Bariatric Surgery Myths
Owner's Note: Progress aims to provide full-spectrum obesity medicine services. Part of that spectrum of treatment includes bariatric surgery. Often times, when we mention this with patients we are met with strong opinions of never wanting to consider surgery. However, surgery is another tool in the tool box of treatment, and still provides the most significant benefit in weight loss and other health improvements compared to any other weight loss medication or plan. We asked a bariatric surgery specialist from the University of Minnesota-Fairview to help us address some of the most common myths about about this type of surgery.
Last Resort: For years, bariatric surgery has been thought as a last resort to achieve weight loss. I’d argue bariatric surgery should be considered as soon as weight loss is discussed. When considering tools for weight loss we need to look at realistic outcomes and long term goals. On average, diet and lifestyle interventions achieve 2-5% total body weight loss. Adding a dietitian and intensive follow up can improve average outcomes to 5-10% weight loss. With antiobesity medications achieving an average weight loss of 10-20%, we need to consider if that will get you to your goals. Bariatric surgery, on average, achieves 30% total body weight loss. While medications have come a long way in the last decade, we have yet to see a medication that can reliably achieve results equivalent to bariatric surgery. In a comprehensive weight management program you should be able to combine antiobesity medications before and after surgery to optimize weight loss outcomes. Be realistic about your goals and keep an open mind about all your options.
Extreme Diet/ Lifestyle changes: Often, people think of bariatric surgery and recall stories they have heard about diet and lifestyle changes that feel extreme and are required for life. In the initial post-op period, guidelines for eating/ drinking are made to prevent complications and improve outcomes. These restrictions loosen as you are further out from surgery. Depending on the surgery you and your team choose, there are minimal restricted foods long term. Long term dietary recommendations post bariatric surgery look very similar to recommendations for someone who had achieved their weight loss without surgery.
Long term complications: There are risks associated with all surgery. Any time modifications are surgically made to the body there is a risk for complications. Procedures like the sleeve gastrectomy can be chosen to limit long term risks/ complications like malnutrition, dumping, and internal hernia. Some risks can be managed with diet/lifestyle modifications like ensuring adequate protein/fiber with meals. If concern for complications are a barrier to surgery, it’s worth a conversation with the surgery team.
Loose skin: Often, people express concern for excess skin after bariatric surgery. Unfortunately, it is difficult to get insurance to cover excess skin removal. I understand the concern. However, regardless of how you lose the weight, there will be excess skin. The surgery itself doesn’t cause the excess skin to become a problem. Incorporating a strength training routine and ensuring adequate nutrition can help manage the amount of excess skin whenever losing large amounts of weight. In comparison, carrying excess skin is less risky than the health consequences of carrying excess weight.
It’s a quick fix: There is no quick fix to obesity. Obesity is defined as a chronic disease. Like any disease, there are multiple ways to manage the disease. Bariatric surgery gives you a life long tool to help you reduce the amount of excess weight you carry and then maintain that weight loss. The tool must be used to be effective. It is important to learn how to use the tool from a trusted team. Often, life long and intermittent follow up is beneficial to help with accountability, ensure proper use of tool, and to monitor labs.
Multiple tools: Obesity, like any other chronic disease, sometimes requires multiple treatment modalities. While surgery is the most effective tool available at this time for weight loss and management, it sometimes isn’t enough to completely manage a person’s disease. Medication can be combined with surgery to help achieve additional weight loss, manage hunger/ cravings, or address metabolic adaptation over a lifetime. Working with a trusted team who understands these treatment options can help you achieve success.
