December 15th, 2017

Bariatric surgery: poorly understood, highly effective

We don’t understand much about why bariatric (weight-loss) surgery works, but it does. It’s actually highly effective at helping the obese to lose weight where conventional methods such as dieting and exercise fail. Not only that, but the weight tends to stay off:

The public, on the other hand, generally believes obesity is caused by a lack of willpower, and that it can be fixed with gym memberships and trendy diets. In one 2016 survey of more than 1,500 Americans, 60 percent of the participants said dieting and exercise were even more effective than surgery for long-term weight loss.

Here’s the thing, though: Weight loss surgery is far and away medicine’s best treatment for severe obesity.

The medical case for bariatric surgery has grown much stronger in recent years. High-quality studies on the long-term health outcomes of people with obesity who got surgery show, on average, that they’re able to lose dramatic amounts of weight, and even reverse or prevent their obesity-related health conditions, like diabetes and high cholesterol. A new study out in JAMA Surgery demonstrated this once again.

It doesn’t really surprise me. Bariatric surgery seems like a big deal, and the complications loom large in people’s minds although apparently the health risks for the obese who would qualify for the surgery are greater if they remain obese. But the idea of changing the anatomy of your digestive system is such a drastic one that it gives people pause, and they’re been told for so long that it’s just a matter of willpower to lose weight by dieting that they believe if they only were strong-willed enough it would finally work.

Bariatric surgery must feel like a desperation move, and I think it is. But it usually works wonders.

Here’s more:

The majority of bariatric procedures in America today involve the gastric sleeve and the Roux-en-Y gastric bypass….

With the sleeve, which now makes up more than 50 percent of weight loss surgeries in the US, surgeons staple off and remove about 80 percent of the stomach, transforming the organ from a wide football shape into a slim banana (or sleeve) shape….

With the gastric bypass, surgeons use staples to make the stomach smaller by creating a small pouch, which can only hold about an ounce (or walnut’s worth) of food. Next, they reconnect the small intestine to a hole in the new pouch, so food flows into the pouch, bypassing most of the stomach, and then into the latter part of the small intestine, bypassing the first half of the intestine…

But an additional reason both the sleeve and gastric bypass surgeries lead to long-term weight loss is likely because of the changes in hormones that occur after these procedures. The sleeve, and especially the bypass, seems to suppress hormones that affect hunger and satiety, like the “hunger hormone” ghrelin — something no diet will ever do.

Eating is an emotional activity, and it’s instructive to see (for example, I’ve watched some TV programs that follow people who’ve had the surgery) how difficult the post-surgery adjustment period can be. What they’ve experienced all their lives—how they feel when they eat and how much food they can take in—has changed dramatically, often to the point that they feel no hunger at all and have to be forced to eat, and feel full after just a couple of bites. There’s nothing normal about it, and yet usually they adjust and later are able to eat more, and appreciate being freed of the burden of the fat they’ve lost.

Those of us who are fortunate enough to have only ten or fifteen pounds we perennially want to lose (me), and who don’t eat all that much to begin with (me again), and who have always had a setpoint higher than their desired one (yep, me), are well aware of how vigorously the body defends a certain weight almost no matter what we do. These surgeries (which are not available to someone like me) seem to work to change that setpoint:

In a 2014 study, published in the journal Obesity, researchers compared participants from the Biggest Loser reality TV show who had gone on crash diets and exercise programs to rapidly lose as much weight as possible to people who had gastric bypass surgery….The bypass surgery patients saw their metabolisms normalize within a year, to a rate that matched their new body size, while the TV show contestants saw their metabolisms slow down and stay that way — even six years after losing the weight and, on average, regaining much of it back.

Researchers suspect this is because surgery may reset the “set point,” or the body’s habit of vigorously defending a certain weight range. Once a person gains weight and keeps that weight on for a period of time, the body gets used to its new, larger size. When a person loses weight, a bunch of subtle changes kick in — to the hormone levels, the brain — increasing appetite and slowing the metabolism, all in a seeming conspiracy to get back up to that set point weight.

Amazingly, surgery seems to lower the set point, and even weaken the body’s desire to defend it. And that seems to make keeping weight off a little easier.

Insurance pays for surgery for those who need it, but few who need it seek it and have it. But can you imagine the effect on the health care system if all 20 million people started demanding the surgery and insurance had to pay for it? On the other hand, it might save at least some costs down the line, if the positive effects on health are really that dramatic.

11 Responses to “Bariatric surgery: poorly understood, highly effective”

  1. Doug Purdie Says:

    Gastric Sleeve worked wonders for my wife. She lost 106 lbs. 9 months after surgery, gained back 6 lbs. in the next 3 months but has remained steady for the most recent 9 months. A consistent exercise program helped. Do not dismiss the need to exercise.
    She reports that her tastes have changed also. She actually likes carrots now! Must be because of the hormones no longer secreted by the 70% of her stomach that was removed.
    She was miserable for two months after surgery, though. Over-eating becomes way too easy when the stomach is only the size of an egg. She had to re-learn how to eat. She had to discover which foods would cause problems and which would not. She mourned the old times when she could stuff her face with ice cream and popcorn, but she got through it with great support from her doctors, friends and family. I strongly recommend setting up a network of support before surgery. Kaiser holds support/peer group meetings for people who had the surgery and for people who are considering the surgery.
    But, since those initial two months, her happiness has skyrocketed and by extension mine. She’s way more active now. She goes on hikes with me and leaves me in the dust and I’m a former cross-country runner.
    Thank You for this post and Merry Christmas to you and yours.

  2. Ymar Sakar Says:

    The stomach, heart, and lower spine is its own neural network. What some call a second or tertiary brain.

    This kind of surgery is closer to a lobotomy, in terms of behavioral change.

    The ancient or traditional method for this issue is fasting, with or without water. For 1 day, increasing to 3 days, then 7 days, with pauses in between to rebalance the nutrition content of the body cells. The common sense conception is that the body needs a constant stream of nutrients from digestion, but the amount of energy and toxins produced by the digestive process is huge. Fat and internal energy is better to metabolize instead, since the liver has already purified it. The time it takes for me to stop eating and no longer feel hunger is about 18-24 hours. YMMV due to metabolic differences.

    Humans are weak and have been taught to be the slaves of their body, rather than the masters of this vehicle, machine, avatar.

    More advanced applications involve Eastern methods such as yoga, Tai Chi, or Nikola Tesla’s research.

    After about 2.5 days, absorbing energy from the EM field of the sunlight, becomes feasible. Something Tesla once claimed, but I had to look up to verify my experimental data. It would easily explain how the ancients could fast for 40 days and not die or faint.

    It is very strange to wake up and no longer want to eat anything for the entire day. Then feel the exact same thing later. Without the body’s need to subsist on food from the earth, it has to obtain energy from other sources. This is an entirely different ATP conversion process. It may not even be an ATP cellular chemical process at all.

    The weird part is in the heightened mental perception area of effect, and the lack of physical fatigue.

    What the doctors know about the human system is only the tip of the iceberg, and that is being optimistic.

  3. vanderleun Says:

    “On the other hand, it might save at least some costs down the line, if the positive effects on health are really that dramatic.”

    That’s ye olde “If it saves one life, it’s worth it” concept dressed up in somewhat less rosy colors. Still, it has always seemed to me to be a false concept — unless it is your life or the life of someone you love.

    Hence, it’s popularity exceeds its actual truth. But isn’t it that way with so much of life these days?

  4. Ymar Sakar Says:

    Other data has transplant subjects adopting the tastes, thoughts, or feelings of their donors in the case of organ replacements.

    This would be because the neural network was transplanted and not rejected. Much as modern devices store data in numerous hard drives and solid state drives, this machine people call the mortal body also has redundancies and removable drives.

    Quantum neural science has a different problem with the brain, in that the brain does not have enough data storage for all of our memories. This would easily be explained if the brain was a radio, a wifi relay, and not the hard drive and CPU itself. It is merely the avatar, the actual controller is somewhere else “logged in” at the access point. Destroy the brain and the patient goes comatose, flatlines, and dies. Destroy the radio, and you don’t hear the music.

  5. neo-neocon Says:


    Actually, you misunderstood what I was saying. I was speaking of aggregate costs for the entire group.

    In other words, let’s say a certain number of people (a million, for example) get the surgery. Let’s say it costs insurance $30,000 each (I have no idea how much it actually costs). Let’s say they each are saved years of disability, other surgeries, maybe even rehab or a nursing home. That could mean (and again, I have no idea what the figures are) a financial savings overall for the entire group in terms of the total money spent.

    My comment wasn’t the least bit touchy-feely. It was trying to balance the financial costs of doing gastric surgery versus the financial costs of doing nothing.

  6. vanderleun Says:

    Ah yes, now I see what you were trying to say about the realm of could.

  7. TommyJay Says:

    I always groan when I hear some pol claim that we need to cover everyone with mental health insurance, because the aggregate cost could be so high. And the costs might continue to increase as more and more as folks re-define their own tribulations as ailments.

    But with gastric weight loss surgery, it seems likely (to me) that the aggregate up-front costs would be high and that the long term savings would also be high or much higher.

    On the other hand, I remember my fun-loving father who often said, “Boy, I wish I was as slender as that guy. What fun I would have eating my way back up to my weight!” It was sort of a joke, but not entirely. He was never obese, but probably 15 to 30 lbs. overweight most of his life.

    So … If the weight really stayed off, that would be great. But I’m positive that some small minority would act on my father’s joke. I suppose there could mitigating clauses in the insurance to correct for that. Perhaps.

  8. Julia Says:

    One thing left out of the consideration…. I watch My 600 pound life on occasion and the stories deal with people who need to lose weight prior to the surgery. Some have to lose over 100 pounds! So through diet and exercise (a diet that I don’t agree with, but I digress), they lose enough weight to be considered for the surgery.

    That gives me pause. If they can lose 50-100-150 pounds, perhaps they shouldn’t have the surgery? IMO, it’s an incredibly drastic surgery and should be a means of last resort. The show is heavy on human drama, but I have to think that it’s very accurate though. In nearly every show, the weight is more a physical manifestation of emotional issues.

    Not saying I’m against it, but I think as a society we need to talk more about it.

  9. Ymar Sakar Says:

    The very social concept that you have to “lose weight” is its own negative mind control indoctrination system.

    A human has the power to set their own metabolic limits using a physical skill. So long as they obey Society, of course their body and mind and spirit is going to be at war. A house divided.

    Their alpha state mind waves isn’t stable enough with all the negative thoughts associated with “losing weight” and “exercising”.

  10. Gringo Says:

    On the other hand, it might save at least some costs down the line, if the positive effects on health are really that dramatic.

    Not necessarily. People who live longer will have more years to accumulate health care costs. In addition it is not uncommon and maybe even usual to have high health care costs the last 6 years of your life. My father died at age 67 of lung cancer, a consequence of 40 years of smoking- which he stopped 9 years before he died. Judging by his parents and grandparents, he would have lived some 15 years beyond 67 had he not smoked. Even if he hadn’t smoked, it is quite possible that he would still have had the high health care costs the last 6 months of his life.

  11. Mortimer Says:

    Healthy, active, and athletic, I never had weight issues until well into my 30’s. With a naturally muscular build, I was 175-185 lbs on 5’9″ frame. After getting married, slowly crept up to 220. After moving to a desk job through my 40’s I ended up at 245. No one could guess I weighed that much. I dieted, worked out, got down to 205, felt great. Went back up all the way to 260. In my early 50’s now. Had the sleeve surgery. Down to 178 and feel fantastic. It is very difficult initially but you adapt. No regrets at all. All my numbers are fantastic, blood pressure, cholesterol, all of it!!!

About Me

Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.

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