# 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:** 14\ **Page:** 3
**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, 1:54pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/41 "2008-10-03T13:54:22Z")
> [@jsgoddess](#): > > 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. And to do what one poster said and return to personal anecdotes… I am sure this could be taken too far…there are a couple of people here jumping up and down ranting about 30% of the population being eligible for surgery (untrue). But when I was consulting with the surgeon I was also warned that just because I had not YET developed any of the obesity related illnesses, that didn’t mean I shouldn’t go ahead with it. That is, it might be a good idea for some people to have surgery (if that’s an option for them and they haven’t been successful in other ways) BEFORE they develop diabetes. In my case, I was 34 years old and weighed about 300 pounds. There’s type II diabetes in my family…really, just among women who didn’t take care of themselves. So every time I went to the doctor I was certain that THIS would be the time they told me I was diabetic. I consider the surgery to have helped me dodge that bullet for good. It was nice not to have to reverse something that was already damaged…to get to take care of it BEFORE I had a bunch of complications. Surgery is more risky under those circumstances anyway. ---
**Author:** ![norinew](https://avatars.discourse-cdn.com/v4/letter/n/eb9ed0/32.png) [@norinew](https://boards.straightdope.com/u/norinew)\ **Post date:** [October 3, 2008, 3:05pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/42 "2008-10-03T15:05:58Z")
> [@BlasterMaster](#): > > 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. Yes, it’s me. The one with the kindergarten-level understanding of my physiology. No, my understanding _isn’t_ really that simplistic, I was simplifying it for the sake of brevity. But now I will tell you a little about my surgery, the statistics for success, what it has done for me, and what it does _besides_ limit how much food I can eat. First, about the surgery: it has two components. The first component is to _remove_ about 90% of the stomach. This is different from “traditional” bypass surgery, which staples off most of the stomach, leaving a “pouch”. I was left a fully-functioning stomach (and pyloric valve, which RNY doesn’t feature), just a much smaller one. The second component is intestinal re-routing. The part of your intestines where digestive juices join up with the food you’ve eaten is where you absorb your calories. This part of the intestinal tract is normally called the common channel. My common channel was reduced _significantly_ in length, from about 350cm to about 100cm. This means that of the food I _do_ eat, I malabsorb about 80% of the fat that I take in, about 50% of the protein I take in, and almost none of the simple carbs. Removal of the stomach (not just “closing it off”) is a key part of this surgery because your stomach produces a growth hormone called ghrelin. Ghrelin is currently believed to be related to metabolism. The more we eat and the larger our stomach, the more ghrelin we produce, the slower our metabolism (this was a _good_ thing for our ancestors who would often have to eat huge meals occasionally, instead of the way we eat now). Smaller stomach=less ghrelin production. The stomach is cut in such a way that it is _meant_ to stretch some, to go from about a 4oz capacity to about an 8oz capacity. The stomach is cut along the greater curvature, or “the stretchy part”, so it _cannot_ stretch all the way back to its previous size. Most of the initial weight loss is from restriction of how much you can eat. But the reason the surgery is so successful at helping to maintain the weight loss is the malabsorptive component. Because of the intestinal component, which addresses the biliary limb as well, this surgery has a 90% _cure rate_ for Type II diabetes. In fact, there are docs in Brazil and Mexico doing just the intestinal part of the surgery on diabetic patients who are not very overweight, to cure the diabetes. The “down side” of the surgery is this: every single day, for the rest of my life, I will have to take nutritional supplements because I malabsorb. Every six months I will have to have bloodwork done to make sure my levels are good, and adjust my supplements accordingly. In order to make sure I’m not losing too much muscle mass, I must always focus on protein first, and get at least 90g of protein per day. Statistically, 85-90% of people who have _this particular_ weight loss surgery will be considered “successful” (losing at least 50% of their excess body weight-I personally have lost about 90% of mine), and more than 75% of them will have _maintained_ that weight loss at five years out. These are better statistics than the RNY or the lap band. Still, it is a higher-risk procedure, plus it’s easier to get insurance to pay for the RNY, as well as easier to find a surgeon. My insurance paid for my surgery, I had to travel two and a half hours to have it done. It wasn’t “easy”. It wasn’t even an easy decision for me to make. But I have lost 140lbs and have been off of all blood pressure medication since two weeks after the surgery. The weight loss also makes it much safer to undergo general anesthesia, which I generally need about twice a year (for chronic kidney issues that have nothing to do with my weight). So, in a word, no the surgery does _not_ just limit the amount of food I can eat. If you have any more questions, just ask. ---
**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, 3:59pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/43 "2008-10-03T15:59:02Z")
> [@Blaster\_Master](#): > > 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. The majority of people dealing with those urges appear to be pretty damned unsuccessful if you look at the data. Surgery isn’t ideal because it’s more dangerous. But I get the impression some here would claim it’s horrible even if it were completely safe and free because it offends their sense of what’s natural or they think it’s cheating or lazy. These are the same sorts of objections I hear when discussion turns to antidepressants or other drugs–an idea that if you don’t hoist yourself by your own bootstraps it’s not fair to those who do, or if you don’t self-hoist you are cheating or immature or unable to face the world or want a shortcut, etc. So, what’s your specific beef with bariatric surgery? It appears to work and has some good side effects. The negatives are the expense, the danger, and what else exactly? ---
**Author:** ![Dripping](https://avatars.discourse-cdn.com/v4/letter/d/d2c977/32.png) [@Dripping](https://boards.straightdope.com/u/Dripping)\ **Post date:** [October 3, 2008, 4:10pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/44 "2008-10-03T16:10:16Z")
> [@Max\_Torque](#): > > 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. There is is again, the whining that “waaaa, it’s too haaard”. Weight loss isn’t “easy” for _anyone_. [QUOTE=] The truth is, because I’m a **naturally** large guy with a **big frame** , [/QUOTE] There is no such thing as “naturally large”. You’re fat because you eat too much. And the whole “big frame” thing is bullshit. Cite: [http://www.skinnymyths.com/2008030395/News/Weight-Loss-Myths/You-Weigh-More-If-You-Are-Big-Boned.html](http://www.skinnymyths.com/2008030395/News/Weight-Loss-Myths/You-Weigh-More-If-You-Are-Big-Boned.html) [QUOTE=] I’ll never be “thin”, even if I ate nothing but carrots for two years. [/QUOTE] An asinine statement. Tell that to the holocaust victims who starved to death, I’m sure you’d get lots of sympathy. :rolleyes: [QUOTE=] 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. [/QUOTE] Shrug. Put down the fork. I guarantee you’ll lose weight. ---
**Author:** ![Dripping](https://avatars.discourse-cdn.com/v4/letter/d/d2c977/32.png) [@Dripping](https://boards.straightdope.com/u/Dripping)\ **Post date:** [October 3, 2008, 4:56pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/45 "2008-10-03T16:56:30Z")
> [@norinew](#): > > The stomach is cut in such a way that it is _meant_ to stretch some, to go from about a 4oz capacity to about an 8oz capacity. Why not just limit your intake to less than 8 oz? > [@](#): > > _this surgery_ has a 90% _cure rate_ for Type II diabetes. This is a bit disingenuous. It’s the _weight loss_ that reverses the diabetes. A person who simply stopped overeating and got down to a healthy weight would be just as “cured” as one who opted for this surgery. ---
**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, 5:00pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/46 "2008-10-03T17:00:28Z")
> [@Dripping](#): > > Why not just limit your intake to less than 8 oz? > > This is a bit disingenuous. It’s the _weight loss_ that reverses the diabetes. A person who simply stopped overeating and got down to a healthy weight would be just as “cured” as one who opted for this surgery. I suggest you read my post. ---
**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, 5:19pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/47 "2008-10-03T17:19:18Z")
> [@Dripping](#): > > Weight loss isn’t “easy” for _anyone_. This is misleading. There have been studies that show that people who force themselves to gain weight by overeating have a very easy time later losing the weight. I will look for the cite later (I’m on dial-up right now). > [@Dripping](#): > > This is a bit disingenuous. It’s the weight loss that reverses the diabetes. A person who simply stopped overeating and got down to a healthy weight would be just as “cured” as one who opted for this surgery. You are incorrect. The diabetes is cured before the weight loss occurs. ---
**Author:** ![catflea12](https://avatars.discourse-cdn.com/v4/letter/c/f6c823/32.png) [@catflea12](https://boards.straightdope.com/u/catflea12)\ **Post date:** [October 3, 2008, 5:24pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/48 "2008-10-03T17:24:50Z")
> [@Dripping](#): > > Why not just limit your intake to less than 8 oz? > > This is a bit disingenuous. It’s the _weight loss_ that reverses the diabetes. A person who simply stopped overeating and got down to a healthy weight would be just as “cured” as one who opted for this surgery. Actually, no, it’s not. When I had my bypass surgery I was taken off insulin within a week of the surgery, before I lost any weight. ---
**Author:** ![norinew](https://avatars.discourse-cdn.com/v4/letter/n/eb9ed0/32.png) [@norinew](https://boards.straightdope.com/u/norinew)\ **Post date:** [October 3, 2008, 5:26pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/49 "2008-10-03T17:26:11Z")
> [@Dripping](#): > > Why not just limit your intake to less than 8 oz? > > This is a bit disingenuous. It’s the _weight loss_ that reverses the diabetes. A person who simply stopped overeating and got down to a healthy weight would be just as “cured” as one who opted for this surgery. Nope, the surgery cures it. Cites: [http://diabetes.taragana.net/gastric-surgery-permanently-cures-type-2-diabetes-niddm-clinical-trial/](http://diabetes.taragana.net/gastric-surgery-permanently-cures-type-2-diabetes-niddm-clinical-trial/) [http://www.msnbc.msn.com/id/6233542/](http://www.msnbc.msn.com/id/6233542/) This is evidenced again and again in patients who are off of insulin within mere _days_ (two weeks or less) of surgery, which is not enough time to lose enough weight to get off the meds. It is also evidenced in the fact that, as I said, a variation of the surgery is being done, with excellent results, on diabetics who _are not overweight_. And, as I also said, the surgery doesn’t just limit what I can eat. It limits what I absorb from what I _do_ eat, _and_ reduces the amount of ghrelin that my body produces. ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [October 3, 2008, 5:27pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/50 "2008-10-03T17:27:45Z")
> [@Dripping](#): > > There is is again, the whining that “waaaa, it’s too haaard”. Weight loss isn’t “easy” for _anyone_. > > There is no such thing as “naturally large”. You’re fat because you eat too much. And the whole “big frame” thing is bullshit. Cite: [http://www.skinnymyths.com/2008030395/News/Weight-Loss-Myths/You-Weigh-More-If-You-Are-Big-Boned.html](http://www.skinnymyths.com/2008030395/News/Weight-Loss-Myths/You-Weigh-More-If-You-Are-Big-Boned.html) > An asinine statement. Tell that to the holocaust victims who starved to death, I’m sure you’d get lots of sympathy. :rolleyes: > Shrug. Put down the fork. I guarantee you’ll lose weight. You can not tell anything to holocaust victims who died of starvation. They have been dead a long time. ---
**Author:** ![Dripping](https://avatars.discourse-cdn.com/v4/letter/d/d2c977/32.png) [@Dripping](https://boards.straightdope.com/u/Dripping)\ **Post date:** [October 3, 2008, 6:20pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/51 "2008-10-03T18:20:32Z")
> [@Cisco](#): > > 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? Why didn’t she just switch to diet coke? 😕 ---
**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 3, 2008, 8:39pm UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/52 "2008-10-03T20:39:12Z")
> [@Dripping](#): > > There is is again, the whining that “waaaa, it’s too haaard”. Weight loss isn’t “easy” for _anyone_. Another thing that isn’t easy is staying civil while this debate is outside the Pit, but I’ll do my best. Did you miss the part where I mentioned my weight loss, that it was progressing, that I am in fact _doing_ the very things you’re accusing me of “whining” about? I’m not saying it’s impossible or making excuses, I’m saying that it’s difficult, and it’s certainly not made easier by persons such as yourself who apparently can think of nothing more helpful to do than to deride the efforts of others. > [@](#): > > There is no such thing as “naturally large”. You’re fat because you eat too much. And the whole “big frame” thing is bullshit. Cite: [http://www.skinnymyths.com/2008030395/News/Weight-Loss-Myths/You-Weigh-More-If-You-Are-Big-Boned.html](http://www.skinnymyths.com/2008030395/News/Weight-Loss-Myths/You-Weigh-More-If-You-Are-Big-Boned.html) I never said anything about “big boned”, I said “large frame”. Want some more statistics? I’m six foot two. I was six feet tall by the time I was in the third grade. My bones grew so fast that for a while it was painful to walk, as the small bones of my foot and ankle weren’t keeping up with the rest of me. My shoe size is a 12. In suit jackets, I wear a 60 long. My wife, who is a full foot shorter than me, has the same inseam length that I do (30 inches), which means that most of my height is above my waist. Which, incidentally, is where most men carry their excess weight. My biceps, which you’ll be hard pressed to find fat on, are 20 inches around. My wrists, usually considered a pretty reliable indicator of frame size, are 9 inches around. I have to specially order hats to fit my enormous cranium. In short, I’m a big dude, in ways that no fork could have caused. And the fact is that, while it’s certainly possible for me to be fit and healthy, it’s a flat-out lie to tell me that I can be “thin”. I accept that, and I’m not shooting for “thin”, because that’s simply unrealistic. Sidetrack: about a month ago, in a LiveJournal community, I calculated BMIs for some of the American Gladiators, based on their posted statistics. [Titan](http://www.nbc.com/American_Gladiators/bios/titan.shtml), [Justice](http://www.nbc.com/American_Gladiators/bios/justice.shtml), [Toa](http://www.nbc.com/American_Gladiators/bios/toa.shtml), and [Beast](http://www.nbc.com/American_Gladiators/bios/beast.shtml) turned out to be “obese”, with a 31.4, a 31.9, a 30.9, and a 30.0, respectively. Clearly, they are the very image of unhealth, the sedentary slacker bastards. > [@](#): > > An asinine statement. Tell that to the holocaust victims who starved to death, I’m sure you’d get lots of sympathy. :rolleyes: True, it was hyperbole. I’m sure I could absolutely starve myself into an emaciated husk of humanity. Sure, during all that time I’d be too weak to be of any use to my workplace, my wife, or my child, but that’s what we must endure to be pretty enough for **Dripping** , eh? Dysentery is just nature’s way of saying you’re on the right track! > [@](#): > > Shrug. Put down the fork. I guarantee you’ll lose weight. I have, and I am. Now stop telling me how simple it is, because clearly you have no clue. ---
**Author:** ![light\_sweet\_crude](https://avatars.discourse-cdn.com/v4/letter/l/aca169/32.png) [@light\_sweet\_crude](https://boards.straightdope.com/u/light_sweet_crude)\ **Post date:** [October 4, 2008, 5:03am UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/53 "2008-10-04T05:03:47Z")
Apologies of this come out a bit disorganized… The dislike that is being expressed seems like it is based mostly on the impression that people who are overweight lack moral fiber and so are less worthy as people. Yes, if one is overweight it is at the most basic level because calories in are greater than calories out. Fine. Many argue that they should just ‘put down the fork’ to lose weight. Yet studies has shown that for the majority of dieters this method does not provide meaningful or lasting results. > [@](#): > > After 10 years of conventional treatment- which was not standardized and varied from intensive lifestyle advice and guidence to no treatment at all- weight had increased by 1.6%. With either intensive lifestyle modification, very low calorie diets, and pharmacologic treatment, results (over approx 4 years) show about 5-6kg weight loss. So, medical or conventional treatment does not work. Are you just going to consign these people to diabetes, heart disease, hypertension, increased risk of cancer and poorer outcome if they do get cancer, joint pain, sleep apnea, etc? Or will you offer a treatment that has shown in recent studies: > [@](#): > > …the average 10 year weight loss was well over 19 kg. Yes, if they decreased intake or increased output, they would lose weight. However, it has been shown to be something that people are unable to do. Yes societal factors are at fault, we drive around too much and fast food and convenience food is too available, and more necessary these days because people work long hours. Yes, often there is a mental component. People eat for many, many reasons often unrelated to hunger. Part of the goal of surgery (roux en y, not speaking of the band) is to retrain eating habits. People who undergo RY are told to set eating schedules and not snack in between. Patients are more able to follow this schedule at first because the surgery turns off hunger and allows for the retraining. The reasons for decrease in hunger are not completely understood. Yes, ghrelin levels are affected, and the stomach is smaller, which causes earlier satiety because stretch fibers in the stomach fire to indicate fullness earlier, but there are other factors not completely understood yet (for instance, people often find sweet things less appealing after surgery at first. why?) The surgery is a tool that can improve quality of life and health. Yes, people fail, and they don’t follow the rules, and that is really frustrating. But note the results noted above are an average. The success rates are around 60-75%, with success meaning loss of 50% of excess body weight. No, people should not expect to get to ideal body weight. That is not the norm. However, mortality is decreased: > [@](#): > > In a large retrospective cohort study…long-term mortality from any cause (mean follow up of 7.1 years) decreased by 40% compared with that in the control group. (all quotes from Surgical treatment of Obesity, Eur J of Endocrinology 2008) Anyway, all the detractors sound like the arguments against antidepressants, when people used to just say ‘get over it, just make yourself happy’. Which, I will admit, on my more uncharitable days I also think. I hear less of that type of remark now, probably because antidepressants have become more culturally accepted. Either weight loss surgery will also become accepted, or they will find the magic pill that turns off hunger, and put it in the water with flouride, then people will say it causes autism. Also- people get off insulin early because all you eat in the beginning is protein, and precious little of that- there isn’t enough carbs in the early diet to make glucose an issue. Plus, about 70% of people will re-develop diabetes in 10 years. Also 2- last resort surgery: people who are so obese that they are in imminent danger of dying are terrible candidates for any surgery, much less one that is not immediately life saving. Sorry so long. Won’t ever be able to answer any other topic on the board with any depth, so am trying to milk it now. ---
**Author:** ![Darryl\_Lict](https://avatars.discourse-cdn.com/v4/letter/d/7cd45c/32.png) [@Darryl\_Lict](https://boards.straightdope.com/u/Darryl_Lict)\ **Post date:** [October 4, 2008, 5:54am UTC](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202/54 "2008-10-04T05:54:55Z")
**Dripping** , I think it would behoove you to have a bit more empathy for the obese amongst us. I’m borderline fat with a BMI of around 25, but I was up to about 29 at one point in time. This was pretty disturbing as I had a BMI of 18.2 when I was a freshman in college and was a pretty friggin’ skinny dude. I am convinced that people really do have different appetites. I just don’t get ridiculously hungry and can go for a day without eating without much of a problem at all. I’m pretty sure that my stomach has been shrinking as it is more difficult for me to finish the standard lunch at my local Japanese restaurant. I don’t attribute this to stronger willpower, but just some sort of lucky lack of hunger. By the way, I love to eat, just not huge quantities. [Previous page](https://boards.straightdope.com/t/weight-loss-and-bariatric-surgery-debate/466202.md?page=2)