Sue has done a great job of articulating my objections to weight-loss surgery:
About 5% of people on non surgical weight loss programs can keep off the weight. With weight loss surgery it’s only 7% even with more invasive procedures like the gastric bypass. Many weight loss surgery surgeons don’t expect patients to keep off any more than half their excess weight on the long run even when they are putting in the work, but again, how many seminars tell that to prospective patients who are typically 100 and 200 lbs over their “goal weight”? I know a person who regained 100 of the 200 lbs initially lost with their gastric bypass and they couldn’t for the world, take it off, even with diet and exercise. Apparently their metabolism had been so damaged that eating anything more than 700 calories a day, caused a gain.
How many people would agree to major surgery like weight loss surgery if they knew it would mean a lifetime of dieting and exercise as well as supplements, B12 shots, possible iron infusions, frequent doctor visits and more… and then, to only lose 50 percent of what they initially wanted to lose (for most patients)?
How many people would agree to a gastric bypass if they knew that they had a chance, even a small one, of getting a seizure disorder afterward or reactive hypoglycemia?
How many people would agree to a gastric sleeve surgery (the newest one they are touting) if they knew it called for the removal of 90 percent of their stomach, leaving a pouch the size of a thumb and that if they had any acid in their stomach, they might easily get an ulcer which could quickly ruin the stomach and require the removal of the rest of their stomach or else if they had no acid in their stomach, it could cause all kinds of things including auto-immune disorder (including MS by the way) because of “leaky bowel” syndrome where bacteria from the food eaten is not killed and instead, recirculated into the bloodstream?
How many people would go into a major surgery even with a lower death risk (the lap band has a death risk of 1 in 7000) if they really thought they might be the one to die? As for those surgeries like gastric bypass where the risk of death is much higher (1 in 50 in some studies), how many people would choose this procedure being fully aware of the death risk?
And finally, how many would agree to surgery if they knew they might not die right away but instead become ill, or require additional surgery like losing their colon from sepsis due to perforation (a sometimes repercussion of laparoscopic surgery) or lose their ability to walk?
I’ve never seriously considered weight loss surgery for a couple of reasons. For one, the idea of permanently altering your gut (in the case of gastric bypass) strikes me as just inherently wrong. And I bet that in 100 years or so, when we’ve figured out the connection between the standard American diet and obesity, this surgery will be looked at like we look at lobotomies in the early to mid-20th century: well meaning, but ultimately barbaric and not helpful.
The other reason I’ve not considered it is that for me, the surgery doesn’t adequately address the actual issue at hand, which is appetite. This past November, Rachael Ray had a young woman on who had gained back 100 of the 200 lbs she had had lost via WLS. The video clip of her story isn’t available on the site, but the article hints at the problem:
However, Tracey’s happiness started to disappear as the lost weight started to reappear. Little by little, she tested her body to see if it could handle many of the unhealthy foods that led to her initial high weight.
I remember watching this episode and hearing Tracey talk about how sick she got the first time she ate junk food (it was chips or Doritos as I recall) … and that despite that, she kept eating the food until her stomach began tolerating it.
One of the problems is that your average WLS practice is focused on a good outcome for a relatively short post-surgery timeframe. I have a family member who had her WLS done by a very respectable surgeon with a great (read: minimal) post-op complication rate. His idea of followup were a handful of scheduled visits and a monthly support group meeting. And no surprise, after a year or so, the weight loss slowed and the weight started piling back on — along with the eating.
So the way I figure it, if the problem is the overeating, then that’s what the solution needs to address — and I don’t think invasive surgery is it.
Update, 3/2: Good post from Big Fat Blog on the challenges of making a rational decision about WLS.
Weight Maven is written by Beth Mazur. Beth believes that obesity is more symptom than cause and that the real problem is our Western diet -- especially sugar, refined grains, and industrial oils. Beth writes about nutrition, ancestral health, & food policy. And cats! 
I just discovered your blog, so I’ve been reading through the archives with a shotgun approach.
I love your comparison of weight loss surgery to lobotomies. It’s such an accurate simile, when you think about it.
As a teenager, I managed to lose 30 pounds and have kept them off for 15 years (plus losing 5-10 more) simply because I actually changed my lifestyle-both my eating habits and my quantity of exercise. When people regain pounds after returning to the dietary habits that caused them to be overweight in the first place, how is it that they don’t see the connection there?
This October will by my fifth year with the Gastric Bypass, I knew going into this not to test my body’s willingness to accept the junk that forced the weight gain. I had refused to build up a tolerance for high empty carb, high caloric foods. I’ve found alternatives that were just as tasty with out overeating and disrupting the procedure. I do know how to defeat my gastric bypass and was stupid enough to try it until I stepped on the scale and gained ten pounds! I went into panic mode and revisited the reason I got the surgery in the first place. That was enough for me to recommit a promise that I made to myself. I used to worry about what if something better and safer and saner was discovered. I had come to the conclusion that my life was at stake and I could not wait for the newest procedure to come out. I know I was torn between a lap band or the gastric bypas. I could not see myself having to keep going to the Doctor to adjust it. I also found out a high percentage of those who did choose a lap band switched to gastric bypass. I later found out that those with autoimmune diseases cannot have a lap band. I have MS so that would have been ugly for me. I managed to keep my weight off. My only problem is hernias because of the massive weight loss. I now have to consider having the procedure that will help tighten my core muscles because no amount of exercise will help. Oh I just remembered I do have one regret, going to a thoracic surgeon who did gastric bypass on the side. When I called his office recently I was shocked to find out he has dropped that procedure from his practice. That leaves me with no sane Doctor who will touch me. I went through that with the first hernia and even he didn’t want to see me until I insisted. Once he saw me he scheduled immediate surgery. This procedure is no joke so I do agree with you on learning to modify your behavior to any successful weight reduction program.
Sorry to be so long winded.
Yvonne, thanks for the comment. I’m very sympathetic to those who choose this path, as there aren’t exactly tons of options that have the long-term success people need and want. Best of luck!
Its funny almost 29 years ago before I had this surgery I went to a Doctor who was into phen phen. He looked at me and immediately wanted schedule for a gastic bypass. That was in the infancy stage. I didn’t know much but I’d hear of a lot of deaths at the time. I looked at him and his brochure and politely walked out of his office. One year later I’m contacted by an attorney because of a phen phen law suit. I am thankful I misplaced that prescription and never took one of those pills. Thanks for the wishes of luck.