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Neither Nightmare nor Magic Wand
Once again I am revisiting the subject of weight loss surgery. How does it or does it not mesh with the goal of eating sanely? This question triggers strong reactions—beliefs persist that surgery is an “easy way out”, or a short-term “band-aid” that only masks deeper problems. On the other side, beliefs persist that surgery can solve problems all by itself. In short, the idea of surgery as a drastic solution seesaws with the idea that it’s a lazy solution. The reality is way more complex than this. And given the numbers now turning to surgical solutions, it makes sense to keep a clear focus on their very real pros and cons.
Mention weight loss surgery, and some will react as if you’ve suggested amputation for an sore joint. People just have to eat less, or deal with their emotions, is the thinking. At the opposite extreme, there are those who believe their bands or sleeves will solve problems effortlessly. “Now I can be like everyone else, not always thinking about food.” Both of these surprisingly common views distort reality and don’t help.
About two thirds of American adults qualify as obese (with children’s rates catching up). Over 220,000 people per year now opt for bariatric surgery, an increase of nearly 65% in the past decade. Increasingly, the overweight turn to surgery as procedures become safer, insurance-covered, and effective against illnesses like diabetes. Preparation for surgery involves doctor- and insurance-mandated nutrition counseling, dietary preparation, psychoeducation and evaluation. These are important requirements that help many adjust to a radically changed lifestyle, but they don’t necessarily pave the way solidly enough for everyone.
The Nightmare View Debunked
“If you can lose weight to prepare for surgery, why not just keep at it and do it yourself?” That’s one question people face when considering surgery. And the response is usually “If I could keep it up, I wouldn’t be thinking of surgery!” And that’s the problem in a nutshell. We live in a food environment that simply doesn’t work well with our bodies’ genetic programming. And while it’s not necessarily impossible for the long-term obese to lose those 75, 100, 200 pounds, it’s very, very difficult. Few succeed in the midst of an unsupportive environment, a body that constantly signals hunger, and a metabolism primed for weight holding and easy fat storage. The physical changes caused by long-term obesity make losing extremely difficult. The physical changes imposed by surgery, for some, supports the conditions for facing these challenges more successfully.
Emotional problems, it’s true, usually do factor into weight gain and diet failure. And surgery won’t eliminate them. For surgical solutions to last, these issues need to be addressed (see below). However, it’s also true that not all weight problems correspond to emotional problems. And weight won’t necessarily dissolve once problems are dealt with, anyway. Frequently, too, the restraint provided by the surgical procedure acts as a behavioral modification tool, with emotional changes following.
The Magic Wand View Debunked
If some think of surgery as a shockingly drastic option, others think struggles will disappear after surgery. In fact, procedures can usually be counted on to minimize hunger considerably, and to limit the amount that can be eaten at any one time. Most people will lose weight and see weight-related health conditions improve. However, surgical solutions don’t remove the need to think about how or what one eats—on the contrary.
For success following surgery, especially over the long-term, absolutely demands conscious thought and attention: to how and what and when and where one will be eating. The surgical change can make some aspects of this change easier. But it also introduces new challenges that require careful ongoing attention. Nutrition, exercise, choosing wisely—all of these things take on even greater importance when living on a post-surgical with a tiny stomach. Your health can suffer if you don’t, and you can regain weight.
Many long-term behaviors need to be well-understood, and curbed considerably, before surgery if those health problems and regains are to be avoided. These include: emotional overeating, stress eating, addictive eating (especially of sweets), nighttime grazing and snacking, meal-skipping with later gorging. The surgical restriction can actually help to some degree with curbing these behaviors, so change need not be 100 percent perfect. These habits do need to be mostly changed or eliminated, though, so the help of the changed stomach can support the changes continuing, and even improving over time.
Sane Eating?
In sum, the decision to seek weight loss surgery is not simple. It must consider a host of individual factors. It’s not a great solution for everyone, and it carries risks. At the same time, it does help many who’ve faced frustrating and demoralizing weight loss failures, and who want better health and mobility.
Those who do well put the time and energy into learning and practicing new skills and habits. They may use the support services offered by weight-loss and surgical practices or seek their own support systems. In my practice, I see many who see the decision for surgery, after years of diet struggles, as a chance to make real changes and to dedicate themselves to an attitude of self-care. That’s really what it takes to use a bariatric procedure as part of a committed and concerted effort to eat sanely for the long term.
