Gastric Surgery Myth #1:
Most people who have metabolic and bariatric surgery regain their weight. Metabolic Surgery is used to describe weight loss treatments and procedures to treat metabolic diseases, including, type 2 diabetes. One of the best-known metabolic surgery types is the Gastric Bypass. But, the gastric sleeve is also popular. Gastric sleeve surgery involves removing a portion of a person’s stomach and creating a gastric sleeve, or smaller stomach, that helps a person feel full faster. More than half of the stomach is removed. Unlike gastric bypass surgery, which is considered to be more invasive, gastric sleeve surgery does not rearrange the stomach into two pouches.
Truth: As many as 50 percent of patients may regain a small amount of weight (approximately 5 percent) two years or more following their surgery. However, long term studies find that most bariatric surgery patients maintain successful weight-loss long-term. ‘Successful’ weight-loss is defined as weight-loss equal to or greater than 50 percent of excess body weight. Often, successful results are determined by the patient, by their improvement in quality of life. In such cases, the total retained weight-loss may be more, or less, than this arbitrary definition. Such massive and sustained weight reduction with surgery is in sharp contrast to the experience most patients have had with prior non-surgical therapies.
Gastric Surgery Myth #2:
The risk of dying from metabolic and gastric surgery is more than the chance of dying from obesity.
Truth:As your body size increases, longevity decreases. Individuals with severe obesity have many life-threatening conditions that greatly increase their risk of dying, such as type 2 diabetes, hypertension and more. Data involving nearly 60,000 gastric surgery patients from ASMBS Bariatric Centers of Excellence database show that the risk of death within the 30 days following bariatric surgery averages 0.13 percent, or about one out of 1,000 patients. This rate is considerably less than most other surgeries, including gallbladder and hip replacement surgery. Therefore, despite the poor health status of bariatric patients before surgery, the chance of dying from the operation is extremely low. Large studies find that the risk of death from any cause is considerably less for bariatric patients over time than for individuals affected by severe obesity who have never had the surgery. In fact, the data show up to an 89 percent reduction in mortality, as well as highly significant decreases in mortality rates due to specific diseases. Cancer mortality, for instance, is reduced by 60 percent for gastric surgery patients. Deaths associated with diabetes is reduced by more than 90 percent and that from heart disease by more than 50 percent. Also, there are a myriad of studies that have found improvement or resolution of life-threatening obesity-related diseases following bariatric surgery. The benefits of bariatric surgery, with regard to mortality, far outweigh the risks. It is important to note that as with any serious surgical operation, the decision to have bariatric surgery should be discussed with your surgeon, family members and loved ones.
Gastric Surgery Myth #3:
Gastric Surgery is a ‘cop-out’. To lose and maintain weight, individuals affected by severe obesity just need to go on a diet and exercise therapy program.
Truth:Individuals affected by severe obesity are resistant to long-term weight-loss by diet and exercise. The National Institutes of Health Experts Panel recognize that ‘long-term’ weight-loss, or in other words, the ability to lose weight and keep it off, is nearly impossible for those affected by severe obesity by any means other than metabolic and bariatric surgery. Bariatric surgeries are effective in maintaining long-term weight-loss, in part, because these procedures offset certain conditions caused by dieting that are responsible for rapid and efficient weight regain following dieting. When a person loses weight, energy expenditure (the number of calories the body burns) is reduced. With diet, energy expenditure at rest and with activity is minimized to a greater extent than can be explained by changes in body size or composition (amount of lean and fat tissue). At the same time, appetite is altered following a diet increasing hunger and the desire to eat. Therefore, there are significant biological differences between someone who has medical weight loss by diet and someone of the same size and body composition to that of an individual who has never lost weight. For example, the body of the individual who reduces their weight from 200 to 170 pounds burns less calories than the body of someone weighing 170 pounds and has never been on a diet. This means that, in order to maintain weight-loss, the person who has been on a diet will have to eat fewer calories than someone who naturally weighs the same. In contrast to diet, medical weight-loss following bariatric surgery does not reduce energy expenditure or the amount of calories the body burns to levels greater than predicted by changes in body weight and composition. In fact, some studies even find that certain operations even may increase energy expenditure. In addition, some bariatric procedures, unlike diet, also causes biological changes that help reduce energy intake (calories). A decrease in food consumption with surgery results, in part, from changes in the anatomy of the stomach or gut that restrict food intake or cause malabsorption of nutrients. In addition, bariatric surgery increases the production of certain gut hormones that work with the brain to reduce hunger, decrease appetite, and enhance satiety (feelings of fullness). In these ways, bariatric and metabolic surgery, unlike dieting, produces long-term weight-loss.
Gastric Surgery Myth #4:
Many bariatric patients become alcoholics after their surgery.
Truth:Only a small percentage of bariatric patients claim to have problems with alcohol after surgery. Most who abuse alcohol after surgery had problems with alcohol abuse at some period of time prior to surgery. Alcohol sensitivity, (particularly if alcohol is consumed during the rapid weight-loss period), is increased after bariatric surgery so that the effects of alcohol are felt with fewer drinks than before surgery. Studies also find with certain bariatric procedures (such as the gastric bypass or gastric sleeve) that drinking an alcoholic beverage increases blood alcohol to levels that are considerably higher than before surgery or in comparison to the alcohol levels of individuals who have not had a bariatric procedure. For these reasons, bariatric patients are advised to take certain precautions regarding alcohol:
Avoid alcoholic beverages during the rapid weight-loss period
Be aware that even small amounts of alcohol can cause intoxication
Avoid driving or operating heavy equipment after drinking any alcohol
Find help if drinking becomes a problem
If you feel the consumption of alcohol may be an issue for you after surgery, please contact your primary care physician or bariatric surgeon and discuss this further. They will be able to help you identify resources available to address any alcohol-related issues.
Gastric Surgery Myth #5:
Bariatric surgery increases the risk for suicide.
Truth:Individuals affected by severe obesity who are seeking bariatric and metabolic surgery are more likely to suffer from depression or anxiety and to have lower self-esteem and overall quality of life than someone who is normal weight. Bariatric surgery results in highly effective improvement in psychosocial well-being for many patients. However, there remain a few patients with undiagnosed preexisting psychological disorders and still others with extreme life stressors who commit suicide after bariatric surgery. Two large studies have found a small but notable increase in suicide rates following bariatric surgery. For this reason, comprehensive bariatric programs require psychological evaluations prior to surgery and many weight loss centers have behavioral therapists available for patient consultations after surgery.
Gastric Surgery Myth #6:
Bariatric patients have serious health problems caused by vitamin and mineral deficiencies.
Truth: Bariatric operations can lead to deficiencies in vitamins and minerals by reducing nutrient intake or by causing reduced absorption from the intestine. Bariatric operations vary in the extent of malabsorption they may cause, and vary in which nutrients may be affected. The more malabsorptive bariatric procedures also increase the risk for protein deficiency. Deficiencies in micronutrients (vitamin and minerals) and protein can adversely affect health, causing fatigue, anemia, bone and muscle loss, impaired night vision, low immunity, loss of appropriate nerve function and even cognitive defects. Fortunately, nutrient deficiencies following surgery can be avoided with appropriate diet and the use of dietary supplements, i.e. vitamins, minerals, and, in some cases, protein supplements. Nutrient guidelines for different types of bariatric surgery procedures have been established by the ASMBS Nutritional Experts Committee and published in the journal, Surgery for Obesity and Other Related Disorders. Before and after surgery, patients are advised of their dietary and supplement needs and followed by a nutritionist with bariatric expertise. Most bariatric programs also require patients to have their vitamins and minerals checked on a regular basis following surgery. Nutrient deficiencies and any associated health issues are preventable with patient monitoring and patient compliance in following dietary and supplement (vitamin and mineral) recommendations. Health problems due to deficiencies usually occur in patients who do not regularly follow-up with their surgeon to establish healthy nutrient levels.
Gastric Surgery Myth #7:
Obesity is only an addiction, similar to alcoholism or drug dependency.
Truth:Although there is a very small percentage of individuals affected by obesity who have eating disorders, such as binge eating disorder, that may result in the intake of excess food (calories), for the majority of people affected by obesity, obesity is a complex disease caused by many factors. When treating addiction, such as alcohol and drugs, one of the first steps is abstaining from the drugs or alcohol. This approach does not work with obesity as we need to eat to live. Additionally, there may be other issues affecting an individual’s weight, such as psychological issues or disorders. Weight gain generally occurs when there is an energy imbalance or, in other words, the amount of calories (energy) consumed is greater than the number of calories burned (energy expended) by the body. Energy imbalance may be caused by overeating or by not getting enough physical activity and exercise therapy. There are other conditions, however, that affect energy balance and/or fat metabolism that do not involve excessive eating or sedentary behavior including:
Chronic sleep loss
Consumption of foods that, independent of caloric content, cause metabolic/hormonal changes that may increase body fat (sugar, high fructose corn syrup, trans fat, processed meats and processed grains)
Low intake of fat-fighting foods (fruits, vegetables, legumes, nuts, seeds, quality protein)
Stress and psychological distress
Many types of medications
Obesity also ‘begets’ obesity, which is one of the reasons why the disease is considered ”progressive.” Weight gain causes a number of hormonal, metabolic and molecular changes in the body that increase the risk for even greater fat accumulation and obesity. Such obesity-associated changes reduce fat utilization, increase the conversion of sugar to fat, and enhance the body’s capacity to store fat by increasing fat cells size and numbers and by reducing fat breakdown. Such defects in fat metabolism mean that more of the calories consumed are stored as fat. To make matters worse, obesity affects certain regulators of appetite and hunger in a manner that can cause an increase in the amount of food eaten at any given meal and the desire to eat more often. There are many causes for obesity and that the disease of obesity is far more than just an ‘addiction’ toward food. The treatment of obesity solely as an addiction may be beneficial for a very small percentage of individuals whose only underlying cause for obesity is excessive and addictive eating, but would be unlikely to benefit the multitudes, particularly those individuals affected by severe obesity.
Information from this post is available at: https://asmbs.org/patients/bariatric-surgery-misconceptions