Bariatric
Surgery
Fitness Expert Phil Kaplan discusses
some of the considerations that should be weighed when considering
a gastric bypass or any weight reduction surgery.
Note from the author: When I post
my carefully constructed opinions about controversial fitness
and weight loss topics I am usually flooded with e-mails and
phone calls of gratitude. Intermixed with the thank you expressions
are often expressions of criticism. I am aware that my take
on some of these things might be viewed as potentially hindering
the income of practitioners and sellers of the particular
product or service at issue. I do not apologize. It is not
my intention to jeopardize anybody's business or livelihood.
I believe people should have access to all the information
available, and then, if the products or services being addressed
are truly going to meet patient or customer needs, my explanation
of dangers and risks should simply alert them rather than
sway them. I welcome all comments about any of the issues
I address. I make every attempt possible to look at all sides
of these issues and form my opinions by studying published
research material and speaking with product or service purveyors
and their customers, patients, or clients. I haven't any ulterior
motives other than to provide an unbiased view of the realities
behind offerings that are often overhyped. With that said,
I am prepared for mixed reviews of the information I'm about
to present. Here is my take on Bariatric Surgery:
Singer and talk show host Carnie
Wilson has pretty much become the poster person for bariatric
surgery and now surgeons are advertising their services and
why not? As obesity skyrockets, surgery that promises to bring
an obese individual back to a manageable weight has great
appeal. The ads, unfortunately, seem to sway people into finding
the potential outcomes as positive, when there are serious
risks that should carefully be weighed out.
The two most common Bariatric procedures
are banded gastroplasty and the bypass. I'll explain the basics
of each. Keep in mind, I am not a medical doctor, and this
information is the result only of a foundational knowledge
of anatomy combined with extensive interviews with medical
professionals and bariatric patients.
Before I explain the procedures,
you should know that every bariatric patient I spoke to told
me the residual pain was far more severe than they expected,
even with lengthy pre-surgery consults with doctors.
 The
bariatric surgeon begins with an incision into the upper abdomen
so he can access the stomach. Using a band he sections off
the stomach where it meets the esophagus creating a reduced
area for food to pass through that can hold anywhere from
1 - 3 ounces. Most bariatric surgeons seem to find it best
to use a 1-ounce capacity and allow the new usable stomach
area to expand to the point that it can hold 3 ounces. In
a bypass, he disconnects the small bowel and connects the
larger portion of the intestine to the new stomach "pouch."
It's important to note that this
surgery is drastic and is only a consideration for the morbidly
obese, people who have over 100 pounds to lose. It should
not be viewed as a shortcut for someone struggling to lose
25 or 30 pounds (although I fear that as its popularity grows,
unethical doctors will be compelled to tap further into the
potential for accumulating great wealth creating "pouches").
Since the surgery should only target as candidates people
with 100 pounds plus of excess weight, most who are approved
for surgery will likely have risk factors going in. Obesity,
as you know, contributes to likelihood of hypertension, diabetes,
and pulmonary problems, all issues that can greatly affect
the risk associated with any surgery.
Interestingly, while many candidates
for bariatric surgical procedures have joint issues, arthritis,
circulatory and respiratory problems, the stomach and the
small intestine are often working quite well. It's sort of
ironic that the surgery on a patient with many maladies can
cripple two fully functional organs, the stomach and the small
intestine. Since most of absorption normally occurs in the
small intestine, the risks of malnutrition or nutrient deficiency
are very real.
Complications from bariatric surgery
can include:
- Spilling of gastric juices and
digests into the abdomen
- Peritonitis (a potentially fatal
abdominal infection)
- Malnutrition
- Nutrient Deficiencies
- Nausea and Vomiting
- Dehydration
- Blood clots
In severe cases, the following
long term complications may emerge:
- Dumping Syndrome, where
stomach contents move too quickly through the small intestine.
This can result in violent vomiting and diarrhea, chronic
nausea, weakenss, sweating, and an inability to eat sweets
without unpleasant or serious consequences.
- Gallstones are formed
when cholesterol and other matter form clumps in the gallbladder.
It appears that the more significant the weight loss, the
greater the likelihood of gallstones. Statistically it appears
that more than 1/3 of bariatric surgery patients develop
gallstones.
- Weakening of bone and/or
Metabolic Bone Disease can be the result of decreased
absorption of calcium.
- Anemia may result from
malabsorption of vitamin B12 and iron, particularly in menstruating
women.
Childbearing is not recommended
for women who have undergone bariatric surgery and many develop
residual hair loss and skin problems.
No, I haven't spoken much about
the bariatric "success" stories. It's not because I'm biased,
but rather because I seek to provide balance. Much of the
information the general public comes across is skewed toward
marketing, and when surgery is advertised, of course the risks
will be downplayed. I don't want you to blindly believe bariatric
surgery is a miracle cure. In fact, it appears that significant
weight loss is only achieved in 30% of patients. It's also
important to note that the average weight loss is only 20%-30%
of the pre-surgery body weight, and the surgery doesn't allow
the metabolism or digestive system to operate optimally. After
5 years, a majority of patients have a significant weight
regain and feel helpless since their options are near exhausted.
They are inclined to seek out additional surgical procedures
with even greater risk.
Then there's the cost issue. Based
on the random numbers I compiled, averages run near $20,000
for a Bariatric procedure.
I should also mention that in speaking
to more than a dozen bariatric surgeons from different parts
of the United States, every one told me that their surgical
patients had all been through 10-20 years of dieting. By now
you should understand, consistent bouts with calorie deprivation
guarantee a slower metabolism, greater propensity for fat
storage, and a far greater challenge in shedding fat in the
future. If these patients were taught to eat supportively
and to exercise in a harmony with their healthful nutrition
regimen, I strongly believe many could move past the desperation
that leads them to face the surgical risks in the hope of
being 'rescued."
While I promised I would keep the
identities of the bariatric patients I spoke to confidential,
I don't believe I'd be violating any confidence if I shared
the following:
While several said life was better
after the post surgery weight loss, not one of them felt they
could live the normal life they'd hoped for. They all felt
they had to constantly watch what they put in their mouth.
They all feared regaining the weight. Many were confused by
all the nutritional supplements they were encouraged to take,
some found it difficult to get down the oversized pills, and
many frequently found themselves with abdominal pain, low
energy, and bouts of nausea.
Even some of the patients who were
satisfied with the result and expressed that they were happier
since the surgery had suffered undesirable effects such as
hair loss, bad breath, gum and dental issues, and violent
vomiting if they took in more food than was recommended.
I don't want to make this surgery
sound as if it's a crime. It isn't, and in some cases it can
be lifesaving. As with all drastic measures, the importance
lies in screening, and in making the decision to proceed based
solely upon it being the best option for the patient. In cases
where "morbidly obese" (a terrible terminology, but one used
by the Bariatric community) individuals are suffering life
threatening ailments, or have lost quality of life due to
debilitation that can be directly linked to excess bodyweight,
the risks of surgery might be minimal when weighed against
the risks of continuing to self destruct. It has been clearly
demonstrated that weight loss in the obese can have a very
beneficial effect in cases of hypertension, diabetes, and
elevated cholesterol levels. The crime begins when surgeons
in quest of profits make exceptions in order to perform greater
volume of surgeries. If presently, the American Society for
Bariatric Surgery recommends that this type of surgery should
only be considered for those who are more than 100 pounds
overweight or have a BMI (Body Mass Index) over 40 kgs/(m)2
(body weight in kilograms / height in meters, squared), there
should be serious consequences for those who have a financial
investment in bariatric procedures who market the surgeries
to non-candidates, and especially for those who actually conduct
surgery when it is fact contraindicated. Of course, I am veering
off here into the land of my opinion, but that is my passionate
opinion based upon a high level of interaction with individuals
who feel as if they've been wronged, who suffer a very poor
quality of life, and who turn to desperate procedures ranging
from abusing medications to pursuing continuous risky surgeries,
only because they've been guided by misinformation and disinformation.
If you're considering Weight Loss
Surgery, I'd encourage you to print this and bring it to your
surgeon, and at the very least, have him (or her) address
these issues one at a time. Only with complete education can
you make a wise decision. Remember, you only have one body.
There aren't always second chances.
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