Is weight loss surgery the easy way out?

No, no it isn’t. If you opted for weight loss surgery, don’t ever let anyone tell you that you took the easy way out. If you know someone who opted for it, realize that the decision was most likely made after hours and hours of intense thought and discussion amongst family members and key medical providers. It involves drastic lifestyle changes with a serious commitment to habit alterations. But it’s lifesaving and as I said in my recent post, it is often the best decision that person has ever made for their health.

My goal for this post is to explain the options in the simplest way possible and drive home the fact that, although weight loss surgery may be the most successful end point for weight loss known to date, it certainly is not the easy way out. It’s only a tool, but a damn good one at that.

So here we go, let’s start with the laparoscopic banding procedure. Nothing is changed from your inside anatomy. So you still have your full stomach and intestines intact. The band is purely a restrictive procedure and is just what it sounds like, a band (think of it like a bracelet even) that is placed around the top portion of the stomach. At first, it’s just a fancy expensive bracelet. Shortly after surgery, it can be filled with a salt solution, called saline, to tighten its grip around the stomach, by injecting the fluid through a port that runs from the band to just under your skin. Think of it as blowing up a doughnut ring….that hole in the middle is gonna get tighter when it’s blown up. Problem is, this procedure doesn’t work. I know, that’s a bold statement for me to say, but in the ten years I’ve worked with bariatric surgery candidates, I only saw maybe three patients (out of hundreds) lose the expected 20-25% of their initial starting weight and maintain it off for more than one year. And guess what? All of them eventually had to have their bands removed due to complications and/or weight regain. Luckily, their bands were converted to the sleeve gastrectomy and they were able to continue their lives with a more permanent option.

People see the band as the “noninvasive, less risky” choice. However, that’s just not true. When you have a foreign object placed in your body, it doesn’t like it. The band can slip out of place, corrode, grow into the stomach, get infected, flip over and out of place, the port tubing can get a hole in it and leak, and the possibilities go on and on. Most often, one of two things would happen. I either saw people throw up over and over because food just wouldn’t go down where the band was and eventually their esophagus above the band placement would dilate, or get bigger, and they would end up with essentially two stomachs to fill. Think of it like an hour glass, one on top and one on the bottom….endless hunger. Or I saw them give up and live on liquid, soft foods that slid through the band into the stomach easier…..so milkshakes, pudding, ice cream, jello, mashed potatoes, and even fried foods. It’s not uncommon for someone to even gain weight after this procedure, as you could imagine. Some facilities have smartened up and don’t offer the band anymore. In my opinion, if a surgeon recommends the band to you, run the other way.

The sleeve gastrectomy has gotten lots of attention over the past five years or so for those who have a lot of weight to lose but may or may not have any major health problems. It is a purely restrictive procedure as the surgeon removes around 75-80% of the stomach in a vertical fashion, leaving a banana shape left. Don’t be mistaken, though, your stomach ends up smaller than a banana. Think “man’s index finger” size. It is very restrictive, but what I think helps people out the most is that the part of the stomach that gets removed is also the part that produces the hunger hormone, ghrelin.

So, yea, you may fill up on the same amount of food your two year old niece just ate, but you weren’t really hungry to begin with. And if you have read or listened to any of my content before, you may have heard me talk about how ghrelin increases in production in response to massive weight loss. It can’t with the sleeve gastrectomy. That’s a big plus. I do caution people against choosing this procedure if they have problems with stress or emotional eating or what I call “grazing.” If you don’t eat because of excessive hunger and you have a habit of nitpicking all day long out of boredom or stress, this procedure doesn’t do anything to stop that….you can still eat a small amount of food every couple of hours or so. You can’t, however, sit down to a large meal and finish it in your normal ten minutes. It’s going to take at least twenty minutes to finish off a 1/3 cup of ground turkey. Talk about eating to live! Expected weight loss is anywhere from 25 to 35% of your starting weight. This is life changing for the vast majority of those that are are successful at it.

The last procedure I’m going to talk about here is the roux en y gastric bypass. This one has gotten a bad rep for years which is why I believe there are so many new procedures constantly up and coming, like the stomach stapling at one time, then the lap band, now the sleeve, and the up and coming “balloon” (that’s for another post). But this one has stood the test of time for the last forty years now and remains the gold standard of weight loss surgery. Is it drastic? Yes. Does it involve a huge lifestyle change? Oh yes. Does it work? Yes. I’ve seen lives absolutely change for the better and people leave the hospital off their diabetes medications after having this surgery. There was no waiting period for weight loss, it was immediate. When we talk about this surgery, we are talking about a metabolic operation that changes the body’s hormones with some major rerouting of your digestive system. So, like the sleeve gastrectomy, hunger is no longer an issue. Nothing is actually removed, like in the sleeve, but the part of the stomach that produces the hunger hormone, ghrelin, no longer comes into contact with food. The major difference is that a large portion of the small intestines is rerouted to create a “Y” shape with the new, smaller, egg-shaped stomach and connected lower down the digestive tract which results in calorie malabsorption. Not only are you not hungry and restricted in how much you can eat in one sitting, but you also don’t absorb all the calories you eat at one time. Lastly, high sugar and high fat foods are a no go. You run a high risk of getting sick with the shakes, diarrhea, and breaking out in sweats if you eat even just one small bite of the wrong thing. Interestingly enough, lots of people who have had this surgery experience a change in their taste preferences anyway.

Since expected weight loss is closer to 35% starting weight, I recommend this procedure for the stress eater, person with a slow metabolism, chronic yo yo dieter, and most importantly, anyone with a serious health condition who requires massive weight loss to improve. This would include cardiovascular disease, obstructive sleep apnea, or diabetes.

This is your life, and if someone told you there was a cure for a known disease that you have, would you take it? In 2013, the American Medical Association recognized obesity as a chronic disease. At that point, health insurance companies began expanding their coverage for weight loss surgeries. A chronic disease is something that never really goes away. If you have been struggling with your weight, you know what I’m talking about. You succeed at a weight loss attempt temporarily, but the weight always finds its way back, somehow. I know that this is not for everybody and you may note even qualify.

If it is something you are considering or if you are in a place where you don’t quite qualify, but you’d like some help with your weight, feel free to reach out to me at the below links.

P.S. If you’re looking for online support with like minded moms striving to live a healthier lifestyle, you may be interested in joining my free online support group here.

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Email: contact@jillianmcmullen.com

Jillian McMullen, RDN, CSOWM, LDN

Why it’s not risky to have weight loss surgery

Although I have never personally been overweight, I am an advocate for those who are. It’s not because I watched a family member struggle or have some heart wrenching personal story to share with you. Circumstances ten years ago just lead me to a position working with people who do struggle with weight.

Through that time, I have gotten to know hundreds, if not thousands, of individuals and their personal stories, and why there is so much more to weight loss than “eat less, exercise more.” I’ve helped a lot of people make the scary decision to pursue weight loss surgery, get their habits (and their mind) right on the way there, and I’ve been there that amazing day when they became a literal new person. So much so, I couldn’t even recognize them standing right next to me as I called them into my office for that two month post surgery check up.

I’ve cried with clients, done happy dances with them when the scale hit a certain number, and held the trash can when they needed to vomit because they ate something they shouldn’t have (yea, sucks to do that in your dietitian’s office.) I’ve been the first person to weigh someone after years and years of avoiding the scale. I’ve been the last person to see someone drink a soda before they chucked it in the trash can for good (carbonation isn’t allowed after weight loss surgery if you were wondering.) I’ve also been the first person to find out they’re going for it, for realz. It’s scary, it’s exciting, it’s terrifying, and it’s truly life changing.

Here’s the deal though, I don’t want to hear that “bariatric surgery is high risk” from people who know nothing about it other than that their brother’s coworker’s aunt’s mother in law had that “stomach stapling” procedure back in the 80s and died. Don’t ever take the excitement away from someone by telling them it’s too risky. 

I do get it. I’ve worked with two or three people out of hundreds that had the surgery and it went terribly wrong. They can’t eat food anymore because they had a rare complication. They get to live on a feeding tube for the rest of their life. I’ve gotten to know a couple of individuals who died months later because their health problems before surgery were against them and weight loss surgery didn’t fix it. It sucked. But they were exceptions, more on this later.

But I’ve also seen people get out of wheelchairs, off their diabetes medications, go on vacations again, and live life out of the house again because of this surgery. And that “stomach stapling” or “risky gastro procedure” everyone is so scared of, was actually life saving to someone that used to spend their entire life dieting without success, counting pills, administering injections, and going to doctor visits because their body became a prison.

If you think it’s about eating less and exercising more, think again. Obesity is not a lifestyle choice. If it was, there would be zero obese people in this world trying to lose weight. Everyone would wake up, cherry pick their dream weight and get to it. But if you’re reading this, you probably know that’s not true.

Here are 5 well meaning reasons why I’ve heard weight loss surgery is an unsafe choice and why they are false. If it’s something you’ve been considering but have been convinced it’s a “last ditch effort,” I want to give you some peace of mind to make a rationale choice. I’m not here to tell you to go do it, but I don’t want you to not go do it out of fear, either.

  1. You could die. Obesity itself is the number 2 cause of preventable death (aside from smoking) in the United States today. In this analysis of 13,871 morbidly obese patients from a national registry between January 1996 and January 2006, the risk of death within 60 days following any weight loss procedure was 0.25%, making it a rare event. A main reason for this is because modern day procedures are typically done laparoscopically, meaning only 5 small incisions about one inch in length each are made to perform the procedure rather than a long vertical incision as used to be made. Medicine is always evolving!
  2. It’s a cop out. And you could die. Okay, this is kind of a continuation of the first, but I felt needed more clarification. Bariatric surgery is emerging as a powerful weapon against severe obesity and type 2 diabetes mellitus (T2DM). Numerous studies confirm that weight loss surgery, particularly Roux en y gastric bypass surgery is more effective at bringing those with T2DM into disease remission than those who were undergoing conventional medical therapy. Some studies that back this up include this one, this one, this one, and this one. But there are several more available in case you need more proof. As a reminder, complications of long term, uncontrolled diabetes include: kidney failure, often requiring dialysis, neuropathy leading to toe and/or foot amputations, and heart disease. Not one of these are known complications of weight loss surgery.
  3. You’re going to throw up a lot. Well, yes, if you don’t follow strict dietary guidelines. I get it, this is not a lifestyle for everyone. It requires consuming adequate amounts of nutrition, 5-6 times/day, when you’re barely hungry. It also means you will be preplanning your meals every day, for the rest of your life, including the small details like quantities, calories, and protein grams. You will also need to be picky about what restaurants you choose when and if you decide to eat out in restaurants. Be prepared to eat slower. A lot slower. And chew well. Choose your food wisely. No room for fillers here when your stomach is the size of an egg. So no air swallowing habits either, like chewing gum or soda. Eat the wrong food item and you may be sorry for hours or days following.
  4. You’ll have no energy. Actually, if you’re frame has been carrying an extra 50-100 pounds it’s not supposed to be carrying and all of the sudden, in a very short person of time (say, 4-6 months?), you lose it 50 plus pounds, just like that? Wouldn’t ya think the opposite would be true? Think of it more like this: you’ve been carrying a 75 pounds back pack for a few years and I just took it off. How would that feel? This doesn’t really matter what your starting weight is, either. 75 pounds is 75 pounds.  You will also be forced to eat better with surgery, that’s part of what the surgery is for. Run through the drive through with some friends and a cheeseburger real quick and you’ll be running to puke. It’s just what happens when you’re digestive system is rearranged and shortened. Better diet = more energy.
  5. You’ll just gain it all back, so why bother going through that? Not true. Statically, 20% or 1 in 5 individuals who have weight loss surgery will regain all of the weight lost following surgery. But that also means 80% or 4 in 5 will maintain that loss. Those who do not have surgery? If your body mass index is above 30, the sad and terrible truth is, statistically <1% of individuals will maintain any weight off. I know….

In case you haven’t figured it out by now, I’m a pretty big proponent of weight loss surgery. This may surprise you, but like I said, I’ve worked with lots of people and I know their struggle. I’m also a big proponent of taking control of your own life, whatever that may mean for you…and I’m here to help you on that journey. I’ve got a ton of posts for the non-surgery folk too, so look around!

There are various types of surgeries, but the two most effective and common choices available today are the laparoscopic roux-en-y gastric bypass and the laparoscopic sleeve gastrectomy. If you want to know more about them, I encourage you to talk with your doctor. This post would go on forever if I described them here, but certainly feel free to reach out to me for resources if you want to know what they are.

P.S. If you’re looking for online support with like minded moms striving to live a healthier lifestyle, you may be interested in joining my free online support group here.

Follow me for daily livestreams on Facebook

Instagram: TheOilRD

Email: contact@jillianmcmullen.com

Jillian McMullen, RDN, CSOWM, LDN