Weight Loss and Bariatric Surgery debate

OK, I’m sure I’m gonna get smacked down hard for junior modding, but I thought that it might be courteous for us to leave this thread for the celebration it was meant to be, and so I opened this thread for those who wanted to debate. I will post a link in the other thread.

I stand by my assertion that obese people get fat and remain that way for one simple reason: they refuse to discipline themselves. Staying trim as one ages is, for the vast majority of Americans, extremely difficult. It takes hard work. People who stay slim are willing to put the work into it. Fat people are not willing to. They whine that “it’s too haaard” or that “it’s genetic its not my fault” or even “I don’t eat any more than skinny people do, i’m just programmed to be fat”. All a bunch of nonsense and excuses.

Here is a typical case in point:

There was a special on Discovery Health channel the other day about a 16 year old boy who had been permitted by his parents to overeat himself to 420 pounds. His mother said that he usually ate “3 or 4 helpings” at most meals.

It was a refreshing and inspiring story. Instead of blaming “genetics”, a “thyroid problem” or the fast food industry, the family acknowledged that the kid was simply shoveling way too much food into his mouth. He abruptly reduced his calorie intake to 1500 cal/day, began exercising and lost over 150 lbs in one year! Oh, wait, this is America. Sorry. Actually what they did was blame it all on genetics then pursue a $80,000 stomach stapling procedure for the kid.

Following the surgery, the kid abruptly reduced his calorie intake to 1500 cal/day, began exercising and lost over 150 lbs in one year!

Wait, wasn’t it genetic?

I think the comment by his mother at the end of the show pretty much reveals the truth:

"We can’t believe how much our grocery bill has come down since Brandon’s surgery"

Genetics my eyeball…

I see both sides of this pretty clearly, which is always why I’m such a poor debater.

I am not a fan of bariatric surgery. I was at one time obese and I have had surgery that is very similar as that used to help people lose weight. Mine was done because my stomach ripped open due to an improper para-esophagiel hernia repair. (Probably spelled wrong and entirely irrelevant to the discussion.) The end result is they did a true by-pass of my stomach and now the esophagus goes straight into the small intestine.

And so I speak from experience when I tell you that even with this surgery, you can remain obese. If you don’t change your life style, you can easily gain weight back. (Well, at least I can.)

So if asked, I would council against it. I would suggest that if you can change your life-style enough to lose weight after the surgery, than you can do so before.

But point in fact, I didn’t. And so I come to how I see both sides. I have strong will-power on many things. I quit chewing tobacco after chewing several packs a week for 10 years. I quit with no problems. But that doesn’t mean that quiting the nicotine habit is easy for everyone. It just was for me.

But I couldn’t give up sugar so easily. Hell, I still crave it now. I’m not a fan of surgery, but I for those who have tried everything else, I’m not going to judge them either.

I have no issue with people who have bariatric surgery. To me, there is no moral component to being overweight. I have skinny cats and fat cats, despite food being available equally to all. Unless we think cats have “willpower” and “self-discipline,” I think this is evidence that cats simply vary in how much they want to eat.

Different people have drives of more or less intensity. Some people have extremely strong sex drives; some have none. Some people live to eat; some barely eat enough to survive. Some people gamble away their life savings; some are risk averse.

If you have a problem and seek help, you’re a sensible and responsible person who deserves credit for the clear-eyed way you are addressing your problem.

A well-balanced way of looking at things, but not entirely accurate in my opinion. Not all of these things are equivalent. If you have an overactive sex drive and have a partner whose drive is equal, or you really enjoy masturbation, there can be little or no adverse effects on your life. Gambling away your life savings and eating yourself into obesity are not so victimless, in regards to both the user and those around them. The problem with the surgery, the way I see it, is that it’s pointedly not addressing the problem. It’s putting a band aid on a crack in a dam. I worked in the mortgage business for 5 years and I don’t know what it was about it but this was a business that attracted women. Large women. Our underwriting department was full of them at every company I worked at. I knew about 1 to 3 women per year, every year, who had the surgery. They all lost 100+lbs in the first year, and to my knowledge they’ve all gained back all their weight now. Why? They never addressed the issues that made them obese in the first place. They tried to go around them by having surgery. One lady told me flat out she was having the surgery because she couldn’t stop drinking Coke. She had a bubba keg of Coke on her desk at all times and refilled it throughout the day. Do you think she quit drinking Coke after surgery?

I’m generally against bariatric surgery. I do think there are some cases where it may be a good idea, but those are generally VERY extreme cases where immediate weight loss is paramount to survival, but in generally I think that most people can lose fat and be healthy with changes to their life style.

I think one of the main problems that causes these big clashes of opinion is the verbage. People repeatedly say “All you have to do is eat fewer calories than you burn; it’s that easy.” The way easy is being used isn’t like taking a second grade arithmetic test, it’s being used as a synonym for simple. Losing fat and being healthy is VERY simple, but it is anything but easy. People watch me eat, see the large quantities and that it is not rare that I eat horribly unhealthy food and make comments about how they wish they could eat like that and stay fit. You know why I can pull it off? Because I spend no less than 10 hours a week in the gym, none of which is anything less than intense.

Now, that’s not to say everyone can put in exactly the same amount of effort. I’ve met plenty of people who can eat as much as I do, never exercise, and remain thin as a board; others I see eat significantly less, work out hard, and have significantly more bodyfat. Does that mean the thin person is necessarily healthy, even though he is malnurished and doesn’t exercise? Does that mean the person with more bodyfat, but eats well and exercises is less healthy? Any number of doctors will tell you it’s better to be a “healthy overweight”, than an “unhealthy ideal weight”.

My point is, some peopel set unrealistic goals. There ARE genetic factors, and some people can NEVER look like Arnold or Klum, but that doesn’t make them insurrmountable. Some people will have to fight harder to fight those cravings or work harder at the gym or just have a bit more realistic idea of what they can achieve, but the will power has to be there to be healthy.

Bariatic surgery doesn’t change your life style. I’ve seen plenty of those shows on Discovery and TLC and whatnot where they follow people who get it done. Those people still have to change their diets and exercise or it makes no difference. All the bariatric surgery does is make you feel full sooner and make you sick if you surpass that amount. I even remember one episode where someone got the surgery, but still managed to return to his previous eating habits, stretching out his stomach all over again, and achieving very little results.

I think the biggest problem is cultural and this is something that is well demonstrated by the obesity rates. I think the cause of the obesity rate in the US is just that food is SO readily available and so many of the foods that are bad for you are very inexpensive and very tasty which just makes it that much harder to say no. Further, we live much more luxurious lives. So many people have desk jobs which makes it that much easier to remain out of shape because the only physical exertion you need to do those jobs is to walk to and from your car. The obesity rates won’t change until our culture starts to look at these things differently.

And you know what, I don’t but the genetic thing either. I hate to be harsh about it, but I think it’s the only way. You have a thyroid problem or diabetes? So what, it means you have to be a little more careful about watching what you eat and making sure you exercise enough; it may make it harder and require more will power than others, but it doesn’t make it impossible. You have some kind of injury? So what, there are TONS of ways to exercise that have virtually zero impact like a number of the newer cardio machines, swimming, yoga, etc. You don’t have enough time? That’s just straight BS. Being in bettershape generally means you need less sleep and have more energy. If you can’t afford to give up 20-30 minutes of sleep or TV or whatever then you probably have too much else going on in your life that’s also hurting your health just as much as the spare tire you’re carrying around. You have kids that require your attention? So what, even if you’re a single parent with infants, you can at least put them in the stroller and go for a walk. If they’re older, go biking with them or play ball.

Too many people look at losing weight like they HAVE to eat so little food they’re always hungry or the food has to be tasteless or they have to run 10 miles a day or they have to go do monotonous weight training. If you’re current doing no exercise at all, even walking half a mile every other day will make a difference. Giving up as little as one soda a day (assuming it’s not diet) adds up very quickly.

Losing weight is simple; it’s VERY simple. But it’s hard work and requires will power. Some people may require more or less will power than others, but no one has an easy time doing it. If you’re going to tell me it’s difficult, I can sympathize. I’m often giving advice, to people who ask me, about what realistic expectations are or what they can change in their diet or routines to improve their results. If you’re going to tell me it’s impossible or that it’s TOO hard, you won’t get it. It is not impossible for anyone, basic physics dictates that, but that doesn’t mean that life is fair and that it takes the same effort for everyone to achieve the same results. Hell, most of the problem is the victim mentallity and defeatist attitude that people take into losing weight and getting in shape. If you want it enough, you can make it happen.

People are fat because they eat too much and don’t exercise. Everything else is secondary.

But I don’t see why losing weight through surgery would be considered wrong. The goal is to get people down to a healthy weight, so why not use all tools at our disposal? Why is it a moral issue?

OK, the statistic I’ve heard is that over 90% of people who go on a diet fail to lose weight and keep it off. Over 90%.

Now, let’s imagine there is a disease like malaria or small pox that is affecting a large number of citizens. There is a cure, but it is ineffective 90% of the time. The doctors are frustrated because they know that if people would only take the medicine exactly as ordered, it would work all the time. But no matter what the doctors do or say, 90% of the people to whom they give this medicine, fail to improve.

Would it then be immoral to come up with another treatment? What if the new treatment only works 50% of the time? It’s not a total cure for everyone, but it’s a lot better. Should we scream at the 90% of people the first medicine didn’t work for? Blame them for not taking it properly and refuse to treat them with any other method?

Or should we realize that if a treat doesn’t work for over 90% of the people who try it, then this is an ineffective treatment, and we need to come up with something else.

I agree that there’s no morality involved with being fat, but I don’t think the cats are a fair comparison. Yes, some people have a higher drive to eat more than others. All that means is they will have a more difficult time losing weight if they want to. The people who are driven to eat more than others either have to fight the cravings a little more than everyone else or exercise a little more to make up for the extra calories. The problem is, the desire to get in shape for fat people generally does not outweigh (NPI) the cost of having those cravings or the physical exertion required.

I think Cicso hit it pretty well with bariatric surgery in that it DOESN’T address the underlying problem. A lot of people look at the surgery like the extra cravings will just magically vanish. There’s no accounting for the eating habits, the mental desire/need to eat for pleasure, comfort, or whatever, or for the exercise that is required. We, as a culture, are always looking for a quick and easy fix; sometimes there is one, but usually there isn’t. The best way to handle this is to working toward fixing the way that people look at food, exercise, and will power.

So, sure, if you’re 600 lbs and you’ll die in 3 months if you don’t loose 200 lbs, gastric bypass may be the only way to save your life. But unless you’re on your deathbed, and especially if all you do is eat crap and sit on your butt, it’s not addressing the problem, and it will likely just make matters worse.

I agree that most can, just as most people can be celibate. The question is: Is it so difficult for a number of people that additional tools are necessary?

I think the statistical evidence of “dieting” and increased obesity shows that’s true. It can be done, but it’s hard enough that it isn’t often done.

Don’t allow the perfect to be the enemy of the good. It would be great if everyone could lose fat and be healthy with simple changes to their lifestyles. The evidence is that those changes are difficult and rarely sustained. Additional tools, then, make the changes more feasible for some. Ideal? No! Better than nothing? In many cases yes.

It’s a drastic choice and shouldn’t be entered into lightly. Many people will find it easier to change their habits when their bodies are giving them direct, unpleasant reinforcement for what happens when they stray.

Are there clear stats that show the long-term failure rate of the surgery approaching the long-term failure rate of “lifestyle changes” that do not accompany surgery? I’d be interested if they exist.

I’m not sure this is a fair or accurate analogy. You’ve conceded that it would work all the time if used as ordered, but people aren’t doing it. So instead you come up with one that has simpler instructions but has the potential for significant complications and still doesn’t help a whole more. Why risk those complications, and a still very high failure rate, when you can achieve superior results with fewer complications if you try to find ways to help educate more people to use the other drug.

In fact, in this example, I WOULD say it’s immoral. Why aren’t the doctors looking into why there’s a 90% failure rate? What if some simple changes in the instructions, or some simple supervision in taking the medicince could dramatically reduce the failure rate?

IME, the two biggest factors in people failing to lose weight are poor education and peer pressure. For instance, I know someone who is very fat (about 5’6" 360 lbs) who works a desk job and goes straight home and plays WoW all night. Several times he’s tried to go in and start working out, and immediately people are like “well, if you only did this too, you’d get faster results”; next thing you know, he’s overwhelmed, it feels like too much, and he gives up. Hell, for someone that fat, I’m happy to see him in there putting forth the effort, and the best way to help him is to give him encouragement to keep up with what he’s doing. The poor education part comes down to people going in, working way TOO hard for where their fitness level is, doing exercises wrong, not achieving their unreasonable expectations for results, getting obnoxiously sore and worn out, and giving up.

If more people had support around them that was much more sensitive, even as well intentioned as their nudges are, and if they had better information, training, and oversight, I really think we’d see much better results probably on par or even superior to the alternative.

Yeah . . . there was a girl on The Biggest Loser. I can’t remember her name but I want to say it was the dark-haired girl from Tucson on season 3. The doctor said she had a “real” thyroid problem (think about that, he went out of his way to say that her thyroid problem was real. So many are self-[mis]diagnosed or just dreamed up out of nowhere) - and she still lost huge amounts of weight through diet and exercise.

Not everything in life comes easy. Hell, little worth having comes easy. I knew a woman who was genuinely learning disabled and dyslexic and earned herself a genuine PhD. Did she have to work a lot harder than everyone else? You bet. But she did it. If she can accomplish that, just about anyone can lose weight. It’s so sad to see people sell themselves short when I’ve seen so many examples in my life of the amazing things people can accomplish when they set their mind to it.

I went to the doc and he said I was getting close to diabetic. I was about 60 lbs overweight. I was however not lazy. I played racketball about 7 hours a week and walked my dogs a couple miles a day.
I knew why I was overweight. So I changed my eating habits and added one more day of racketball. I have dropped nearly 40 lbs in 3 months. It really was not that hard. I just eat healthier . I am not scheduled to see the doc for a few more weeks, but I am feeling better. I really did not feel bad though. Once you kick off the weight you see the difference. My racketball is a bit better too.
The last 20 will be a bitch. It goes fast ,at least 4 lbs a week in the beginning. Then 1 to 1 1/2 every other week.

For the most part, I actually agree with you on your reasoning, I just don’t agree with your conclusions. If someone needs to vomit to tell them they’ve eaten too much, I really do think that is a question of will power. Will power, to me, means that someone can do (or not do) something without having to have dire consequences.

However, I certainly don’t disagree that additional tools are helpful, I just don’t think that surgery should be one of them except in extreme cases. I think think there’s a number of simpler and more effective ways to attack the obesity problem, including getting better information out there about diets, exercises, and alternatives.

If I thought I had to have a diet like a lot of dieters seem to think, or that I had to work out comparatively as hard as they do, then I might have given up myself too. For someone that’s 300+ lbs and hasn’t exercised in years, walking a 1/2 mile at 3 mph very well could be as difficult for them as it is for me to run 5 miles at 12 mph. And yet, I see so many first timers at the gym hitting the cardio VERY hard for a VERY long time. Hell, when I first started doing cardio regularly, I did the very same thing; I just got obnoxiously tired, saw virtually zero results, and quickly gave up. When I attacked it again later with better information, it was a lot easier and I got much better results.

After a little bit of searching it looks like it was Hollie from season 4. She lost 105lbs in 14 weeks through diet and exercise, and if the current photos on her Myspace page are to be believed, she has kept it off.

If this is the discussion thread, I’m curious about this post:

Considering that this is someone that actually had the surgery, I find it disturbing to see such a simplistic and childlike misunderstanding of “hunger = empty stomach” and “full stomach = no more hunger.” It’s like something a toddler would come up with, but this is someone that’s had an expensive and life-threatening surgery. Doesn’t hunger have much more to do with glucose and insulin levels than a stomach being literally full or empty?

It has to do with all those things, along with hormone levels and psychological issues. I also had a full gastric bypass, a roux en Y, exactly four years ago yesterday. Honestly, the amount of ignorance about this is astounding. Or I should say that it’s amazing how people who know SO little about surgery or issues of obesity still feel they know more than everyone else and have a right to spout nonsense. It would be an extremely daunting and frustrating task to try to educate everyone…and most don’t wish to be educated anyway, since they already believe they have the last word and the “one true answer” about weight loss solutions.

My favorite are all the “I’m not a fan of surgery/I don’t LIKE surgery” comments. There are no FANS. No one LIKES the idea that such a drastic measure must be taken. It’s a last resort, done to save the patients life and/or drastically improve their quality of life. I’m certainly not an advocate of surgery and would never suggest that someone else undergo it. I can only say that it was a wise decision in my case and that I both a) had no serious physical complications and b) adhered to my post-surgical plan and rules and continue to do so now. I know many others who have had the same result.

Issues about why a person is overeating in the first place are addressed by a good pre-surgical program. If they’re not, the patient should seek another program or another means of addressing these things. I agree that self-destructive behavior can have an ongoing psych component that must be fixed. Gastric bypass patients have a fairly high rate (up to 1/3) of switching to other destructive behaviors when they can no longer eat to excess.

Another thing that’s annoying me: All the comments about the expense of surgery to the patient. “I would take the easy way out, but I can’t afford it” is about as offensive as it comes. First of all because it’s clearly not the easy way out of anything.

Second, good health insurance generally covers this surgery. That is because they know that success without surgery in approved situations (BMI over 40 or a BMI over 35 with co-morbidities) is abyssmal. Please consider that weight loss surgery is much less expensive, for whoever pays for it, than diabetes, heart attacks, high blood pressure, joint replacement, sleep apnea, eczema, and a stroke.

The other misconception: All surgery does is restrict intake. Very, very wrong.

It’s more and more often being taken lightly these days and almost as a cosmetic surgery. The woman I mentioned above who “couldn’t” stop drinking Coke was not morbidly or life-threateningly obese. She was maybe 5’9", 250lbs. She had a very pretty face and wanted to be skinny again. This was by no means a “last resort”. It was more like a first.

Well, then let me plead ignorance on this. Please explain what the surgery does besides reducing the amount of food you can eat. If this is not true, then the information out there being spread is wrong and it needs to be corrected.

You claimed in the post above it that there is a lot of ignorance about gastric bypass surgery, but you don’t even go on to explain WHAT we’re ignorant about. Does reducing the size of the stomach effect the ability of the body to absorb calories from the food? If that’s the case, wouldn’t it also reduce the body’s ability to absorb nutrients?
Besides, unless reducing the size of your stomach actually completely reprograms your metabolism, you are still stuck with making life-style changes that include changing your diet and exercising. So my question to you is, if you were given the exact same diet and exercise regimen, and followed it with the same dedication that you have, but did not get the surgery, would you have achieved the same results? If not, why? If it has something to do with a smaller stomach effecting how the food is digested, could the diet have been adjusted somewhat to account for that? IOW, what exactly does the gastric bypass do to improve the effects of the prescribed diet and exercise plan that they provide?

  1. Morbid obesity is defined as anyone having a BMI of 35 or greater (only 30 by some standards). At 5’9" and 250 pounds, your associate had a BMI of 36.9, thus putting her life at risk and qualifying her for surgery. I believe you are typically qualified as obese if you are 20% over your ideal weight. It doesn’t take THAT much.

  2. Anyone who undergoes such surgery lightly or for cosmetic reasons is being ridiculous. Any surgeon who performs it under such circumstances should lose his/her license.

  3. I suspect that an increasing number of obese people, along with higher numbers of them seeking surgical solutions, simply means that more MORONS are having surgery along with everyone else. Probably the same percentage of morons in the general population. The existance of these people does not indicate that surgery is always a bad idea or always undertaken for petty, unrealistic reasons. I know a lot of skinny idiots too. Some of them do stupid stuff and fail at their undertakings.