Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Intro: This is the first in a four-part video series on bariatric surgery, the most common of which are stomach stapling and gastric bypass, and both make major changes to a person’s gastrointestinal anatomy. So how safe are these procedures, and how well do they work for weight loss? Tune in to find out.
The treatment of obesity has long been stained by the snake oil swindling of profiteers, hustlers, and quacks. Even the modern field of bariatric medicine (derived from the Greek word baros meaning weight) is pervaded by an “insidious image of sleaze.” Beguiled by advertising for fairy-tale magic bullets of rapid, effortless weight loss, people blame themselves for failing to manifest the miracle or imagine themselves metabolically broken. On the other end of the spectrum are overly pessimistic practitioners of the opinion that “people who are fat are born fat, and nothing much can be done about it.” The truth lies somewhere in between.
The difficulty of curing obesity has been compared to learning a foreign language. It’s an achievement virtually anyone can attain with a sufficient investment of energies, but it always takes considerable time and effort. And of those who do stick with it, most will regain much of the weight lost. To me this speaks to the difficulty, rather than the futility. It may take smokers an average of 30 quit attempts to finally kick the habit. Like quitting smoking, it’s just something that has to be done. As the Chair of the Association for the Study of Obesity put it, it doesn’t take “willpower” to do essential tasks like getting up at night to feed a baby; it’s just something that has to be done.
Our collective response doesn’t seem to match the rhetoric or reality. If obesity is such a “national crisis” “reaching alarming proportions,” dubbed by the post-9/11 Surgeon General as “every bit as devastating as terrorism,” why has our reaction been so tepid? For example, governments meekly suggest the food industry take “voluntary initiatives to restrict the marketing of less healthy food options to children.” Have we just given up and ceded control?
Our timid response to the obesity epidemic is encapsulated by a national initiative promulgated by a Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council: the “small-changes approach.” Since small changes are “more feasible,” suggestions include “using mustard instead of mayonnaise” and “eating 1 rather than 2 doughnuts in the morning.” Seems a bit like bringing a butter knife to a gunfight, but with only one croissant.
Proponents of the small-changes approach lament that unlike other addictions—e.g., alcohol, cocaine, gambling, or tobacco—we can’t counsel our obese patients to give up the addictive element completely, as “no one can give up eating.” But just because we have to eat doesn’t mean we have to eat junk, like just because we have to breathe doesn’t mean it has to be through the end of a cigarette.
What about bringing a scalpel to the gunfight instead? The use of bariatric surgery has exploded from about 40,000 procedures, noted in the first international survey in 1998, to now hundreds of thousands performed every year in the United States alone. The first technique developed, the intestinal bypass, involved carving out about 19 feet of intestines. More than 30,000 intestinal bypass operations were performed before “catastrophic,” “disastrous outcomes” were recognized. This included protein deficiency-induced liver disease, which often progressed to liver failure and death. This inauspicious start is remembered as “one of the dark blots in the history of surgery.”
Today, death rates after bariatric surgery are considered “very low,” occurring on average in perhaps 1 in 300 to 1 in 500 patients. The most common procedure is stomach stapling, also known as sleeve gastrectomy, in which most of the stomach is permanently removed. Only a narrow tube of stomach is left, so as to restrict how much food people can eat at any one time. It’s ironic that many patients choose bariatric surgery convinced that “diets don’t work” for them, when in reality that’s all the surgery may be—an enforced diet. Bariatric surgery can be thought of as a form of internal jaw wiring.
Gastric bypass, known as Roux-en-Y gastric bypass, is the second most common bariatric surgery. It combines restriction—stapling the stomach into a pouch smaller than a golf ball—with malabsorption by rearranging your anatomy to bypass the first part of your small intestine. It appears to be more effective than just cutting out most of the stomach. It results in a loss of about 63 percent of excess weight, compared to 53 percent with a gastric sleeve. But gastric bypass carries a greater risk of serious complications. Many are surprised to learn that new surgical procedures don’t require premarket testing or FDA approval and are largely exempt from rigorous regulatory scrutiny.
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