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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