Woohoo!!! Weight Loss Surgery for All, Coming Soon…

tummy tape

Bariatric surgery, once seen as the last resort of the morbidly obese, is slowly becoming a viable option for additional populations on the obesity spectrum. The idea behind these surgeries is to reduce the size of the stomach, in one of several ways. The patient experiences quick weight loss as a result.

We received a pitch email yesterday, from the PR agency of a Pittsburgh bariatric surgeon, informing us that guidelines for eligibility for bariatric surgery are changing. In 2008, you had to have a BMI of 40 or higher to be considered for weight loss surgery. But now, doctors from several expert boards are recommending surgery for obese people with BMI’s starting at 30, if they have additional risk factors such as diabetes or metabolic syndrome.

We asked Dr. Yoni Freedhoff, MD, an obesity and nutrition expert, assistant professor at the University of Ottawa, as well as blogger, whether this is good or bad news. His response:

Good news.

And bad.

Good because it offers a quality and quantity of life increasing intervention to more people.

Bad because more people need it.

While people regularly talk of how it’d be so much better without surgery the fact remains, we don’t seem to be very good at helping people make lifelong changes that provide the same outcomes surgery does.

Looking at bariatric surgery through the eyes of a friend who had a successful procedure last year, we can vouch for its life transforming effect on her. But from a societal perspective, this development is another sad sign that we are captives of a system that leads us down a very dangerous food path. Poor regulatory controls and excess corporate influence have created an obesogenic economy that is choking our health.

Our generation has no less self control than that of our parents or grandparents. Our patriarchs did not get as fat or sick as we are because there were less daily opportunities to eat fattening foods and drink diabesity causing soft drinks. Today everywhere you turn there is a vending machine or an ad to eat something junky.

We get told that it’s our own personal responsibility to eat right, but poor public health policy has a major contribution to this country’s high obesity rates. Simple measures like calorie labels on food and drink in movie theaters, limitations on soft drink size, improved labels, and a 100% ban on advertising to kids are almost impossible to push through Congress because our politicians and bureaucrats are in the pockets of lobbies and corporations.

In the coming years, expect to see more solutions that fix the problem of obesity, instead of solutions that prevent it.

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  • Kim Moore

    I can also vouch for the life changing effects of bariatric surgery. I am three years post-op, and it took gastric bypass surgery for me to learn that what we consider “food” in the US, really isn’t. It took gastric bypass to teach me how to actually cook, not just prepare something out of a box or plastic wrapper. It took gastric bypass to bring my weight down enough so I could actually get up and move, and now I run half marathons and adventure races. But in order for me to keep my 125 pounds lost at bay, I have to cook and eat real food, work out regularly, run races, lift weights, and do ALL the things we are supposed to do to maintain a healthy weight and lifestyle. Weight loss surgery was the tool to help get me started down the right road, but it doesn’t keep the weight off without any effort, and it certainly won’t change your habits for you. You have to DO THE WORK and you have to do it for life. Just like someone who hasn’t had their stomach worked on.

    • http://www.fooducate.com/ Fooducate

      Kim – thanks for sharing your story, it’s inspiring!

    • http://www.facebook.com/profile.php?id=628296864 Naomi Kietzke Young

      Yes, Kim, your story is inspiring, and I have a colleague who has done lap-band surgery and followed up with the same enthusiasm. HOWEVER, I have other friends and co-workers who have NOT followed through, or have had debilitating side effects. So when you say, “You have to DO THE WORK and you have to do it for life. Just like someone who hasn’t had their stomach worked on.” that says to me that expanding use of the surgery is NOT the answer. Finding ways to make it more attractive for people to “do the work” without incurring the risks of surgery is the answer.

  • R

    As an aside, I a RN that works on a unit that cares for a lot of Bariatic surgery patients. This is major surgery, changing the anatomy of your GI system (depending on what surgery is performed) and I am amazed at the percentage of patients that seem to go into it without really knowing how much pain and potential complications there are…as a patient you really need to be educated and motivated, get up and ambulate within hours after surgery and frequently throughout the hospital stay. where I work, you are expected to be discharged on day 3 post-op…the majority of the patients do very well, but I have seen a fair number of complications (with patients that have done all the “right” things…complications still can occur for sure) that would make me very hesitant to have this surgery.

  • http://www.facebook.com/columbusfoodie Becke Jones Boyer

    I’ve had two weight loss surgeries. One in 2001, and a second one in 2008. The one I had in 2001 wasn’t the right type for my body size (500+ lbs, and I had a very conservative RNY that failed when I didn’t get the restriction the pouch promised. The second one was a revision to the first – I was 380 when I had that done, but failed to fix the underlying eating disorder – problem with that, is if the surgery is super malabsorptive like my revision one, eating disorders can darn near kill you even faster than in the normal population. I spent 6 months in the hospital and almost died, Still don’t regret having the revision (it’s kept me in the 220ish range – I’m up a bit because of new medication, but slowly taking it off again), but it comes with some pretty hardcore commitment to eating differently and religious supplementation of vitamins.

    But both surgeries have been found to be effective in eradicating diabetes and high cholesterol, not because of the weight loss itself, but because it keeps your body in a constant state of very mild anemia. More and more, doctors are advising the intestinal configuration but no stomach size restriction for people who are having serious problems controlling those two diseases in particular. But for any type of bariatric surgery to have a long term effect in controlling weight, it’s pretty important to eat healthily and exercise, and to address any psychological factors head on. Unfortunately, most people don’t learn this until after they’ve lost some weight after surgery and then rebounded because they didn’t make the lifestyle changes, or until they’ve switched one addiction (food) for another (alcohol, drugs, etc).

    Either way, it does make a world of difference to those who have it. And that it isn’t the “easy way out”, by any means.

    • http://www.fooducate.com/ Fooducate

      Thanks Becke for sharing your story.

  • IrreverentAlien

    It is my understanding that before the surgery and after it one has to lead a healthy lifestyle, with no alcohol, not too fatty or high-caloric food. From the testimonies I read below, it is also important to exercise regularly and from Kims testimony the key phrase is indeed: ” you have to do the work and you have to do it for life”. So if all those gastric bypass patients would take their own health more seriously, before considering surgery, they would also see changes. Of course not as fast as with a surgery, but changes are coming when “someone” does “something”. I reckon gastric bypass surgery is so popular in the US because it perfectly fits the “instant gratification” mentality of big parts of the American society. As do twinkies, diet or normal sodas, snacks and all other food that causes in big part the obesity epidemic in this country (the other part being the people themselves).

    A little over a year ago I was feeling (and fearing) that I needed to switch from a 38 size to a 40. I have always exercised but obviously not enough to combat the increasing weight. When the switch in clothing size loomed I decided that i could not go on with that and started doing “something”. I made some major and minor nutrition changes, started running, which I had always hated and started setting myself an exercise goal. Triathlon. This Sunday I will be doing my first Olympic and I have not been in the shape I am in right now for at least 18 years. I went from close to 240 lbs a little over a year ago to a current 194. My aim is 180lbs where I will stop loosing weight, and only maintain it.

    I do not think there is a way for everyone, and neither is gastric bypass for everyone, but the battle for keeping a healthy lifestyle is mainly won in our heads. If we use our heads only for consuming (TV, Social Networking, Video Games, etc) instead of creating, the ability to win such a battle is going to diminish.

    As for the guidelines being lowered in accessibility to the surgery, I reckon that the doctors guild just wants to expand their market as they probably took care of most of their potential clients in the higher weight class. Its money driving this move to more of this “increase quantity and quality of life intervention”

    • http://www.facebook.com/columbusfoodie Becke Jones Boyer

      Irreverant: There’s a major difference between starting at 240 lbs. and starting at 500 lbs. For someone to be able to get to that level of super-obesity, there’s factors at work that go way beyond simple lifestyle changes – metabolic disorders, satiety disorders, eating disorders, genetic disorders. We’re just starting to scratch the surface with regards to our understanding of obesity, and it’s pretty unfair to paint all of those who suffer from it with the same brush – I can tell you that I tried quite a few things before I even considered my first surgery, none of which worked long term as once my body got used to the changes, would adapt and make maintaining and continuing that weight loss darn near impossible. There was a study done a few years ago that said without surgical intervention, 95% of diets would fail. For me, the surgery WAS lifesaving. Literally. Between an enlarged heart, blood sugar that was becoming unstable, and a pretty bad case of obstructive sleep apnea, I was in worse shape at 28 than many 80 years olds are in. I agree wholeheartedly with Kim. Weight loss surgery is a tool that levels the playing field for those with physiological causes of obesity, but you still have to do all the work. But remember, you actually have to still be here to be able to do it – if you’re a stroke waiting to happen because of super-high triglycerides or if you have your limbs amputated because of complications of diabetes, diet and exercise won’t do a darn thing. If there is no other positive effect other than staving off those wolves, then it’s been worth it.

  • Cactus_Wren

    http://junkfoodscience.blogspot.com/2007/01/junkfood-science-weekend-special.html

    “In the more than forty years that bariatric surgeries have been performed, there have been no randomized, controlled clinical trials that have shown any long-term improvements to actual health or that lives are saved or extended by these surgeries — not any of the dozens of types and variations being performed, and certainly none of the new procedures claiming to be better and safer.[...]

    “Most studies only report short-term outcomes, before long-term complications and the inevitable weight regain manifest themselves….even though weight regain is well known among weight-loss researchers for all weight-loss interventions. The first five post-op years, when weight loss is most dramatic, are known as the ‘honeymoon period.’ Most bariatric studies last under 2 years.[...]

    “The Mayo Clinic reported in 2000 that 20% to 25% of gastric bypass patients develop life-threatening complications, but the recent Lap-Band U.S. clinical trials done to earn FDA approval reported 89% of patients had at least one adverse event, one-third of them severe. Complications from lap bands are more likely to require surgery to correct and the bands result in so much more vomiting, they are known as ‘surgical-induced’ bulimia among medical professionals.”