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Given the alarming worldwide rise in severe obesity, it is not surprising that there is an increasing demand for bariatric surgery (often referred to by the misnomer “weight-loss surgery”). As a non-surgeon, I have always preferred to steer my patients to non-surgical solutions, wherever possible. Unfortunately, when it comes to obesity that significantly affects your health and quality of life, non-surgical solutions are rarely effective in the long term.
Not that we lack “success stories” of individuals who have lost hundreds of pounds, often through drastic caloric restriction and heroic doses of exercise. But overwhelming scientific evidence shows that very few of these folks (if any) will manage to keep the weight off. (Unfortunately, weight-regain stories seldom make the columns of newspapers and covers of magazines – thus skewing public opinion on just how feasible and sustainable significant weight loss actually is.)
As I often tell my patients, it is one thing to climb Mount Everest, but setting up camp to live there is a very different story.
This is where bariatric surgery comes in. Although not everyone who undergoes surgery will be successful (or satisfied) with the weight loss, the odds of achieving substantial and sustainable weight loss with often remarkable improvement in health and well-being are in the order of 4 to 1 (compared with an estimated 1 in 20 for diet and exercise alone).
That said, bariatric surgery is anything but an easy way out. In fact, even the decision to consider surgery as a treatment option is far from easy. Virtually all patients who stand to benefit will struggle for years with futile diets and exercise programs before entertaining the possibility of having their stomachs bypassed.
Many fear the pain and complications of surgery – very understandable but far from the reality of modern bariatric surgery, where the risk of serious complications at experienced centres is barely different from having your gallbladder removed.
Far more concerning to many is the stigma that comes with bariatric surgery. Many patients would prefer to undergo this operation in secret for shame of the disparaging comments that they can expect (and have experienced) from their families and friends (not to mention total strangers) for having taken the “easy way out.”
Compare this response to that encountered by patients who undergo other surgical treatments for “preventable” diseases – like, say, coronary heart disease. Indeed, I have many patients who openly and proudly proclaim the fact that they underwent a “coronary triple bypass” operation (in reality a rather simplistic “plumbing” solution to a complex and, in most cases, entirely preventable vascular disease).
Yet we would hardly consider someone undergoing open-heart surgery as taking the easy way out. We appreciate that patients who have undergone this procedure will need to embark on a lifelong process of rehabilitation, lifestyle change and meticulous attention to taking their many medications should they wish for their newly acquired bypasses to stay open.
No less is true of people who opt for bariatric surgery. They, too, have to embark on a lifelong journey of rehabilitation and lifestyle change with meticulous attention to meeting their daily dietary requirements (not easy on often vastly reduced caloric consumption), and religiously taking their daily vitamins together with a healthy dose of exercise. The surgery makes these changes easier, but the patient still has to do the work – day after day after day after day– forever.
The more I work with people who are considering or have undergone bariatric surgery, the more I have come to appreciate and respect their struggles, determination and fortitude. Making surgery work for them is a daily and lifelong struggle – albeit, a struggle that at least carries a comfortable margin of success (compared with their previous struggles that did not).
As with the rapidly decreasing demand for coronary bypass surgery, I hope to see the day when demand for bariatric surgery will decrease because we will have made important strides in the non-surgical treatment of severe obesity (as we have for the non-surgical management of coronary artery disease). Or, even better, we will have made significant inroads into preventing this condition in the first place.
But until then, let us create a climate where bariatric surgery is seen for what it is – a highly effective and relatively safe treatment for a serious medical condition for which we simply have no other comparable treatments.
Dr. Arya M. Sharma is professor and chair in Obesity Research and Management at the University of Alberta. In 2005, he spearheaded the launch of the Canadian Obesity Network. He is also Past-President of the Canadian Association of Bariatric Physicians and Surgeons. Sharma maintains a widely read blog on obesity prevention and management. You can follow him on Twitter @DrSharma