Bariatric Surgery Misconceptions


Bariatric Surgery Myths and Misconceptions

What people get wrong about weight loss surgery

This is a myth, however, there are grains of truth to this. Almost all patients report hitting a weight loss plateau, followed by a slight (5-10%) weight regain. This is normal; in fact, this is supposed to happen! Eventually, a patient will reach a point of equilibrium where they are eating enough food to maintain their weight, despite having a much smaller calorie intake.

Another grain of truth is that there are patients who regain the weight they lost after surgery in the long term, however, there are several reasons for this. One reason is because of stomach stretching, which will allow the patient to return to their old eating habits if left unchecked. Another reason is because of a surgery that wasn’t performed properly; for example, if a stomach pouch is made too large, it will not be able to restrict food intake enough to maintain weight loss. In these scenarios, revision bariatric surgery is recommended.

This is simply false. Bariatric surgery has a very low rate of mortality at about 0.3%. This is comparable to most surgeries and is largely due to risks of infection and blood clots, which exist in all surgeries. However, the risks are well known and so surgeons require some level of pre-op prep.

This idea is ridiculous, and if it were true, we wouldn’t have an obesity epidemic. The reality is, diet and exercise programs (as effective as they are for most people) have low rates of adherence due to societal factors, economic factors, and environmental factors. Not only that, but severely obese patients have mitigating factors that prevent them from adequately executing an exercise program, such as joint and tendon issues, heart problems, and poor muscular strength.

This is completely untrue, however, there is one grain of truth to this. Bariatric surgery increases a patient’s sensitivity to alcohol. This is due to two factors. The first factor is that high levels of body fat mitigate the intoxicating effects of alcohol, which essentially means that obese patients need more alcohol to get drunk. The second factor is due to the changes made to the digestive system which causes alcohol to pass through the system much more quickly, leading to a more acute intoxicating effect. Patients who continue to drink the same amount of alcohol they had before surgery would therefore be at a higher risk of developing alcohol-related problems in both the short term and the long term.

There is no proof that bariatric surgery increases suicide risk. However, there are mental health risks associated with bariatric surgery that must be addressed. First is the issue of the population: severely obese people are more likely to have mental health comorbidities, including depression, anxiety, obsessive-compulsive disorder, and more. Since this is the population that undergoes bariatric surgery, it makes sense that there would be an association between surgery and suicide, but correlation does not equal causation. However, there’s more.

Bariatric surgery causes rapid weight loss, which results in rapid hormonal changes that can result in short-term problems with mood. These may manifest as depression or anxiety. Another risk of rapid weight loss is that while the body is quickly losing weight, the patient’s body image is not catching up nearly as quickly. This can cause body dysmorphia.

Suicide is a serious issue and bariatric surgeons are highly concerned about their patient’s long-term outcomes. For this reason, all board-certified bariatric surgeons require an extensive psychological evaluation for prospective patients.

This myth assumes that all bariatric procedures cause malabsorption, which is simply not true! Adjustable gastric bands, sleeve gastrectomy, and several other procedures do not have any malabsorptive component, meaning that the only risk of deficiency would result from undereating. Not only that, but malabsorption typically targets fats rather than micronutrients.

However, indeed, patients of some procedures such as gastric bypass and duodenal switch have a higher risk of vitamin and mineral deficiencies. Bariatric patients are prescribed a special multivitamin made specifically for them, which reduces the risk of deficiency.

Simplifying the problem of obesity by saying “it’s just an addiction” does obese patients (and the field of bariatric medicine) a serious disservice. After all, we cannot treat obesity in the same way we treat drug or alcohol addiction because, unlike these substances, we will never wean a patient off of food. We need to eat to live, after all!

The fact is, persistent severe obesity is a multi-faceted issue. Most obese patients do not suffer from acute food addictions such as binge eating disorders, although some certainly do. Many different issues can contribute to obesity, such as metabolic syndrome, auto-immune diseases, medications for pre-existing conditions, disabilities, poverty, depression, anxiety, obsessive-compulsive disorder, and more.