Weight-Loss Surgery: What You Need to Know

Monday, 27 Jan 2014 09:35 AM

By Nick Tate

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New Jersey Gov. Chris Christie's decision to have weight-loss surgery last year highlighted the increasing popularity of such procedures and how they can help individuals who've been unable to shed pounds through diet and exercise. But weight-loss surgery isn't for everyone and is hardly a quick fix for obesity.
 
To help separate the facts from fiction, Dr. Nick Nicholson, a nationally known bariatric surgeon who has performed more than 10,000 procedures, has written a new book: "Weight Loss Surgery: The Real Skinny." He tells Newsmax Health the biggest misconception about bariatric surgery is that it is a one-and-done remedy for obesity.
 
"The No. 1 thing that I believe is the biggest fallacy is people think this is the easy way out — they think this is kind of taking a short cut and it's much more similar to cosmetic surgery, say," he says. "When in reality, the surgery that we perform is probably only about 10 percent of a patient's success over all.
 
"The majority of the time there's a lot of time and effort that's going to be required by this, there's a lifestyle change that people need to buy into and people need to understand how this is going to impact every aspect of their lives — not just at the dinner table."

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Dr. Nicholson explains that diets and exercise programs alone are rarely successful in helping very obese individuals shed pounds and maintain a healthy weight. For many, losing weight initially is not that difficult, but the greatest challenge is making significant and lasting lifestyle changes so they don't regain it over the long run.
 
"Diet and exercise alone in morbidly obese patients is 98 percent ineffective," he says. "So when you look at a lot of those ads on TV and they talk about everybody's lost all of this weight, maybe so, but does that translate to long-term weight loss? It's easy for people to lose weight … it's the keeping it off [that's tough]."
 
He adds that many people who fail to achieve lasting weight loss have a "finish-line mentality" — that is, they aim to lose weight for a specific occasion or point in time — such as a wedding, a high school reunion, or beach vacation. But once that event or date passes, they fall back on old patterns of behavior, eating unhealthy diets, or ease off on exercise, so the weight piles back on.
 
By contrast, those who are able to lose weight and keep it off incorporate lasting changes into their lives, so that eating a healthy diet and exercising become a way of life. For many who turn to Dr. Nicholson for weight-loss surgery, that lesson is learned the hard way.
 
"The average patient has usually failed a minimum of 10 diets [and have] been contemplating it for 2.5 years, done hours of research online," he explains. "Those are the people that I like to talk to. Those are people that are very well educated about the process, they usually have a very good understanding of the risks, the benefits … the last thing you want is the person that woke up on Monday and figured that they'd go the doctor on Tuesday and just see what they’ve got to offer."
 
The American Society for Metabolic and Bariatric Surgery says 200,000 Americans have some form of weight-loss surgery each year. Christie underwent what is called gastric band surgery — a 40-minute procedure in which a tube is placed around the stomach to restrict the amount of food one can eat.
 
Gastric band surgery is common, but is often not as successful as other types of weight-loss surgery, such as gastrectomy and gastric bypass. Gastrectomy involves the surgical removal of about 75 percent of the stomach to limit how much a person can eat.
In gastric bypass, a surgeon connects the upper stomach directly to the lower section of the small intestine, creating a shortcut for the food so fewer calories are absorbed.
 
Dr. Nicholson says choosing the right form of bariatric surgery can be key to a patient's success.
 
"That's kind of the Holy Grail in this business — knowing which operation would fit which individual the best," he explains. "The main determinant of that is, are they honest with themselves? Once you explain the limitations of these operations and their strengths and their weaknesses, people really need to go home and be honest with themselves. Because if they go home and tell themselves, 'Well I know that I've eaten ice cream every day for the last 50 years of my life, literally, but I'm sure if I have surgery on Wednesday I'll stop.' … That's highly unlikely."
 
Dr. Nicholson also notes that bariatric surgery has been shown to have other health benefits that go far beyond mere weight loss. A growing body of research has found it can virtually reverse Type 2 diabetes. Studies have shown that Roux-en-Y gastric bypass melts away pounds not only by re-routing the digestive tract, but by changing the bacteria in the gut — in effect replacing fat-promoting microbes with those tied to weight loss.
 
"One of our operations, the gastric bypass, the national data on that shows that that has a 95 percent cure rate of Type 2 diabetes within 12 to 18 months," he notes. "The numbers are astonishing across the board, and … you know, a cure of Type 2 diabetes is amazing."
 
 

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