The weight loss surgery industry

According to The American Society of Bariatric Surgeons, 20,000 bariatric weight-loss operations were performed in the United States in 1995. That grew to 45,000 in 2001 and then 63,000 in 2002. Last year, there were 103,200. They predict obesity surgery will be performed more than 150,000 times during 2005 in the United States.. Surgical weight loss has become big business and medical centers have been scrambling to start programs and train surgeons.

Weight loss surgery is an expensive operation and the extremely obese are a very large potential market that includes a high percentage of individuals who are desperate to lose weight. The procedures are attractive to hospital administrators because they're thought to drive other services, including follow-up visits, X-rays, and additional surgeries. There are a lot of economic incentives built in.

We're now seeing some very sophisticated and slick advertising campaigns being waged by medical centers and doctors to promote a surgical solution to people who are 100 pounds or more overweight (less in some cases). Some of these are very reminiscent of the ads for other weight loss plans including phony diet pills and quick weight loss schemes. Celebrities have given their personal weight loss surgeries a very high profile in the public square thus giving the procedure an appearance of relative ease and good plan for quick and permanent weight loss.

Weight loss surgery is often presented as the only viable solution for obesity. This preys upon the sense of desperation that most morbidly obese people feel. However, there are no studies to prove that surgery is the only workable option or that it's the best option.

Weight loss surgery can change lives and save lives. Persons who suffer from weight-related problems  such as diabetes, high blood pressure, breathing problems, sleep apnea, back, foot, and joint pain, often see a significant improvement in their health as they shed their extra weight. People who once were disabled with clinically severe obesity may be able to return to normal activities, go back to work, and greatly increase the quality of their lives.

The dark side

There is another side to the weight loss surgery industry that the advocates, advertisements, and celebrities don't speak a lot about. It can be pretty exciting to read about all the successes—to see all the fantastic before and after photos, but the down side gets precious little mention in the media. This down side is a lot bigger than the promoters of these procedures would have us believe.

We naturally tend to identify with the successes—the before and after pictures and celebrity advocates. We don't seem to assimilate the statistics for complications and death to the same degree. We tend to think positively about the idea of absorbing fewer calories from our food, but not too seriously about the fact that the portion of our intestine that is responsible for absorbing much of the nutrients our bodies need, will be bypassed—that our stomach will be either surgically altered or banded so that it will be virtually impossible to get all of the nutrients we need from the food we eat—for the rest of our lives. We don't consider the fact that we may never be able to eat a normal meal again. We imagine a life were we will no longer be obsessed with food, but give little thought to the emotional impact being denied the ability to sit and eat a full meal with the family might have, or having to face the emotional and life-skills issues we once used food to avoid.

What we know

The first thing we know is that people who are extremely obese can and do shed their excess weight and keep it off naturally. We know that there are NO really good studies to verify just what percentage actually do lose weight and keep it off and how many don't. A lot of people, such as those who shed their extra weight through 12 Step anonymous programs, are not and can never be reliably accounted for. We know that a lot of people who drop their extra weight are not under the care of a physician or one that is part of any scientific study about weight loss.

We know that weight loss surgery does result in improved levels of blood pressure, cholesterol, and blood sugar, and that these risk factors return if the weight is regained.

We know that the very fast weight loss often seen in the first year post surgery carries with it significant chances of lean muscle loss including possible organ damage. It increases the chances for gallstones and kidney stones.

We know that the stomach is not simply passive container for storing chewed up food. It plays a complex role in the processing of nutrients. We also know that gastric bypass surgery bypasses the section of small bowel in which many vitamins are digested and absorbed.

We know that weight loss surgery is no guarantee of permanent freedom from obesity. Diet and exercise are still required. One study done in 1999 (The Hebrew Study) showed that 25 percent of gastric bypass patients had regained all of the weight they had lost by the 9th year and that only 7 percent of the individuals in the study had kept all of their weight off. This begs the question, isn't this the same "diet and exercise" people who shed their extra weight by natural means use.

The American Society of Bariatric Surgeons expects patients to keep off 60 percent of the initial post procedure weight loss if they change their lifestyle to include dieting and exercise. Of course most patients who have bariatric weight loss surgery did so because they failed to eat a proper diet and were sedentary in the first place.

We know that binge eating serves a powerful psychological function for people who do it. Binge eaters eat in an almost addictive way to distract themselves from boredom or anxiety, to push angry feelings down, or to anesthetize themselves to depression, painful feelings, and memories. The need for the escape and diversion binge eating offers will not magically disappear once surgery is performed.

We know that some people die on the operating table. That subsequent corrective surgeries are fairly common. We know that intestinal leaks causing peritonitis, blood clots, and wound infections are potentially deadly complications that can happen post surgery. Bowel obstructions, hernias, kidney stones, anemia, pernicious anemia, osteoporosis, neurological damage, and adhesions, are not uncommon complications. Vomiting if too much or the wrong thing is eaten and uncontrollable diarrhea after eating are common complaints during the first year or so after surgery.

We know that there are a lot of surgeons who are new to this field and are relatively inexperienced. Researchers at the University of Washington, after reviewing the records of more than 66,000 obese people said that patients were 4.7 times more likely to die during a surgeon's first 19 procedures than after the surgeon has gained more experience. Dr. Philip Schauer, director of bariatric surgery, at Magee-Women's Hospital of the University of Pittsburgh, said in an interview published in the New York Times, "To master a weight-loss operation, a surgeon needs to perform it 100 times."

We also know that weight loss surgery has many advocates including a huge number of people who have had the operation. No doubt about it, there are a lot of happy satisfied customers. We know that at least some of them will have longer more satisfying lives as the result of that surgery... or do we???

What we don't know

As popular as weight loss surgery is becoming, there has been no long-term studies verifying the safety or long term results of these procedures. What happens 20 years down the road? No one really knows for sure.

What happens to our bodies and our brains over the long term if we have to count on non-food sources of vitamins, minerals, and micronutrients to survive? There is conflicting data on this and again, no one really knows over the long term. And since the surgery causes our systems to not easily absorb nutrients from food, what makes us think we will be able to actually absorb the nutrients we need for optimum health from pills?

Will people be able to maintain this supplementation if they get Alzheimer's disease, have a small stroke, suffer age related short-term memory problems or end up in a nursing home? If their insurance is dropped? If they should suffer a bout of clinical depression? If they lose their job and hit hard economic times? If their life and living situations are unexpectedly and drastically altered?

The National Institutes of Health says 10 to 20 percent of bariatric surgery patients need additional surgery for complications, and nearly 30 percent develop nutritional deficiencies that lead to conditions like anemia and bone loss.

In April 2003, The Journal of the American Medical Association, raised very serious and scientific questions about the effectiveness of weight loss surgery, about the safety of the procedures, and has raised ethical questions about the way the surgery is being promoted in the media. In 2005, a study of Medicare patients published in the Journal of the American Medical Association, found a higher-than-expected risk of death in the year after surgery, even among young patients—that weight loss surgery may be a lot riskier than most patients realize. Another recent study found that study found rehospitalization rates within a year following the surgery were as high as 19 percent for surgery related problems.

Recently the rationale that weight loss surgery can cut down on the health-care costs associated with being obese took a big blow. A large ongoing study in Sweden found that the use and cost of drugs in obese patients to be about the same, whether or not they had the surgery. Those who didn't have the surgery needed medications for obesity related problems such as diabetes and cardiovascular disease, while those who underwent the procedure needed treatment for gastrointestinal-tract disorders, anemia, and vitamin deficiency.

In the April 2001 issue of Self Magazine, Edward Livingston M.D., director of the University of California Los Angeles Bariatric Surgery Program stated, "By doing this surgery, you're creating a medical disease in the body. Before you expose someone to that risk, you have to be absolutely sure that you are treating an illness which is equal to or greater than the one you are creating." "Would you have surgery to lose weight?"

Some questions to ask before committing to any surgical weight loss procedure

How many such surgeries has the surgeon has performed and what is that specific surgeon's rate of mortality for the specific surgery you are considering. How about any other complications that don't result in death? Don't accept any generalized statistics—you want that surgeons personal statistics.

Is the procedure 100% reversible? Is the procedure really 100% reversible???

Why it's ok for a surgery patient to eat a very low calorie diet (500 to 800 calories a day), but it's not recommended and is considered clearly unhealthy for regular dieters, the elderly, or people with anorexia and other eating disorders?

Are the statistics really that much better for keeping the weight off over the long haul with bariatric surgery as compared to normal diet and exercise and how do those statistics compare to the findings of the government sponsored  "Weight Loss Registry" study?

What part of the digestive system absorbs calcium before surgery, and what part absorbs it after surgery?

If I take calcium supplements after surgery and my system no longer absorbs them, how does that work?

Are there ANY other options than surgery?

Am I willing to risk dying, to put my very life on the line, to lose weight?

A statistic frequently used by advocates of weight loss surgery is that 95 percent of people who lose weight gain it all back. That statistic is based on a small study from 1959 and has absolutely no validity today. There are several different types of effective treatment options to manage weight before a surgical procedure should be considered including: dietary therapy, physical activity, behavior therapy, drug therapy, and combined therapies. There are medically run treatment centers and outpatient counseling may help. There are community based hospital run outpatient programs and there is always Overeaters Anonymous and other self-help groups. Having tried several diets on their own in no way indicates a person has exhausted available resources. Many severely obese people have Binge Eating Disorder (BED). Diets only exacerbate BED so traditional weight loss programs and diets may have been the wrong treatment modality all along. Eating disorder specialists should be consulted before drastic surgical options are considered. Weight loss surgery is quite dangerous and must be considered a treatment of last resort.

When a person gets down to the point that it's their weight or their life, surgery may be a reasonable option. Advocates including people who have had the surgery seem to have a tendency to understate the side effects and daily inconveniences. As with most things concerning diet and weight loss, I recommend a healthy dose of very rational skepticism be applied coupled with intensive personal research from a multitude of sources.

I subscribed to several weight loss surgery support groups at Yahoo and found that a great many post weight loss surgery group list members continue obsessing about food. How to get enough protein and what are the best sources. How to mix protein drinks so they don't taste horrible. How to make the healthy foods they should eat resemble the sugary fat filled desserts and junk food they use to eat. What foods can they eat or drink. What foods don't cause attacks of diarrhea or vomiting. I also found that they often obsess about the weight they are losing or not losing. When compulsive overeating and binge eating disorder are viewed as a disease process (eating disorder), those things are considered to be part of the problem. It makes no sense that they should also be part of the solution.

Bariatric weight loss surgery is a serious surgical procedure whose long term weight loss success depends on a persons lifelong commitment to diet and exercise. Surgery is NOT the easy way out.

This web site is for informational purposes only and is not meant to serve as medical advice or to replace consultation with a professional dietician, nutritionist, physician, or mental health professional. None of the information presented within this web site is meant to diagnose, prescribe, or to administer to any physical or emotional ailments or conditions.