Carnie Wilson Has 2nd Bariatric Surgery: Is Surgery Ever the Right Choice?

Carnie Wilson made the news this week when she admitted to having her second bariatric surgery.  She had gastric bypass surgery 12 years ago and lost 150 pounds.  We all remember her twirling through the talk show circuit with her transformed body.  Like many people, the weight crept back on over the years. She had two children and struggled to control her weight during and after pregnancy.  After regaining much of the weight, in January of this year, she had adjustable gastric band (e.g., Lapband) surgery.  Although it may seem odd that someone would have bariatric surgery twice, gastric bypass and adjustable band surgeries are actually two very different procedures.

Gastric bypass

Gastric bypass surgery involves surgically creating a small pouch in the stomach and then connecting it directly to the intestines thereby bypassing the remainder of the stomach.  Adjustable band surgery is less invasive, done via laparoscopy, and involves attaching an inflatable device on the top portion of the stomach to create a smaller stomach pouch.  In both surgeries the idea is that a smaller stomach space will fill up with food much more quickly, thereby reducing consumption. Gastric bypass surgery however typically leads to larger weight losses (60% of “excess” weight) than adjustable band (40% “excess” weight).  “Excess” weight is the amount of weight one carries above and beyond what would be considered their normal weight. For example, if you were 100 pounds overweight, a loss of 50 pounds would be a loss of 50% of your excess weight.

Adjustable band

If you have been following my posts you will certainly know that I am a huge proponent of weight loss via lifestyle change.  However, it may surprise you that I am also a strong believer in bariatric surgery, under the appropriate circumstances. Bariatric surgery is not an alternative to lifestyle change, it is a tool to help people become more successful at lifestyle changes.  Bariatric surgery is surgery though and therefore comes with risks.  For that reason, it is only appropriate when the benefits outweigh the risks.  Bariatric surgery may be a good choice in the following circumstances:

1.  You have type 2 diabetes.  If you are obese and have type 2 diabetes, consider that gastric bypass surgery is a cure for type 2 diabetes in 80% of patients.  The effect of the surgery on diabetes is not due to the weight loss because in most cases diabetes resolves long before much weight is lost.  Research suggests that surgery may improve the body’s ability to respond to insulin.  Even if your diabetes is well-controlled, consider that it could be completely resolved once you have the surgery.  Resolving diabetes is no small benefit, diabetes is associated with cardiovascular disease and myriad complications including amputation, blindness, and disability.

2.  If you have had very little success at losing weight on your own and are very limited in your ability to exercise.  If you are unable to exercise due to a chronic condition that is related to your obesity such as significant chronic pain and/or joint problems, losing weight via lifestyle may be difficult, especially if you are over 50 years old.  To really explore whether you can safely exercise, you should see a physical therapist or an exercise physiologist.  If the options for exercise are limited, bariatric surgery might be a choice to consider. By helping you shed a lot of your extra weight, your pain/joint condition may improve thereby allowing you to develop an active lifestyle. That active lifestyle will be key to your success going forward.

3.  If you have multiple other medical conditions that are a result of your obesity or if you have a strong family history of diabetes and other conditions that are a result of obesity.  Obesity in itself is not so much of a health problem, the real problem is that it increases risk for many chronic conditions.  If you are extremely healthy in terms of your blood sugar, cholesterol, waist circumference, and blood pressure, if you have no problems with your joints or chronic pain, and you do not have a family history of these problems, then losing large amounts of weight through surgery will not necessarily have a huge impact on your health.  However, if you and your family are riddled with obesity-related conditions, then your health stands to benefit much more from surgical approaches.

4.  You have a strong feeling that this is the right choice for you.  You shouldn’t feel guilty about the decision to have surgery.  It is not a cop out or a cheat.  Surgery gives people a very helpful jumpstart on weight loss and can make lifestyle changes going forward much easier than they are now by removing significant barriers like pain, diabetes, and other conditions.  If you have a strong feeling that this is the right choice for you and you are prepared for the commitment that it entails then you should definitely explore the option further.

You Should Not Consider Bariatric Surgery if:

1.  If you think it is a magic bullet.  Bariatric surgery is not a magic bullet.  It will help you lose weight for a while but then the onus is right back on you.  Regaining all of the lost weight is very possible and not even that uncommon.  People who do not commit to a healthy lifestyle after the surgery are highly vulnerable to regain.  Unlike diets, regain with surgery is delayed.  On a diet people usually gain weight back within a few weeks or months.  With surgery, people won’t begin to regain the weight until 18 months to 2 years.  People who feel like surgery is a magic bullet will not be prepared for the commitment and will end up on the road to failure.

2.  If you think it will be easy.   Bariatric surgery involves an extensive process of nutrition counseling, temporary liquid diets, and pre- and post-surgery meetings and preparations.  Most clinics will ask that you lose some weight before the surgery, start on a special diet, and exercise.  If you find a clinic that does not ask you to go through multiple steps like this you should find a new clinic.  A good clinic will prepare you for success by giving you the right nutrition, behavioral, and exercise support before and after surgery. If you view these steps as a hassle, then you are not in the right mindset for surgery and will be at high risk of weight regain in the long run.

3.  If it is in the back of your mind that if it doesn’t work you will just try it again.  Even though Carnie Wilson had a second surgery, keep in mind that most people do not.  Many surgeons will not want to do a second surgery for you.  In fact, they may lose hope in you.  Surgeons want to set you up for success. They might not want to take the risk of an additional surgery unless they are very sure you did not squander the results of the first surgery with a blatantly unhealthy lifestyle.  Surgery is an intensive and invasive process, only plan to do it once.

4. You Haven’t Truly Made Committed Attempts to Lose Weight.  One of the criteria to be eligible for surgery is that you have had numerous failed weight loss attempts.  Nearly everyone on the planet meets this criterion, right?!  Well, no.  If you can’t honestly say that you put your heart and soul into previous weight loss attempts, then you aren’t really meeting this criterion.  If your reason for not losing weight in previous attempts was because you were too busy or stressed out to make lifestyle changes, these problems will not go away with surgery.  You will need to make the very same lifestyle changes.  The difference will be that regaining the weight you lost from surgery will be 10 times more demoralizing than it is from a usual diet attempt.  Once again, if you aren’t committed to making lifestyle changes, surgery will not make a long lasting difference.

The decision to have bariatric surgery is a very personal choice.  If you are thinking about it, make an appointment at a surgery center near you to discuss the options.  Also, connect with others who have had the surgery to understand the realities.  The decision to have bariatric surgery involves a full consideration of all the benefits and risks, but the best outcomes will only be achieved by people who are fully committed to a healthy lifestyle.

At the end of the day, that it is the thing that will make or break us all.

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12 Comments

  1. John says:

    Well stated.

    Reply
  2. Hi Sherry,

    First, thank you for your views here. It’s nice to see a health professional focus on the positive choices and results of weight loss surgery. I had RNY Gastric Bypass Surgery four years ago tomorrow (3/25/08) and I have since maintained a loss of 150 lbs and it has entirely changed my life. Because of this surgery, I no longer have gout, sleep apnea, pre-diabetes, hypertension, of PCOS. I am also a professional dancer and choreographer, and I am physically active almost every day. My journey has been chronicled at http://www.youtube.com/divataunia if you are interested.

    I just wanted to point out a few things out:

    “Gastric bypass surgery involves surgically creating a small pouch in the stomach and then connecting it directly to the intestines thereby bypassing the remainder of the stomach. Adjustable band surgery is less invasive, done via laparoscopy, and involves attaching an inflatable device on the top portion of the stomach to create a smaller stomach pouch. ”

    Just to clarify, in most cases, gastric bypass is also done via laparoscopy. Five small incisions were made in my abdomen with my RNY gastric bypass. That paragraphs reads as though only Lap-Band is done that way, so I just wanted to clarify.

    “Bariatric surgery is not an alternative to lifestyle change, it is a tool to help people become more successful at lifestyle changes.”

    THANK YOU. I think this is the misconception on both sides of the fence. At four years out, maintaining my weight is often times a struggle and I work very hard at it. However, this surgery was a tool that made that significantly easier for me in the beginning and continues to help me to this day. It’s never a magic bullet – it’s always hard work, now with assistance that makes it much easier to stay on track.

    “Obesity in itself is not so much of a health problem, the real problem is that it increases risk for many chronic conditions.”

    I believe that this statement is very inaccurate. From the Obesity Action Coaltion (www.obesityaction.org):

    Obesity has been classified as a disease by various medical associations such as the American Medical Association (AMA), the American Society of Bariatric Physicians (ASBP), the North American Association for the Study of Obesity (NAASO) and since 2002, even the Internal Revenue Service (IRS).

    Obesity is a metabolic, chronic and progressive disease with a significant genetic predisposition. Childhood studies conclude obesity to be as high as 70 percent genetic with 30 percent being related to psychosocial and environmental factors. Studies of identical twins separated at birth have shown that they much more closely resemble the weight of their biologic parents than their adoptive parents. Scientists believe there are approximately 1,000 genes related to weight and more than 200 have already been discovered.

    Obesity in fact is a disease, very much like the previously mentioned co-morbid conditions that it can cause and/or make worse. This is because they also are genetic, metabolic, chronic and progressive. However, there are a few notable differences that make it that much more important that we understand how to treat this disease effectively.

    “Many surgeons will not want to do a second surgery for you. In fact, they may lose hope in you. Surgeons want to set you up for success. ”

    I think that’s a pretty damaging statement. Any health professional that “loses hope in you” should NOT be in the health care profession – AT ALL. A health professionals job is not to judge you, it is to heal you and/or keep you healthy. This is just indicative of a bigger problem in our health care system: the need for obesity sensitivity training.

    “The difference will be that regaining the weight you lost from surgery will be 10 times more demoralizing than it is from a usual diet attempt. Once again, if you aren’t committed to making lifestyle changes…”

    Again, I’m surprised by the language you are using here. Demoralizing? This is setting people up for failure. I would hope that in your daily practice you use much less harsh language with your clients.

    Reply
    • Sherry says:

      Hi Diva Taunia, thanks for your comments! And glad to hear that surgery has had such an impact on your health. In terms of your comments about obesity being a disease, I realize that organizations have classified it as such, but what I am saying that it is possible to be obese and metabolically healthy. Such individuals will have less health benefits to gain from surgery. That being said, it might reduce risk for future metabolic dysfunction, but again, some people with obesity do not end up with greater metabolic dysfunction than much thinner people. The decision to have surgery comes back to a balance of the risks and benefits. For such an individual, I would urge them to work with me on lifestyle changes and see how far we could go with that approach.

      In terms of weight regain after surgery being “demoralizing,” what I am referring to is the fact that people often feel much more discouraged after they have gained the weight back after surgery (than they would after a usual weight loss attempt). I think this is because surgery often feels to people like their last hope effort–and if it doesn’t work, then nothing will. Of course I do not believe this and I would work with them on lifestyle changes and also figuring out what went wrong. I am not against a second surgery at all, it is just that my experience with bariatric surgeons is that they are very hesitant to do it. This is probably why so few are done. When I said the surgeon might “lose hope” I was just referring to the fact that the medical team really does expect the patient to do their part. It is so important to the treatment team that the patient is set up for a good outcome. Few professionals would kick you out the door, but they might hesitate on a second surgery until you’ve worked with behavioral and nutrition folks to really figure out what happened and how it will be different the second time around. I should have elaborated on this point!

      I should also mention that I do work in a clinic that includes both bariatric and lifestyle interventions for obesity.

      Anyway, thanks for all your comments! I find there is a lot of negativity about surgery, as though it is somehow a cop out, and it is most definitely not. We have had numerous patients like you, who have achieved enormous benefits to their health. These are far more the rule than the exception. I wanted to address surgery on my blog (which is so heavily focused on lifestyle changes) so that it is very clear to readers that I am a proponent of bariatric surgery as the right choice for many people.

      Thanks again!

      Sherry

      Reply
  3. Oops – hit submit too soon.

    Overall, I think you did a nice job with this article, and I want to thank you. I work pretty tirelessly for this cause, so I couldn’t have passed on by without commenting on what I did. :)

    Many thanks, and I hope that my comments are taken in the constructive way that they were meant. Discussion helps move things forward in a positive way, and I appreciate the article and your efforts!

    Cheers,
    Taunia

    Reply
  4. Anoop says:

    Very good post, Sherri!

    From what I have read, surgery somehow changes your gut physiology. It is somehow resetting your genes.

    Reply
  5. Kelly L says:

    Obesity is a metabolic disease. The duodenal switch, the most effective bariatric surgery available, fixes insulin resistance and provides a 90-98% CURE rate for type II diabetes where other bariatric surgery types only provide a remission. The intestinal portion of the DS has been given to normal weight individuals for years in Europe as a cure for diabetes.
    http://www.ncbi.nlm.nih.gov/pubmed/15760494
    Why weight loss surgery sometimes fails:
    http://vimeo.com/25570146

    Reply
  6. Sandra says:

    I can feel for Carnie and her weight gain. Fortunately I had RNY surgery far after my years of child bearing ( age 46) so of the 140 pounds I dropped ( 328 to 188) I have kept it off except for a 10 pound yo yo that makes me pretty crazy. Anyone who thinks that bariatric surgery will cure them is dead wrong. It is just another tool when your health is being threatened by your inability to lose weight. I have a family tendency towards diabetes although I have not had it, but I did have high BP and a decade of inability to lose weight despite supervised medical attempts to lose weight. ( I lost weight but not enough to remove me from morbid obesity). Surgery was a Godsend but even after surgery many folks are able to eat things that are just not healthy (myself included) . I just have to tell myself how unhealthy these things are to leave them alone, and remind myself that the hiking trips to do 14ers are much better than eating sugary treats and starchy foods daily. Good luck to Carnie and anyone else struggling with this.

    Reply
  7. Meg Bressette says:

    I had surgery in 2005 (not bariatric) that was done by the one of the top Bariatric Surgeons in Boston at the time. That surgery forever changed my life and I am asked every single time I am admitted to the hospital if I had Gastric Bypass because my condition is one that is often seen after that surgery. I lost 100 lbs (over 60 lbs in 6 weeks after surgery) and if I am not really careful I can drop 10 lbs now without even trying which I know sounds like a dream but isn’t as it has damaged my heart. I am now completely housebound, unable to exercise much (I do tai chi & meditate daily) and can no longer eat foods that have high fiber, lose electrolytes easily and get injections of B-12. Just recently it was noted that I have an extremely low Vitamin D level and my blood glucose is now elevated (no Diabetes in family).

    I like that you talk about Obesity honestly (I was heavy when this surgery was done and couldn’t seem to lose weight – I’d lose 25 lbs and then stall out no matter what). I wish you had discussed the very real, significant side effects or in my case & many others the life changing results that surgery can have on your life.

    Reply
  8. Carlos says:

    The option of undergoing Gastric Bypass surgery Los Angeles is not
    the solution for those kind of people. If you are not in the pink of health, then weight loss surgery is obviously not for
    you as you may not only fail in losing weight but ended up
    losing your life as well. All studies show the positive effects of bariatric surgery and could help type 2 diabetes and obese patients receive free insurance coverage for weight loss surgery.

    Reply
  9. Karen says:

    Question: I know that Medicare will cover a Rouxen-Y gastric bypass. I had one in 2004 and have gained back a little over 100 pounds. I did not have Medicare in 2004. I am disabled due to numerous back problems, am pre-diabetic, and am possibly facing knee replacement surgery. I am 58 years old but feel 98! Does anyone know if Medicare will cover any other or just this surgery I previously had. I felt so much better in 2004 after my weight loss! I want to feel better and be healthy again! Answers anyone?? Thank you!

    Reply

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