Sunday, June 28, 2015

Is Gastric Bypass the Right Choice?

Bariatric surgery, including gastric bypass surgery, has become a popular remedy for obesity in this country.  Hospitals have weighed in on this issue and are marketing this service directly to the public who are ever willing customers of this slenderizing surgery.  I have many patients who have undergone the procedure and the results have been variable.   It’s too dismissive for me to refer to gastrointestinal bypass (GIB) as a ‘procedure’ as it is major surgery with major potential complications.  There are several types of bariatric surgery available today, but GIB is the standard surgery performed.

It profoundly reroutes the guts and changes every day of your life.  This is not like undergoing a heart bypass surgery when after a period of recovery you resume your normal life.  After GIB, there is no normal life afterwards.  Your life is irrevocably altered.  Meals are such a significant and personal part of our lives.  Think of all of life’s celebrations and you will recognize that food is a part of them.

Scale from Ancient Egypt

I point out these strong caveats to remind folks that the decision to proceed with GIB is not a casual one.  It requires careful deliberation and an understanding of the lifelong changes that one is committing to.  In addition, this operation is no quick-fix cure.  A patient who is a food addict, for example, will regain the lost weight after surgery, a sad and predictable outcome.  This is why high quality bariatric programs screen patients very carefully psychologically.   If a program accepts nearly all applicants, then one must wonder about the quality of the institution.

Personally, I feel that bariatric programs pull the trigger too quickly and that the public is too willing to serve as targets.  These surgeries, which should be regarded as last resort rescues are increasingly offered as front line therapies.  Eligible patients are rightfully told that GIB weight loss can melt away diabetes, sleep apnea and hypertension.

Before consenting or seeking GIB, have all other methods of weight loss been exhausted?  Has the individual received intensive dietary and nutritional counseling from weight loss professionals?  Has there been an adequate system of coaching and accountability?   Quitting a diet or two after a few weeks does not constitute exhausting all efforts.  I think that the existence and marketing of bariatric programs has influenced patients to leapfrog over conventional weight loss programs directly to the operating table.

I absolutely believe there is an important role for bariatric surgeries.  I am less sure that we are performing these surgeries only when they are the most appropriate option.  It's weighty issue for sure.  Feel free to weigh in yourself.


Jessica Brown said...

Awesome news! Thanks for all your hard work!

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Jeff Herschler said...

I completely agree. If anything your concerns are not stated strongly enough. Leapfrogging conventional weight loss techniques is contrary to the Triple Aim. An analogy might be an alcoholic who undergoes liver transplant. The new liver will surely be ruined like the last one if the patient has not learned to control his/her alcohol consumption. In the same way, an irresponsibly promoted Bariatric Surgery program will treat the symptom (obesity) without treating the underlying causes (poor diet, lack of excercise and food addiction). The outcomes will be poor, the cost exorbitant.

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