Bariatric Surgery: Cuts Both Ways

It is estimated that, as of 2008, 1.4 billion adults are overweight or obese worldwide. In a sub-category, approximately 10 million Americans are morbidly obese. To be clear, morbid obesity is generally defined as “100 pounds or more over an individual’s ideal weight range, hav[ing] a BMI greater than 40, or a BMI greater than 35 in addition to serious medical comorbidities.” (1)

What is bariatric surgery? Bariatric surgery is currently touted as the most effective medical intervention for those who are morbidly obese. Effective, meaning that the surgeries produce the most weight loss over a long period of time.

There are currently three different mechanisms of action that the surgeries induce:

  1. Malabsorptive (nutrients are intentionally not completely absorbed from the stomach and intestine)—biliopancreatic diversion ± duodenal switch
  2. Restrictive (limited amount of food is allowed into the small pouch the doctors create)—vertical banded gastroplastyadjustable gastric banding; gastric sleeve
  3. Hybrid of malabsorption and restriction—roux-en-y gastric bypass

So you might be wondering why I’m telling you all of this, and linking you to various semi-gross pictures—am I right? The reason is because I am not fully supportive of the so-called “most effective” treatment of morbid obesity, despite (or perhaps, due to) the fact that I am in graduate school for nutrition. Don’t get me wrong; I believe that obesity is a significant medical problem and needs to be treated. But I’m not sure that slicing and dicing up the gastrointestinal tract is the way to go.

While there is initial rapid weight loss, this is largely due to controlled starvation in which patients basically survive off of protein shakes and vitamins for the first three months. Most people cannot conceive of a meal being several tablespoons of food. However, if patients eat more than that amount after surgery, they’ll make themselves sick. If patients don’t hydrate well, or eat something they shouldn’t have, then they’ll end up back in the hospital. Patients are signing up for a lifetime of controlled malnutrition, because there’s no reversing the surgery once it’s done.

In the long-term, we really don’t know how these patients are going to do with the current drastic surgery methods. All we do know is that for the rest of their lives they will have to be on vitamins that are specific to bariatric surgery patients. Furthermore, there is a problem with changing the food behaviors along with the routing of the gastrointestinal system. There is rarely adequate behavioral and nutritional support after the surgery, and patients will often return back to an environment that is not conducive to their success and gain the weight back.

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All I’m saying is that there needs to be more research done before recommending such an invasive and drastic surgery for medically at-risk patients. Yes, I am aware of the multiple and severe medical issues that accompany morbid obesity. But I am not convinced that these surgeries are the way to go. They smack of too much of a “pop a pill” solution to me, instead of the long-term health that is sustainable throughout a life time.

What are your thoughts on bariatric surgery? Tweet us @litdarling!

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(1) Escott-Stump, Sylvia. Nutrition and diagnosis-related care. Lippincott Williams & Wilkins, 2008.

View Comments (2)
  • oh dear. honey, i get you want to be a nutritionist and are working your way there- i even understand that you have dealt with eating disorders in your life and i commend you on recovery. that said, if you have never been an obese or morbidly or even super morbidly obese person your opinions and warnings are invalid to me. you’re entitled to have them, but i would rather have this discussion and learn from someone who has experienced being overweight to a major extent or who has worked for more than 10 years in the bariatric field. i appreciate your concerns, but it seems more like concern trolling to get paid for an article. thank you but no thank you.

  • Thanks Rae for posting, I’m glad someone said it! It’s also untrue that the surgeries are irreversible, I know a good amount of people who have had the lap-band reversed and a few more who have had the gastric bypass reversed as well. Know your info.

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