As a bariatric dietitian, every week I counsel dozens of patients who turn to weight loss surgery to help them lose weight and get healthier. Rarely does a week go by when I don’t talk with at least one patient who shares a common story with me. Someone in their life – it could be a spouse, friend, parent, child or co-worker – feels their decision to have bariatric surgery is taking the easy way out. That if they just really committed themselves to losing weight, they would (and should) be able to do it on their own.
Since this is my chosen and much-loved line of work, it frustrates me to hear this misconception used to belittle someone’s choice. It presupposes that people who come to a decision to have bariatric surgery have never tried diet and exercise before – or even worse, they just didn’t try hard enough. It assumes that the need to have bariatric surgery is a terrible failing. This opinion – that bariatric surgery is the easy way out – is not only condescending and dismissive, but it’s completely inaccurate based on the current science. I say this with confidence and conviction and will gladly discuss why this reputation is so undeserved with anyone who is interested. So it might surprise you to know that once upon a time, I used to think this way, too. What changed my mind? The science of obesity and weight loss surgery turned me from a doubter to an advocate.
The Science Behind the Disease
We know that long-term weight loss in individuals who have obesity is difficult to achieve through diet and exercise alone. We also now know that is because obesity is a complex disease, made up of a combination of genetic, neurological, endocrine and lifestyle factors. Together they create critical biological imbalances that work against weight loss efforts and maintenance of a lower weight. Because the body sees weight loss, even desirable weight loss, as a stressor, this sets into motion a series of events that makes maintaining lost pounds highly unlikely. We eat less but feel more hungry, while at the same time our bodies burn fewer calories with each pound lost. Is this fair? Definitely not. But it is reality in the majority of cases.
Bariatric procedures, on the other hand, allow for reduced calorie intake in different ways. By altering the size of the stomach and in the case of the gastric bypass the absorption of nutrients, less food results in a full feeling more quickly. This is accompanied by changes in hormone levels which communicate with the brain to reduce hunger and decrease appetite. These changing hormones are also believed to be responsible for the rapid improvements often seen in Type 2 diabetes and hypertension that often follow a bariatric procedure. In many cases, patients may no longer require medications to treat these conditions in the days immediately following surgery, long before any significant amount of weight has actually been lost.
Bariatric Surgery Changes Lives
Studies and data aside, the personal stories are the most convincing and inspiring. Over the years, I have seen many lives transformed following weight loss surgery. So who are the people having these surgeries? To be clear, they are not someone looking to lose 20 or 30 pounds. This type of weight loss can likely be achieved through a combination of appropriate medical intervention and lifestyle changes, such as proper diet, exercise and improved sleep. Gastric bypass, gastric sleeve and gastric balloon procedures, on the other hand, are subject to strict guidelines set by the Food and Drug Administration (FDA), insurance companies and, of course, your surgeon. The FDA determines which patients meet the criteria to have surgery and your doctor will outline the steps that must be taken to complete the pre-operative process. If you have a policy that covers bariatric surgery, your insurance company will set additional guidelines that determine other issues that affect your path to surgery, such as how long of a waiting period you have or whether you need to commit to an exercise program before surgery.
In addition, bariatric patients work with dietitians to optimize their eating habits and ensure they are meeting their nutrient needs before and after surgery. They meet with a psychologist to make sure they are capable of committing to the lifestyle changes necessary to be successful in the long run. Of course, the amount of preparation and follow-up care will vary from one practice to another and is often influenced by a patient’s health insurance provider. At New Jersey Bariatric Center, we encourage regular post-op visits with a nutritionist, attending a monthly support group and finding an exercise buddy or favorite class to stay committed to physical activity.
Surgery alone does not equal success. Creating good nutritional habits, exercising, having a positive relationship with food and developing a solid support system are all things that take time. But they will make or break success in the lifetime that follows the decision to have surgery. I know the science behind these life-changing procedures and I know the humans who live this reality everyday. This is not a quick fix, or easy or a guarantee. But it is a chance. A really good chance, for someone willing to put in the work. So send the naysayers packing, or better yet a link to this post! And I’ll be here to cheer you on every step of the way.