While excess weight and obesity are some of the most researched topics in modern-day society, mainly due to the incredible rise in weight-related comorbidities, we do not often get the exciting news of new surgical guidance or suggestions from influential organizations. When they happen, it’s a big deal and something we should consider carefully. Just that happened last month when the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) released joint guidance intended to update federal guidelines since 1991. In your research of bariatric surgery, you’ve likely come across these older guidelines, which essentially state that patients with a BMI of 35 or over with one or more obesity-related comorbidities or patients with a BMI of 40 or over regardless of comorbidities may be eligible for bariatric surgery. While these guidelines have been in place for the best of three decades, they have also limited access to bariatric surgery for millions of patients suffering from excess weight-related conditions but with no qualifying BMI. How is this possible?
Ultimately, the reason for this is the inherent inaccuracy of the BMI calculation. The BMI was never intended to be used as a measure of obesity. The larger question is, what exactly is obesity? Arbitrary BMI levels very loosely define obesity – there’s little empirical evidence behind it.
If you’re considering bariatric surgery, you have likely tried many diet and exercise programs to get back into shape over the years. If you haven’t been successful, don’t beat yourself up. Unfortunately, for most, these programs are not effective. Many patients regain their weight, and often put on even more, after some time. Despite a lifetime of being bombarded with diet plans that claim to work, we continue to be lured into the promise of weight loss and fat-busting with little or no work. And it’s no surprise it often ends in frustration.
So, to get right to the point, fat loss and weight loss do not happen without work; no matter what road you take to get there. To lose weight, proper diet and exercise are essential. And this is also true after bariatric surgery.
You may be coming off a failed diet and feeling frustration and despair as you read this. You may feel very alone now, but you should also know that millions of people are in the same position. Losing weight is not easy and doing so without help is even more challenging. We are often taught that the key to weight loss is a deficit of 3500 calories at a time (equal to the loss of a single pound). However, sometimes it feels like you’ve restricted so many more calories than that, yet the number of pounds lost has not kept up. Well, there is a reason for that, and it is called metabolic adaptability.
Recent studies have shown that your metabolism may not slow until about 60. However, just like it does each day, as you eat and exercise, it adapts. And this is one of the reasons why losing weight without a catalyst like bariatric surgery is so difficult.
Whether you are a bariatric patient or not, diet and exercise are vital components of any weight loss program. But while the concept of simple calories in versus more calories out for weight loss is true, it does not tell the whole story. Diet and exercise contribute to weight loss and improved health in different ways.
You have undoubtedly received plenty of advice on diet and exercise. You have a post-operative manual from your practice, giving you the blueprint for how to lose weight consistently and safely over time. You are also motivated, partly by your decision to have weight loss surgery, but also because you’ve seen the dramatic results early on. However, calories in and out may not always be the end of the story, and we must look at the weight loss process overall to give ourselves the best chance to lose weight quickly and maintain that weight loss over the long term.
Let’s cut right to the chase. The decision to have bariatric surgery is a very personal one. Many factors come into play when you make that decision, and whom you tell is, frankly, entirely up to you. We have some patients that wish to tell everyone they know about their decision, while others don’t say a word to anyone but their medical team. Either way is acceptable, but there are a few considerations:
If you keep your decision about bariatric surgery close to your chest, be sure you have some kind of support system available to you. This can include your bariatric practice, but it’s also important to have a support system outside your surgeon’s office. The support can come online or in person, or you may have a small group of trusted friends that also had bariatric surgery and are willing and able to keep your decision between you.
You’ve probably agonized over decisions far smaller than having a life-altering surgery. No one can question that this decision is one of the biggest you’ll ever make. But what factors should go into deciding to have bariatric surgery or continue with the status quo? While we are bariatric surgeons, we do not, by any means, believe that bariatric surgery is suitable for everyone. Hopefully, considering the following will help you make the right decision.
Proton Pump Inhibitors (PPIs) are often very appropriate and effective for measurable acidic Gastroesophageal Reflux Disease GERD. PPI use may be less appropriately prescribed in situations of functional dyspepsia (where recurrent indigestion has no apparent cause) and where motility problems of the GI tract may be responsible for heartburn symptoms often overlapping with symptoms of actual acidic GERD. Allergic esophagitis may also mimic GERD, and treatment with PPIs may have been attempted.
As a person who prides herself on her ability to research any topic to death, I thought I knew everything there was to know about bariatric surgery and recovering from it before I walked in the hospital doors. In some cases, I was happy; in others, less so, to learn, I could not have been more wrong. Everyone has a different experience when they go through bariatric surgery, so I can’t promise you that my exact experience will be the same as yours. Some people lose hair; some don’t. Some wind up with excess skin after weight loss, and some people’s skin bounces right back. Our bodies are different, so it makes sense that our response to surgery will be different too.
One thing is certain – the information your medical team gives you before surgery is your best friend. They taught me some things I didn’t take seriously enough and some that I incorrectly assumed would not apply to me. If I could go back and do it all over, I would tell myself to listen to my medical team and give myself a heads up about the following six things:
Morbidly obese patients simply have not had as much access to joint replacement surgeries as their regular BMI counterparts. It is not uncommon for an obese patient to go to an orthopedic surgeon and be told to come back after they have lost weight. This is incredibly frustrating for patients who suffer from what can be debilitating joint pain. They could have been struggling to lose weight for years, and now the pain in their joints makes it difficult or impossible to exercise. They know, more than anyone, that what’s holding them back is a disease and one that is decidedly undertreated even in modern medicine.
The orthopedic surgeons denying a joint replacement to morbidly obese patients are not trying to discriminate or fat-shame. They have valid reasons backed by research as to why they don’t want to perform a joint replacement on obese patients with certain BMIs. Research has shown that obesity makes a patient less than ideal for joint replacement surgery.