General Question

Charles's avatar

Is bariatric surgery the most successful way to keep weight off?

Asked by Charles (4786 points ) April 14th, 2012

The sleeve, gastric bypass, the band, etc. Do people who have these procedures have a higher rate of keeping weight off compared to dieters? Supposedly, 80%-95% of people who try to lose weight with diets fail to keep most of the weight off long term. Supposedly, the numbers are about opposite for weight loss surgery. A lot of people will concede ”...for extremely obese people…who have exhausted all other means to lose weight…” weight loss surgery is acceptable. But, why not for people who are only 50 pounds overweight? Why do people have to be 40+ BMI or (35 BMI plus one pre-morbidity) to do the weight loss surgery thing? It works, why not?

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36 Answers

Judi's avatar

There are a lot of risks. I think (could be wrong) that 1 in 100 die from gastric bypass. It is not reversible.
The Lap band (I believe) is less dangerous, but they are still pretty picky about who gets it. I’m not sure why.
I know that many patients gain the weight back anyway. You still have to change your habits even if you have the surgery. I have a friend who got the lap band and said “but I can still eat fudge!” She wasn’t real successful.

Charles's avatar

My understanding is, yes, they can eat fudge, and yes their habits have to change but the big difference is the habits change not because of willpower but because those surgeries supposedly make it physically impossible to overeat.

Judi's avatar

But they eventually adapt. They stretch their stomachs back out.
If something happens in bypass they can end up dying from malnutrition because they bypass to much of the parts that absorb nutrition.

Aethelflaed's avatar

Almost everyone who gets any bariatric surgery is also a dieter. The surgery is far too expensive for most people to afford out of pocket, so they have to go through insurance. Going through insurance means they have to provide detailed records of trying to lose the weight via dieting and exercise, have a therapist sign off on the procedure and the patient’s mental health, and many more hoops. And insurance won’t pay for a procedure they don’t absolutely have to.

Charles's avatar

The sleeve (VSG) has become very popular because supposedly it doesn’t allow the stomach to stretch. Something about 80% of the stomach is removed, that part of the stomach that stretches. The part of the stomach that remains (the 20%) doesn’t (can’t) stretch.

Linda_Owl's avatar

Many who have bariatric surgery do regain the weight. It takes a total mind-set change in order to keep the weight off. Many who do manage to keep the weight off are left with sagging skin if they were obese when they had the surgery & this sagging skin does not go away without plastic surgery. Having the bariatric surgery is a Catch-22 situation.

Charles's avatar

“Many who have bariatric surgery do regain the weight..” I guess it depends how many “many” is. As a percentage, I understand it to be a lot less than dieting alone.
It may take a mind set but taking a mind set is probably a lot easier when you’d be in severe pain if you ate too much.

I don’t understand why more people aren’t opting for WLS seeing that just about every other method (which is basically dieting or “changing your eating habits” (whatever that means) fails about 90% of the time.

Aethelflaed's avatar

@Charles Because they can’t afford it.

Seaofclouds's avatar

Bariatric surgery is not a guaranteed fix it. There are major health side effects that come along with the surgery. The people that undergo this surgery have to be very mindful of their nutritional status. Our stomachs play an important role in absorption of nutrients and bypassing that area can lead to malnutrition in a lot of the patients that have the surgery. There are risks up to and including death from the surgery.

The reason doctors limit who they recommend the surgery to is because they look at the risks vs the benefits and for some, the risks are too great. I know many people that would have loved to have the surgery, but their doctor’s would not let them because of their risks.

Another thing to look at is when a patient is unable to make lifestyle changes necessary to help lose weight (such as healthier eating and increased physical activity) before the surgery, they are very likely to be unable to make those changes after surgery as well. Bariatric surgery is only successful in the long term when the patient is able to make the necessary lifestyle changes in addition to getting through the surgery.

The absolute best way for weight loss and to keep the weight off once it is gone is to make lifestyle modifications. Anyone in the process of trying to lose weight should be seeing their doctor so they can know if there is more going on that can interfere with their weight loss (such as hypothyroidism and other medical conditions). With treatment of their medical issues, they should be able to be successful with the lifestyle changes.

Ponderer983's avatar

The best to keep weight off is to change your lifestyle. Surgery is a quick and easy fix, but not lifetime guaranteed. I know a guy who was 400 lbs and got it done. He lost a lot of weight, but never change his lifestyle. He is now bigger than he was before the surgery. I am heavy and I just had a conversation with my doctor about going on a doctor supervised weight loss program. I told him I don’t want the surgery because I want to change my life (I do qualify to have it done). But you have to come to the decision to change your life.

janbb's avatar

A friend of mine had it done and went from 395 pounds to 175. It was done 10 years ago and he has kept the weight off; he is very careful about what he eats. He does still have saggy skin though.

Charles's avatar

“Bariatric surgery is not a guaranteed fix it.”

It apparently has a lot higher guarantees than diet and exercise and the ubiquitous “change your habits”

Charles's avatar

“The best to keep weight off is to change your lifestyle.” The best way to win the lottery is to pick the right numbers – too bad in both cases the percent of people who succeed is pretty low.

Charles's avatar

“Because they can’t afford it.” For the price of a used car a lot of people could rid themselves of one the biggest causes of depression and health problems.

jca's avatar

I had the sleeve 11 months ago and have lost over 100 lbs since. I had no comorbities but I did qualify by my weight. I have had zero complications and I recommend weight loss surgery to people who need to lose a lot of weight. Insurance companies will pay for it if you qualify, because the surgery is equivalent to two years of treating a diabetic patient (this is what one of our politicians who also had it found out from our insurance company). So if I were to become diabetic, two years of that would be equivalent to what the surgery costs (about 30k total plus the pre-qualifying appointments).

I had a coworker who had the sleeve and he was very successful. I started thinking if he can do it, anybody can. I thought about myself and my friends who are obese and how we constantly talked about losing weight, or did yo-you dieting and gained it back.

I know people who have gained it back from the bypass but not the sleeve. My surgeon has several nutritionists on staff, and they suggest seeing the nutritionists from time to time, especially if you gain a few pounds, to get back on track. They also have pre and post op support groups, which are helpful.

I would guess that the death rate is lower than 1 in 100, but whatever it may be, the people that die from the surgery probably had other complications, like diabetes or major heart issues.

As far as hanging skin goes, I don’t have any but I think even if I did, that would be a small price to pay compared to a lifetime of obesity and resulting diseases. Is it better to be blown up like a balloon, with diseases and joint problems, and die an early death, or thinner and healthier with some excess skin?

Aethelflaed's avatar

@Charles “The price of a used car”? Um, no, the price of 4 years of state-school university tuition. (And, you might want to back up your “biggest causes of depression and health problems” with some studies. Trauma tends to be a much bigger cause of depression, and extra weight only causes health problems at extreme levels, and can often even give you extra health.)

Charles's avatar

“I recommend weight loss surgery to people who need to lose a lot of weight. ”

Why not a moderate amount of weight, say 40 pounds? Why does a person have to be 100 or more pounds overweight to benefit from the sleeve?

Charles's avatar

“Um, no, the price of 4 years of state-school university tuition” Um ya, The sleeve costs about $20K.

Charles's avatar

”(And, you might want to back up your “biggest causes of depression and health problems” with some studies.”

http://www.psychologytoday.com/articles/200305/the-obesity-depression-link

Charles's avatar

“Trauma tends to be a much bigger cause of depression, ” Most WLS is laparoscopic, no trauma, out of the hospital the next day.

Aethelflaed's avatar

@Charles The gastric bypass and the lapband both cost more like $40k. (And what the hell kind of used cars are you buying for $20k?? Is that actually cheap in your world????) And which one works is highly dependent upon each individual patient and their specific needs – it’s not just whichever one is cheapest.

Have you considered that maybe not everyone who is overweight is so upset about it that they want to undergo massive surgery that will drastically change their life for decades to come? That some people are actually ok with their bodies, even if you aren’t?

Do NOT come at me with Psychology Today. That is popcorn reading, not scholarly work. Also not scholarly: A tabloid such as the Daily Fail, and a blog dedicated to people who want to lose weight using a study done by a notoriously fat-shaming women’s mag that only sells issues if people feel bad about being fat. Google Scholar is right there; use it.

No, trauma. Like, being raped? Having a parent die? Being bullied?

Charles's avatar

“Have you considered that maybe not everyone who is overweight is so upset”

Nope. Never considered that. Nobody is happy being fat.

“That some people are actually ok with their bodies, even if you aren’t?” I doubt it. Besides, I’m not fat so I am OK.

jca's avatar

@Aethelflaed: The link you provided discusses overweight and obese adults. Most people who qualify for weight loss surgery are morbidly obese. I think statistics on morbid obesity tilt the scales (if you’ll pardon the pun) toward it causing more harm than good – higher risks of cancer, diabetes, high blood pressure, high cholesterol, joint replacement, sleep apnea, stress incontinence, GERD.

Aethelflaed's avatar

@jca I would agree with you that morbidly obese is it’s own thing, but since @Charles‘s question was more along the lines of “why doesn’t anyone whom I personally don’t find slim enough get surgery to fix their fugliness?”, I figured it was appropriate.

@Charles Meet the fat acceptance movement. They would like you to stop policing their bodies (their bodies are their own, not yours, not anyone else’s, just like your body is your body). They would also like you to stop telling them what they think, what their moods are, generally pay them the basic respect you want them to pay you. Believe it or not, tons and tons of them are happy, and they do not give a millionth of a shit if they don’t meet your personal standards for what other people should look like; their pretty sure their bodies and selves are just as “ok” as yours is. And as my own personal note, if you’re so damned happy, why are you starting a thread to hate on other people?

Charles's avatar

A) This isn’t a fat acceptance issue. It’s a question about considering WLS for those who aren’t morbidly obese
B) Fat acceptance doesn’t sound like a solution.

And yes, I doubt there are many people who don’t mind being overweight.

jca's avatar

@Charles: There was something a few months ago that the insurance conpanies were going to lower the minimum to 75 lbs, which would open the door for a lot more people to qualify for WLS.

Aethelflaed's avatar

@Charles Acceptance rarely is the solution. Hatred and bigotry really is the best way to go.

bewailknot's avatar

WLS can be a quick temporary solution, but if you do not make a permanent lifestyle change at the same time, the fix will not last. I had WLS 8 years ago, (total cost over 90K) and lost 160 pounds. I have gained some of it back due to my refusal to avoid liquid calories, mainly chocolate, which unfortunately does not make me sick. I still have to drink protein shakes or start losing my hair. With the risk of complications so high, especially infection, I think WLS should be used for those with additional weight-related health issues.

Seaofclouds's avatar

@Charles It seems as if you are overlooking the risks of the bariatric surgeries and the recovery that they require in order to be successful. Those risks and the recovery requirements are why the surgery is not used for everyone that is overweight.

jca's avatar

@Charles: I am still having trouble understanding your goal with this question. Surgery is not for everyone. Even if they quality, not everyone wants surgery, wants the restrictive eating, wants the recovery or can take off work to recover. I did it, I had a great surgeon, great recovery, no complications, miraculous weight loss, want everyone to know what a miracle is was and I can’t complain but it’s not for everyone. Some people say to me “I couldn’t have it, I like to eat too much.” I’m like “hello? Like I don’t like to eat? Who doesn’t like to eat?”

Charles's avatar

“wants the restrictive eating” My understanding is restrictive eating would not be due to will power but of satiation – you simply can’t or do not want to overeat – much easier than using will power to limit calories (which is the reason people are getting overweight in the first place).

“Some people say to me “I couldn’t have it, I like to eat too much.” I’m like “hello? Like I don’t like to eat? Who doesn’t like to eat?”” Of course everyone likes to eat – you eat to the same satisfaction level but with less food. Instead of three donuts or two bowls of ice cream or two Big Macs or Two large fries, you get just as satisfied with ¾ of a donut or one scoop or one regular burger or one small fries.

jca's avatar

Exactly, @Charles. You just can’t eat that much.

Charles's avatar

“You just can’t eat that much”

Now, given the choice between restricting your calories using will power and diet, vs. restricting your calories by achieving a satiation/satisfaction point, which one would more likely lead to long term success?

jca's avatar

What do you think? Are you asking a rhetorical question? What you’re trying to argue is unclear.

Ponderer983's avatar

@Charles You know what, apparently you had already made up your mind about the answer to your question before you posted it, judging by your responses to people’s comments.

(“Have you considered that maybe not everyone who is overweight is so upset”
Nope. Never considered that. Nobody is happy being fat.
“That some people are actually ok with their bodies, even if you aren’t?” I doubt it. Besides, I’m not fat so I am OK.”) <——That is some arrogant, ignorant shit you just spit out right there! Just because you have never been overweight doesn’t mean you know ANYTHING about this demographic of people to which I belong. I am DAMN comfortable in my skin and probably get more ass than you ever have or will. I AM okay with my body, I am not OK with my health, which is the reason why I am deciding to lose weight. It has NOTHING to do with my happiness. I would rather be the size I am than be a stick figure with my bones visible through my skin, no ass and no chest.

But to answer your original question, We just don’t fucking know!

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