Bariatric Surgery: Not the Easy Way Out

Weight Loss Surgery Carries ‘Easy Way Out’ Stigma

bariatric doctor with patient

By Andrea Hanson, MS, RDN, LN, Avera Bariatric Dietitian

No matter how we look at it, weight loss is hard. While there are plenty of opinions about bariatric surgery, some people who want to lose weight think of it as “the easy way out.”

As a member of the team that guides patients through this serious surgical approach, I’ll be the first to be honest with you and anyone considering this approach: It’s not an easy way out of being obese, and it’s not a shortcut to a healthier you.

Here’s why:

  1. It’s a major surgical procedure. Although done using minimally invasive techniques such as laparoscopy, bariatric surgery is a significant procedure that leads to some serious changes to your internal anatomy. It could mean the complete removal of 80 percent of your stomach, or the creation of a bypass of the stomach that allows malabsorption. No matter what approach the patient and surgeon takes, the procedures come with many of the same risks and complications of other surgeries.
  2. It’s only one piece of the puzzle. Bariatric surgery is not the “magic fix” some would make it out to be. It’s simply a tool, that when used correctly, can help facilitate weight loss. Think about it this way: you wouldn’t buy a new car, fill it with the wrong fuel, ignore its scheduled oil changes and leave it in “Drive” all the time, right? Bariatric surgery is similar, and your stomach, after surgery, is like this new car. You have to provide it with the right fuel, like protein, vegetables, fruits, whole grains and low-fat dairy and take proper care of it if you want to improve your health and see results.
  3. There’s no easy way out. When it comes to extreme weight loss, or really any weight loss for that matter, let’s face the facts: there is no easy way out. It takes hard work, devotion and patience to use all the tools available to make progress and your best life. Facing that fact and dedicating yourself to the journey knowing it can make success more likely.

So whether your weight loss journey includes the ups and downs of the dieting roller coaster, or it incorporates an intense exercise-routine or if leads you to an operating room, remember the truth: weight loss is hard!

There is no easy way out, but there are plenty of options, including bariatric surgery with the support of a strong, professional team. It can help you succeed.

Myth:

Weight loss surgery is for everyone

Fact:

Not exactly. We believe that everyone should have the chance to live a healthy life, but sometimes surgery isn’t the best option. Our experienced surgeons meet with each potential patient to discuss their medical history, lifestyle and health goals in order to determine their options. We offer non-surgical procedures and medical weight loss options for patients who want to lose weight without surgery.

Myth:

Weight loss surgery is the easy way out

Fact:

It is merely a tool and one step in a long process. It is true some people with obesity cannot lose weight simply by diet and exercise alone. However, we know that our patients put time into researching their options, showed courage to ask for help, and they committed to lifelong lifestyle changes.

Myth:

People who get weight loss surgery are lazy

Fact:

Any successful weight loss patient will demonstrate that this is false! Surgeries such as gastric bypass or gastric sleeve, as well as non-surgical options such as gastric balloon, are very effective in supporting weight loss but long term success ALWAYS depends on major lifestyle changes. We offer comprehensive support for patients and we see firsthand how much hard work they put into healthy meal planning, workout routines and developing healthy habits.

Myth:

After weight loss surgery you don’t need to do anything else to support losing weight

Fact:

Life after weight loss surgery looks very different than life before, and many of our patients are glad for that! Immediately after weight loss surgery there are different phases of a post bariatric diet to follow, as well as changing activity levels. If patients resume their diet or activity levels pre-surgery, they are at risk of gaining weight. Going into surgery with a determination to change your habits, treat yourself with love, and seek support, will set you up for success.*

Myth:

Weight loss surgery is more dangerous than obesity

Fact:

Not true! Obesity is potentially fatal. Comorbidities such Type 2 Diabetes, hypertension and associated cancers pose a threat to the health of people struggling with obesity. While any surgery carries some risks, typically the risks of complications from obesity and comorbidities outweigh the risks of complications from surgery. We explain all risks of weight loss surgery to our patients and our goal is to serve our community in Dallas and Fort Worth with safe procedures that can help patients successfully meet their health goals.

Myth:

Weight loss surgery is unaffordable

Fact:

Many health insurance policies cover weight loss! Our experts can help navigate your insurance benefits with our free insurance check. Some patients opt for self-pay because they don’t have insurance or because they want a faster timeline than insurance allows. We have special pricing and financing options available for self-pay patients. Additionally, life after weight loss surgery may mean fewer medications or long term health costs – plus, many of our patients say that their newfound health is priceless.*

​US News {amp}amp; World Report recently noted that gastric bypass surgery not only cuts your appetite but also might reduce your desire for high-fat foods. Over the years, I’ve had friends who have suffered through gastric bypass or lap band procedures. They’ve all shed weight as if they had made a pact with Satan — quickly and what appears to be easily.

People applaud their weight loss and congratulate them on how thin they’ve become and how good they look.

Not I.

I don’t like cheating and I don’t like short cuts, especially (at least) when it comes to such a big thing (pun totally intended).

My weight has yo-yoed during the years. I’ve been normal weight, thick, chubby, and obese. When I was at my heaviest, 250 pounds, I did the unthinkable. I cut my calories to less than 500 per day and began exercising two hours daily. Guess what? I also lost weight as if I had a pact with «he who must not be named.» (Oh, wait, that’s Lord Voldemoort; I mean the other guy.)

It was difficult, especially at first. But every day I — and my will — grew stronger. And after three months (in which I lost 80 pounds), I was very, very proud of myself.

How can I be proud of someone who takes the easy route? Someone who decides that having a surgeon cut them open and rearrange or modify their insides is easier than eating less and exercising more? It’s just lazy.

And if you’re too lazy to cut calories and exercise, you don’t deserve to be skinny.

Before I get a ton of comments about how some people are so obese they don’t have a choice — chill, please. You’re the type of person who enables drug addicts and criminals. I have the Learning Channel. I’ve seen those shows about the heaviest people on the planet, including Manuel Uribe from Mexico, who weighed more than 1,000 pounds and was dubbed «the Fattest Man on Earth.» He began losing weight by exercising and cutting down on eating. Sure, his exercise consisted of doing arm circles while lying in bed, but it burned more calories than lying there eating tacos.

And if the fattest man on Earth can say no to food and yes to exercise, so can all of the self-indulgent, overweight, spineless jellyfish who take the easy way out.

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WEDNESDAY, Dec. 12, 2018 (HealthDay News) — For many obese people, weight loss surgery can be a new lease on life, but too few who qualify for the procedure opt for it.

One big reason: The widespread notion that surgery is an «easy way out,» signifying a weakness of willpower to slim down using diet and exercise.

Almost 40 percent of nearly a thousand surveyed in a new study thought weight loss surgery (or «bariatric surgery«) was this kind of lazy, quick fix for weight loss.

And a «large percentage of the population — nearly 50 percent — think that weight loss surgery is performed for mostly cosmetic reasons,» added lead researcher Dr. Heather Yeo. She’s an assistant professor of surgery at Weill Cornell Medical College in New York City.

That’s «unfortunate, as there are clear health implications to obesity, and strong data which support the effectiveness and safety of weight loss surgery,» she said.

Yeo believes people need to become aware of the health dangers linked with obesity.

«Obesity is a public health epidemic that contributes to mortality and many other health conditions, such as hypertension and diabetes,» Yeo said. «Weight loss surgery has a low rate of complications and also has excellent success.»

The patients who want weight loss surgery are not doing it to look better, agreed Dr. Eric DeMaria, president of the American Society for Metabolic and Bariatric Surgery.

Mostly, «they want better health,» he said. «The effective treatment for this disease of obesity is bariatric surgery, and 99 percent of the people who could benefit by this treatment aren’t getting it.»

But given the stigma around obesity, many patients don’t consider weight loss surgery, DeMaria noted. «You’re almost admitting to being a personal failure as a human being, because you can’t lose weight by yourself,» he said.

But that’s a false perception, DeMaria said. Obesity is a complex disease of metabolism. «It’s extremely difficult to treat without assistance of medications or surgery in addition to all the behavioral stuff,» he explained.

DeMaria said the surgery is safe and effective. In addition, he noted, «It also treats all the serious medical conditions that accompany obesity and even reverses the risk of premature death.»

Teresa Colón

I am a professional dieter.

I can lose 20, 30 pounds at the drop of a hat. I follow all the rules, do all the things, and rejoice as I slip into old clothes or shop at new stores.

I’ve been on all kinds of popular diets, including WW, Nutrisystem, and Atkins. I’ve done extreme calorie restriction diets, eating 600 calories a day and getting weekly vitamin B injections, so I don’t die in the process. There are many others, too, though none of the phen-phen or grape-a-day variety.

Whoooosh — all the weight I’ve lost comes roaring back, bringing with it a few new friends.

I can debate the merits of each. I can size a 3-ounce chicken breast by eye; I know the calorie count of all kinds of fruits and how to build a meal around vegetables. I know how to minimize carbs while not eliminating them, make my own condiments to reduce sugar intake, and which foods have “healthy” fats (here’s looking at you, avocados).

Inevitably, however, there comes a time when necessity dictates a break in form, or a situation arises where I am literally unable to follow whatever plan I’m on.

Or something else happens where life intervenes and whoooosh — all the weight I’ve lost comes roaring back, bringing with it a few new friends.

Only four people in 100 can maintain weight loss for five years or more.

I’m not alone in this. 96% of people who lose weight regain it all back within five years. Look at that number again — 96% percent.

That means that only four people in 100 can maintain weight loss for five years or more. FOUR.

So, does that mean the other 96 are lazy, unmotivated, and need to develop self-discipline? Or could it be that something else is going on?

What we know today is that every time we gain weight, our body establishes a new setpoint, a weight at which our body has confidence we will have fuel in case of a food deficit.

Once considered an extreme — and dangerous — solution, evidence now shows that surgery is the most effective weight loss option available today.

We reinforce this setpoint every time we diet: our body gets the message that today’s ample portions could be tomorrow’s starvation. It stores every extra bit of energy it can to make sure we have energy on hand for emergencies. Each time we lose weight, our body raises that setpoint to an increasingly higher level.

And, in the ultimate double-whammy, our body also cuts back on our metabolic rate, the number of calories we burn while doing an activity. A person who diets their way down to 150 pounds will have a slower metabolism than a similar person at that weight who did not diet.

These issues all appear even before we consider medications that cause weight gain and other genetic and medical causes of obesity (such as a hypothyroid).

I might classify surgery as working-smarter-not-harder, except that it’s harder, too.

There’s been an increase in interest and medical approvals for bariatric surgeries as more evidence comes out to suggest it is the best way to fight obesity. Once considered an extreme — and dangerous — solution, evidence now shows that it is the most effective weight loss option available today.

Whether it’s the Vertical Sleeve Gastronomy (VSG), gastric bypass, duodenal switch/loop, or a variation of these options, the overwhelming majority of patients who choose surgery maintain a weight loss of 50–80% of their excess weight over ten years. And when I say “overwhelming majority,” I mean over 90%.

So now, we have (at worst) TEN people regaining all their weight versus the non-surgical 96.

We know a few things about why surgery is successful as an option. Some options are restrictive, meaning that the patient literally cannot eat more than a couple of ounces of food at a time.

Insurance providers insist on having you jump through all kinds of hoops before they approve the procedure.

Others remove or skip sections of the intestines, leading to malabsorption of nutrients in the digestive tract.

Some do both.

Obviously, these effects are critical in terms of the initial weight-loss, which typically occurs over an 18 month to two year post-op period. In this duration, not only is the patient losing weight, they experience an enforced and extended-time period to learn new eating patterns and build healthier habits.

You can’t cheat by having an ice cream if you know you will have nausea, sweating, and severe diarrhea within a couple of hours from the sugar in it.

Interestingly, however, the surgeries also appear to reset the metabolism. This part is less well-known, but the evidence is growing around this phenomenon. We can’t explain it yet, but these surgeries seem to lead to more significant internal changes than the simple diet-and-exercise approach.

Most programs insist on a 10% pre-op weight loss before you qualify for surgery.

Yet, the stigma around weight loss surgery perpetuates. Those considering it often hear it called “the easy way out.”

It’s anything but.

Let’s start with the qualifying process. Unless you’re engaging in medical tourism, insurance providers insist on having you jump through all kinds of hoops before they approve the procedure.

Many require attendance at bariatric or Overeaters Anonymous support groups. There are “bariatric program orientation” meetings, to make sure you know your options and the expectations. There is also a psychological evaluation to make sure you are mentally healthy enough to undergo the surgery and its aftereffects.

Beyond that, there is all the medical screening. Cardiologist visits to make sure your heart will withstand the vigors of surgery; sleep studies to test for and treat sleep apnea. Evaluations of your medical history to ensure you are both heavy “enough” (usually meaning a BMI over 40) or that you have enough obesity-related conditions to justify the procedure.

Welcome to the world of chicken broth, sugar-free jello, and water.

Then there is the stress of the co-pay. It is not unheard of for people to pay $10–20,000 out of pocket for the surgery in the United States, one reason why Mexico has a thriving medical tourism practice (whose patients rave about the high quality of care at fantastic prices).

Assuming you’ve made your way through all these hurdles, there is the final one: You have to lose weight — first. Most programs insist on a 10% pre-op weight loss before you qualify for surgery. A few will only require a two-week liquid diet to thin out the liver and reduce risk in the procedure. In some cases, both are necessary.

Some people get surgery within two months of starting this process. More commonly, it takes six months to a year — or more!

Then there’s the entire post-op experience. Most procedures are done laparoscopically via five or six inch-long incisions around the abdomen. After, there is a one- or two-night hospital stay while everyone waits for you to pass gas and pee at least once.

There are rules about [drinking] water, too, which you will now follow for the rest of your life.

Oh, and despite how much pain you are in, you have to walk around the hospital, too. It’s essential for healing and preventing blood clots.

For the next few days, you are on a clear liquid diet. Welcome to the world of chicken broth, sugar-free jello, and water. You can only take tiny sips (and no straws! straws cause excess air intake and gas) as you desperately try to find a way to get a couple hundred calories into your body.

From clear liquids, you graduate to full liquid meals. You have to get at least 70 grams of protein every day, so protein shakes and yogurts are your new best friends. Assuming, of course, that the surgery hasn’t made you lactose intolerant, another common side effect of bariatric surgery.

And between meals, it’s sip, sip, sip your water to get 64 ounces every day.

There are rules about water, too, which you will now follow for the rest of your life. No drinking water for at least 10–30 minutes before a meal, to make sure you don’t get too full too quickly and miss out on vital nutrients.

You are now consistently the last person finished at every meal, and you eat a third of what everyone else does.

Similarly, you don’t drink water for 30 minutes after your meal so that your body can take the best advantage possible of the nutrients you are ingesting.

After a few weeks of drinking all your meals and praying to hit 600 calories a day, you graduate to puréed foods. Scrambled eggs, puréed chicken…everything goes through a blender before it hits your mouth. Yum.

Somewhere in here, it’s a good idea to develop a regular exercise habit.

About three months after surgery, you get to have your first real food! But put down that potato chip, because it could get lodged in your “pouch” (tiny new stomach) and damage or even reopen your stomach. Bread is also not a good idea, because your body can’t process it in quite the same way it did before surgery.

And sugar? Sugar is likely to cause dumping syndrome due to malabsorption. Have something sweet and experience the joy of sweats, diarrhea, stomach cramps, nausea, and vomiting.

Your body takes on the contours of a melted candle as the excess skin piles up.

Everything else gets chewed to a pulp before swallowing. Congratulations — you are now consistently the last person finished at every meal, and you eat a third of what everyone else does.

Periodically, you go through a Buyers Remorse phase as you mourn caffeine (not safe for your pouch), the ability to take ibuprofen, or struggle with the intense vitamin regimen that is your fate for life. Perhaps you get hit with one of the common mental health challenges significant weight loss causes.

Possibly your marriage falls apart as your spouse can’t handle the more confident version of you that emerges from under the fat.

But all this is worth it because you are dropping weight in a way you never have before. Your body takes on the contours of a melted candle as the excess skin piles up around your arms, legs, and abdomen.

You are off of your blood pressure medications, your diabetes is gone, and the only pills you take are the daily vitamins to prevent malnourishment. You get to shop in the same stores as everyone else, and you experience the world in entirely new ways.

Sure, you might need skin surgery (or surgeries) to get six-to-ten pounds of skin removed, but pictures show you how far you’ve come.

In 2015, I stepped on the scale for the first time in years and was shocked to see the number staring back at me. At 5 feet 5 inches, I weighed 275 pounds. And it wasn’t just my physical health that was suffering; I was also utterly depressed, had no self-esteem, and was headed down a path of total self-destruction.

That number on the scale motivated me to take control of my life and my health. Over the next year and a half, I underwent gastric sleeve surgery (a permanent procedure where doctors drastically reduce the size of your stomach), hired a trainer, and lost 175 pounds-something I’ve maintained for the past two and a half years.

I’m not going to lie: I’m damn proud of my hard work, dedication, and commitment to regaining my health. That’s why I’ve shared my progress on social media: to help others who might be in my shoes. While I get a plethora of positive and heartwarming messages, I receive a lot of negativity as well-mainly surrounding the fact that I’ve had weight-loss surgery and plastic surgery.

Just the other day, for instance, I had someone write explicit body-shaming comments on over 200 of my posts. That’s right: 200. The common theme? That I’m a «total phony» and don’t have the right to show before-and-after pictures because I took the «easy way out» through my surgeries.

But here’s the thing: There is no easy way out when it comes to extreme weight loss. Yes, I’ve had surgery-which is something I’m very transparent about. But I, like most women who undergo these kinds of procedures, learned the hard way that surgery only works if you do. (Related: The Ripple Effect of Weight-Loss Surgery)

From my gastric sleeve procedure, I lost 60 pounds in two months. Not because I changed my lifestyle, but because I had to go on a liquid diet for about three weeks before the surgery and for three weeks post-op. News flash: Any person who does that (regardless of their size!) is going to lose a considerable amount of weight.

What most people don’t know, however, is that once I was able to eat normally again, I gained almost all of that weight back because I didn’t make any changes to my lifestyle or eating habits. Sure, I couldn’t go and binge on my normal portion sizes (because my new, smaller stomach wouldn’t let me), but I still found new and creative ways to eat my feelings. Within the next two months, I regained 45 pounds and was basically back at square one.

It was humiliating. Even though I could only eat about four ounces of food at a time, I was still gaining weight. How? Well, what some people don’t know is that even after gastric sleeve surgery, there are still some foods that can «slide past» your sleeve. While I couldn’t eat a lot of bread, fried chicken, steak, and other high-volume foods, junk food like chips, popcorn, frappuccinos, and sugary drinks «slid» right past my sleeve.

Regaining so much weight even after weight-loss surgery finally made me realize how desperately I needed to change my horrible relationship with food. I sought out a trainer and nutritionist who understood my situation, and it was through him that I learned how to choose what I want most versus what I want now. I had to learn that when I «messed up» (because we all mess up) it didn’t have to become a pattern and that I could get right back on track. (Related: 25 Experts Reveal the Best Advice to Achieve Any Goal) Like any other person going through extreme weight loss (surgery or not), I had to practice those things every single day to finally lose all the weight and keep it off.

Along the way, I’ve gotten a tummy tuck and breast augmentation-but not only for aesthetic reasons. I had a lot of loose skin in those areas that kept getting infected. If I really wanted to restore my body to its original shape, I could undergo four or five more surgeries to remove loose skin around my butt, legs, and arms, but I’m perfectly okay having that extra skin as a reminder of what I’ve been through. (Related: 10 Women Who Seriously DGAF About Their Stretch Marks and Cellulite)

At the end of the day, weight-loss surgery is only a tool that works if you put in the effort. I know the work, blood, sweat, and tears that went behind my transformation. By no means was it as simple as saying, «I had three surgeries and look at me now!» It was a complete and total evolution of my mindset, my approach to healthy eating and fitness, and my desire to be healthy and strong.

Today, I follow a strict ketogenic diet, spend half an hour at the gym five or six times a week, and live a pretty active lifestyle overall. I’ve maintained my 175-pound weight loss for over two years. But still, every day has its ups and down. I have to watch what I put into my mouth because if I slip up for an extended amount of time, I know I’d gain all the weight back pretty easily.

Without that weight-loss surgery, I would have never regained the weight, never hit rock bottom, and never made the changes I desperately needed to regain my health. Even with the surgeries, the road was painful and difficult and will continue to be for the rest of my life.

So for all you haters out there: I did not «take the easy way out.» I fought to be where I am today and that’s something I refuse to be ashamed of.

Discussion

The notion that bariatric surgery is an “easy fix” is alive and well. The idea that obesity is the fault of the individual15 remains prevalent in our society. This societal attitude of blaming individuals for their obesity might lead further to the idea that people with obesity do not deserve what is perceived as an “easy fix.

” Another possibility is that the speed of the resulting weight loss, rather than the rigors of surgery and subsequent lifestyle changes, makes the surgical approach seem “easy” in comparison to changing one’s diet, decreasing dietary intake, exercising, or struggling with a weight loss.

The internet contains numerous accounts of patients encountering this negative attitude from others and defending their surgical experience as not “easy.” There are several forums on Facebook that deal with gastric bypass and sleeve gastrectomy support that have thousands of members.

A keyword search on one group yielded 24 comments about “the easy way out.”16 One person noted, “It’s not an ‘easy’ way out. I didn’t really know how to address this when someone said it to me”. Another commented, “My family feels that I’m taking the easy way out.”

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