Bariatric Surgery: The Easy Way Out?

Many of my patients who are considering bariatric surgery struggle with their decision. They feel they should be able to lose weight without such drastic measures. After all, they've lost weight dozens of times before. They express that bariatric surgery feels like the easy way out. Sometimes it isn't the patient with this perception, it's a family member. "He thinks I should be able to do this on my own, without surgery," I often hear. If we compare typical weight loss outcomes of bariatric surgery to conventional weight loss methods, we see that surgery is by far the most effective treatment for extreme obesity. It isn't even close. Only about 15-20% of people lose at least 10% of their weight (losing 25 pounds if someone weighs 250 pounds) and keep it off for one year, without surgery.

What about when individuals receive really good nonsurgical treatment with professionals--can they lose weight that will come close to what we see with bariatric surgery? The Look AHEAD trial was a well-funded study by the National Institutes of Health. Individuals with diabetes participated at 16 different sites across the United States. The goal was to determine the impact of weight loss on cardiovascular disease and death in people with diabetes. Treatment was designed by experts in the obesity field and it was carried out at facilities well equipped to provide high quality nutritional and fitness interventions. The average weight loss at one year for those who were severely obese was about 25 pounds. By comparison, one-year weight loss for individuals receiving sleeve gastrectomy and gastric bypass is 67 and 92 pounds, respectively. Not only does the average person lose more weight after weight loss surgery, he or she is more likely to keep it off. At three years after surgery, 46% of sleeve gastrectomy patients and 65% of Roux-en-Y gastric bypass patients kept off at least half of their excess weight. 

So if surgery is more effective, it is the easy way out, right? Not so fast. Saying surgery is an effortless means to weight loss is like saying marriage is taking the path of least resistance to remedy loneliness. True, marriage will probably decrease your chances of feeling lonely. I know this may be a surprising fact, but marriage also significantly increases the chances of divorce! In addition, I still know some married people who are lonely. Just like marriage may decrease loneliness, it is by no means easy, just ask my wife. Like marriage, bariatric surgery requires sacrifice and commitment. Complications can also often occur. Neither marriage nor bariatric surgery should be entered into lightly.

I enjoy working with people who want to commit to behaviors that will lead to success after bariatric surgery. But I also love helping those who want to manage their weight without surgery. In the long-run both types of patients have to do similar things to be successful. Surgery patients willingly trade some freedoms and accept some risks to increase their chances for success. Those seeking weight loss without surgery either don't meet insurance qualifications or have decided that, for them, the risks outweigh the benefits. It is a personal choice. If you are considering bariatric surgery, get the facts. Your friend's or co-worker's weight loss surgery experience may be entirely different than yours. Once you have the facts, share them with those that care about you and want to help. No matter what you decide, it is important to understand that long-term weight management is challenging and there is no easy way out. 

Unick, et al., Effectiveness of lifestyle interventions for individuals with severe obesity and type 2 diabetes. Diabetes Care, 2011; 34, 2152-2157.

Coleman, et al., Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system. Surgery for Obesity and Related Diseases, 2014; 10, 396-404.