Lenox Hill Bariatric Surgery Program Bariatric Center

Does anything stop obesity for life?

Aug. 06, 2019 by Mitchell S. Roslin

I am a Bariatric surgeon and love what I do.  I really believe that the impact that well -done procedures can have on individuals is dramatic and often wonderful.  But, I cringe when I see advertisements promoting that surgery can cure obesity for life.  It means those offering this suggestion do not understand the metabolic complexity of the causes for obesity and overestimate the power of a procedure.

For many reasons, bariatric surgery is the best treatment that we have for severe and morbid obesity for those that have obesity related medical conditions or have limitations on their quality of life because of their excess weight.   With proper procedure selection, an understanding of each individuals’ objectives it can be a fantastic tool.   It is underutilized and should be offered to more people.  However, it is not a cure for obesity.

Obesity is secondary to the bodies inability to correctly balance its energy needs.  Instead of the brain balancing energy intake and expenditure, the body perceives a need to consume more food.   Why this happens is just beginning to be understood.  A simple explanation is that the food that we are eating seem to cause an inflammatory reaction.  With inflammation ,the message the body gets is that it most preserve energy to fight the ongoing stress.  Weight loss, and the abrupt change in eating following bariatric surgery reduce the inflammatory cascade.  We have just completed a study showing that weight loss surgery changes the genetic expression of genes that cause inflammation and are involved in coronary artery disease.

All this sounds great and promising.  However, what caused the inflammatory reaction to begin with.  The foods that we are surrounded by.   The chips at the gas station.  The quick drink of juice or the oversized bagel.  Dairy products and milk, perceived as a high quality and healthy are underestimated as culprits.  Following surgery, patients return to the same environment with the same choices that existed before surgery.  Yes, initially they will be less hungry and full faster, but even these feelings will subside.

Thus, surgery by itself cannot stop obesity for life.   Unfortunately, if you are just like everyone else the path is paved for weight gain.  To be healthy in this environment, you need to be proactive.   Every person contemplating weight loss surgery needs to learn what to eat.  Additionally, you learn best by doing, not memorizing.  Preparing food and understanding what is in what you are eating is the best strategy.  The lists given about what to eat work until you are no longer frightened.   What bariatric surgery can do better than any other modality is potentially turn back the clock.  Eating less of the same foods that you previously consumed will virtually guarantee that you will not stop obesity for life!