A Bariatric Surgeon’s Viewpoint of WLS & Patient Success
January 22, 2018My Viewpoint of WLS
Many of my patients' questions are focused on the goal they will achieve with weight loss surgery (WLS), for instance, how much weight will they lose? And, how fast? I respond to them with an educated estimate according to the findings of highly regarded research conducted worldwide and the specific surgical procedure to be performed. Generally, from my viewpoint of WLS as a bariatric surgeon, the information that I tell them is enthusiastic and satisfying, because the expected weight loss is usually quite considerable.
None of my patients ask me how long will such a result last, in my opinion, the latter is as important as the former query.
Weight loss surgery, like all fields of medicine, is not an exact science. The results are dependent on a number of several factors and variables ranging from genetic inheritance and associated diseases, through surgical technique (the approach to performing a certain surgical procedure), to the habits and discipline of the patient (it is here where the bariatric surgeon can least influence patient's choices)
Patients With The Best Results? Well Informed Ones!
It is usually among those patients with a healthy and positive mental state where bariatric surgery attains its best results. The patients that are well informed about the kind of changes their bodies will go through. The patients that ultimately know the scope and limitations of weight loss surgery are those people who will give the best of themselves in order for surgeons to help them achieve their goals and enjoy optimal results.
If one were to say that in weight loss surgery, the surgeon operates not only the patient’s stomach but also his or her brain (or rather, his or her mind) is equivalent to saying that weight loss surgery is like waving a magic wand to solve your obesity problems overnight.
While it is true that weight loss surgery has astounding results, it is also true that it takes work and dedication for the patients to maintain those results.
In other words, having weight loss surgery is to acquire the best tool available to achieve a healthy weight and improve metabolism. As with any tool, it is required to learn how to use it properly. Put in the wrong hands (or mindset), it could even be dangerous. As an example of WLS and a patient that isn't well informed, someone that had the RNY Gastric Bypass for two days and "decided to eat a whole hamburger because he felt fine." Obviously, such a careless patient would suffer from an anastomotic rupture causing the corresponding intestinal leak that would inevitably land him in the intensive care unit with a high risk of death.
Choosing Weight Loss Surgery
If you’ve already decided to have weight loss surgery, you’ve probably tried all kinds of diets, exercises and the results have been disappointing until now, am I right? Well, congratulations, you’ve decided to acquire the best tool available to lose weight, improve your health and be a new and better person.
What's next? It is very easy and difficult at the same time, to learn to live as a post-op, you must acquire better habits. It is important that patients are informed about the new and fantastic road that is just beginning, obtain the motivation and put forth the ongoing effort to maintain the excellent initial results. It is also key that a patient is well informed of research how to best use the wonderful tool that they have. Support from a surgeon and the multidisciplinary team will be a great help in order to achieve your goals - I’m talking about psychological therapy and nutritional counseling.
Bariatric surgery isn't recommended for those people whose mind plays against them such as having compulsive eating disorders, or those who use food as a coping mechanism. Another issue is for people that are not well informed and do not understand what has been modified inside their bodies through the bariatric procedure such as those mentally challenged, suffering from dementia, schizophrenia or people of old age as well as very young children.
Nevertheless, those people who understand and accept the acquired anatomical changes and believe it is possible to modify their sedentary and unhealthy eating habits can obtain the amazing results they want.
Two Main Approaches to Weight Loss Surgery
There are two main approaches to weight loss surgery. The first, some of the procedures restrict the amount of food you can ingest (restrictive); the second decreases the amount of nutrients your body is able to absorb after having eaten (malabsorption). Some of the procedures combine both kinds of procedures (restriction and malabsorption).
As a personal opinion from my perspective is the restrictive factor of surgery is the most important in order to achieve a lasting change in a person’s unhealthy habits. The reason is you will eat lower quantities many more times a day. If the patient manages to make this a lasting habit, then weight loss surgery will be successful for many, many years.
The stomach is a muscle and it’s elastic, so if every time you eat something you distend the stomach to the limit, then that stomach (a gastric pouch in the RNY Gastric Bypass or VSG Gastric Sleeve) will be progressively enlarged. In a matter of few years, you will lose all the ability to restrict your food intake and possibly be able to eat a double hamburger at dinner. If you eat to your pouch's capacity often enough, this will be detrimental to your weight loss.
Decreasing the Absorption of Calories
On the other hand, the desire is to decrease the absorption of calories achieved by an intestinal bypass in order to avoid food and digestive juices to pass through all the length of the bowel. When this occurs, less of what you eat can be absorbed. The patient will lose weight. Despite the intestine being shorter, stretching can occur so every time food passes through, it will "learn" to absorb more until it will be able to absorb the nutrients out of everything eaten. Then the restriction aspect is also lost, and the result will be starting to regain weight.
That is why weight loss surgeons will make the necessary modifications in your body to have a restriction, low absorption, or both.
We will give you the best tool available to lose weight and/or improve the control of your diabetes and many other weight-related diseases. How long your tool will last depends entirely on you (here, I insist, you need some help from nutritionists and psychologists). Remember that we operate the stomach, not the brain (mind).
 | ABOUT THE AUTHOR Dr. Salvador Ramirez, is a Board Certified Surgeon specializing in Bariatric Weight Loss Surgery at ALO Bariatrics. Dr. Ramirez has performed thousands of bariatric surgery procedures since 2005 and has received numerous awards for his work in bariatric surgery. His commitment to helping patients transform their lives extends across the spectrum of their treatment, from being involved in pre-operative education to follow-up care and support programs after surgery. |
