I have one friend and one relative who have had this procedure and the results are phenomenal: one (female, about 5’4) went from 350 lbs and largely bedridden to less than half-that (i.e. from mobility impaired obese to basically- plump) while the other (male, 50s, went from a life-threatening 500 pounds to a still big but nowhere near as impossible to maneuver 275 or so). Celebrities who have undergone the procedure to dramatic effects include Al Roker and father-daughter Brian & Carnie Wilson.
There’s no question as to whether or not the procedure works: failures are few and far between. However, my understanding of the procedure (and IANAD) are that it works by reducing stomach size and forcing the person to get full faster and eat less. It is actually the reduced caloric intake that does the work (same as with any other diet including Atkins).
Do you think that the procedure is overused? Do most people who have this procedure suffer from severe psychological issues that cause overeating and, if so, what will stop them from overeating following the surgery? What does the surgery do that diet and exercise will not, and have their been any long term studies on possible health problems the procedure causes?
(For the record in case anybody is curious, I’m fat now and have been most of my life though I’ve never been anywhere near morbidly obese. I rarely watch my diet. My own weight may be influenced in part by a genetic predisposition but by far it’s mostly due to overeating and underexercising.)
Gastric bypass surgery not only limits the amount of food a person can eat at a given time by reducing the capacity of the stomach, but also reduces the nutrients absorbed by the body by bypassing a length of the patient’s small intestine.
There are several different procedures available… Some less radical than others. If you’re so inclined, I urge you to explore this site for in-depth info on the subject:
Also, it’s not easy for just anyone to have this type of procedure. Insurance companies will often require documented attempts to lose weight under a physician’s care with or without the use of pharmaceuticals. Most patients are required to undergo a psychological evaluation prior to approval. And most importantly, a person has to have a BMI (Body Mass Index) of 39 or above (IIRC).
I had Roux en-Y gastric bypass surgery in April of 2003 and I’ve lost almost 150 pounds. Diet and exercise are essential to the success of my weight loss thus far and will continue to be the cornerstone of long-term success. Does the surgery do anything special? Well, it does limit the amount of food that you can eat at one time, and over time this also helps you to rethink what a portion size is, so when you are able to eat more food at once (after 9 months or so you can eat a ‘regular’ meal, usually) you are more likely to view a smaller portion size as sufficient. There is also the bypass of the duodenum, which may affect the absorption of fat significantly. However, in talking with my surgeon (who happens to be the head of general surgery at the Mayo Clinic) off the record, he confessed that it isn’t known for certain exactly how the combination of stomach size reduction and duodenum bypass works to produce weight loss, but it does work, and it works far better than stomach size reduction alone.
Also…yes, many people who are candidates for bariatric surgery have to deal with psychological issues and deeply-ingrained habits of poor nutrition or eating behaviors. My hospital required all bariatric surgery patients to take a one-year course on learning to control eating behaviors and encouraged all patients to continue to attend support groups after surgery.
If I have a nice stretch of eating clean and I eat sugar one day, I may get sleepy and feel a little icky for a while, but that’s about it. It digests and I go on my merry way.
If my husband’s aunt did that, who had GBS last year, she would get the shakes, throw up, and generally wish she was dead for a half hour. It’s called dumping, and from what I hear it is so unpleasant that one episode will make you NEVER want to eat another no-no food again. A good thing, I guess, if your goal is to eat healthy. You’re forced to after the surgery. In a lot of ways your choices are totally taken away.
Watch someone who has had GBS eat sometime. Guess what? They’re doing Atkins! Lots of protein and NO sugar! The only difference is their body gives them immediate, VERY negative feedback if they cheat.
Yes, I personally feel GBS is WAY overused, especially in my little area here in WV where the waiting list is over a year long, and that’s with 2 hospitals in the same city doing the surgeries. I think it should be a last resort, when it’s either get the surgery or be dead in a few months.
People use the “I’ve been on every diet in the world” as an excuse but surprise: going on a diet doesn’t make you fat. It’s the giving up and stopping all of the new healthy habits that makes you fat! If you go on a diet and lose 50 pounds and you get bored with not being able to pig out and you get tired of exercising 5 times a week, of course you’re gonna gain the weight back. Doesn’t mean you need surgery, I think it means that you don’t want to lose the weight enough to put in a long-term effort.
Generally speaking. Spare me the “I have a bad thyroid” story. I am talking about otherwise normal people who have no underlying health conditions that make them gain weight.
Losing weight is the hardest thing in the world. I’ve lost 80 something pounds and I have about 120 to go. Some days I want to throw in the towel, and there are also days I think “gee, GBS would make things so much easier.” However, the things I struggle with daily are still the same things I’d struggle with if I had the surgery, and plus my body would never be normal again. I’d rather fight my way through to the end and still have my body intact at the end.
The thing about gastric bypass is that there isn’t very good data on the long term effects. As you grow older, tissues stretch, weaken, and do all sorts of nutty things, your metabolism changes, your nutritional needs change, etc. And this particular surgey just hasn’t been done enough, long enough ago, for the reasons its done, to have conclusive data on whether it leads to problems down the road. The people having it today are in some sense guinea pigs, though there is no
The surgery itself is very intense, and not only is it probably going to be overused, but because it is so profitable, many shoddy doctors are going to want to get into doing them (its not brain surgery, but it takes some real experience to know how to deal with complications and make it work smoothly): with the result that we get lots more needless moralities. At present, I really hope it is used only for people who are seriously endangering their health, rather than people for whom it is mostly cosmetic with only moderate risk.
The other complication I’ve seen is that people lose so much weight so fast that they litterally become walking skin bags, and have to have plastic surgery to remove all the extra stretched out skin.
Exercise is, IMHO, far more important than diet for most people. Of course, it’s also far more effective at keeping you from GETTING overweight, but that’s another story.
But “failures are few and far between” doesn’t take into account that this is a procedure with a significant morbidity and mortality associated with it.
This is a major surgical procedure undertaken on someone who is morbidly obese and therefore, by definition, not in good health. We are talking problems with the anaesthetic, compromised immune system, diabetes, hypertension, heart and lung disease etc.
It should NEVER be used as a quick fix, because when it goes wrong, it can go very badly, even fatally, wrong.
A lot of overweight people are in denial about their eating habits, and have unrealisitc ideas of what they need to do in order to lose weight. If it was alcohol or drugs we would be happier saying that they had an addiction, in my opinion continuing to over-eat in the knowledge that it will kill you is like someone with lung cancer smoking, or an alcoholic with liver disease drinking.
I feel the answer to an addiction is to acknowledge it and fight it, not to have surgery without dealing with the root problem.
In my opinion this procedure should be reserved as the last resort, when diet and exercise, psychotherapy, addiction counselling and all the other approaches have been tried and have failed. I understand that some people do need it, but I question the widespread use of it as a means of preventing people taking responsibility for their own choices.
THis doesn;t remotely address the OP, but the woman who lived across the street from my parents died during GB surgery. Admittedly, she weighed like 400 pounds, so any surgery was a huge risk, but still, she died. So I am not sure if incidents like these are not “few and far between.”
I’ve been tracking every bariatric surgery in this hospital for a month now (all Roux en Ys and lap bands) – 36 surgeries and not a bit of morbidity or mortality in the lot. (Offhand I’d estimate it to be around 0.5%, but I have no real figures for that yet – give me a few months.)
It’s certainly not performed lightly. Prospective patients do have to go through some pretty rigorous couseling, and they are tracked for at least 6 months (often more like several years) before the doctors will agree to perform the surgery. And even then, sometimes the patient will have to lose a certain amount of weight before the surgery is performed.
Also, it seems that they won’t operate on someone with a mere love handle problem. It’s not a few vanity pounds. It’s when the possible complications from surgery are far outweighed by the risk of obesity, and all other avenues have been explored.
There have been several stories in the news over the past year or so about the effects of gastric bypass on the body’s level of a hormone called “ghrelin”. I am not well versed in the matter, but as I understand it researchers know that this hormone stimulates the appetite, but they do not yet know why people who have undergone gastric bypass have much lower levels of this hormone.
“Gastric bypass surgery decreases appetite-stimulating hormone ghrelin”
I thought one of the main differences between traditional dieting and excercise alone as opposed to gastric bypass, was the plateau. From most of what I’ve read, people going the traditional route, hit a plateau in their weight which is very difficult to get past. Basically becoming stuck, though they are still putting forth the effort which was allowing them to lose weight in the first place. I can see myself giving up or at least becoming overwhelmingly frustrated, if that were my case.
The results with bypass surgery, still seem to have a plateau, but after a much more dramatic amount of weight loss? I know it’s possible to gain back the weight even after the surgery, so my thoughts are that it’s not really a complete lack of effort on the patient’s part. They still need to eat a healthy diet and exercise to keep the weight off for the long haul, so the surgery is more of a leg up.
According to the International Bariatric Surgery Registry the mortality is 0.3% in the first month, with 7% of patients suffering complications, ranging from wound infections to pulmonary embolism.
The full report is available at http://www.asbs.org/html/rationale/rationale.html. (That’s not a link as I can’t do them). It should answer a lot of the questions raised, it’s data gathered from surgeons around the world who perform bariatric procedures.
Like I said, when it’s necessary, it’s necessary, but you have to be very desparate for it to be so.
i can’t really think of anything more depraved than eating yourself to death.
i will honestly say that i hold so much negativity towards fat people i can’t see ANYTHING past the fat (nor do i have any desire to whatsoever). i dont care what you know, what kind of person you THINK you are - if you’re fat thats all i need to know about you.
do i think gastric bypass is whack ? i will let you figure it out.
Good catch. Ghrelin is a powerful appetite stimulator. Several hormones are involved in the dance, but just for starters:
“Ghrelin acts to stimulate food intake and once lean individuals start eating ghrelin level drop again. Thus it is believed that ghrelin acts as a trigger to start. In the current edition of TherapeuticAdvances we report on data showing that ghrelin levels do not fall after eating in obese individuals suggesting that this trigger is not reset.”
It appears that ghrelin is made in the stomach. That makes sense; gastric bypass surgery reduces the area of the stomach. Less stomach, less ghrelin. This article talks about PYY, another hormone, made in the intestine, that counteracts ghrelin and suppresses appetite:
“Both studies come from a London-based group led by Stephen R. Bloom of Hammersmith Hospital. Among obesity researchers, Bloom has been one of the most outspoken and optimistic about the potential for finding natural ways to trick a body into wanting less food. His group recently identified a hormone, made by the intestine, that appears to shut off hunger after a meal. Dubbed PYY, short for peptide YY3–36, it appears to be a natural counterpart to the hunger-inducing hormone ghrelin, (SN: 2/16/02, p. 107).”
“Last year, Bloom and his colleagues showed that people of normal weight injected with PYY ate about one-third less at a buffet than did untreated individuals (SN: 8/10/02, p. 83).”
"Now, in the Sept. 4 New England Journal of Medicine (NEJM), they report that PYY similarly suppresses appetite in lean and overweight human volunteers. That’s a potentially critical finding, given the roller-coaster history of leptin, another hormone that stirred dreams of a miracle weight-loss drug. While leptin can also stifle the drive to eat, most obese people don’t lack the hormone. Instead, they seem to be resistant to its effects, so leptin injections haven’t produced much weight loss in many of the obese people tested so far. "
The above article, and others, have just begun looking into the role that 4 hormones – PYY, ghrelin, leptin, and PP (pancreatic polypeptide) in both overeaters and undereaters (i.e. anorexia).
People with Prader-Willi Syndrome, a genetic disease that causes slow development, mental retardation, and constant hunger leading them to morbid obesity, have ghrelin levels that are “off the charts”. Other good stuff in here, too: