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Why Bariatric Surgery Can Fail (Part 5)



So, just to wind down this series, I would like to finish with an aspect of bariatric surgery that is seldom talked about. It is particularly relevant to patients at the extreme end of obesity.

Many of these patients will have lived with severe obesity for a long time. They will have very few social contacts (except perhaps on the internet).

Many will not have partaken in what others would consider very ‘normal’ activities: going to a cinema, strolling around in a mall or park, shopping for shoes or clothes, having a mani-pedi or even just their hair done, getting on an airplane or even just into a regular car (let alone drive one).

As they lose weight, gain back their health and energy, and begin venturing out again, they will face all kinds of challenges both physically and mentally.

Many will have the support they need and do just fine.

But others, will flounder, feel socially incompetent – like a new immigrant to a foreign country.

Trips to a supermarket or the public library can be daunting.

It even takes time to recognize that that person reflected in the store window is really and actually you!

This process of ‘rehabilitation’, which eventually can encompass issues like facing the job market or considering going back to school is not easy.

Very little research seems to have been done on these issues – I can only imagine a whole new field for occupational and recreational therapists and social workers.

Bariatric surgery is truly life changing – in the real sense of the word.

I hope that this series of articles has perhaps touched on some issues that many may not have considered before.

I hope that those who have themselves experienced some of these issues or have seen them in their own patients can relate to some of these difficulties and see them reflected in my posts.

Bariatric surgery is about far more than finding a competent surgeon.

it is a very individual and personal decision – one that can empower – one that requires courage and determination.

It is definitely not a ‘cop-out’ or ‘conceding defeat’ or even remotely ‘taking the easy way out’.

It is most certainly not just about surgery.

Never have so many people around the world been in the need of or decided to undergo surgery – this is work in progress. As for most conditions mistakes are made, new research and greater experience changes and improves practice.

There is no quick or magical fix for obesity – surgery is currently perhaps the best option for most patients with severe obesity – hopefully, it will not remain the only one.

For many patients, surgery is definitely not the right option – hopefully, these patients can be identified and counseled accordingly.

For those, who are most likely to benefit, timely access is important – life is short enough without having to lose years of it to a condition that can perhaps not be cured but is definitely treatable.

AMS
Toronto, Ontario

p.s. Meet and greet with Dr. Sharma and friends: Toronto, Friday, June 3, 5.00-6.00 pm, L’Espresso Bar Mercurio at 321 Bloor Street West, (southeast corner of Bloor & St. George) – the more the merrier!

7 Comments

  1. This has been an excellent series on the many factors and outcomes to consider and acknowledge when it comes to bariatric surgery. Many outcomes of surgery contribute to the disability experience of persons with obesity. Some reduce the experience and some exacerbate or contribute to the experience. Occupational therapists are trained to work with patients to participate in all aspects of life including work, rest and play by addressing barriers such as those experienced by obesity. For anyone interested in learning more about the profession I encourage you to go to http://www.caot.ca. Thanks Dr. Sharma for continuing to promote a multidisciplinary approach to obesity treatment and research.

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  2. Really enjoyed reading this series, Arya. Just great how you put everything together in a neutral but informative way. That takes so much skill in writing. You are making such a contribution and Canada is really lucky to have you.

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  3. Consider making this series a pamphlet for GPs: “Before you Refer a Patient for Bariatric Surgery.”

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  4. I tried to give this article ten stars, but messed up, somehow.

    In this series, you have really hit a lot of the main points surrounding bariatric surgery, issues that aren’t usually discussed by surgeons or even a lot of support groups. This article struck me as being particularly sensitive to the issues confronting people.

    I remember going to work (after 10 years at home, raising kids) at a weight of 300 pounds and feeling completely invisible. It was a strange feeling but also, strangely comforting. After losing 120 pounds, I was suddenly “visible,” and it was a very difficult and confusing feeling. People who used to look right through me were suddenly opening doors and smiling–like that. The whole world seemed to change. It took a lot to get used to it, and I’m not sure I’m entirely used to it, or even ready to go further with it, which is why (maybe?) I’m stuck at the weight I’m at–a lot thinner and healthier, but not still “obese.” Thanks for being so sensitive. I do think we need more counselors and social workers who are educated in this area, and maybe people like you could be training other physicians to be more sensitive to and knowledgeable of these issues!

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  5. Clearly more help to adjust to a new life can be helpful, but we don’t know what to offer or who to offer it to. We see our patients doing things at the age of 40 that they really should have gotten out of their systems at the age of 18. We have just scratched the surface of the mental health issues. I tell my patients that they will be treated differently, the reason is not just that now they look better because they lost weight. They are very different people, they interact differently, they smile more, they feel better, they look you in the eyes when speaking. Weight loss surgery does change peoples lives.

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  6. Dr. Sharma, what an amazing series of articles. I am so honoured and priviledged to know you and to have worked with you over the years since my gastric bypass.

    I noted one of the comments was to produce a pamphlet… I think a book Dr. Sharma – a go to publication that works to answer the questions, and poses the questions, and sets the facts out there.

    You have done so much incredible work, but I know that so much more work needs to be done. Thank you for all that you do

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