Dieting Debate

The Dieting Debate: Non-Surgical vs Surgical Weight Loss

July 27, 2020

The Dieting Debate

I work with clients that have lost a lot of weight because they have had bariatric surgery.  This is what I specialize in, “nutrition for post-weight loss surgery clients.”  Now, if you have lost a lot of weight because you have had bariatric surgery, does this make you different from one of my clients who have lost a lot of weight but did not have bariatric surgery? That's where the dieting debate comes into play.

Dieting Debate: Aren’t Most Diets Restrictive in Some Form?

Bariatric surgery is a restrictive surgery, right?  You have a smaller pouch or stomach after surgery and you may or may not have had a malabsorption procedure also. We all agree that bariatric surgery restricts the amount of food that you are able to eat.  

What about Keto? Isn’t it restrictive? Let’s go deeper. Aren’t most diets restrictive in some form? Low-carb restricts carbohydrates. Calorie restriction restricts calories. Low-fat diets restrict fat.  Most “diets” have a certain type of restriction involved.

Let’s be honest.  Bariatric surgery is sometimes frowned upon in the “regular” ketogenic and "low-carb world", even among professionals. No matter how much it irritates me, I have to listen to my peers and try to understand where they are coming from and why they feel this way.  

One of the reasons for their strong opinion is because many people, even before having the surgery, have to lose a little bit of weight.  Most surgical teams want to see that their clients have made an effort to lose weight and that they are committed to the weight loss surgery process. It’s also to shrink the liver so that your surgery is safer to perform.

Dieting Debate: Carbohydrate Restrictive Pre-Op Diet

Usually, this weight loss prior to bariatric surgery is achieved through a type of carbohydrate restrictive pre-op diet. Surgical teams have different pre-op diets, but one thing that most of them have in common is protein shakes combined with low carb options.

This is a very quick and very effective fat loss strategy that is NOT intended to be used for the long term.

Carbohydrate restriction, with an emphasis on protein, is the silver bullet for losing weight before bariatric surgery?  It is so effective that a lot of professionals in the ketogenic and low-carb world wish that people would just stay on the pre-op diet. If the diet is working and the weight is being lost, why would people even have the surgery?  Why wouldn’t they just continue on this diet? Wouldn’t that be better than having surgery and having a large portion of your stomach removed and/ or your intestines rerouted? 

These are the questions I get from my fellow colleagues. This is why a lot of people question bariatric surgery. 

It is a part of my work to explain to the “others” why my clients choose surgery.

Dieting Debate: What Works for One, Doesn't For Others

So many people who have bariatric surgery did it because they felt like they tried everything. They exhausted their options. They tried Weight Watchers, Jenny Craig, and the Cabbage Soup Diet. They tried calorie counting. They tried a low-carb diet and the Atkins diet. They exercised to the extreme. Nothing worked and they were not able to stick with it for the long haul. Most of us like to believe that low-carb and keto works for everybody … if you just follow the rules. 

We are biochemical individuals.  What works for one person is not necessarily going to work for the next one.

Sure, we all wish that we could be successful without having surgery. Do I personally wish that nobody needed to go under the knife? Of course, I wish that to be true. Do I wish that Keto or Weight Watchers or low-carb or whatever was successful for everybody? Of course, I think that would be perfect.

But since that is not the case, I genuinely believe that there is a place for weight loss surgery.  

The reason I say that is because there are a lot of people who could be successful on any number of diets but it’s not only the food necessarily. It could be a psychological reason. There could be a food addiction involved. It could be compulsive eating or compulsive overeating. It could be binge eating. It could be a lot of different reasons combined.

Depression and Trauma

A lot of people who get to the kind of bodyweight that makes them a candidate for bariatric surgery have a traumatic past. There can be depression involved. Something has led them to consume food and the amount that enabled them to get to a point of being a candidate for bariatric surgery. Who are we to judge?

Our food system is broken and we have lost our way.  

These types of issues do not just “go away” with a Ketogenic diet. They don’t go away on a low-fat diet. In cases like this, bariatric surgery can be the starting point. It can be the catalyst that encourages or forces people to stick to a certain eating pattern because they have to. They have no choice in the beginning. If they eat too much food or if they eat certain kinds of foods, they will get sick. Something very unpleasant will happen. In those cases, surgery really is something that starts people on the path that they need to be on.

Unfortunately, we know that some people regain weight. Some people regain all of the weight and then some more. Some people start to regain some weight, and they find something before they get back to where they started from. 

Of course, this is tragic. You’ve been through major surgery. You’ve had a major physical trauma and here you are, years later, worse off than you were to start with. So we’ve got to find a way to prevent this from happening or to reverse it if it has already started.  

Anatomical Differences

There is another important part, besides the bingeing or addiction issues that applies to a lot of people whether or not they have had bariatric surgery or they are thinking about having the surgery. 

Somebody that has had bariatric surgery, does not have the same anatomy as pre-surgery. Let’s remember to keep that in mind. The body has been altered and it works a bit differently now.  

If you have lost a substantial amount of weight, surgery or no surgery, you are possibly an obese person, living in a slender body and your body will fight you VERY HARD to get back to being obese again.  This is physiological. Your body believes it has a “set point” and it tries to bring you back to it.

A lot of people can lose weight (surgery or no surgery), the difficult part will always be to maintain that loss for the long term.  

We have to remember that "weight-reduced obese” is not a thin person. They are a weight-reduced obese person. This is why the carb creep is so insidious when we start to feel like we can have a “little piece of cake” or “one piece of toast”.  Some people can tolerate this but some people are set on the trajectory of a regain. The insulin is going to skyrocket.  The glucose is going to skyrocket. The hormonal response from eating carbs will still be the same.  

Since your body wants to return to the size it was before, you need to be more vigilant now.  

The Best Weight Loss Surgery Advantage

But, I left the best weight loss surgery advantage until the end. One other detail that is often overlooked is how bariatric surgery changes the hormones that interact with the brain that help decrease appetite, reduce hunger and helps us feel satisfied with less food for a longer period. Oh yes my friends, it is the ghrelin factor.  

You often hear me say that “obesity is a hormonal disease” and one of the main hormones to take the stage is ghrelin. What happens when we have gastric sleeve surgery and the section which produces the hormone ghrelin is removed? In the beginning, we have a reduction in our appetite because this hormone stimulates it. No ghrelin hormone = less hunger. Winning!!  

Now, if obesity is a hormonal disease, there are MANY hormones involved and it’s not “only” ghrelin so, with time, the appetite can return for some patients. This is where an excellent post-surgery nutrition plan takes over. If we can lower blood sugar and insulin levels through diet, we will experience much less hunger overall.

Physical Structure Changes

If you have had bariatric surgery,  you understand that you are not on a “diet.”  You have had major surgery.  This is more than losing a bunch of weight. This is losing a bunch of weight because you had a major change to the physical structure of your body. The most relevant issue with regards to the post-op bariatric clients I work with are nutrient deficiencies.   The way around this is an excellent nutritional plan and supplementation.  

There's so much information out there. There's so much mis-information out there. My clients are special and they need to work with somebody who understands their specific needs and requirements.  

I salute you.  You made the important decision of wanting to lose weight and be healthy.  Continue with your desire to learn more about nutritional science and remember that beautiful you are a biochemical individual.  

Check out the articles by Sheri Burke, RHN, on ObesityHelp!

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Sheri Burke RHN


Sheri Burke is a Registered Holistic Nutritionist and Bariatric Coordinator at International Patient Facilitators in Tijuana & Cancun, Mexico. She has worked with bariatric surgery patients for 10 years & provides nutritional guidance to pre and post bariatric patients. Sheri is passionate about supporting patients so she created a VSG Blanket & a VSG Plush.

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