Bariatric surgery

[Lil Honey]

I know of a local woman (don't know her personally) that will be undergoing bariatric surgery.

 

I think it was about nine months ago that she had talked about having it done, but the doctors told her that she had to try every other avenue. She started L.A. Weight Loss (can I say that?), but only did it for about two months. Then the doctors gave her the approval for the surgery.

 

Pre-op, she has to ingest nothing but liquids for several days. After surgery, there is (what seems to be a long) period of time that she can still only have liquids. Then, soft food for another extended period of time. Then, she will have to eat very small portions several times a day.

 

This is from http://www.webmd.com/content/article/14/1689_51239.htm :

 

As with any major operation, bariatric surgery is far from foolproof. The death rate nears 1%, meaning up to 400 people may die from the procedure this year alone. As many as 20% of patients need additional surgery to mend complications, such as abdominal hernias. Due to malabsorption in the shortened digestive tract, roughly 30% of patients develop nutritional deficiencies, such as anemia and osteoporosis, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

 

Then there are the lifestyle changes. People who once ate freely and copiously must become hyperattentive to their diets. The new stomach requires several tiny, nutrient-rich meals a day supplemented with additional vitamins and minerals. Eating too much or indulging in rich, sugary, or fried foods can overload the sensitive pouch and cause dumping -- a term used to describe the sweats, chills, and nausea that result from food filling the pouch and overflowing straight into the small intestine.

 

It is my understanding that there is a lot of counseling in regard to lifestyle changes, etc. post-op.

 

Now, my question is this: Why not drink the liquids, eat the soft foods, eat many smaller meals throughout the day, and give the patient counseling WITHOUT the surgery? Doesn't it seem that it would make sense that they would lose weight minus the risks?

[Lil Honey]

From the same web address, I suppose this answers my question (in part):

 

It's clear that nonoperative treatment doesn't work for the severely obese, Brolin says. "In this group, the failure rate of dieting approaches 100%."

 

Other weight-loss experts concur. Compare bariatric surgery to dieting and it's no contest, says John Foreyt, a psychologist at Baylor College of Medicine in Houston, who works extensively with bariatric surgery patients. The average dieter loses 10% of his body weight. For someone who is severely obese, that can be a mere 30 or 35 pounds, says Foreyt.

 

Using behavior modification, such as diet and exercise, the most weight a person can hope to shed is one to two pounds per week, says Randall Flanery, a psychologist at the St. Louis Behavioral Medicine Institute in St. Louis. At that rate, a person who needs to drop 150 to 200 pounds may die of an obesity-related illness before getting the weight off, he says.

 

But isn't the fact that a person is eating a specified amount and specified foods also a "diet"? The only difference is knowing that if you overeat, you are not going to have good things happen. And with faster weight loss, I imagine a person could exercise more sooner. (?)

 

I don't know. This whole idea concerns me.

[JayKay]

When you are post bariatric surgery, you are...yes...on a highly restrictive diet.

 

The reason patients are able to adhere to the diet is because they physically are unable to consume more food. If they eat beyond their capacity they have horrendous side effects (namely vomiting, cold sweats, shaking, diarrhea and stomach pain)

 

 

I counsel a post-surgery patient who finds it extremely difficult to eat more than 1/2 a protein bar for breakfast. She has worked up from eating liquid shakes and puddings to ground meats and very soft vegetables at lunch and dinner. She is only able to consume about 900-1,000 kcals per day.

 

She is at high risk for dehydration as she can't take liquids with her meals; they fill her up too fast. She has to drink between meals, after waiting a certain amount of time. Even then, she can't drink large amounts.

 

She has to meet her protein goals to avoid hair loss and other complications associated with protein malnutrition. With her tiny appetite, it is essential that she focus on the protein component of her meal first. Therefore, she is often unable to eat much in the way of low-protein foods, like fruit and green vegetables. She is at risk for certain nutrient deficiences, as well as constipation from lack of fiber.

She has to take these big old vitamin pills to fill in the gaps. She will have to take these for the rest of her life.

 

 

Over time, weight loss slows for the post-surgery patient. Some will remain at a higher-than-desirable weight, no matter how few calories they take in. For example, a man who weighed 500 pounds may find that his new weight settles at 270 and not the the 190 he'd hoped for.

 

About 40% of patients gain a substantial amount of weight back, as they gradually 'stretch' their pouch. They will always have to work on behavior modification and adhere to a strict diet.

 

Yes, it would seem a lot easier just to follow the diet and not have surgery. But for whatever reason, some food addicts need a drastic measure to curb their addiction.

[Outcast]

I have greater hope for some med to be devised that would deal with the biological problems involved with overeating - people who can't detect when they're full or are hungry all the time, etc etc. There are definitely medical conditions that can contribute to morbid obesity - I'm hoping they are still focusing on curing those issues.

[Lil Honey]

There was a guy on the radio this morning who weighed 500 pounds, had the surgery and now weighs 240 (I think he said).

 

I can't even imagine how difficult it would be to go from eating one way for years to eating almost nothing (only liquids, etc.) I'm amazed that it takes a physical restriction (the possibility of getting sick) to keep from overeating. Would that be a physical issue (they do know when they are full) or would it be a psychological issue (they can't/won't stop when they are full)? Could be both, I suppose.

 

Still, I think I'd be more willing to cut back on regular food gradually than go through all that a patient must have to go through . . . and if it IS mostly psychological, it only makes sense that the therapy is what makes it work.

[Pink_Tulip]

I have two family members who have had this surgery. They didn't have, nor were offered, any traditional counselling. They had a consult with a dietician before the surgery, but both pretty much blew the information off. They believed that once they physically couldn't eat anymore, their problems would be solved and all that information was useless.

 

Two weeks before the surgery, my family got together, and my cousin sat at the table and went through two big bags of chips along with her dinner. She said she had to 'enjoy it now.'

 

It has been about 8 years since she had her surgery, and she isn't that much smaller than she was before the surgery. Over time, her eating habbits came back, and she stretched her stomach out to be big enough for her to maintain an obese weight. Her husband, who had the surgery a few years before her, is the same.

 

I can't speak for all people who get this surgery, only for my family members, but it seems to me giving surgery for what looks more like a compulsive disorder rather than a weight issue is unethical. I don't know, I certainly don't have all the answers. I can see how for some people it can be lifesaving. But I guess I just don't see it as the solution many others seem to. It makes me sad to go out with my cousin, who has been morbidly obese her entire life, and watch her eat herself to death. She was on the medications, diets, then surgery, nothing worked. She still grossly overeats.

 

Someone above mentioned doing surgery patient counselling, I hope things have changed since my cousins had it done and that is now required, maybe it could have made my cousins' surgeries more successful.

[agnf666]

Well, I think in my family genes has to be a "weight problem" I pretty sure to that... because everyone... including me has this problem...

 

My dad has tried numorous diets and they helpd for a while but then the wieght just comes back on. So, he has decided to go for the Bariatric surgery. In which, this monday he will be having it done... I'm very scared about this... I want to show him all the support I can but I am just a little scared...

 

I think this will work out for him though... he seems to be very excited and can't wait to go about his "new life"...

 

There is a pill out that is suppose to curve your appetite , but I haven't heard too much about it yet...

 

I think everyone's varies in results... Some people might have not stuck to the whole diet thing... There will be a time when your stomach goes back to it's normal size and that is when you have to make sure you eat right to keep the wieght off...

 

I will keep you guys posted on this whole thing as my dad goes through this next week...