Dr. Cheryl Woodson

Why I Don’t Think Weight-loss Surgery is the Answer

Over one third of American adults and about a fifth of our children are obese. Obesity caries a significant risk of diabetes, heart attack, stroke, and other blood vessel illnesses, as well as arthritis, and some cancers. There are also psychosocial issues related to depression and discrimination.  Everyone is looking for a solution, and now, medical doctors can earn certification in obesitology.

Jeff and Rita Sachs of Sweat Equity, Ltd in Homewood, IL will help you with fitness (see their guest blog 1/6/2015,) but many people choose to lose weight with medicine, or surgery. Past weight loss medications focused on appetite control, but most of us don’t eat because we’re physically hungry; even the poorest Americans eat better than many of the world’s other citizens. We eat to feed emotional hungers, manage stress, control anxiety, and comfort ourselves when we experience loss (real or imagined.) Newer medications combine compounds that treat depression and diabetes, hoping to affect the chemical processes that govern obesity. The jury is still out, but I think everyone will agree,

We aren’t obese because our stomachs are too big.

I am not a bariatric surgery fan, irrespective of the type of surgery: Roux-N-Y (classic bypass surgery, which is less common today), lap band, or gastric sleeve. This is the US of A; even though we don’t have the best health care in the world, we do have the best medical care. We know how to do procedures. The bursting wounds, infections, massive diarrhea, and vitamin deficiencies that plagued early bariatric surgery are a thing of the past. Today, the rates of death and other side effects are very low, but there are other unfortunate outcomes .

One of my patients turned to alcohol when her stomach was the size of her thumb, and she could no longer manage her stress by over-eating.  She lost two executive positions, her house, car, and lifestyle to alcoholism.  Others blamed obesity for social challenges, but became depressed when weight loss failed to find them life partner, or a better job. I can’t count the number of times I’ve heard, “I thought my life would change.” It won’t.

The people who did well with weight loss surgery became fully committed to healthy eating and exercise. Most bariatric surgery programs offer a six-month pre-surgery period to begin those lifestyle changes. I can’t help but wonder how many times their clients solidify these habits and lose weight so successfully that the bariatric surgery people DO NOT recommend the operation.

I have recommended weight loss surgery for only two people; both were under 40 years old, weighed over 400 pounds, and had already suffered serious health problems. I don’t recommend the surgery regularly because in my medical practice and in my personal life, I can think of only a few people who did well. Most regained more weight than they lost (researchers say 30% regain the weight within ten years.)

A recent study reported that bariatric surgery cures diabetes. I beg to differ. Weight loss cures diabetes, no matter how it happens.

To be fair, several people said the surgery jump-started their weight loss, giving them the motivation to change their lifestyle and maintain it. I hope this is true, but the long-term success rate remains to be seen.

If you consider this treatment, be sure to find a bariatric surgery program with a solid pre-surgery program that encourages healthy habits AND helps you define and refine your relationship with food.  Also, look for a program with a long, comprehensive follow-up support program and stay in it. Six-weeks is not enough. Even though your stomach will be smaller, this is a life-long struggle.

 

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