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Obesity Fact #9: Bariatric Surgery Works


sharma-obesity-surgery3The final obesity fact in the New England Journal of Medicine Paper on obesity myths, presumptions and facts states simply that,

“In appropriate patients, bariatric surgery results in long-term weight loss and reductions in the rate of incident diabetes and mortality.”

and hasten to add that,

“For severely obese persons, bariatric surgery can offer a life-changing, and in some cases lifesaving, treatment.”

This is not a fact anyone can argue with, as the data on the overwhelming benefits of bariatric surgery for patients with severe obesity are now well documented.

This is not to say (as regular readers will recall) that there are not inherent risks in undergoing bariatric surgery, both in the short and long-term. But, for patients with significant obesity related health problems, the benefits far outweigh these risks.

Nevertheless, bariatric surgery should never be seen as a quick fix (it is not), as a desperate measure (it is not), or as a treatment to be reserved for only the most severe and intractable cases (it is not). Rather, modern bariatric surgery, done in the right patient with the right pre- and post-surgical care, is currently the accepted treatment for patients, who need to lose more than 20% of their body weight for health reasons.

The more health reasons the patient has, the more benefits there will be.

Readers interested in a more comprehensive discussion of the pros and cons of bariatric surgery may wish to read a previous series I wrote on this topic.

AMS
Edmonton, AB

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3 Comments

  1. Hi Dr. Sharma, :)

    Dr. Jeffrey Friedman addressed bariatric surgery in his lectures on YouTube. He acknowledges most patients are less obese and it can be useful. However, patients are stil left obese after , just less so. The average BMI is about 32 and this is on 8-00 calories a day.

    it is far, far from perfect. There are thin people who eat really well and much moe than 800 calories a day. I have observed this amoung my friends and the public. Go to any fast food restaurant. You will see 5 foot 100 pound women eating LARGE McDonald’s sandwiches. Most I have seen certainly were not eating happy meals by any means.

    The obese should not have to eat only 800 calories for the rest of their lives. Hopefully ,guys like Friedman and Rosenbaum will figure this thing out. We need to find the BIG answer to the BIG question. Einstein had little patience for scientists who drilled a holes in the thinnest part of the object. ( not going after big answers and being conservative)

    We know so little, even about physics. This is evident by all the discoveries we make almost everyday at the Large Hadron Collider. We refine our instruments and learn more and more. But, we realize how little we know.

    There IS hope though. Dr. Friedman was talking about working on a PILL FORM and avoiding the surgery and all it huge risks completely . As we know favorabe gut hormone changes occur with bariatric surgery. They are working on IDENTIFYING speicfically what this COCKTAIL is.

    THAT seems worthwhile.

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  2. “…This is not a fact anyone can argue with…”

    In that case, well, I’m certainly not going to attempt to do THAT. :)

    I’ll *merely* share the following information and let readers conclude whatever seems relevant or helpful.

    It seemed absolutely certain to me, a few years ago, that I was destined to remain very fat (i.e. “morbidly obese”) unless some amazing medical intervention, such as surgery, could be obtained. Now, however, my weight is “normal”—for whatever that’s worth—and weight maintenance is not even a struggle for me.

    I didn’t realize (nor did anyone else) that I’ve lived with (even in childhood) some pretty severe cognitive impairments involving some very specific kinds of executive functions (i.e. serious neurological challenges), and that my poor brain—:)—along with my other regulatory systems (endocrine, etc) had been “attempting” (so to speak) to achieve the best homeostasis possible for my whole body, given the limitations of my specific physiological—neurological—impairments or disabilities (or maybe abilities, depending on how you look at it.)

    It occurs to me that people with this kind of neurological impairment (or developmental disability) are rarely diagnosed correctly, and, in fact, it has only quite recently come to pass that better diagnostic protocols are available to more readily and accurately ascertain the severity and specific areas of executive function impairment. For instance, some people have greater impairment in self-regulatory functions involving emotional responses (to stressful circumstances or interpersonal conflict, for example). Those specific kinds of neurological (executive function) impairments are more likely to present in somewhat more obvious ways compared to OTHER kinds of self-regulatory cognitive impairments—kinds which I happen to live with and which are necessary for effective organization, planning, short-term (working) memory, time management, sleep regulation, self-motivation, and the like.

    Based on research reviews I’ve been able to complete via PubMed—reviews of salient literature related to ADD, ADHD, and executive (brain) functions in general—it would seem that this severity of impairment in executive function (i.e. mostly involving the specific cognitive, self-regulatory abilities just mentioned…organization, etc) is probably quite rare. Clearly, not enough is yet known, but perhaps less than 2% of the general population have this specific range of impairment in this more focused area of neurological functioning, which means of course that what I’m discussing perhaps applies to a very small number of “candidates” for bariatric surgery.

    You might imagine that a neurological impairment of this nature and severity would be obvious for a competent general-practice doctor (or, at least, for a specialist) to observe and diagnose—or at the very least it would be relatively obvious to a person who LIVES WITH IT for decades to recognize as something pathological rather than typical. Unfortunately, it resembles a psychological (mental) illness that might be amenable to more standard treatments involving psychotherapy, occupational counseling, skills acquisition, CBT, etc.

    In other words, without the use of appropriate diagnostic procedures—including, in some cases, technological tools—the pathology is likely to require decades to sort out. So, I’m suggesting that it might save a few bariatric patients A LOT OF GRIEF if their surgeons are committed to determining if impaired executive functions are at the core of their patient’s struggle to self-regulate eating behaviors. I recommend diagnostic protocols recently advanced by Russell A. Barkley, Ph.D., whom I’ve never met and have no connections with beyond reading his texts on the subject.

    Hopefully, this will be a field that gets much more attention in the next few years. I certainly hope others can be spared the kinds of suffering I’ve endured—especially before I arrived at a more thorough understanding of my brain. It is possible for some of us, like me, to find or create innovative ways of living that compensate for some of the self-regulatory impairments that result in chronic emotional, social, and even physical pain.

    Thanks, Dr. Sharma, for the opportunity to share some of my lived experiences in hopes that another may be helped.

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  3. Yes it helps…I got my bariatric surgery done for weight issues got complicted by diabetets in the year 2011. I liked it most as it got done in India for only 10k dollars the cost which was a huge saving for me. i lost around 30 kg in 3 months time and felt good for my health. I am still feeling good

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