This is not some easy fix. This is a last resort, and there are countless people who have reached their last resort. Morbid obesity is a serious problem, and for many surgery is only thing that will help.
Society stigmatizes bariatric weight loss surgery as much as it stigmatizes the overweight, and that needs to stop. These procedures can make lives way better. In many cases, it saves lives. Yes, bariatric surgery is often a lifesaving procedure that needs to be more available. People who scorn it are jerks.
And it goes beyond surgery. For it to be effective, it still needs to be done in conjunction with lifestyle change like the kind recommended in this book. Even if you’re getting surgery next week, keep reading.
I spoke with Dr. Arya Sharma on this subject, who I’ll now explain is a professor of medicine & chair in obesity research and management at the University of Alberta, as well as founder and scientific director of the Canadian Obesity Network. It is also worth noting that Dr. Sharma is not a surgeon and doesn’t get paid based on whether or not his patients opt for surgery. However, he has received consulting and speaking honoraria from bariatric surgery device makers. In some cases, patients are talked out of surgery.
The people Dr. Sharma sees have extreme body weights, with most of them being over 300 pounds and suffering from myriad negative health consequences and mobility issues as a result.
Dr. Sharma emphasizes that bariatric surgery is not a “cure,” and that substantial lifestyle changes are still required. What’s more, success is measured in alleviating of comorbidities (negative health consequences) rather than pounds lost.
“The surgery has its risks,” Dr. Sharma told me. “It’s important to balance the risks of having it vs. not having it. The more health problems you have, the better idea surgery appears to be.”
And a 2009 analysis out of the Duke University Medical Center shows that the risk is less than previously believed. Dr. Eric DeMaria looked at almost 58,000 patients of bariatric surgery and found that the death rate from surgery was only 0.135% – a total of 78 people.
Complication rates were much higher at 10%, with the most common complaint being nausea / vomiting. Over 200,000 undergo bariatric surgery each year, making it one of the most common procedures performed in the U.S.1 Surgical techniques continue to advance to improve safety.
But it’s important to note this low mortality and complication rate data was accrued from participants in the Bariatric Surgery Centers of Excellence program. Not all surgeons qualify as excellent. Some are bad. Some are (legal disclaimer: this is my opinion) in partnership with evil.
On a completely unrelated note, let’s talk about brothers/doctors Julian and Michael Omidi. Well, Michael is still a doctor after a three-year probation lapsed in 2011, but Julian had his license revoked for “dishonesty” in 2007.2 Both The Los Angeles Times and TV’s 20/20 have investigated their “1-800-GET-THIN” weight loss surgery “marketing” company, exposing many sordid details that you can find via a Google search. Because of a lawsuit filed by 1-800 GET THIN, LLC against the LA Times,3 I need to be clear that these guys don’t perform the surgeries. They market them, or something.
Anyway, there have been a number of deaths, and the FDA took action about their lap-band surgery (marketing) billboards being plastered all over southern California, and in October, 2012 the FBI launch a criminal investigation against the Omidis for a long list of potential fraud violations.4
So here’s a hint: Perhaps you should not look to a surgeon who advertises on a billboard, especially if they have a number like 1-800-GET-THIN for you to call. That alone should send up warning flags.
If you meet the criteria, if you’ve tried everything and are at your last resort, do your homework and find a reputable clinic to discuss your surgical options. Yes, there are risks, but the benefits can be significant for those who have no other options. “With surgery, four out of five will be successful,” Sharma said. And yes, these numbers are a lot more favorable than those who stick with just the diet and exercise route. It becomes a question of being in a desperate enough health situation to consider surgery as an option.
“It’s better to ask who is not successful than who is,” Sharma told me. “The unsuccessful ones are generally those who want to let the surgeon do all the work. It’s not a quick fix. The patient also has work to do.” He also explained patients with addiction issues and major depression don’t do well.
There are different types of surgery available, with the more challenging surgeries also being the more effective ones.
“The gold standard is the Roux-en-Y,” Dr. Sharma said, referring to a form of gastric bypass. “It’s more complex, but has been around the longest and gets the best results.” He explained the “sleeve gastrectomy” is easier to do but less efficacious, and the adjustable gastric band (a lap band) is the easiest but leads to even less weight loss.
“I tell patients, ‘If you want to make the surgeon’s life easier, get a band. If you want to make your life easier, get a bypass’,” Sharma told me. I’ll note that just this past weekend I was in Kansas City for The Fitness Summit and had a conversation with bariatric surgeon Rachael Keilin from Texas, who told me that the 5-year efficacy for lap-band vs. Roux-en-Y was similar. It seems like it takes longer for the lap-band to get full results, while the gastric bypass seems to get most of its results sooner.
I’m going to take a moment to reaffirm that I’m not even close to being an expert on this subject. The purpose of this post is to provide information about surgical options available for those whose weight is causing them serious health issues and who have tried everything to lose weight and still been unsuccessful. You MUST do thorough research and discuss this with a qualified surgeon before making any decisions.
“I had been overweight my entire life,” said Kris Beneteau, a 48-year-old office worker in Windsor. She started dieting when she was 14. Her doctors gave her amphetamines at one point for weight loss. “I tried everything and my weight did go up and down. My top weight was 271 in 2008.
Kris had the Roux-en-Y procedure, performed laparoscopically. It involved consultations with a dietitian, psychologist and a heart specialist. Exercise is an important part of the follow up.
“It creates built-in willpower,” she said. “You physically can’t eat much and you have negative responses to eating the wrong foods.”
Kris runs, lifts weights and enjoys the elliptical trainer. She’s been holding at 145lbs for a year now. “There is not even one regret about getting the surgery,” she said.
Jennifer Davis, a 40-year-old government worker in Ottawa also had the Roux-en-Y, which helped her achieve over 100lbs of weight loss.
“I am absolutely happy I had it done,” she said. “My only regret is that I didn’t do it sooner.”
Davis, who spent a year learning about the procedure to make sure it was the right choice, told me she saw it as one tool out of many. “I tried to diet and exercise as much as possible,” she said. She did have one unfortunate run-in with a young personal trainer at GoodLife Fitness who told her the surgery was a bad idea. He was trying to sell her $8,000 worth of personal training, saying that was what she really needed. To any trainers who are reading this: don’t try to shame any of your clients out of weight loss surgery. Simply tell them to get all the facts and make an informed decision, and support them in that decision.
“One of the things I try to keep in mind is that I have such a limited space in my stomach I want to make each of those calories count,” she said. “I want it to be something good for me.”
I think Jennifer’s advice is the best way to close this chapter:
“It’s not a walk in the park and it’s not a cure,” she said. “It’s a tool to change your life, and if you don’t use it as such you’re wasting everyone’s time.”
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James S. Fell, CSCS, is an internationally syndicated fitness columnist for the Chicago Tribune, Los Angeles Times and AskMen.com. He is the author of Lose it Right: A Brutally Honest 3-Stage Program to Help You Get Fit and Lose Weight Without Losing Your Mind, published by Random House Canada.
REFERENCES
- “Large scale analysis finds bariatric surgery relatively safe,” https://www.dukehealth.org/health_library/news/large_scale_analysis_finds_bariatric_surgery_relatively_safe
- David Rosenman, Administrative law judge, decision of the Division of Medical Quality, Medical Board of California. Case # 17-2004-162146.
- “1 800 GET THIN, LLC vs. Michael Hiltzik,” CASE NO. CV11-00505 ODW (PJWx), https://www.scribd.com/doc/61322093/1800-Get-Thin-v-Hiltzik
Stuart Pfieffer, “GET-THIN brothers in fraud inquiry,” Los Angeles Times, October 23, 2012.