Society loves quick fixes, especially when it comes to weight loss. Often these quick fixes are in the form of a gimmicky pill, powder, or workout, so it’s easy to write them off as a scam. Occasionally, these quick fixes come from seemingly legitimate sources like medical doctors, and these are the scary ones, because the “scam” is a little harder to detect when the proponent has “M.D.” after their last name. One of the most successful scams perpetrated to date by modern medicine is the whole host of procedures that fall under the bariatric surgery umbrella, such as gastric bypass.
What is bariatric surgery?
Simply put, these procedures reduce the functional size of the stomach, causing those who have had the procedure to feel full quicker, thus causing them to eat less. Most people who have had gastric bypass can become physically ill (nauseated/vomiting) if they consume too many calories at once.
Who is it intended for?
The intended population is defined very broadly; I address why this is problematic later in the blog. Several major medical organizations (including the National Institutes of Health or “NIH”) recommend bariatric surgery for individuals with a body mass index of over 35 and who have chronic diseases such as diabetes, high cholesterol, and other co-morbidities. Also it is required that these individuals have failed in their attempt to lose weight through diet and exercise. So, for example, someone who is 5’5” and 210lbs with diabetes and who has failed to lose weight through diet and exercise would be an appropriate candidate for bariatric surgery. Estimates suggest this is about 2-4% of the population.
Is it effective?
Interestingly, despite what you may have seen or read, results are mixed when you review the scientific literature. The general conclusion is that bariatric surgery is effective at reducing weight and disease status short-term. This appears to result in a reduction in early mortality. Some research, however, suggests insignificant differences in mortality rates long-term. Overall, for the appropriate population, the procedure does seem effective.
Where is the scam?
So far this sounds pretty good if you’re in that 2-4% of the population for whom this procedure is appropriate, right? Well yes and no. Despite whatever attempts are made pre- and post-surgery to modify patients’ behaviors, the period around surgery is too short to ascertain if there is any true behavioral change. Thus, it is rare that bariatric surgery patients adopt a significantly healthier life style, particularly with regard to exercise the long term.
Bariatric surgery is a scam because it costs so much money. Statistics suggest the average bariatric surgery costs $20,000-$40,000, with the exact cost depending on several factors. While insurance will cover the cost in cases of “medical necessity” (which is defined arbitrarily), those who must pay out of pocket are being scammed out of $20,000-$40,000! At a time when health care costs are one of the most polarizing topics of conversation, and we are literally in the middle of a financial crisis when it comes to funding health care, is this really the best use of your health care dollars? Reallocating 10-20% of that money (saving 80-90%) to research and programs to help better address the true behavioral, exercise, and nutrition issues is the only way to resolve this problem once and for all.
In addition, because the threshold for bariatric surgery is so low (35 BMI and diseased), the procedure is available to people who are not the intended recipients. For the bedridden 500lb man or woman, bariatric surgery may be the only plausible way to facilitate weight reduction. In our 210lb example from above, however, the individual can engage in proper behavior change and exercise to lose weight. Turning every person who has a 35 BMI and a disease into a bariatric surgery candidate is laughable medically and does that person a great disservice by not empowering them to make true changes on their own.
The Bottom-Line
Bariatric surgery is medically necessary in certain circumstances. In the case of grossly and morbidly obese individuals who are bedridden, I definitely think it is effective and necessary. It was never intended, however, to be a vehicle for weight loss in a population that could accomplish weight loss through nonsurgical means. Don’t fall victim to the scam of an unnecessary and costly medical procedure — if you can walk in and out of your doctor’s office to discuss the procedure, you probably don’t need it.