DRHOOK- Ties that bind: Bariatric surgery can't work alone

the handsome doctor John Hong of Charlottesville

"You have to die of something." I hear that at least once a week in my practice. People who say this about their high cholesterol and hypertension indicate that they accept the associated risks of congestive heart failure, strokes, and peripheral artery disease. Obese people who say this mean they accept the risk of diabetes, heart disease, blindness, kidney failure, sleep apnea, etc.

But do they really?

I guess having medical issues is like a man who fears baldness. You can prophylactically use products to prevent hair loss, but how will you ever know if you're getting any benefit from using them? Lord knows, hair stylists have told me that my forehead is as big as Greenland, but I refuse to douse Rogaine on my pate.

I understand that many of the 70 million obese Americans adults and 70 million overweight American adults wonder if they can "slip by" illness because not everyone who's overweight or obese will have medical problems. But just like Las Vegas, the odds are usually not in your favor. Craps!

Bariatric surgery is the new "diet pill" of the 21st century. The two most popular types of bariatric surgery are gastric bypass and gastric banding. Gastric bypass, which is more effective, involves re-routing the stomach and intestines. Gastric banding is less invasive– it puts a ring around the stomach (sort of like a "mini-me" strangling the stomach to stop eating). 

I know the current studies show that bariatric surgery is effective in helping control diabetes, high blood pressure, high cholesterol, obstructive sleep apnea, and other complications of obesity. These results apply more to those with a Body Mass Index (BMI) of 40 or more– the highest level of obesity.

In my own practice (as well as seeing folks in the real world), I'm not so sure bariatric surgery is really all that. Initially, it seems to work really well. I've seen patients lose 100-150 pounds in the first year, and going from 350 to 200 pounds is great. 

However, keep in mind that when a person is only 5'3" and their target weight is more like 115-130 pounds, there's still more work to be done. 

I've been able to lower or stop diabetic, blood pressure, and cholesterol meds with this weight loss. Usually the person is able to be up and about much more easily. Weight loss of that magnitude is like being released from prison.

But with freedom come choices. 

Unfortunately, quite a few people make the same bad choices that caused the obesity in the first place: overeating, over drinking (especially sugary drinks), and under-exercising. One of my cousins, a year after gastric bypass surgery, had dinner with us. On his fourth slice of extra-large pizza and his second beer, I said, "Isn't– or should I say, wasn't– your stomach the size of a thumb?" 

He ended up needing a second bariatric surgery.

Some folks plead for me to give them diet pills, and it's the same with bariatric surgery. "Doc, if I can just get a head start to lose this weight, I know I'll be able to keep it off." 

I can understand this plea because once a person becomes pre-diabetic or diabetic, it's very hard to lose the weight. And most folks won't exercise on a routine basis– or just won't exercise at all. My observation is that most bariatric surgery veterans stop exercise after a year, and their weight starts to creep up again. 

Look at poor Carnie Wilson and Randy Jackson. Their weight goes up and down like yo-yos.

In the Pixar Animation/Walt Disney movie, WALL-E, everyone is morbidly obese, and at this point the real world is becoming the same way. 

So much for Disney's good old claim to fame: "It's a Small World."


Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.