Misconceptions About WLS 6 2

The Real Deal on Common Misconceptions About Weight Loss Surgery

August 8, 2018

Weight Loss Surgery could be more accurately called "Metabolic Surgery" due to its mechanism of action. The most powerful effects of weight loss surgery are by changing and re-formatting the manner in which the body uses energy and utilizes food. (I discuss this in detail in one of my articles that is about Metabolism.)

Common Misconceptions About Weight Loss Surgery

As with any treatment option, there are many misconceptions about WLS. Social media has made it easier to communicate but one has to be very careful with some of the advice given and the misconceptions spread. Many of these have no scientific basis.

There are scientific methods we use to look at the effectiveness of a treatment option. When we provide a new drug/surgery or treatment option, we want to know what are the short, intermediate and long-term effect of such an intervention.

We know that people react and respond differently to a complex disease like obesity, where many factors play an interactive role. Therefore, we look at a large number of patients and try to determine the average and most common effects of the treatment option.

Results bias can occur when someone is doing exceptionally well and have a large number of social media followers who promote his or her results. The opposite is true as well. You have to look at the effect of a treatment on a large number of patients, always be wary when the fine print says ‘these results are not typical’.

Having said that, let us look at scientific data we have collected so far about metabolic surgery effects and the results. Obesity is a disease that can include food addiction, similar to alcoholism or drug dependency. Plus, the chance of dying from metabolic surgery is greater than the chance of dying from obesity. A patient may debate this, so let us look at the evidence. We know that class II obesity and greater BMI, which translates into a BMI of 35 or greater, have a significantly higher mortality risk.

I always tell my patients that it’s not a simple question of quantity! We like to say that a person had a good life. A good life translates into a fulfilling and good quality of life. The two must go hand-in-hand.

As a disease process, obesity is far more complicated than we appreciate. In certain situations, food addiction may play a pivotal role. I would not offer these patients surgery until their addictions are well-controlled with therapy and they can show restraint and significant lifestyle changes. However, in the vast majority of people, it’s a combination of multiple factors which lead to gaining weight and being unable to lose it.

We know that cardiac disease, diabetes, arthritis, back pain, knee pain, pulmonary disease, certain cancers along with a myriad of other debilitating conditions are significantly increased in obesity. Therefore, metabolic surgery services to help decrease the incidence of these conditions and ultimately provide a better quality, as well as the quantity of life to the individual, is the desired outcome.

One of the most common motivators for having surgery that I regularly hear from my patients is to be able to do more and enjoy life by being more active.

Surgery is an ‘Easy Way Out’!?

This is completely bogus and often repeated by ignorant people who don’t understand the disease process of obesity and never bothered to educate themselves! I get angry when I hear that because it disrespects the incredibly hard work my patients and other bariatric patients put in before, during, and after weight loss surgery.

Losing weight and keeping it off is a constant battle we all face every day. It’s difficult because we are fighting our genes which have evolved over centuries to keep up alive during starvation periods. This means we are exceptionally good at extracting most of the calories from food, and terrible at losing weight and keeping the excess weight off.

For centuries, the instinct for people to survive was different than it is now with the easy accessibility of food. In those years, the main focus was where we were going to get our next meal. So, when the next meal came, we made the most of it and the excess weight gained was used as an insurance policy to keep us from dying by starvation. That isn't the case now.

Successful bariatric patients are the most disciplined and hardworking patients I know. The surgery is only a tool which helps with fighting one aspect of the disease, but the rest is on the shoulders of the patient.

In fact, I think bariatric patients are very brave in making the decision to have surgery. Just think about it, surgery is the most powerful tool we have to fight obesity, so the decision to have weight loss surgery is one the patient makes to give it all they've got. The weight loss that bariatric patients achieve is through tremendous sacrifices and hard work. Every day, I get to watch the weight loss surgery journeys of my patients' hard work and commitment to fight the disease of obesity.

Cross-Addiction and Suicide Risk After WLS

These are broad-brush generalizations but are important to discuss for the awareness of WLS patients.

Addiction is another complex disease process with many parts of it which can be behavioral, environmental, societal, social, and personal. People with alcohol abuse prior to surgery generally have an increased risk of alcohol abuse after surgery.

I don’t believe that it has anything to do with the surgery itself, but perhaps a relapse of a condition prior to surgery. Many bariatric patients do enjoy a glass of wine or an alcoholic beverage post-surgery. However, it’s unusual and there is no data to support an increase in alcoholism in a patient who didn’t have these addiction issues prior to surgery.

As to suicide, while there is a slight increase in the suicide rate in patients who have undergone weight loss surgery, the exact reasons are not clear. Furthermore, the rate isn’t significantly higher than the general population to discourage metabolic surgery.

I think this calls for more research into the factors which may lead some patients to become more suicidal. A very important factor in successful and healthy weight loss is to stay in touch with your bariatric surgeon and team, medical providers, or a mental health professional even if it is for a yearly visit. The underlying factors seem more social than medical. The more positive people you have in your life the more likely you will succeed post-surgery.

The most important decision you have to make is when you think you need help, then please ask for help! We all need help at different times in our lives so make sure to reach out.

ABOUT THE AUTHOR

Dr. Husain Abbas of Memorial Advanced Surgery, is a Board Certified surgeon and fully trained in Minimally Invasive Surgery. After his surgical residency at St. Mary's, a Yale University affiliated hospital, Dr. Abbas completed a fellowship in Minimally Invasive Gastroesophageal and Bariatric Surgery at the University of Florida, Gainesville. Dr. Abbas' expertise extends to a wide array of gastroesophageal disorders, anti-reflux surgery, complex hernia repairs, endocrine, oncology and bariatric procedures.

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