Misconception: Most people who undergo bariatric and metabolic surgery regain their weight.
TRUE:
Up to 50 percent of patients may regain a small amount of weight (approximately 5 percent) two years or more after surgery. However, longitudinal studies find that most bariatric surgery patients maintain successful weight loss long-term. “Successful” weight loss is arbitrarily defined as a weight loss equal to or greater than 50 percent of excess body weight. Satisfactory results are often determined by the patient, based on their perception of improved quality of life. In such cases, the total retained weight loss may be greater or less than this arbitrary definition. This massive and sustained weight reduction with surgery stands in stark contrast to the experience most patients have previously had with nonsurgical therapies.
Misconception: The chance of dying from bariatric and metabolic surgery is greater than the chance of dying from obesity.
TRUE:
As body size increases, longevity decreases. People with severe obesity have several life-threatening conditions that greatly increase their risk of dying, including type 2 diabetes, hypertension, and more. Data involving nearly 60,000 bariatric patients from the ASMBS Bariatric Centers of Excellence database show that the risk of death within 30 days of bariatric surgery averages 0.13 percent, or about one in every 1,000 patients. This rate is considerably lower than that of most other operations, including hip and gallbladder replacement surgery. Therefore, despite bariatric patients' poor health before surgery, the chance of dying from the operation is exceptionally low. Large studies find that the risk of death from any cause is considerably lower for bariatric patients over time than for people affected by severe obesity who have never undergone the surgery. In fact, data show a mortality reduction of up to 89 percent, as well as a very significant decrease in mortality rates due to specific diseases. Cancer mortality, for example, is reduced by 60 percent for bariatric patients. Death associated with diabetes is reduced by more than 90 percent, and death from heart disease by more than 50 percent. Furthermore, numerous studies have found improvement or resolution of life-threatening obesity-related diseases after bariatric surgery. The benefits of bariatric surgery, with respect to mortality, far outweigh the risks. It is important to note that, as with any serious surgical procedure, the decision to undergo bariatric surgery should be discussed with your surgeon, family, and loved ones.
Misconception: Surgery is an "excuse." To lose and maintain weight, people with severe obesity only need to follow a diet and exercise program.
TRUE:
People with severe obesity are resistant to long-term weight loss through diet and exercise. The National Institutes of Health Expert Panel acknowledges that long-term weight loss—or, in other words, the ability to sustain weight loss—is nearly impossible for people with severe obesity through any means other than metabolic and bariatric surgery. Bariatric surgeries are effective in maintaining long-term weight loss, in part, because these procedures compensate for certain diet-induced conditions that are responsible for rapid and efficient weight regain after dieting. When a person loses weight, energy expenditure (the number of calories the body burns) is reduced. With dieting, energy expenditure at rest and with activity is reduced to a greater extent than can be explained by changes in body size or composition (the amount of lean and fat tissue). At the same time, appetite regulation is disrupted by dieting, increasing hunger and cravings. Therefore, there are significant biological differences between someone who has lost weight through dieting and someone of the same size and body composition as a person who has never lost weight. For example, the body of a person who reduces their weight from 200 to 170 pounds burns fewer calories than the body of someone who weighs 170 pounds and has never dieted. This means that, to maintain weight loss, the dieter will have to eat fewer calories than someone who naturally weighs the same amount. Unlike dieting, weight loss after bariatric surgery does not reduce energy expenditure, or the number of calories the body burns, to levels greater than those predicted by changes in weight and body composition. In fact, some studies even find that certain operations can even increase energy expenditure. Furthermore, some bariatric procedures, unlike dieting, also cause biological changes that help reduce energy intake (food, beverages). A decrease in energy intake with surgery results, in part, from anatomical changes in the stomach or intestine that restrict food intake or cause nutrient malabsorption. Furthermore, bariatric surgery increases the production of certain gut hormones that interact with the brain to reduce hunger, decrease appetite, and increase satiety (feeling of fullness). Thus, bariatric and metabolic surgery, unlike diets, produce long-term weight loss.
Misconception: Many bariatric patients become alcoholics after surgery.
TRUE:
In reality, only a small percentage of bariatric patients report having problems with alcohol after surgery. Most (but not all) who abuse alcohol after surgery had problems with alcohol abuse at some point before surgery. Sensitivity to alcohol (especially if alcohol is consumed during the period of rapid weight loss) increases after bariatric surgery, so that the effects of alcohol are felt with fewer drinks than before surgery. Studies also find that with certain bariatric procedures (such as gastric bypass or sleeve gastrectomy), drinking an alcoholic drink increases blood alcohol levels to considerably higher levels than before surgery or compared to the alcohol levels of people who have not undergone a bariatric procedure. For all of these reasons, bariatric patients are advised to take certain precautions regarding alcohol:
– Avoid alcoholic beverages during the period of rapid weight loss
– Please note that even small amounts of alcohol can cause intoxication.
– Avoid driving or operating heavy machinery after drinking alcohol.
– Seek help if drinking becomes a problem
If you think alcohol use may be a problem for you after surgery, contact your primary care physician or bariatric surgeon to discuss this further. They can help you identify available resources to address any alcohol-related issues.
Misconception: Surgery increases the risk of suicide.
TRUE:
Individuals affected by severe obesity who seek bariatric and metabolic surgery are more likely to suffer from depression or anxiety and have lower self-esteem and overall quality of life than someone of normal weight. Bariatric surgery produces very significant improvements in the psychosocial well-being of most patients. However, a few patients with undiagnosed preexisting psychological disorders and others with overwhelming stressors remain suicidal after bariatric surgery. Two large studies have found a small but significant increase in suicide rates after bariatric surgery. For this reason, comprehensive bariatric programs require psychological evaluations before surgery, and many have behavioral therapists available for postoperative consultations.
Misconception: Bariatric patients have serious health problems caused by vitamin and mineral deficiencies.
TRUE:
Bariatric surgeries can cause vitamin and mineral deficiencies by reducing nutrient intake or by causing reduced absorption in the gut. Bariatric surgeries vary in the degree of malabsorption they can cause and in which nutrients may be affected. The most malabsorptive bariatric procedures also increase the risk of protein deficiency. Micronutrient (vitamin and mineral) and protein deficiencies can negatively impact health, causing fatigue, anemia, bone and muscle loss, impaired night vision, reduced immunity, loss of proper nerve function, and even cognitive defects. Fortunately, nutrient deficiencies after surgery can be avoided with proper diet and the use of dietary supplements—vitamins, minerals, and, in some cases, protein supplements. The ASMBS Nutrition Expert Committee has established nutrient guidelines for different types of bariatric surgery procedures, and they have been published in the journal Surgery for Obesity and Other Related Disorders. Before and after surgery, patients are informed about their dietary and supplement needs and monitored by a nutritionist experienced in bariatrics. Most bariatric programs also require patients to have their vitamins and minerals monitored regularly after surgery. Nutrient deficiencies and any associated health problems can be prevented with patient monitoring and adherence to dietary and supplement (vitamin and mineral) recommendations. Health problems due to deficiencies typically occur in patients who do not follow up regularly with their surgeon to establish healthy nutrient levels.
Misconception: Obesity is just an addiction, similar to alcoholism or drug dependence.
TRUE:
Although a very small percentage of people affected by obesity have eating disorders, such as binge eating disorder syndrome, which can result in the intake of excess food (calories), for the vast majority of people affected by obesity, obesity is a complex disease caused by many factors. When treating addictions, such as alcohol and drugs, one of the first steps is to abstain from the drugs or alcohol. This approach doesn't work with obesity, as we need to eat to live. Additionally, there may be other issues affecting a person's weight, such as psychological problems. Weight gain usually occurs when there is an energy imbalance, or, in other words, the amount of food (energy) consumed is greater than the number of calories burned (energy expended) by the body performing biological functions, daily activities, and exercising. Energy imbalance can be caused by overeating or not getting enough physical activity and exercise. However, there are other conditions that affect energy balance and/or fat metabolism that do not involve excessive eating or sedentary behavior, including:
– Chronic sleep loss.
– Consuming foods that, regardless of calorie content, cause metabolic/hormonal changes that can increase body fat (sugar, high fructose corn syrup, trans fats, processed meats, and processed grains).
– Low intake of fat-fighting foods (fruits, vegetables, legumes, nuts, seeds, quality proteins).
– Stress and psychological distress.
– Many types of medications.
– Pollutants
Obesity also “begets” obesity, which is one of the reasons the disease is considered “progressive.” Weight gain causes a series of hormonal, metabolic, and molecular changes in the body that increase the risk of further fat accumulation and obesity. Such changes associated with obesity reduce fat utilization, increase the conversion of sugar to fat, and enhance the body's ability to store fat by increasing the size and number of fat cells and by reducing fat breakdown. Such defects in fat metabolism mean that a greater portion of consumed calories are stored as fat. To make matters worse, obesity affects certain appetite and hunger regulators in a way that can cause an increase in the amount of food eaten at any given meal and the desire to eat more frequently. There are many causes of obesity, and the disease of obesity is much more than a simple “addiction” to food. Treating obesity solely as an addiction may be beneficial for a very small percentage of people whose only underlying cause of obesity is overeating and addictive behavior, but it is unlikely to benefit the masses, particularly those affected by severe obesity.
