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You Ask, I Answer: Bariatric Surgery

lapbandWhat is your opinion on bariatric surgery? I have lost a lot of weight by eating less and exercising more, but it took me a long time and I still struggle at times.

I recently spent some time working at a bariatric center where they do procedures on adults and teenagers and it got me thinking about the issue.

Just wondering where you stand on the growing popularity of this weight loss solution.

– Maria (Last name withheld)
New York, NY

I certainly appreciate the need for surgical intervention with morbidly obese patients.  In many instances, it’s a matter of preventing an untimely death as a result of an overworked system that can no longer handle the amount of effort and work it takes to sustain itself.

My concern, though, is for patients who do not simultaneously seek out help for their compulsive behaviors, thinking there is solely a physical component to their weight issues.

A few years ago, actually, reports surfaced of many post-bariatric-surgery patients developing a gamut of addictions following their bariatric surgeries — from gambling to alcohol and drugs.  Depending on who you speak to within the field of bariatric surgery, anywhere from 5 to 30 percent of patients develop some sort of addiction shortly after receiving treatment.

One problem, as you may imagine, is that research on this issue is fairly limited since the procedure itself is fairly new.

That said, I can’t say I am at all surprised.  Too often, we forget that, for the vast majority of individuals, compulsive eating has deep, emotional roots.

Bariatric surgery has its merits, but it must be part of a multi-prong approach that also examines psychological issues and foundations.

It frustrates me that so a large percentage of conventional medicine practice fails to acknowledge the mind-body connection.  Detaching the emotional from the physical is, in my mind, an erroneous way to deal with medical concerns.

If someone binges almost uncontrollably out of emotional issues dealing with self-sabotage and self-hatred, bariatric surgery does not tackle the root of the problem.

The weight will be lost, but the emotional scarring that leads to the destructive behavior will simply be transferred somewhere else.

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5 Comments

  1. Mary said on May 14th, 2010

    I am an obese person who considered bariatric surgery at one time. I was enrolled in an inpatient bariatric program and was able to lose weight through just changing my eating habits and making better food choices so I never went through with the surgery. However, one of my friends in the same program did have the surgery. Initially, he lost a lot of weight over the first year but because he never really dealt with his psychological issues for overeating, he began regaining all the weight he lost. I guess weight loss starts in the head first. Take care of that and the body should follow.

  2. Derek Helderman, RD, LMNT said on May 14th, 2010

    I think this is an issue with very relevant pros and cons. There are very positive attributes to proceeding with bariatric surgery (obviously potential weight loss and accompanying lessening of co-morbidities being foremost), as well as some negatives associated with the procedure. I don’t have extensive experience in dealing with bariatric patients, though I have participated in the pre and post procedure counseling of some bypass patients.

    My main concern with this procedure is not the immediate implications, but those that will occur in, say, 40 years. We’re now chopping out the stomachs of an increasingly younger demographic.

    There’s a stark difference in completing this procedure on a 45 year old patient who’s suffered from chronic diseases (T2DM, HTN and CVD) for 20 years and realistically has 20-30 years left to live, and a 15 year old patient who, yes, may suffer from the very early stages of CVD but realistically has another 60 years to live. How will the body respond to having only 15% (via sleeve gastrectomy) of the stomach present for the next 60 years? How do those risks compare with the risks associated with being overweight for 60 years?

    There may be no serious long-term surgery side effects; I don’t know. I hope there aren’t. I’m totally in favor of gastric bypass in instances where patients are morbidly obese and genuinely have no other option. At 750lbs, it’s just not realistic to lament “eat less, move more”. At that level of obesity, there’s a very good chance, as Andy points out, that there are serious psychological problems and addiction issues present. Removing a patient’s stomach and eventually food will result in weight loss, but it probably increases the chances of addiction in other facets of life. This situation is different from a 300lb patient who is more capable of weight loss through behavior modification. It isn’t easy, but it’s possible.

    I’ve actually heard of bariatric patients who, at a “borderline” weight, have intentionally GAINED weight to be above the threshold for being approved for the procedure. This is a dangerous precedent to set.

    So in short, this is a seriously complicated issue that I think will get even more precarious in 50 years.

  3. Andy Bellatti said on May 14th, 2010

    Derek,

    Thanks very much for contributing to this topic. You make some excellent points about long-term effects to the gastric and digestive system.

    I am a big advocate for psychotherapy in regards to food issues. Even if one is not morbidly obese, I am a firm believer that our relationship with food often says a lot about ourselves. For example, I once knew somebody who was overweight through most of their childhood, adolescence, and early adult life.

    This person hits 30, and loses weight successfully. They also began exercising and generally taking better care of themselves (more attention to grooming, etc.)

    The amount of attention this person received from other people (in terms of physical attraction) was so new/overwhelming/scary that they began to eventually put the weight back on. A few months into the weight gain, they began therapy and realized that after DECADES of using food (and their excess weight) as a shield, there was a new vulnerability that they had to contend with…

  4. Kiersti said on May 14th, 2010

    I am a Bariatric patient who had RNY or gastric bypass a year ago. I have lost 175+ pounds and have discovered a whole new way of eating and living. The program I had surgery through was a Blue Cross program of distinction which means that it met specific requirements such as having to take 16+ hours worth of nutrition and behavior classes. I had to pass an evaluation by a psychologist and meet a number of other requirements.

    I too know people who have had the surgery and have not seen the success I have had and it all come down to making real and lasting changes to activity levels and nutrition intake. The surgery is not a fix – the surgery alone won’t make for lasting weight loss. The surgery is a *tool* to help.

    Because of the surgery I have to follow a strict vitamin and mineral regimen – for the rest of my life – and get annual tests to make sure that vitamin and mineral deficiencies do not develop. In addition I have to be aware of things like timing when I eat and drink and pay strict attention to protein consumption. My relationship with food has COMPLETELY changed….and needless to say this is a good thing.

    In spite of my success with weight loss this has definitely not been the “easy” way out and I have dealt with a number of issues with emotional eating and having to find new ways to process and deal with stress and boredom. But I knew this going in because I was well prepared for the challenges that I would face and feel that I continue to build upon a powerful suite of new tools.

    Frankly Andy…your “Small Bites” are a part of my continuing education process. Just wanted to share my story a little and say thank you.

  5. Andy Bellatti said on May 15th, 2010

    Kiersti,

    Thank you for sharing your story with me and all Small Bites readers.

    I am very happy to hear your program realized the importance of emotional and psychological factors in your success following bariatric surgery.

    Additionally, thank you very much for the kudos. I, too, feel that Small Bites is an ongoing journey for me, as I continually seek out new knowledge, and enjoy the dialogue that often occurs in each post’s “comments” section.

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