Not About The Scale

It’s Not About the Scale

May 16, 2022

Bariatric surgery is a big step in someone’s weight loss journey. It is a procedure that changes your life in so many ways. However, I have often seen patients focus on the numbers on the scale and forget to see the big picture. It is important to know that it’s not about the scale.

Let’s take one of my recent patients, let’s call her Jane. Jane had a sleeve gastrectomy a year ago and has been doing well. Before surgery, she was struggling with obesity. She was on multiple medications for diabetes, high blood pressure, and high cholesterol and had sleep apnea, and used a CPAP machine. Worst of all, she could not keep up with her kids because she had difficulty with mobility and got winded easily.

She had the sleeve gastrectomy, the surgery went well and she was back home the day after surgery. When she got home, she was able to reduce her diabetes medication by half. When I saw her for her one-month post-op appointment, her PCP had taken her off all of her diabetes medications. She started seeing her weight drop dramatically. She did not go into the surgery with a goal weight in mind, but after she saw how the numbers were dropping on the scale, she decided to set a goal for herself: the weight before she had kids.

She followed the recommended diet: ate 3 small meals with 2 snacks, made sure she got 60-80 grams of protein daily, made sure she was getting at least 60 ounces of fluid, and walked on the treadmill for 45 minutes 4 times a week. She hit that weight goal at her 6-month post-op visit. She then decided to set a new goal, she wanted to be the weight she was at her wedding. She worked hard and hit that goal in 2 months. She had never dreamed of being at this weight ever again. So she decided that she wanted to lose more weight and set a goal of the weight she was in high school. She worked hard but the numbers on the scale weren’t dropping as much as she would like.

When I saw Jane for her 1-year post-op appointment, she said to me: “I lost a lot of weight initially but now the numbers on the scale are not going down as much as I would like…..I feel discouraged”. That’s when I asked Jane to take a step back and look at how far she has come and how much she has achieved.

Bariatric surgery is  not about the scale

The benefits of bariatric surgery go way beyond just losing weight. Let’s delve further into these:

1.  Improved quality of life

Obesity causes impairments in quality of life like fatigue, body pain, physical limitations, low self-esteem, and depression. Many studies have shown that patients who had bariatric surgery not only live longer but also show markedly improved quality of life.

The big picture: Think about how much your life has changed for the better after the surgery

2.  Long-term remission of Type 2 Diabetes

Obesity is a major risk factor for developing type 2 diabetes, and more the 90% of type 2 diabetics are overweight or obese. Diabetes is the leading cause of kidney failure, new cases of blindness among adults, and lower-limb amputations and it is associated with an increased risk of heart disease and stroke, high blood pressure, nervous system disease, and pregnancy complications. Bariatric surgery is highly effective for obese patients with type 2 diabetes, allowing almost all patients to remain free of insulin and other related medications after surgery.

The big picture: If you were diabetic before surgery, think about how much better your diabetes is now. Isn’t it great not to take as much medication as you used to?

3.  Improved cardiovascular health

Weight loss surgery decreases a person’s risk of heart disease, stroke, and high blood pressure. Large studies have shown that bariatric surgery leads to close to a 50% reduction in heart attack risk and more than 50% reduction in stroke risk.

The big picture: You can rest easier knowing that your risk of a sudden heart attack or stroke is much lower.

4.  Eliminate obstructive sleep apnea

About 80 to 85% of patients experience remission of their sleep apnea after surgery and are able to stop using a CPAP machine at night.

The big picture: Think about getting restful sleep without using a CPAP machine.

5.  Reduction in depression

Bariatric surgery leads to improved emotional health and a significant decrease in depression. Patients have better self-esteem and are able to do the things they love again.

The big picture: Think about how much better you feel about yourself now and how you can enjoy activities you used to struggle with before

6.  Relief of joint pain

A lot of stress is put on weight-bearing joints like back, hips, and knees by carrying around excessive weight. This causes joint damage and the need to use medications to control the pain. Losing weight relieves the stress on these joints and allows people to stop medications and enjoy more mobility

The big picture: Think about how much more mobility you have now and no more painful joints!

7.  Reversing fatty liver disease

Fatty liver disease or Non-alcoholic steatohepatitis (NASH) is the number one reason for a liver transplant and bariatric surgery is the most effective way to stop and reverse the progression of fatty liver or NASH.

The big picture: your risk of liver disease decreases after weight loss surgery

8.  Obesity associated cancer

Large studies have shown that obesity causes an increased risk of many cancers including colon, breast, endometrium, gallbladder, and pancreatic cancer. Obese men have a 52% higher chance of dying from cancer while obese women have a 62% higher chance of dying from cancer when compared to normal weight men and women. There is a significant reduction in cancer risk after bariatric surgery based on several large studies.

The big picture: your risk of getting cancer greatly decreases after you have bariatric surgery

9.  Improved fertility

Polycystic ovarian syndrome (PCOS) is strongly associated with obesity. It is found in 30-70% of obese women of reproductive age and is associated with irregular periods and infertility. Weight loss is a mainstay of PCOS treatment and bariatric surgery helps improve fertility.

The big picture: if you were having difficulty becoming pregnant, losing weight after surgery greatly increased your chances of becoming pregnant

10.  Lower mortality

Large studies have shown that obesity is associated with a higher chance of dying early. Multiple studies done in Europe and North America have shown that having bariatric surgery significantly reduces this risk.

The big picture: you will live a longer and healthier life.

Let’s go back to Jane. She no longer took any medications for diabetes. Her blood pressure and cholesterol were now normal. She didn’t need her CPAP machine and was able to run and play with her kids. She had so much more energy now to do the things she loves and the confidence to put herself out there. She feels and looks great.

Bariatric surgery’s benefits are your health and not about the scale

While it is easy to become fixated on the number on a scale, there is so much more you have gained following your bariatric surgery. Bariatric surgery is not just a one-time procedure but a whole life-changing journey. You have become a new you, living a better lifestyle and experiencing a new level of health. Forget the scale and celebrate all that you have accomplished!

Dr. Alph Emmanuel is board certified in General Surgery and joins New York Bariatric Group as a general and bariatric surgeon.

Not About The Scale


Following a year of practice in general surgery, Dr. Alph Emmanuel completed a fellowship in Bariatric, Minimally Invasive and Robotic Surgery at the Magee Women’s Hospital of University of Pittsburgh Medical Center, one of the oldest training programs in the field of bariatric surgery. Dr. Alph Emmanuel is board certified in General Surgery and joins New York Bariatric Group as a general and bariatric surgeon.