As many of you who’ve struggled to lose weight know, it isn’t easy (understatement of the year). People will at times lose a lot of weight, only to regain it plus some. It’s hard to stick with diets and exercise regimens week after week, month after month, year after year.
Bariatric surgery overview
An option that seems to hold out the promise of long-term success is bariatric surgery, aka weight loss surgery. There are several types of weight loss surgeries available today. The most invasive are the gastric bypass type surgeries, which typically result in the most weight loss, but potentially have the most complications, especially in the peri-operative period. On the other end of the spectrum is the “lap band” procedure in which an adjustable band is filled with various amount of fluid to make the opening to the stomach smaller. Typically, it has the fewest serious complications, but also results in less weight loss. However, it’s fully reversible. Somewhere in the middle are the gastric sleeve type procedures in which part of the stomach is resected.
Positive research on bariatric surgery?
A new study in the British Medical Journal compared several different outcome measures between people who had undergone bariatric surgeries to those who had undergone non-surgical weight loss over a two year period.
Compared to those in the non-surgical weight loss group, those who had undergone bariatric surgery lost significantly more weight (close to 60 pounds more on average), they had more remission of their diabetes and pre-diabetes, they had a higher quality of life, they needed fewer medications, their blood sugar was lower, their good cholesterol was better, and their triglyceride (blood fats) levels were lower. Other studies have also shown a reduction in mortality (presumably through fixing people’s diabetes, as well as other obesity related conditions such as sleep apnea).
On the other hand, people in this study also developed more iron deficiency anemia, and 8% of people needed further surgeries. Other studies (as well as my own clinical experience) have shown other nutritional deficiencies such as vitamin B12 deficiency.
But what’s the catch…
Great! Let’s forget the gym, the diets, the struggle.
Not so fast. Let’s discuss the flip side. We’ll start with the limitations of the above study, and at the same time, touch on other relevant issues. The above study only followed people for two years. It’s well known that many people gain much of the weight back as the years go on. This tends to occur much more with the lap band, but I’ve seen it with the bypass surgeries as well. I’ve even seen people end up heavier than before their surgery! Furthermore, this study wasn’t powered to tease out differences between the different types of weight loss surgeries. My feeling is that the bypass surgery, which is also the most invasive, also had the most impressive results.
There are also the day to day side effects. For example, people with the lap band who are banded too tightly also tend to vomit if they eat too much or the wrong types of food. I’ve seen people with the lap band subsist on cake and yogurt (or ice cream) because fruits, vegetables, chicken, and other healthy fare did not go down well due to the narrow opening leading to their stomach. People who have undergone the gastric sleeve may develop heartburn. And of course, as mentioned above, I have seen people end up in the operating room to fix complications (at times needing several procedures and numerous CAT scans to see what’s going on, which subjects the body to much damaging radiation).
Furthermore, all of the studies above were conducted in bariatric “centers of excellence” under perfect conditions, and all of the subjects had tried losing weight on their own before undergoing surgery. Thus, the results may not apply to people who use less expert surgeons/hospitals or who have never seriously tried to lose weight through diet and exercise.
Should you opt for surgery?
So, what’s the bottom line? Should an obese individual jump to surgery?
If you’re young and otherwise healthy (no diabetes, heart disease, etc), and if you’ve never seriously tried to lose weight before, then there’s no convincing evidence that the surgery will improve any long term health outcomes, and the possible complications might be worse than the benefits. On the other hand, if you’ve struggled to lose weight, and have serious medical problems (especially diabetes requiring insulin, in which it’s especially difficult to lose weight), then weight loss surgery may be a reasonable option for you.
If you’re considering undergoing surgery, then definitely do your homework. Studies have shown superior outcomes with experienced surgeons and hospitals. Furthermore, it seems to me (based on what I’ve seen in my own clinical practice), that the people who are the most successful long term are those who use the surgery as a nice push in the right direction, and continue exercising and watching their dietary intake. Those who simply rely on the surgery do initially lose weight, but are the ones who seem to gain a lot of it back as the years go on.
There’s one final point that I wish to emphasize, which I alluded to earlier. If you do undergo the surgery, be on top of taking your vitamins and checking your levels. I’ve had a number of cases of permanent nerve damage from years of low vitamin b12 levels, and I’ve seen a number of other nutritional deficiencies causing a variety of symptoms and conditions (e.g. headaches, debilitating fatigue).
(Image source: National Bariatric Link.)