# Weight Loss and Bariatric Surgery debate **URL:** \ **Category:** Great Debates\ **Created:** [October 2, 2008, 5:47pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202 "2008-10-02T17:47:56Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Blaster\_Master](https://avatars.discourse-cdn.com/v4/letter/b/cab0a1/32.png) [@Blaster\_Master](https://boards.straightdope.com/u/Blaster_Master)\ **Post date:** [October 2, 2008, 8:56pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/21 "2008-10-02T20:56:30Z")
> [@Freejooky](#): > > If this is the discussion thread, I’m curious about [this post](http://boards.straightdope.com/sdmb/showpost.php?p=10265896&postcount=13): > > 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? You know, I missed this post in the previous thread. While I agree that it’s a simplistic and childish understanding of hunger, I’d even go a step further. The very implication that THEY understand what hunger is, but the rest of us don’t is not only a True Scotsman fallacy, but it’s downright offensive to imply that somehow everyone else doesn’t feel as hungry as she does. And in the last part you quoted, it even goes that much farther to prove my point that it’s a matter of will power. To paraphrase, she had surgery so that she would feel satisfied with 8 oz of food rather than having the will power to stop eating with 8 oz when she didn’t quite feel satisfied. ---
**Author:** ![tdn](https://avatars.discourse-cdn.com/v4/letter/t/94ad74/32.png) [@tdn](https://boards.straightdope.com/u/tdn)\ **Post date:** [October 2, 2008, 8:57pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/22 "2008-10-02T20:57:47Z")
> [@KnitWit](#): > > 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. In fact, I thought it was a requirement. I know it is with the surgeons I work with. I’m surprised people are saying (or implying) that doctors give out the surgery like candy or that patients don’t understand the lifestyle changes completely. Around these parts, you have to fulfill a whole lot of requirements before they’ll open you up. Patients who don’t get the knowledge don’t get the surgery. ---
**Author:** ![Cisco](https://avatars.discourse-cdn.com/v4/letter/c/ccd318/32.png) [@Cisco](https://boards.straightdope.com/u/Cisco)\ **Post date:** [October 2, 2008, 9:08pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/23 "2008-10-02T21:08:03Z")
> [@KnitWit](#): > > 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. Are you saying, at that size, she couldn’t have stopped drinking Coke and started exercising to solve her problem? You’re flip-flopping here from “it’s a last resort / drastic measure” to “you don’t have to be in all that bad a situation.” > [@KnitWit](#): > > Any surgeon who performs it under such circumstances should lose his/her license. Agreed, and so should the guy who mutilated Michael Jackson’s nose, but I bet he’s a millionaire. > [@KnitWit](#): > > The existance of these people does not indicate that surgery is always a bad idea or always undertaken for petty, unrealistic reasons. I’ve been very careful throughout this discussion to avoid using absolute terms like always/never, everyone/no one, etc. I definitely never said that this surgery was always undertaken for petty, unrealistic reasons. ---
**Author:** ![KnitWit](https://avatars.discourse-cdn.com/v4/letter/k/f0a364/32.png) [@KnitWit](https://boards.straightdope.com/u/KnitWit)\ **Post date:** [October 2, 2008, 9:15pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/24 "2008-10-02T21:15:01Z")
> [@Blaster\_Master](#): > > 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? Okay, the thing is, I talk a lot. And I type almost as fast as I talk. So I keep making these long rambling, and increasingly frustrated posts as I try to fill people in. Please go to [www.obesityhelp.com](http://www.obesityhelp.com) for a description of a full gastric bypass or the Roux en Y surgery. There is a lot of ignorance out there, I just don’t know if I have the energy to dispell myths and I’m not sure it’s really going to help. Yes, typical gastric bypass surgery does much more than simply restrict intake by making the stomach smaller. First, the least elastic portion of the stomach is made into a small (2-4 oz.) pouch. The exit from that new pouch (the stoma) is made very small so that food can’t simply go through and be replace by more food (if that makes sense). The rest of the stomach is stapled off from the pouch and continues to operate…it is not removed. Then the intestines are re-routed…the first 18-20 inches are BYPASSED (aha, there’s where we get the term gastric bypass!) and the intestines are “re-connected” to the newly formed pouched at a different point. This all accomplishes a number of things. Yes, it’s restrictive. The pouch eventually stretches to about 6 ounces or the size of an egg. Food won’t pass through quickly because of the very small stoma or exit from the stomach. You feel full very quickly and this can be more of a painful feeling than simply a full feeling. Next, production of a number of hormones that signal hunger in a normal person throughout the day either discontinues or is levelled off to a very low level. Appetite can be completely changed by this. Second, you don’t produce stomach acid in your pouch, though varying levels (by person) of stomach acid production still occur in the “old stomach” and enter the digestive system at the point in which it connects. So breakdown of food is greatly hampered and doesn’t really start until the food enters an entirely different potion of the intestines than it does in a normal person (this is likely what accounts for “dumping syndrome”). The 18 inches of bypassed intestine are where a normal person absorbs a) sugar, b) fat, and c) most of their water solutble vitamins and protein. So the answer is to your last question is YES. One of the reasons this surgery is dangerous and not to be undertaken lightly is that an entire host of nutritional deficits and the problems they can cause is entirely possible…actually you are LIKELY to experience them at some point. No one knows exactly how much of our protein we now absorb, so most of us are on protein supplements of some sort for life. In addition to being very careful about my food intake and making sure that I get nutrient and protein dense foods in FIRST I also take an entire handful of vitamins every day. I also take omega 3 fatty acides. Some of these require an emptier digestive track for greater absorption, so they’re taken either pre- or post-meals on a specific schedule. Yes, I will have to do this the rest of my life. There’s actually an illustration of the post-surgical system on Wikipedia that’s pretty good (though I’m obviously aware of the shorcomings of wikinformation). ---
**Author:** ![KnitWit](https://avatars.discourse-cdn.com/v4/letter/k/f0a364/32.png) [@KnitWit](https://boards.straightdope.com/u/KnitWit)\ **Post date:** [October 2, 2008, 9:25pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/25 "2008-10-02T21:25:03Z")
> [@Cisco](#): > > Are you saying, at that size, she couldn’t have stopped drinking Coke and started exercising to solve her problem? You’re flip-flopping here from “it’s a last resort / drastic measure” to “you don’t have to be in all that bad a situation.” No, I’m not flip-flopping. I’m suggesting a couple of things. First is that since you weren’t privy to her actual weight and likely didn’t overhear any conversations she had with her doctor, you really don’t KNOW how severe her condition was. At the height and weight you quoted, she more than qualified for surgery. If she had a co-morbidity, her doctor may have even considered it urgent. I’m unaware of what she tried previously to lose weight or whether your verdict on her diet was justified. I don’t know the woman or whether she could or couldn’t have succeeded without surgery. I only know that her aforementioned height and weight WERE a “bad situation” by my definition and that of weight loss surgeons. I also wanted to point out that lots of people (not necessarily anyone here) who spout nonsense about “lazy fat people” also easily hit the 20% overweight mark, thus themselves qualifying as obese. Americans have lost sight of how a “small” weight problem (by our standards) actually makes us clinically obese and makes us more likely to have health problems. Please see tdn’s post about surgical requirements. It takes around 6 months to be qualified for surgery once you start the pre-surgical program. If you know someone who got into a lousy program and was scheduled for surgery without being informed of its seriousness that is a malpractice issue, not an issue that belongs in a discussion of weight loss issues. ---
**Author:** ![KnitWit](https://avatars.discourse-cdn.com/v4/letter/k/f0a364/32.png) [@KnitWit](https://boards.straightdope.com/u/KnitWit)\ **Post date:** [October 2, 2008, 9:26pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/26 "2008-10-02T21:26:33Z")
> [@Cisco](#): > > Are you saying, at that size, she couldn’t have stopped drinking Coke and started exercising to solve her problem? You’re flip-flopping here from “it’s a last resort / drastic measure” to “you don’t have to be in all that bad a situation.” No, I’m not flip-flopping. I’m suggesting a couple of things. First is that since you weren’t privy to her actual weight and likely didn’t overhear any conversations she had with her doctor, you really don’t KNOW how severe her condition was. At the height and weight you quoted, she more than qualified for surgery. If she had a co-morbidity, her doctor may have even considered it urgent. I’m unaware of what she tried previously to lose weight or whether your verdict on her diet was justified. I don’t know the woman or whether she could or couldn’t have succeeded without surgery. I only know that her aforementioned height and weight WERE a “bad situation” by my definition and that of weight loss surgeons. I also wanted to point out that lots of people (not necessarily anyone here) who spout nonsense about “lazy fat people” also easily hit the 20% overweight mark, thus themselves qualifying as obese. Americans have lost sight of how a “small” weight problem (by our standards) actually makes us clinically obese and makes us more likely to have health problems. Please see tdn’s post about surgical requirements. It takes around 6 months to be qualified for surgery once you start the pre-surgical program. If you know someone who got into a lousy program and was scheduled for surgery without being informed of its seriousness that is a malpractice issue, not something that belongs in a discussion of how easy/difficult weight loss is. ---
**Author:** ![Blaster\_Master](https://avatars.discourse-cdn.com/v4/letter/b/cab0a1/32.png) [@Blaster\_Master](https://boards.straightdope.com/u/Blaster_Master)\ **Post date:** [October 2, 2008, 9:35pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/27 "2008-10-02T21:35:01Z")
> [@KnitWit](#): > > 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. The point here is, BMI is a pretty arbitrary system. As a data point, I am 6’, 228 lbs (last I weighed myself), and I have about 8-9% body fat and my BMI is 30.9. I’ve been as heavy as about 255 lbs (when I was lazy and not doing cardio) with roughly the same muscle mass for about an 18% body fat and a BMI of 34.6. Even at that weight, I was no where near obese, muchless morbidly obese. Hell, most people still looked at me as being in good shape. Yet, I was 3 lbs away from having a 35 BMI, being morbidly obese and potentially qualifying for gastric bypass surgery? Granted, I’m a bit of an extreme example. My point is, just because this woman had a 36.9 BMI doesn’t mean she was necessarily in any serious medical danger or that she was anywhere near being beyond the point where an attempt at changing her diet and/or exercise habits wouldn’t have been worth a better shot. If what he says is true, that she was downing obscene amounts of Coke, that is a good example of someone who I don’t think should have had the surgery and should have been told by the doctor that she needs to make further changes to her lifestyle first. > [@](#): > > 1. 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. I fully agree on this point. The sad part is, I think a lot of doctors do a lot of unnecessary procedures, not just gastric bypass, but any number of other surgeries. Beyond that, a lot of people DO look at surgery as an easy fix. People use to get lipsuctions and tummy tucks for cosmetic reasons. Now people look at gastric bypass, rightly or not, as roughly the equivalent and a quick and easy fix. I don’t think it’s the equivalent, and I don’t think it’s an easy fix, and I think that’s part of the problem. More information needs to be out there to warn people about the dangers, the side effects, and the actual intended purpose of the surgery. > [@](#): > > 1. 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. This is a strawman argument. I don’t think anyone ever said that gastric bypass is always a bad idea. If you’re like the 700 lbs man who hadn’t been out of bed in some number of years and can’t even lay on his back because the weight on his chest puts too much pressure on his lungs and he starts to suffocate, then yeah. But extreme circumstances call for extreme measures. More than 30% of the US technicaly classifies as obese. Does that mean 30% of the US should be candidates for this surgery? ---
**Author:** ![Blaster\_Master](https://avatars.discourse-cdn.com/v4/letter/b/cab0a1/32.png) [@Blaster\_Master](https://boards.straightdope.com/u/Blaster_Master)\ **Post date:** [October 2, 2008, 9:53pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/28 "2008-10-02T21:53:54Z")
> [@KnitWit](#): > > Okay, the thing is, I talk a lot. And I type almost as fast as I talk. So I keep making these long rambling, and increasingly frustrated posts as I try to fill people in. Please go to [www.obesityhelp.com](http://www.obesityhelp.com) for a description of a full gastric bypass or the Roux en Y surgery. > > There is a lot of ignorance out there, I just don’t know if I have the energy to dispell myths and I’m not sure it’s really going to help. > > Yes, typical gastric bypass surgery does much more than simply restrict intake by making the stomach smaller. First, the least elastic portion of the stomach is made into a small (2-4 oz.) pouch. The exit from that new pouch (the stoma) is made very small so that food can’t simply go through and be replace by more food (if that makes sense). The rest of the stomach is stapled off from the pouch and continues to operate…it is not removed. > Then the intestines are re-routed…the first 18-20 inches are BYPASSED (aha, there’s where we get the term gastric bypass!) and the intestines are “re-connected” to the newly formed pouched at a different point. > > This all accomplishes a number of things. Yes, it’s restrictive. The pouch eventually stretches to about 6 ounces or the size of an egg. Food won’t pass through quickly because of the very small stoma or exit from the stomach. You feel full very quickly and this can be more of a painful feeling than simply a full feeling. > > Next, production of a number of hormones that signal hunger in a normal person throughout the day either discontinues or is levelled off to a very low level. Appetite can be completely changed by this. Second, you don’t produce stomach acid in your pouch, though varying levels (by person) of stomach acid production still occur in the “old stomach” and enter the digestive system at the point in which it connects. So breakdown of food is greatly hampered and doesn’t really start until the food enters an entirely different potion of the intestines than it does in a normal person (this is likely what accounts for “dumping syndrome”). > > The 18 inches of bypassed intestine are where a normal person absorbs a) sugar, b) fat, and c) most of their water solutble vitamins and protein. So the answer is to your last question is YES. One of the reasons this surgery is dangerous and not to be undertaken lightly is that an entire host of nutritional deficits and the problems they can cause is entirely possible…actually you are LIKELY to experience them at some point. No one knows exactly how much of our protein we now absorb, so most of us are on protein supplements of some sort for life. > > In addition to being very careful about my food intake and making sure that I get nutrient and protein dense foods in FIRST I also take an entire handful of vitamins every day. I also take omega 3 fatty acides. Some of these require an emptier digestive track for greater absorption, so they’re taken either pre- or post-meals on a specific schedule. Yes, I will have to do this the rest of my life. > > There’s actually an illustration of the post-surgical system on Wikipedia that’s pretty good (though I’m obviously aware of the shorcomings of wikinformation). FTR, this is more or less what I understood about the procedure; I was, however, unaware of just how restrictive the diet was. Would a fair summary be that it reduces the amount you can eat comfortably (or before feeling full or satisfied or whatever verbage you want to use) AND that it reduces your body’s ability to absorb the food the good things (vitamins, minerals, proteins, etc.) along with the bad (excess fats, sugars, etc.)? It also puts you on a very restrictive diet. But here’s the part I don’t understand. If that’s a fair assessment of what it does, couldn’t one apply a similar diet and achieve the same results without surgery? Obviously, since less of the food is ultimately absorbed, it may require somewhat different portion sizes and food combinations. That is, if after the surgery you absorb 20% less of the food, then you could achieve similar results by following the same diet but with portions 20% smaller. That is, it still ultimately seems to me like it doesn’t really change anything that can’t be effected with a lifestyle except for that “full feeling” you describe. But it has the added problems of being forced to take a handful of pills each day the rest of your life in the best case, and any number of possible surgical complications in the worst case. I’m going to take a longer look at the website you linked as time permits. ---
**Author:** ![Max\_Torque](https://avatars.discourse-cdn.com/v4/letter/m/e9bcb4/32.png) [@Max\_Torque](https://boards.straightdope.com/u/Max_Torque)\ **Post date:** [October 2, 2008, 10:12pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/29 "2008-10-02T22:12:56Z")
I believe that people who think that weight loss is a simple matter of willpower are wired a bit differently than those of us who struggle. Let me see if I can come up with a good analogy: Let’s take smoking as an example. There are lots of smokers out there. Many people quit, and many who quit eventually start smoking again, despite their best intentions. Clearly, smoking is a difficult habit to break. It is, however, perfectly possible to stop smoking, entirely, and never again consider having another cigarette. This is not the case with food. Unlike tobacco, we all _must eat_ a certain minimum amount each and every day to survive. How successful do you think people would be at quitting smoking if they were told, “Okay, you have to stop smoking for your health. But you _must_ smoke three cigarettes every day in order to survive. Exactly three, no more and no less.” Trying to “quit” smoking, while smoking every day? It’s unfathomable. And yet, that’s precisely what people expect from a tub of goo such as myself when it comes to food. So, yeah, I’m a fat sack of crap. Right now I’m on phentermine, which helps with hunger control, and I’ve managed to lose about 42 pounds since the beginning of July. But, it ain’t easy, and I resent the implication that it is. I’ve managed that loss by eating a whole lot less, taking the phentermine, working out every day on stairs, walking, or weightlifting. Couple that with the fact that I have an 18 month old daughter who needs chasing after, and what you get is my life today: every waking hour occupied, no time to rest or be myself or do anything I enjoy. It’s a recipe for stress, which is not conducive to weight loss. The truth is, because I’m a naturally large guy with a big frame, I’ll never be “thin”, even if I ate nothing but carrots for two years. The lowest I’ve ever weighed in my adult life was 232, in high school, during a period when I worked out two hours a day and ate approximately half a meal a day. If I can get back to 255, I’ll be ecstatic. You don’t have my body. And those who presume that they understand what being “me” is like with flippant little platitudes like “just put down the fork” offend me. ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [October 2, 2008, 10:36pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/30 "2008-10-02T22:36:23Z")
Some insurance companies require a complete medical work-up and a pre authorization request with documented weight loss attempts under medical supervision (phy2ss ) . Few private insurers or managed care plans cover, regardless of whether it is medically suggested. Then coverage varies from 50 to 100 percent. I looked it up. Cost of the operation is from 25 to 50 thou. ---
**Author:** ![Malacandra](https://avatars.discourse-cdn.com/v4/letter/m/45deac/32.png) [@Malacandra](https://boards.straightdope.com/u/Malacandra)\ **Post date:** [October 2, 2008, 10:54pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/31 "2008-10-02T22:54:46Z")
> [@Max\_Torque](#): > > I believe that people who think that weight loss is a simple matter of willpower are wired a bit differently than those of us who struggle. Let me see if I can come up with a good analogy: > > Let’s take smoking as an example. There are lots of smokers out there. Many people quit, and many who quit eventually start smoking again, despite their best intentions. Clearly, smoking is a difficult habit to break. It is, however, perfectly possible to stop smoking, entirely, and never again consider having another cigarette. > > This is not the case with food. Unlike tobacco, we all _must eat_ a certain minimum amount each and every day to survive. How successful do you think people would be at quitting smoking if they were told, “Okay, you have to stop smoking for your health. But you _must_ smoke three cigarettes every day in order to survive. Exactly three, no more and no less.” Trying to “quit” smoking, while smoking every day? It’s unfathomable. And yet, that’s precisely what people expect from a tub of goo such as myself when it comes to food. > > So, yeah, I’m a fat sack of crap. Right now I’m on phentermine, which helps with hunger control, and I’ve managed to lose about 42 pounds since the beginning of July. But, it ain’t easy, and I resent the implication that it is. I’ve managed that loss by eating a whole lot less, taking the phentermine, working out every day on stairs, walking, or weightlifting. Couple that with the fact that I have an 18 month old daughter who needs chasing after, and what you get is my life today: every waking hour occupied, no time to rest or be myself or do anything I enjoy. It’s a recipe for stress, which is not conducive to weight loss. > > The truth is, because I’m a naturally large guy with a big frame, I’ll never be “thin”, even if I ate nothing but carrots for two years. The lowest I’ve ever weighed in my adult life was 232, in high school, during a period when I worked out two hours a day and ate approximately half a meal a day. If I can get back to 255, I’ll be ecstatic. > > You don’t have my body. And those who presume that they understand what being “me” is like with flippant little platitudes like “just put down the fork” offend me. Hi, I’m **Malacandra**. A year ago I weighed 288lb. I now weigh ~199lb. Prior to this year I had never been under 200lb since the 1970s. Ecstatic? Pretty happy, you bet. I just put down the fork (and got my fat ass off the sofa). In my opinion based on experience, it is not mere _eating_ that is analogous to the cigarette buzz - it is the sensation of “couldn’t eat another thing”. And _that_ is something you never have to go back to. ---
**Author:** ![MaddyStrut](https://avatars.discourse-cdn.com/v4/letter/m/dbc845/32.png) [@MaddyStrut](https://boards.straightdope.com/u/MaddyStrut)\ **Post date:** [October 2, 2008, 11:10pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/32 "2008-10-02T23:10:53Z")
> [@Cisco](#): > > 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? That’s interesting. I have two friends who had the surgery a couple years ago and both have been successful at keeping off the weight they lost. However, they didn’t just have surgery and assume the problem was fixed. Both joined (and are still in) Weight Watchers, got counseling for other issues going on in their lives, and started exercise programs. Now that they’ve achieved healthy weights, it’s actually easier to keep it off than to lose it since they know how to eat, understand why they may overeat, and are much more active physically (exercise and general activity is so much easier when you weigh less). I realize I have a sample size of a whopping TWO! But I’m curious as to what factors may lead some people to commit to lifestyle changes that will help them keep the weight off while others slip back into unhealthy habits. My friends aren’t any more disciplined or conscientious than most people. However, both did think long and hard about the surgery and thought about it (and what it would mean) for months (maybe years) before going under the knife. ---
**Author:** ![Blaster\_Master](https://avatars.discourse-cdn.com/v4/letter/b/cab0a1/32.png) [@Blaster\_Master](https://boards.straightdope.com/u/Blaster_Master)\ **Post date:** [October 2, 2008, 11:12pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/33 "2008-10-02T23:12:07Z")
> [@Max\_Torque](#): > > I believe that people who think that weight loss is a simple matter of willpower are wired a bit differently than those of us who struggle. Let me see if I can come up with a good analogy: > > Let’s take smoking as an example. There are lots of smokers out there. Many people quit, and many who quit eventually start smoking again, despite their best intentions. Clearly, smoking is a difficult habit to break. It is, however, perfectly possible to stop smoking, entirely, and never again consider having another cigarette. > > This is not the case with food. Unlike tobacco, we all _must eat_ a certain minimum amount each and every day to survive. How successful do you think people would be at quitting smoking if they were told, “Okay, you have to stop smoking for your health. But you _must_ smoke three cigarettes every day in order to survive. Exactly three, no more and no less.” Trying to “quit” smoking, while smoking every day? It’s unfathomable. And yet, that’s precisely what people expect from a tub of goo such as myself when it comes to food. I think your analogy is apt, but I think your conclusion is wrong. That is the very definition of will power. That is, yes, I think eating less could easily be as or more difficult than quitting smoking or alcohol because you CAN put those aside every day but you still have to eat. However, it still comes back to the same thing, you have to control your impulse to eat more ([definition of will power](http://dictionary.reference.com/browse/will%20power)). The amount of will power required may be different for each person, but it’s still a matter of will power. Some athletes play on broken bones, seperated shoulders, and some won’t play because of a minor strain in their finger. Does the first group necessarily feel less pain than the second? Quite frankly, I think this excuse holds no weight at all. Do you think everyone else doesn’t feel hunger as intensely as you do? Hell, I’ve felt ravenous to the point of it causing a migraine. Do you think I feel any less unsatisfied when I don’t feel like I’ve eaten enough, but know I should stop? Do you think it takes any less will power on my part to wake myself up early, often on less than five hours of sleep, and run more than 4 miles every morning and then go and do some very intense weight training for 2 hours each evening? Do you think it takes me less will power to replace some of my meals with protein shakes? Do you think it takes me less will power to not eat a whole quart of ice cream or have a giant piece of cake at a party? What exactly is wired differently about someone like me? Yeah, maybe my base metabolism is a little higher so to achieve the same results you’d have to do a little more cardiovascular work. But there is no way you can justify that somehow anything that I do to maintain my health is anything other than simple will power. Every single morning my alarm goes off, I’m tempted to hit snooze, but I don’t. Every time it’s time to hit the gym at night and I’d rather take a nap, I’m tempted to go to bed, but I don’t. Everytime I eat out, I’m tempted to order all kinds of food, but I don’t (well, okay, sometimes I do pig out, but still). What part of that ISN’T will power? > [@](#): > > So, yeah, I’m a fat sack of crap. Right now I’m on phentermine, which helps with hunger control, and I’ve managed to lose about 42 pounds since the beginning of July. But, it ain’t easy, and I resent the implication that it is. I’ve managed that loss by eating a whole lot less, taking the phentermine, working out every day on stairs, walking, or weightlifting. Couple that with the fact that I have an 18 month old daughter who needs chasing after, and what you get is my life today: every waking hour occupied, no time to rest or be myself or do anything I enjoy. It’s a recipe for stress, which is not conducive to weight loss. No one said it was easy. Hell, I’ve been trying to say over and over how hard it is. And I’ve been to the point where you are in terms of time. I was working a full time job, working on my PhD with almost twice a full time course load, I was involved in a serious relationship that sucked up any spare time I had between these things, and I was exercising no less than 10 hours a week, and I was averaging about 4.5 hours of sleep a night. I didn’t so much as have time to watch TV or even check my personal e-mail for months at a time. Yes, that level of stress is not conducive to weight loss, but if I’d not maintained my exercise, I’d have been MORE stressed. It took an enormous amount of will power to make myself continue to go to the gym, even when I was dead tired, but I never missed a day… ever. > [@](#): > > The truth is, because I’m a naturally large guy with a big frame, I’ll never be “thin”, even if I ate nothing but carrots for two years. The lowest I’ve ever weighed in my adult life was 232, in high school, during a period when I worked out two hours a day and ate approximately half a meal a day. If I can get back to 255, I’ll be ecstatic. This is exactly a scenario I was talking about. Not everyone is going to look like Arnold. In fact, some of the most in shape people I’ve known have guts simply because that’s how their body stores fat. They have 12% body fat, and it seems like every ounce of it is right on their belly. If what you say is true about your weight and your activity level in high school, you may be yet another case of where the BMI just fails miserably at saying how healthy you really are. I’m not in any way endorsing some sort of ideal image that everyone should be right in that “ideal weight” zone. And, like I said early, it’s SO much better to be a healthy and overweight, than unhealthy and have an ideal weight. > [@](#): > > You don’t have my body. And those who presume that they understand what being “me” is like with flippant little platitudes like “just put down the fork” offend me. No one is claiming to have or know more about your body than you do. But everyone who makes an attempt to be healthy has to deal with the very same urges you do. Sure, maybe their intensity is different than yours, who knows. But if it’s will power for someone with a different level of intensity on those urges than yours, what makes the level of intensity of your urges different? Medication and surgery can help make those urges easier to manage, but it’s still a matter of controlling your urges and that is exactly what will power is. ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [October 2, 2008, 11:29pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/34 "2008-10-02T23:29:42Z")
> [@Cisco](#): > > 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. That’s not necessarily true for everyone. The reasons for people being overweight are varied. Take diabetes as an example: The worse your control gets with diabetes, the worse you feel and the less you’ll want to do and the more you’ll want to eat. Some of the surgeries have remarkable success in “curing” some Type II diabetics. Eating problems can be a sign of depression, which can lead to hopelessness and a spiral of bad choices. Get a jump start and some of those problems can be addressed more directly. Generally, I believe most obesity has a physical cause. (Yeah, I know it all has the physical cause of eating more than you’re burning, but I mean the underlying issues.) The person has a higher than average hunger drive, is depressed, is anxious, etc. Such people are eating because it’s instinctual to eat when you’re tired. A reduction in fatigue leads to a reduction in eating. My husband is disabled with heart issues and diabetes. He recently went on Provigil, and suddenly eating better, sleeping better, having better habits, they’re all easier for him now. What does Provigil do? It makes you more alert/awake. So, I don’t think we can just say, “Oh, Sally is fat because she’s got a bad relationship with food.” She might, or she might be exhausted all the time and her body is trying desperately to get the energy it thinks it needs. ---
**Author:** ![lorene](https://avatars.discourse-cdn.com/v4/letter/l/65b543/32.png) [@lorene](https://boards.straightdope.com/u/lorene)\ **Post date:** [October 3, 2008, 1:37am UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/35 "2008-10-03T01:37:10Z")
> [@tdn](#): > > In fact, I thought it was a requirement. I know it is with the surgeons I work with. I’m surprised people are saying (or implying) that doctors give out the surgery like candy or that patients don’t understand the lifestyle changes completely. Around these parts, you have to fulfill a whole lot of requirements before they’ll open you up. Patients who don’t get the knowledge don’t get the surgery. You’d be surprised, **tdn**. I know 4 women who have had the surgery, all in the Boston area, but none at your hospital (although often doctors are affiliated with more than one hospital, so who knows…). Of the 4, 3 went though all of the pre- and post-counseling for as long as it was recommended. The 4th just blew it off and had a surgeon who was pretty laissez-faire about the whole thing. All lost weight initially. 3 lost enough weight to get down to near-normal BMIs. All of them eventually started re-gaining. It’s been 3, 5, 6, and 8 years since each woman’s surgery. All are now at over 225 lbs. My sample size is only four, but it’s not promising. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [October 3, 2008, 5:53am UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/36 "2008-10-03T05:53:55Z")
Please excuse my interruption of this exercise of humble opinions and anecdotes for this small intrusion of what the evidence actually says. [Cochrane’s reviews](http://www.medscape.com/viewarticle/486718) are considered among the best for evidence-based reviews in medicine. As follows: > [@](#): > > Twenty – six trials were included. … > Compared with conventional management, surgery resulted in greater weight loss (21 kg weight loss at eight years versus weight gain), with improvements in quality of life and comorbidities. Some complications of surgery occurred, such as wound infection. For the morbidly obese gastric bypass generally works and “will power” (even with much support) rarely does. Even with minimal weight loss the bypass procedure may significantly reduce the morbidity associated with obesity. [In _Science_](http://www.sciencemag.org/cgi/content/summary/sci;320/5875/438?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=gastric+bypass+diabetes&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT) (link to summary, quote from full article on other side of firewall) some studies are presented that show how bypass may turn out to be an effective treatment for diabetes, not per se from weight loss but from other hormonal effects. > [@](#): > > Recently, however, a growing number of studies are suggesting that the surgery has a profound effect on gut hormones, which could explain its impact on appetite, diabetes, and the low blood sugar that’s turning up. One of the first clues emerged in 2002, when Cummings looked into a well-recognized oddity. Gastric bypass restricts the stomach, forcing people to eat smaller meals. One might then expect “that people would be compelled to sip milkshakes all day long,” says Cummings. That’s not what happens. Many move away from calorie-dense foods altogether. > > Curious, Cummings began examining levels of ghrelin, a hormone produced mainly by the stomach that stimulates appetite. Most people have peaks and valleys in ghrelin levels throughout the day as they consume meals and then become hungry again. In those who’ve had gastric bypass, Cummings found, ghrelin levels in blood were low and changed little all day, suggesting that something about the surgery dampens ghrelin production and hence appetite. > > The role this plays in diabetes resolution has not been firmed up, and researchers are now more closely examining how gastric bypass affects other hormones. Rubino’s work, for example, has focused on the intestines, which produce a different suite of chemicals and hormones from those the stomach churns out. In 1999, Rubino turned to rats to examine whether the surgery’s effects on diabetes were due to calorie restriction and weight loss alone. He tried to tease apart distinct features of his “patients”–the rats, in this case–and different features of surgery. When performed on lean animals with type 2 diabetes, gastric bypass had the same positive effects on the diabetes as in obese ones, suggesting that weight loss was largely irrelevant. Furthermore, Rubino performed the intestinal bypass portion of the operation, skipping past the duodenum and the jejunum that link up to the stomach, but leaving the stomach intact. There was a “direct antidiabetic effect,” he says. … > > …Currently, U.S. National Institutes of Health guidelines recommend that gastric bypass surgery be considered only for people who have a body mass index (BMI) of at least 35. (A BMI of 18.5 to 25 is considered normal.) At a meeting in Rome last year, 78% of attendees supported lowering the limit to a BMI of 30 for those with diabetes. Should the number be even less? “We need more data to know if a lower bar is okay or if there should be any bar at all” when the goal is diabetes treatment, says Cummings… > > … the surgery reduces diabetes deaths by 92%. “It’s the most profound effect in terms of mortality from diabetes ever reported,” Rubino says. “What is the price of that?” The surgery is not without risk and it does not always work. But persistent morbid obesity, especially with diabetes as a complication, is with greater risk and even greater societal cost. And the alternative of telling those with morbid obesity who have honestly tried reasonable diet and exercise that they just need more will power is a documented failing strategy. Please feel free to return to personal anecdotes and humble opinions now. Thank you. ---
**Author:** ![even\_sven](https://avatars.discourse-cdn.com/v4/letter/e/dfb087/32.png) [@even\_sven](https://boards.straightdope.com/u/even_sven)\ **Post date:** [October 3, 2008, 6:30am UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/37 "2008-10-03T06:30:08Z")
> [@autz](#): > > 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? I think that surgery for people who could lose wait using traditional methods is poor stewardship of resources, personal and medical. It’s kind of like abortion- even the most pro choice person in the world agrees that “don’t get pregnant in the first place” is a better solution. Personally I believe a good chunk of our national obesity problem is that we’ve built our communities such that people don’t walk and children don’t play outside. Obesity is heavily linked to geography. People in walkable cities don’t get as fat. Urban sprawl is killing us. And yet we keep building developments without sidewalks, without safe routes for children to walk to school and without nearby facilities. ---
**Author:** ![bdgr](https://avatars.discourse-cdn.com/v4/letter/b/a87d85/32.png) [@bdgr](https://boards.straightdope.com/u/bdgr)\ **Post date:** [October 3, 2008, 6:58am UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/38 "2008-10-03T06:58:06Z")
The lowest weight I ever got down to was 275. I’m 6’6 and I was pretty thin at that time. I stayed at that weight by the poverty diet plan. A typical days intake for me was a box of cheap macaroni and cheese mixed up with margerine, no milk, because it was all I could afford. and maybe a couple of otter pops, because I could get a box of those at sams club for nothing. Occasionally I would get left over hot dogs from the concession stand a friend ran once or twice a week. I was able to keep this off because I couldn’t afford food, and I hated myself so I felt I deserved to be hungry all the time. for over a year. I was painfully hungry from the time I woke up in the morning, to the time I fell asleep at night. once I got some self esteem back and got where I could eat regularl food my weight shot back up. If I eat to the point that I am not constantly distracted by hunger I will be fat. I now weight between 380-400 or so depending on the time of year I don’t eat that much, but I’m pretty crippled up with a bad back and bad knees so I don’t get much exercise. Every one is different, and different people have different reasons for being overweight. Just the fact that most people who simply try to reduce calories and exercise fail should say that we need to try something different. ---
**Author:** ![KnitWit](https://avatars.discourse-cdn.com/v4/letter/k/f0a364/32.png) [@KnitWit](https://boards.straightdope.com/u/KnitWit)\ **Post date:** [October 3, 2008, 1:16pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/39 "2008-10-03T13:16:30Z")
> [@DSeid](#): > > As follows:For the morbidly obese gastric bypass generally works and “will power” (even with much support) rarely does. > > Even with minimal weight loss the bypass procedure may significantly reduce the morbidity associated with obesity. Thank you for taking the time to look up and post hard facts. This was the same study that was presented to me in pre-surgery seminars. It’s unfortunate that lots of us are at work and can’t take the time to properly use resources. ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [October 3, 2008, 1:46pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/40 "2008-10-03T13:46:15Z")
> [@DSeid](#): > > Please feel free to return to personal anecdotes and humble opinions now. Thank you. Thanks for the data. It’s what I expected but wasn’t certain of. I had definitely heard of the astonishing results re: insulin-resistant diabetes. Like all tools, this surgery could certainly be misused. But the data suggest that taking it out of the toolbox would be a mistake. [Previous page](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202.md?page=1) [Next page](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202.md?page=3)