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 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.
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.Share on Facebook