Common Questions Before Bariatric Surgery

Bariatric Surgery: Separating Fact from Fiction

It starts soon after you announce that you are thinking about having weight loss surgery. A friend calls to relate a horror story she read in a supermarket tabloid, another tells you about a celebrity who regained all the weight she lost plus more. Family members quote horrifying pseudo-statistics about mortality rates and talk about the potential for painful complications.

With all of this resistance, it is only natural for you to begin doubting whether bariatric surgery is a good choice.

To help you find your way through the jungle of misconceptions and myths regarding bariatric surgery, we’ve decided to address some of the most common questions that come up before or after surgery. While this is not designed to replace a serious discussion with your personal physician and your surgeon, we hope it helps make your decision a little easier.

Isn’t Bariatric Surgery Taking The “Easy Way Out?”

Almost every person who has decided to undergo bariatric surgery has first struggled through various diets and exercise programs with varying levels of temporary success. It is only after years of futility and frustration that most people even start to work up the courage to have their guts rearranged.

In addition to the fear of pain and concern about complications that comes with facing any form of surgery, some people also bear an unfair burden of shame when they consider having weight loss surgery. They buy in to the false argument that they were too weak to succeed losing weight by “conventional means.”

An increasing body of research indicates this is not the case. In fact, numerous studies continue to show lifestyle and behavioral modification are often not enough to help obese individuals lose a significant amount of weight and keep it off.

A 2015 paper published in the journal Lancet Diabetes & Endocrinology is one of the growing number of scientific articles to make the case that obesity is not just a result of sedentary behavior and poor eating habits but is actually a serious chronic disease that can be traced to biological causes.

The lead author of the paper, Dr. Christopher Ochner, Assistant Professor of Pediatrics and Psychiatry at the Icahn School of Medicine at Mount Sinai, has pointed out that while lifestyle modifications may help overweight individuals lose weight, the bodies of those who are obese seem work in a manner that defends the excess pounds against all efforts to get rid of them.

Dr. Ochner and his team came to the conclusion that people who suffer from obesity are biologically different from people who have never had obesity. They suggested we alter our perception of obesity as weakness and understand it bears certain similarities to addictions; some patients can overcome it but it cannot be cured by diet, exercise or self-discipline alone.

This why bariatric surgeons and dieticians stress that weight loss surgery is not, by itself, a solution but it a tool.

Once you receive this tool, there is no guarantee you are going to use it well. People who successfully lose a substantial amount of weight after bariatric surgery and retain most of that weight loss, would not call the process an easy one. Those who succeed embark on a lifelong journey. Each day of that journey requires meticulous attention to meeting their daily nutritional requirements, reaching their exercise goals, monitoring the supplements they have to take and dealing with the inevitable setbacks that are part of being human.

Fortunately, many people do put in the time and effort after surgery and do achieve a measure of success. Studies show the odds of achieving substantial and sustainable weight loss after bariatric surgery are about 1 in 4, in contrast to an estimated 1 in 20 for diet and exercise alone.

We do not believe weight loss surgery is the “easy way out” for people struggling with obesity but, for many of them; it may be the most effective ways out.

Isn’t It True That More People Die From Bariatric Surgery Than Die From Obesity?

The American Society for Metabolic and Bariatric Surgery database tracks nearly 60,000 bariatric patients. Data from this source shows the risk of death within 30 days of having weight loss surgery breaks down to approximately 1 in every 1,000 surgeries. This rate is significantly lower than mortality rates reported during and after gallbladder and hip replacement surgery.

However, other sources report higher bariatric surgery mortality rates depending on the type of surgery performed. While adjustable gastric banding has a very low mortality rate, there is a 30 to 50 percent chance that a second operation will have to be performed to adjust the band. Some studies on one of the most popular and effective forms of weight loss surgery, Roux-en-Y gastric bypass, report mortality rates ranging from 2 in 1000 to as high as 5 in 1000 within 30 days of surgery. The recent development of less intrusive mini-gastric bypass procedures is expected to lower that risk though we presently don't have enough reliable data to confirm that expectation.

Biliopancreatic Diversion with Duodenal Switch is often considered one of the most potent surgeries for large-scale weight loss, however it also the most complex. Statistics on this more invasive procedure indicate mortality rates as high as 1.1 percent (about 1 in 100) 30 days after surgery. While it is true there is a small amount risk in every form of weight loss surgery, severe obesity may be even riskier.

Scholars at Columbia University's Mailman School of Public Health have determined that 18.2% of all deaths in the United States between 1986 through 2006 were associated with causes brought on by being overweight or obese.

Having weight loss surgery and adopting a healthy post-surgery lifestyle can not only improve the quality of life for an obese person, statistics indicate it may extend it.

Data from several large studies show up to an 89 percent reduction in mortality for bariatric patients over time when compared to individuals with severe obesity who never had the surgery. When we look at these numbers by condition, the numbers are pretty impressive.

• Cancer mortality is about 60 percent less for bariatric patients.
• Death associated with diabetes is reduced by approximately 90 percent.
• The risk of death by heart disease is more than 50 percent less in bariatric patients when compared to those who remain severely obese.

When weighing risk versus reward, the potential rewards may outweigh the risk of the surgery, particularly for those who are morbidly obese. That said, we still strongly recommend discussing your decision to have surgery with your personal physician, your family members, loved ones and your surgeon before taking the leap.

Don’t Most People Regain The Weight They Lose After Bariatric Surgery?

While it is true some people regain all of their lost weight or more in the years after having bariatric surgery, reports of success and failure vary. And ultimately, success rates are within your control based on commitment.

For instance, research published in American Medical Association's journal JAMA Surgery reported five years after laparoscopic sleeve gastrectomy almost half of patients regained a significant amount of the weight they originally lost.

On the hand, a study published by the U.S. National Library of Medicine and the National Institutes of Health reported the long-term success rate of those who had the exact same form of weight loss surgery as a weight loss of over 50% that was maintained for six years or more. They did note that some weight gain occurred during the third and sixth year after surgery but the researchers concluded regular follow-up visits would probably prevent this weight regain from happening.

The deeper you delve into the medical literature on this topic, the more contradictions raise their tousled heads.

We believe the answer can be found in the difficult road patients encounter after their procedures. For most of them, the first year can be amazing. Some bariatric patients call this “the honeymoon period.” During this time it is easy to maintain discipline. Impressive weight loss encourages them to stick to their plan. After many forms of weight loss surgery, the patient can only tolerate small amounts of food yet hunger is not a major issue. After gastric bypass and other malaborptive surgeries, there is even the harsh penalty of extreme nausea, rapid heartbeat and other unpleasantness known as “dumping syndrome” to help remind a person that sugar or strarchy treats might not be such a good idea anymore.

As time goes on, some people can't resist the urge to push the boundaries. A little cheat here, a little discomfort there, a little bigger cheat the next time and the pouch eventually expands allowing one to tolerate more food. The digestive system adjusts to allow more unhealthy food and the urge to push against the boundary becomes even stronger until the shadow of failure becomes a solid presence.

Of course, this conjecture does not apply in all cases. Each person's journey is different and each reason for weight gain is also different. This all goes back to our answer to the first question. Weight loss surgery is not magic, it requires hard work. To succeed you need to develop a whole new healthy lifestyle. This means learning new ways to eat, developing regular exercise habits, religiously taking your nutritional supplements, joining a formal or an informal support group and always keeping your eye on your goals.

Here at Bariatric Choice, we’re committed to help you reach your weight loss goal and maintain your healthier body for life. That is one of the reasons we have recently created a new line of Bariatric Choice products formulated specifically for bariatric patients in addition to our wide selection of foods and supplements from the brands known and trusted by both doctors and patients.

From high protein shakes to healthy snacks, you can trust the Bariatric Choice brand to combine quality and value making your journey to a healthier lifestyle a little more pleasant and a lot more affordable.