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Old 05-17-2019, 04:16 AM
Maastricht is offline
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We are barely using the best tool we have against obesity (Vox article and discussion)


Today there's an article on VOX explaining that weight loss surgery ( sleeve and R-Y gastric bypass) are both safe and effective tools against individuals suffering from morbid obesity. Yet the tools are very much under used. The article tries to explain why we're so irrational about it.

VOX says that the individual health risk of being ( and quite likely remaining) obese is much larger then the health risk of undergoing surgery. The quality of life for an individual is much better after surgery, especially for young people.
The costs for society are about even, and if you count the health risk of diabetes ( which is practically cured by gastric bypass surgery) the costs for society are clearly positive.

I share this article also, because this summer sees the 9th birthday of my own gastric bypass surgery. I had three threads about my journey on the Dope, links here.

Nine years out, I'm doing great. Just had another extensive bloodwork check up and my stats are fine. Weight-wise, I'm stable and have been stable at between 72 and 76 kilo's these past years, just like my surgeon predicted ( he said I would stabilize at 70 kilos). I'm 170 tall. For you non-metrics: I'm stable at 159 to 167 pounds at 5 feet 7 inches on bare feet.

I have no problem whatsoever eating healthily and in reasonable moderate amounts. I not eat like somebody with willpower, and yet I have been operated on my stomach, influencing hormones; I have not been operated on my brain. So much for the concept of willpower in fighting morbid obesity...

My only limitations since my surgery are pasta and fresh bread, and I can't eat too much sweet foods (candy or fruit or wheat crackers) or I will feel tired and unpleasant for 90 minutes. That happens rarely these days, and if it happens, that's because I haven't been paying attention properly, not because I lost a willpower battle with myself. Last month a I had it for the last time, after snacking absentmindedly on a box of dried dates while reading the paper and not getting up to make myself a better snack.
All battles of beating myself up over not having enough willpower, and trying and failing at dieting, all of that just...vanished.

Eating well is just not a struggle anymore, and hasn't been for the past eight years. That means my mind was freed up for other issues to worry about, so my happiness base line has returned to what it was ( as happiness baselines usually do).

But I can still say my mini gastric bypass surgery was one of the better things I ever did for myself! I'm also one of the lucky 30 % who hasn't had much loose skin.

I take one bariatric vitamin supplement pill in the morning and another one ( with calcium) at night. That's it. No vitamin shots, ( I had one in the past 9 years) no deficiencies.

How are the other Dopers doing who had weight loss surgery?

Last edited by Maastricht; 05-17-2019 at 04:20 AM.
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Old 05-17-2019, 11:17 AM
Inigo Montoya's Avatar
Inigo Montoya is offline
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Thanks for this, and awesomeness to you. Nearly 100 pounds is life-changing. I didn't see the answer right away in your links, so I'm sorry if you've already covered this: how long did it take you to lose that?
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Old 05-17-2019, 11:36 AM
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I'm glad it worked for you, but
Quote:
We are barely using the best tool we have against obesity
is more than a bit misleading. The cost-benefit analysis for someone who is morbidly obese is likely to be different from someone who is simply obese.

Still, good for you.

Regards,
Shodan
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Old 05-17-2019, 11:46 AM
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Explain 'cost-benefit analysis' as you would apply it to this situation?
Do you literally mean it's not worth $XXX to lose XXX pounds and establish a permanent means to maintain a healthy weight?

And although "morbidly" was left out of the title, I don't think anyone puts "Surgery" and their 10 pound spare tire in the same mental box.
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Old 05-17-2019, 01:00 PM
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Quote:
Originally Posted by Inigo Montoya View Post
Explain 'cost-benefit analysis' as you would apply it to this situation?
Do you literally mean it's not worth $XXX to lose XXX pounds and establish a permanent means to maintain a healthy weight?
I literally mean it may or may not be worth spending $X and undergoing a surgical risk of X% in order to incur an X% chance of losing X number of pounds and keeping them off for X number of years, depending on whether the number of pounds you want to lose is X or X+50.
Quote:
And although "morbidly" was left out of the title, I don't think anyone puts "Surgery" and their 10 pound spare tire in the same mental box.
The Vox article's title was click bait, obviously. That happens, and I don't think it is unintentional.

Regards,
Shodan
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Old 05-17-2019, 02:50 PM
Wesley Clark is online now
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I'm not sure if OP is looking for an actual discussion or just venting on what she sees as an ineffective use of an effective tool against obesity.

But if I had to list the reasons obesity surgery isn't used I'd say:

1. For most people, obesity is more seen as a moral issue than a health issue. They feel obesity is due to letting their urge for gluttony and sloth get the best of them, and they see surgery as cheating. I'm not saying I support this view and I personally compare it to people who think abstinence only is the solution to stds and who feel condoms are cheating, but is a major hurdle. Obesity is stigmatized, but using anything other than 'willpower' to solve it is also Stigmatized, even though willpower rarely works long term for obesity.

2. Insurance doesn't always cover the procedure. At my old job I inquired about getting surgery only to be told my insurance will not cover it. So I asked if I self pay and have complications down the road would insurance cover that. I was told that no, they wouldn't cover that either. So for a lot of people they would have to pay for surgery and any complications out of pocket. Even if insurance does cover it they may make you jump through endless hoops first. It's usually not as easy as a doctor recommends it and you get the surgery. Insurance tries hard not to cover it.

3. Some of the surgeries have serious complications. Dumping syndrome, vitamin deficiencies, hypoglycemia, etc. Obesity may suck but a lot of obese people can control their health problems (somewhat) with pharmacology and moderate lifestyle changes. So surgery isn't always desirable.

4. There are so many surgeries now that people aren't sure which one to get.

5. Newer and better surgeries are coming out and some people are waiting on them. For mee personally, the full sense device sounds like a good option if it passes tests. Various new surgeries like gastric plication, the full sense device, endoluminal sleeve, etc are less invasive, easier to have installed, reversible and cheaper. The full sense device can be done outpatient endoscopically and can work better than every other surgery out there, resulting in 80% of excess weight lost in six months. So some people feel it's a rapidly changing field and they're waiting for safer, cheaper and more effective therapies to hit the market. Medicine barely understands how obesity works or how to treat it, so getting a permanent surgery when the field is constantly changing and learning can be intimidating.

6. There cam be some unpleasant and unexpected side effects of surgery. Self harm, divorce rates, suicide, addiction, etc all go up. The causes could be multiple (drugs and alcohol affect the brain different, identity crisis, nutritional deficiencies, hormonal changes, etc) but it's a fear people run into. I don't know if the statement that 80% of marriages end in divorce two years after surgery, but if so it's something people consider.
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Last edited by Wesley Clark; 05-17-2019 at 02:54 PM.
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Old 05-17-2019, 04:01 PM
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Add - not everyone is helped by obesity surgery. Many people are, but some people are not losing weight or gaining the weight back.

People need to have some idea if they're going to have a chance of success with the surgery before they have it. I think the medical community needs to do some analysis on who is being helped vs. who isn't.
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Old 05-17-2019, 04:09 PM
Wesley Clark is online now
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Quote:
Originally Posted by Zyada View Post
Add - not everyone is helped by obesity surgery. Many people are, but some people are not losing weight or gaining the weight back.

People need to have some idea if they're going to have a chance of success with the surgery before they have it. I think the medical community needs to do some analysis on who is being helped vs. who isn't.
True, and because we still don't really understand how obesity works (if we did we'd have widespread cures for it) I don't know if we even know why some do well and others not.

Bile acids seem to play a role in how effective bariatric surgery is.

https://www.wjgnet.com/1007-9327/full/v22/i39/8698.htm

https://www.sciencedaily.com/release...0326142209.htm

But sadly I don't know if we know why one person reacts well and another doesn't. And because of the stigma against obesity, most people probably assume how successful bariatric surgery is is directly proportional to how effective people are at overcoming their urges for sloth and gluttony rather than the complex biochemistry underlying the condition.
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