Bariatric surgery: extreme solution to a basic problem

We've all seen the billboard signs for bariatric clinics, with images that suggest a carefree, happy lifestyle to go along with the newly slim bodies following weight-loss surgery.

And perhaps you've read reports of how bariatric surgery reduces mortality rates for the morbidly obese (with one common definition--though not the only one--being those with a body mass index, or BMI, of 40 or over).  This Wikipedia article is typical in presenting the benefits of bariatric surgery: reduced mortality due to conditions associated with excess weight, reduction in diabetes, and so on.

Dr. Yoni Freedhoff, a Canadian who writes the blog Weighty Matters, is a big supporter of bariatric surgery. He's recently lamented the delay in Canadian patients being approved for out-of-the-country bariatric surgeries (the waiting list in Canada is apparently long). I really like his blog in most ways, but I'm somewhat leery of bariatric surgery.

I read such conflicting reports. On the one hand, the risk of the surgery is arguably offset by the effect of the weight reduction in improving people's health and longevity. On the other, after surgery patients can have a number of complications, and even if they don't, they have to be careful of their diet--probably just as careful as having dieted to lose the weight in the first place. The problem is that dieting is difficult. As Dr. Freedhoff often says, if it were easy to lose weight, we wouldn't have this obesity epidemic.

I've seen some studies that show that significant amounts of weight are lost and kept off by those who undergo the surgery. Yet according to Sue of suethsayings, ( and thanks to Weight Maven for steering me to that blog) the vast majority of surgeries don't result in permanent weight loss:

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.

I suppose that achieving even just half the weight loss desired is an improvement, but I doubt that most people deciding to have the surgery know that such an outcome is far more likely than that they'll achieve and keep their target weight.

You may wonder why I'm interested in this topic, since--although I could certainly stand to lose several pounds--my weight is in the normal range.

I'm interested because obesity is one reason for our country's sky-high health costs. According to Michael Pollan, 75% of our health care spending is on chronic conditions caused by our diet. Americans have access to lots and lots of cheap food, food that is processed such that the tastes we evolved--love of sugar, fat, and salt--are exploited. When humankind evolved, cramming a lot of calories in when possible helped us survive through lean times.

Now we're getting way more calories than we need, and, to quote Pollan again, the cheapest calories make you the fattest.  Our government subsidizes corn, so all that corn oil and high fructose corn syrup added to processed food is very cheap. Flavor enhancers are cheaper to add than using food with actual flavor.

In other words, I don't blame the epidemic of obesity on individuals, or at least solely or mostly on individuals. I agree with the Weight Maven that obesity is a symptom more than it is a cause.  It's a symptom of the horrible Western diet rich in refined carbohydrates, sugar, and bad fats (not saturated fats--polyunsaturated fats). And this diet is advertised to people day and night. Fast food "restaurants" are ubiquitous. My own late sister, usually skeptical and a critical thinker, used to be pulled in by TV advertising time after time, even though that special burger or shake never failed to disappoint.

Then you have the spurious "healthy" foods, like the glucose-free stuff now being promoted. It's still refined carbs, folks, even if there's no wheat in it. When America got hysterical about fat, the food industry responded with a whole lot of low-fat foods that compensated for the fat with a lot more sugar and who knows what else to get the "mouth feel" and taste right. 

What's worse is that so many people are now so addicted to the taste of processed food that actual food isn't as appetizing to them. I read a blog recently written by a guy who avoids fast food but says he still thinks Big Macs taste good. I was surprised, because after years of avoiding processed food, such food tastes pretty bad to me.

Americans don't pay as high a percentage of their income as people in other parts of the world, including Europe. We're used to cheap food; we demand cheap food. Well, you get what you pay for. We're getting obesity and all that goes with it. People on very low incomes have no choice. But a lot of people who do have a choice still choose the unhealthy diet. Their taste buds have been conditioned to prefer it; they've been told that cooking from scratch is difficult and/or time consuming; good food costs more; and advertising and a Taco Bell or Burger King everywhere you look make the wrong choice an easy one.

All these things drive desperate people to bariatric surgery in a last-ditch effort to shed those health-threatening pounds. It really isn't useful for smug thin people to spout lectures on will power or even to extol the virtues of a better diet (something I've been guilty of, alas). In the face of the mighty machinery of the food industry, a better diet can be hard to achieve.

So the "basic problem" of the title of this post isn't that obese people take in too many calories, although that's an obvious one. The basic problem is our food industry, from agribusiness' practices to government policy to advertising to children and everything in between.  

That's a problem no number of bariatric surgeries is going to address. Unfortunately, the basic problem of which I write is not, therefore, an easy one to solve. It just seems typical that the individual has to suffer and deal with something on an individual level that really is a systemic problem: maximized profits above every other consideration. 

[Cross-posted to View from the Loft]

Comments

[bariatric bypass surgery]

It was said about three years ago on a CBS News report that 1 in 50 people die from complications of gastric bypass surgery. I've seen the numbers adjusted but people considering this need a serious reality check.

[wow gold]

that is terrible