Bariatric Surgery is NOT the Easy Way Out: A Bariatric Surgeon’s Perspective

July 11, 2013

I was at a social function earlier this week and a woman asked me what I do for a living.

“I’m a bariatric surgeon,” I replied.

To which she said, “What do you think about that?  You know, people just taking the easy way out and having surgery for their weight.”

Whenever I tell people that I'm a bariatric surgeon, the issues of self-control, discipline, and exercise come up.  I have people judge me as an enabler, and judge all of my patients as weak-willed.  Sometimes, it can be so frustrating that I don’t want to disclose any information about my career.  Then I think about my patients. My patients are hard-working, caring, sensitive, intelligent individuals that are battling a disease.

Should I ask people at parties to tell me from what diseases their grandparents or parents died?

“Your mother had lung cancer?  She shouldn’t have worked in that factory.  Your father had a heart attack?  He should have checked his cholesterol.  Your sister died of breast cancer? She should have gotten screened earlier. “

People that label bariatric surgery as the easy way out just don’t understand the disease process.   My patients have each tried dozens of diets. They have lost hundreds of pounds through aggressive medical weight loss programs, only to gain all the weight back and then some.  It’s not just a simple issue of discipline and a diet.  Obesity is a disease, just like cancer, diabetes, heart disease, and stroke.  Those diseases don’t go away with discipline and diet either!  Our own American Medical Association officially declared obesity as a disease earlier this year.

Obesity has genetic components, well documented in the medical literature.  There are socio-economic factors involved.  Many of our patients have an abuse history, and sub-consciously shroud themselves from unwanted physical attention through their weight; hence, obesity has a psychological component.  There are numerous metabolic issues at play, such as diabetes, hypo-thyroid issues, poly-cystic ovarian syndrome, and leptin insensitivity.

Now consider the thought process involved in undergoing surgery.  Patients need to admit to themselves and their families that they have a disease that is so profound that they need to see a doctor to treat it.  Then they have to see a mental health provider, to evaluate them for untreated mental illness and coping skills.  Next, they have to see a dietitian and may need to undergo 6 months of medically supervised weight loss, depending on their insurance.  Then they have to have a major surgical procedure.  Granted, it’s typically performed laparoscopically, but they still need to undergo general anesthesia and have someone operate on them in order to help fight this disease.  They may incur significant expense, loss of time from work, and/or time away from school.  Finally, they have to take vitamins for the rest of their lives, and they have to follow up with a mean surgeon (me) forever!

Does that sound like the easy way out?  How do I explain to a woman at a party that, without surgical intervention, only 30% of my patients would live to see their 65th birthday?  How do I explain the humiliation involved in asking for a seat belt extender on an airplane?  To not be able to go to a movie, or an amusement park.  To have to have a family member do your toilet care because you simply cannot reach?  To not be able to run after your child when he or she is in danger? To have people judge you as lazy and slovenly before even shaking your hand?  To be discriminated against when applying for a job, just because of the way you look?

Obese people are the last population that folks think of as socially acceptable to ridicule.  Yet, over 30% of Americans are considered overweight.  While I’m thrilled that the AMA has declared obesity a disease, how long until the rest of society recognizes that ruling and stops discriminating?

To my patients:  I will continue to fight on your behalf. Your bravery, your willingness to take control of your health care, and your dedication to a constant battle makes me proud to be your doctor.  Keep up your efforts, and let’s work together!

---