Gastric Surgery: Why I’m Against It

The thing that bothers me about gastric surgeries for weight loss is that, as best as I can tell from reading and research, it’s not that it changes your metabolism or body chemistry. It doesn’t change your hormonal balance. It just decreases your ability to eat large quantities at a given moment (though lots of small meals throughout the day can add up to the same amount overall).

And yet the precursors that get brought up are, “have you tried diet and exercise already?” That just doesn’t compute to me. If not eating as much worked on any sort of long term basis for the given subject, then the diet would have worked and gastric surgery would be unnecessary. Really, what an interest in or recommendation for gastric surgery means is that a) diet changes do not work for this person or b) this person has not actually tried changing diet. If it’s case A, then gastric surgery won’t do anything either. If It’s B, then we’re doing major physical organ destruction to accomplish a change in mental condition.

That’s why I can’t get behind gastric surgery for anyone.

Anecdotally*, I’ve never seen it work in the long term for the people I know who have done it…and to me, that just means they’re in category A, and they (and their insurance) got screwed out of $$$s by a procedure that never had a chance of working on them. For the people it works for, I suspect they’re in category B…which, great that it worked, but if we’re okay with that from an ethical perspective, we could also start doing castrations to cure sexual addiction…or removing livers to cure alcohol addiction. Or, we could go back to ye olden days of lobotomies to “cure” mental illness.

Originally posted as a comment on jezebel.com

* This is not a real word. I don’t care. I’m making it a word.

3 thoughts on “Gastric Surgery: Why I’m Against It”

  1. First: ‘anecdotally’ is certainly a word via normal english morphological rules. Also, google says so.

    Second: Gastric bypasses that use a Roux-en-Y don’t just change stomach capacity, but also bypass (hence the term ‘gastric bypass’) up to several feet of the small intestine. This absolutely affects food absorption. (As well as hormonal levels.)

    In any case, I’d call all such surgeries essentially “experimental”: we don’t have a great understanding of how the whole flow of digestion works. They’ve figured out some surgeries that, for reasons they don’t entirely understand, work over the long term in most cases. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856611/ for some non-anecdotal numbers.)

    We also have competing anecdotes: my wife had gastric bypass surgery in 2003; she initially lost > 140lbs, and has gained about 30-40 from her nadir. I’ve seen ~5 year success on at least one other person.

  2. Bypassing the small intestine definitely affects absorption. But I don’t think I’ve seen any evidence or discussion of it changing metabolism or hormonal balance in the long term…doesn’t mean it doesn’t exist. Also, if you get a digestive issue that prevents absorption through the intestinal tract, most doctors consider it a bad thing. You need that tract to absorb the critical parts of your food. Sure, by getting rid of it, you eliminate some of the time for your body to absorb the bad parts, but you also get rid of the ability to absorb the good parts.

    Plus, it boils down to that, even in what you cite above regarding your anecdotal case, you’re citing weight. Is weight the right measure of success? I don’t think it is. It’s a symptom, not the disease. I think the future will look back on this as something stupid we did once, not as some kind of real solution. That having been said, I don’t disparage the people who are doing it. On an individual level, people are free to do whatever they want with their own body. But, I do look down on the doctors and the cultural bias that prescribes it, that pushes it, that acts like it’s a cure, that suggests it for teenagers and younger, etc.

  3. Here’s an article that talks about bypass surgeries that cause remission of type 2 diabetes, where the results appear to not be linked with weight loss. Here’s another (that actually highlights some of the negatives of the apparent endocrine change).

    I’ve done more web-trawling research on this in the past (being type-2 diabetic), but no longer have the records of it. The practical upshot at the time was, unsurprisingly, that more research was needed.) So in my case, where I once said that there was no way I’d ever have gastric bypass surgery (having seen what my wife has gone through)… if it’s a cure for diabetes I’m at least a little on the fence.

    Also, if you get a digestive issue that prevents absorption through the intestinal tract, most doctors consider it a bad thing.

    Well, sure. Malnutrition’s one of the minor and easily treatable side-effects.

    Is weight the right measure of success? I don’t think it is.

    I agree with this to some extent. I’d argue that the measure of success is the reduction of comorbidities that are correlated with weight, but that this often incorrectly gets shorthanded into “reduction in weight” because it’s the simplest to measure.

    I do look down on the doctors and the cultural bias that prescribes it, that pushes it, that acts like it’s a cure, that suggests it for teenagers and younger, etc.

    This I completely agree with. One of the major problems with the bariatric surgery industry is that it’s rarely presented as what it is: a tool that should be applied with deep care, like any major irreversible life-altering surgery. It’s positioned as an easy way to “lose weight” when it’s really nothing of the sort.

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