE of them...seemed to think that I would not be able to be healthier by just changing my lifestyle. They said I was the perfect candidate...since I have no major issues right now too. As far as I'm concerned...a 1 in 100 chance of dying is WAYYYYYY to high!! Those are supposedly the odds...

I was just truly curious how a community like this would feel about this drastic measure...since my Docs were making me feel like I was an idiot for NOT considering it...!! And I was thinking more like they were idiots for even suggesting it!!!!

Aoife · 06-09-2008, 02:27 PM

I think it is an option for people who are really so bad off mentally that they think there is no other way. They've convinced themselves of that, and that's just the way it is. There's often people I see (We watch that show... Big Medicine on Discovery Health or some similar channel, check it out, kinda interesting) Who prolly have no real other recourse. They're convinced that this is the only way. OR people who are bedridden, extremely obese, etc...

But there's plenty of options... apparently they don't even need to do the band or the reroute... they could just make the stomach smaller, for instance. There's apparently a case for the surgery being able to cure diabetes although I didn't go look up how... but apparently there's been cases... probably having to do with how hormone production changes after such surgery or something.

If you can and are succeeding in a lifestyle approach, then I don't see a reason to change that. I don't really think anyone that goes for it sees it as an easy way out or a magic bullet... just that it's the ONE THING that can truly help them. Is it? I don't know.

There's something to be said for the cases where maybe it's "not the person's fault." I mean, is lack of proper nutrition education your fault? Is a predisposition to being sedentary and overweight your fault? Not really. Are there ways to take control of your own life and overcome disadvantages? Sure.

But I think the "not your fault" is true in most cases, in a small way... very few people set out to become obese... it just "happens." Now, usually it happens from overeating and undermoving... but for many people the subconscious reasons for the overeating ... not being personally aware...

Hell, most people don't have that high degree of personal awareness. People who think they can still function on no sleep, after working for too many hours, whatever...

ramble ramble ramble...

still though, that show is interesting from the perspective of trying to better understand who does this stuff and why. For some people, at least in their mindset, it's their only hope. They think they'll die without it.

sidonia · 06-09-2008, 02:44 PM

I guess my problem with the whole approach is that they don't account for the psychological reasons that people are obese. Most if not all the time there are reasons, and a quick fix for the time being may be fine...if it's what they think they need. But in many cases they gain the weight back...you can re-stretch the stomach lining and end up eating like you were before.

My point is I guess...if you're willing to make the lifestyle changes they ask you to make when you are having the surgery...why not just do it in the beginning...? Instead of circumventing the real problem...which is...psychologically...why you eat...in the first place?

I dunno...all I knew was in my head I thought...oh no...not for me!!!
I totally understand if others need and want it...that's what's wonderful about having the right to do what you want with your own body...

LisaS · 06-09-2008, 03:02 PM

my guess on why the gung-ho Drs. -
they've had obese patients for years and virtually the only arrow in their quiver was diet & exercise - which has really low compliance in the population at large and therefore they don't see it as effective in their practice. Yet they see their patient population going downhill with co-morbidities: diabetes, heart disease, strokes, neuropathy, etc.

Now they finally have a new arrow in their quiver and they are offering/pushing it to their population because it does seem to help some people over that compliance hump - especially good programs that have good aftercare programs.

Not that I agree with it - but I can see how they might react this way given what many of them must see in dealing with their patient population.

I think if you do it on your own (well, we'll help

) with diet and exercise and finding your own demons and dealing with them -- they will be absolutely thrilled to see that the old-school diet & exercise actually works too.

Aoife · 06-09-2008, 03:19 PM

Quote:

Originally Posted by sidonia

I guess my problem with the whole approach is that they don't account for the psychological reasons that people are obese. Most if not all the time there are reasons, and a quick fix for the time being may be fine...if it's what they think they need. But in many cases they gain the weight back...you can re-stretch the stomach lining and end up eating like you were before.

Actually, they do. Plenty of doctors, I have no idea if all do, require psychological treatment, precisely because they know that noone gets to that state because they decided they wanted to.

Quote:

My point is I guess...if you're willing to make the lifestyle changes they ask you to make when you are having the surgery...why not just do it in the beginning...? Instead of circumventing the real problem...which is...psychologically...why you eat...in the first place?

Because not everyone has the necessary support system in place to succeed in a long term battle to get their life back. Because some people really have the complete and total belief that nothing else can work. Because they're already bedridden at 1200 pounds and their mother just keeps feeding them. Because they've managed to slow their metabolism enough that they would have to eat so little that they couldn't ever be full...

I know, I agree with you. But I'm sure that the people getting it believe it's their only option.

Quote:

I dunno...all I knew was in my head I thought...oh no...not for me!!!
I totally understand if others need and want it...that's what's wonderful about having the right to do what you want with your own body...

true.
And you can do it because you know you can.

Lost Dog · 06-09-2008, 03:31 PM

I used to think it was bs to some degree. I couldn't think of something more horrible than forced undereating. But, in one of Lou's stories, he writes about a little known side effect.

Is Surgery the Magic Bullet Against*Obesity? - Male Pattern Fitness

Quote:

Originally Posted by my quote of Lou quoting someone else

A big reason the operation works is because it seems to suppress appetite. "If you listen to your patients, they come back and they say, 'Doctor, you put the fire out,'" Hutcher says. ... Paul Delios of Saugus, Mass. has lost 90 pounds. He owns a doughnut shop with his siblings, but he's able to resist the cravings. "Before I'd have cravings for everything. Now I really don't," he told Stahl.
For most patients the cravings really do disappear. One theory is that's because the operation suppresses the levels of a stomach hormone called "grelin" that activates the sensation of hunger.

I really don't know enough to comment on the risks vs rewards. I wish I could not be hungry, since I always am, but I'm managing so far.

Aoife · 06-09-2008, 04:00 PM

I think that's how the cure diabetes thing works too...

SpacecityPaula · 06-09-2008, 06:23 PM

Last spring between NPR and PBS there were a spate of stories about Bariatric Surgery (I'll post links to them at the bottom for your own reading). One documentary on the local PBS station talked about the digestives system having it's own "nervous" system. (the doctor made some reference to it being the third brain or something) and that when people have the bariatric surgery it somehow lobotomizes the digestive system.

I've included two posts from my Old O2 Journal that pretty much summarizes my thoughts on Bariatric surgery/Surgery for weightloss in general.

Quote:

okay on a more serious note. I head this story on NPR on the way home about a 19 year old kid named Rocky who couldn't stop eating and eventually had Gastric Bypass Surgery

http://www.npr.org/templates/s tory/s...toryId=9499004

You can hear the original story and the follow that I heard yesterday from this link.

This kid is an example of why I don't believe in Gastric Bypass Surgery. It didn't stop this kid from eating at all. Has he lost weight - Yes. But because he didn't address the underlying issues of WHAT emotions he is trying to stuff/soothe with food, he's now having problems with binging.

I've watched people I know have this kind of surgery. In the vast number of cases, it doesn't seem to work. One person had complications from the surgery and then ballooned back up to her previous weight and then some.

One person thought it would somehow solve her marriage problems because she would be cuter/thinner/sexier for her hubby and it didn't change anything. They ended up divorced and she's remarried since then. Another person I know had loads of problems because she wouldn't eat what she's supposed to. And another got things squared around, but couldn't eat certain foods without getting sick and because she doesn't eat everything on her plate, her hubby now eats it and he's gained a lot of weight.

As I listened to the story of Rocky, I was absolutely horrified by what I heard. I just wanted to reach through the radio and say "This is not the way. You need to exercise. You need to look at what is going in your head and what you are NOT dealing with. And someone around you should give a clue and get you psychiatric help because you are still binging."

Quote:

Okay I've had 12 hours to sleep on the documentary I watched last night called Fat: What No One is Telling You. Honestly.... I hated this documentary because of the hopelessness they give people. I caught a few bits of the follow up shows they had on my local PBS station. Here's the blurb from the PBS web site.

Quote:

Face it: We're fat.

With 66 percent of U.S. adults either overweight or obese, our girth is a serious public health issue. Yet many of us still view being overweight as a character flaw, a lack of self-control, or even a moral crime.

But does fat really equal failure? FAT: What No One Is Telling You explores the myriad psychological, physiological and environmental factors that can make it so tough to shed pounds and keep them off. In this documentary, Executive producer Naomi Boak and producer/director Tom Spain, both Emmy Award honorees, share new scientific knowledge about hunger, eating, and human metabolic operation. This film also explains our psychological responses to food, and shows how external pressures (such as oversized restaurant portions and the unending barrage of food advertisement) make fighting fat so difficult, both on the personal and national levels.

FAT's engaging personal narratives create snapshots of our national struggle with obesity:

Meet Rosie Dehli, a Minnesota grandmother, battling to get fit so she can enjoy an active, playful relationship with her grandchild.
Meet Mary Dimino, an actress and comedian, in New York, NY, who exemplifies the hard work people must do to lose pounds and stay healthy once they've been obese.
Meet America Bracho, a public-health professional in Santa Ana, California, who is educating families about nutrition while encouraging her Latino community's children to move, both in school and at home.
Meet Rocky Tayeh, a Brooklyn, New York teenager grappling with the very personal (and highly criticized) solution of undergoing Lap-Band surgery.
Meet Dr. Lee Kaplan of Harvard University Medical School and Massachusetts General Hospital, who is a clinician, researcher and above all an empathetic warrior in the battle against obesity
The voices of these and other real Americans tell the story of the biological barriers, cultural habits, and economic realities that contribute to our nation's expanding waistline.

Rocky, who's radio interview I posted yesterday, was one of the central characters in this documentary. And it seemed to back up my impressions of him yesterday - the boy has no self control or discipline - and his family doesn't help the situation.

I actually liked Mary Dimino. She seemed to have a good square head on her shoulders and realized that it was going to take changes in order for her to see differences. She's a woman however, that exercises 3 hours a day.

America Bracho impressed me as well. She is making changes at the community level in an effort to curb the obesity epidemic. One of her co-workers actually was talking with Latinas about the idea of Comfort food.

I did learn some interesting stuff in terms of the medicine. It appears that the digestive tract has its own nervous system and that many of our impulses to eat come from this second nervous system. It also seems that because Gastric bypass surgery cuts the nerves that communicate with the brain, many people have the urge to eat curbed for the first time in their lives.

I also learned that music tempo and lighting will greatly effect how much you eat. There were also some interesting bits on portion control and eating 5-6 meals a day.

In one of the after shows, they also talked about the people who have registered as successful dieters. They said that the most successful people changed their lives completely to fit their goals - the people they hung out with, the foods they ate, and many of them went into the training/fitness industry.

I can honestly say that I've seen that kind of shift in my thinking. One of the boards I hang out on I don't post as much because of how my thinking has changed about food, fitness and the roles it plays in my life. For me Food is fuel, nothing more. I really hate the idea of comfort food, because people are supposed to provide comfort not food. For me, fitness through cardio exercise and weight lifting is a way for me to function in life. I am more focused when I do these activities. For me, reaching my goals in these activities gives me confidence in other areas.

And finally, I am seeing a growing focus in my personal writing that talks about being a healthy (mentally and physically) person that is shifting what I want to do with my life - and I am making changes in my life so I can do what I want in the long term with this newfound personal interest. I don't want to be a trainer, but I can use my skills as a writer to intelligently discuss what I see and maybe affect people in a way others haven't previously.

LisaS · 06-09-2008, 06:37 PM

I had a chance to talk with a dept chair (anesthesiology) for Mayo med school a few years ago and we talked a little about the Mayo experience with bariatric surgery there in Rochester. The improvements can be so dramatic so fast that it is hard to argue against them if you have a patient with co-mobidities. He talked about running into patients at the hardware store just a few weeks (or months) later and hardly recognizing them (it is a small town after all). Their lab work resolves, their dependence on meds drops, all good outcomes.

That's not to say that there are serious possibilities for complications at the time of the surgery - for example - if your patient is barely mobile pre-op - you cannot get them up and walking immediately post-op to prevent clots - because that's more than they could handle pre-op.

So, yeah, I get it from their view - but I really don't care for it conceptually it from my view. But I assume with someone who is very sick (but not too sick yet) it might be the only chance to get them to live long enough to resolve all their other issues. By that I mean the people might not have the 2-3-4 years it would take conventionally. (in other words, not you)

sidonia · 06-09-2008, 07:05 PM

Ok...so the other reason I was prompted to ask about this. My cousin who just turned 40, has been obese all her life. She has NEVER been in a gym, never made any effort to lose weight...not dieting not working out, not even so much as walking after dinner. She has always just eaten what she wanted when she wanted. She just had the surgery in January. She is 62 lbs lighter already. She looks thinner, but she is miserable and everything she eats upsets her stomach and makes her throw up.

My problem is, she has not made the decision that after she loses the weight she will join a gym. She is convinced that she won't need to do "that". She has also already started eating some things that she shouldn't. Apparently you are not allowed to eat processed sugar and this is a woman who could polish off an entire carton of ice cream by herself.

I hate to see her be set up to ultimately fail. THey did lots of testing, or her heart, her lungs, her sleep patterns, but they didn't do any psychological testing. THey did no counseling...only seminars about the surgery and any questions you might have. How do they know she won't go back to eating the way she did before? THey don't!

I understand if you have no other option...and you've tried it all, but selling this to people who are more than capable of doing this themselves seems crazy to me! She has a supportive family...3 sisters who would do anything for her and her mother and father too!

I think it's like when they introduced Redux, and Fen Fen...it's a quick fix...it seems like the easier way...and it's pretty much instant gratification. I know her, and I know that until she takes the time to discuss where her food issues come from...there is no end to this. She and I have similar issues. I went to the shrink...I am dealing with the issues...and THAT has been the only thing that helped me actually be able to do this long term.

What if doctors are setting them up to fail? After all...the meds they thought were revolutionary and were going to solve all our problems were killing people...!!!

I dunno...I guess I'm just emotional about it...because its a loved one...I hate to see her set up to fail...hopefully she won't...

Aoife · 06-09-2008, 08:02 PM

Frankly, not getting counseling before and during, or misusing the tool of surgery (whatever kind) is the fault of the patient or the doctor, not the surgery. It's like any other tool... it can get you where you want to be if you use it correctly. It can mean the world to someone who thought they had no option and it gives them the hope and the determination to change their lives.

Otherwise it's just like any other diet.

Knocking something as terrible and knocking the people that use it and it works for them because some people use it and it doesn't, well it doesn't do anyone any good.