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Why Diet and Exercise So Rarely Works in Obese Patients (And Why Bariatric Surgery Does)

Woman on diet eats a salad and wonders why she can’t lose weight and keep it off

Have you struggled with continuous dieting and exercise but not seeing results? You are not alone; many others have and are dealing with the same issue. For most people, especially those suffering from obesity, losing weight is more complicated than eating less and exercising more. Genetic, environmental, and hormonal factors all play a role in weight loss. These factors can make weight loss difficult and cause frustration and desperation to pursue unhealthy extremes in losing weight. Sadly this often leads to more weight gain and longer-term medical complications. Losing weight is not always a matter of willpower or motivation, so categorizing people who are obese as lazy or unmotivated is simply untrue.

Obesity is not just being overweight; it is a disease. The American Medical Association recognized obesity as a disease in 2013, stating, “Our AMA recognizes obesity as a disease state with multiple pathophysiological aspects requiring various interventions to advance obesity treatment and prevention” 3. And this disease is prevalent. According to the Centers for Disease Control and Prevention (CDC), in 2017 – 2018, the United States obesity prevalence was 42.4% 2. Obesity is also complex – it is a chronic disease caused by environmental and genetic factors that require treatment.

Getting bariatric surgery might seem easy to some people, but that is far from the truth. Rather strict diet and exercise will still be needed after weight loss surgery. Patients must follow their post-op lifestyle guidelines after surgery to decrease the risk of complications.

Bariatric Surgery Is Not for People Who Need to Lose a Few or Even 30 Pounds

It is important to remember that having bariatric surgery is a big commitment and needs to be taken seriously. You cannot just sign up and schedule yourself for bariatric surgery. There are numerous criteria you need to meet to qualify for bariatric surgery. You’ll have to watch our seminar or see it in person, see a psychiatrist discuss your decision to have surgery, and undergo pre-operative testing. Like any surgery, some risks and benefits need to be considered.

According to the American Society for Metabolic and Bariatric Surgery, the qualifications for bariatric surgery are;

  1. BMI ≥ 40, or more than 100 pounds overweight.
  2. BMI ≥ 35 and at least one or more obesity-related co-morbidities such as type II diabetes, hypertension, sleep apnea, other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.
  3. Inability to achieve a healthy weight loss sustained for some time with prior weight loss efforts 5

The New York Times published an article in 2017 where Dr. Laurie Twells was interviewed and discussed weight loss surgery. She quoted saying, “These patients have lost hundreds of pounds over and over again…the weight that it takes them one year to lose is typically back in two months…bariatric surgery is probably the most effective intervention we have in health care” 1.

It is thought that when someone has been obese for a long time, their body resists weight loss by reducing its metabolic rate. When you have bariatric surgery, it alters your digestive system to help you lose weight but not reduce your metabolic rate.

In 2017, TIME magazine published an article titled “The Weight Loss Trap: Why Your Diet Isn’t Working.” Dr. Kevin Hall, a researcher at the National Institutes of Health (NIH) studying weight loss, shared his research that more than 80% of obese people who lose weight end up gaining it back. This is due to their resting metabolism slowing down 4. Bariatric surgery aims not only to make the stomach smaller but to alter how your body absorbs food so that you feel full and have decreased hunger. In many cases, bariatric surgery also represents a hormonal reset. Surgeries like the gastric sleeve remove the primary production center of the hormone ghrelin, while the gastric bypass may reset gut flora within days and weeks of surgery. These are both situations that do not occur with diet and exercise.

As you can tell, there is a significant psychological component to weight loss after bariatric surgery. By opting for surgery, you have finally admitted that you need help. It may have taken you months, years, even decades. But by letting go and getting help, the struggle, frustration, and disappointment with yourself diminish, and you can finally turn your eyes toward the goal.

Key Takeaways

Diet and exercise don’t always work for people struggling with obesity. Environmental, genetic, and hormonal factors all play a role in stopping you from losing weight. Obesity is a chronic progressive disease that requires aggressive treatment and maintenance.

Studies have shown that when someone has been obese for a long time, it is difficult to lose weight and keep it off because the body’s metabolic rate slows down to compensate for the lower caloric intake and the body’s set point kicks in – a new, higher normal weight.

The goal of bariatric surgery is not just to make the stomach smaller to lose weight; it works by changing how your body absorbs food and how some hormones are secreted. Although weight loss surgery may seem like the easy way out, it is far from it. The process of getting bariatric surgery is not easy. After surgery, your journey is just beginning and will include diet, exercise, and lifelong maintenance.


  1. Brody, J. E. (2017, February 13). Why weight loss surgery works when diets don’t. The New York Times. Retrieved May 19, 2022, from
  2. Centers for Disease Control and Prevention. (2021, September 30). Adult obesity facts. Centers for Disease Control and Prevention. Retrieved May 19, 2022, from
  3. Obesity. AMA. (n.d.). Retrieved May 19, 2022, from
  4. Sifferlin, A. (2017, May 25). The weight loss trap: Why your diet isn’t working. Time. Retrieved May 19, 2022, from

Who is a candidate for bariatric surgery?: Patients: ASMBS
. American Society for Metabolic and Bariatric Surgery. (n.d.). Retrieved May 19, 2022, from