"WLS Is Not A First Line Treatment" Oh Really???

I'm always amazed that they refer to WLS as "not a first line treatment." If you've been chronically obese for years it's a foregone conclusion that you dieted/exercised and failed (as we all do). So yes, indeed, in my view it absolutely IS and should be viewed as a "first line treatment" because, well, it's the only treatment or intervention that has a snowball's chance in hell of working. And any obese person who is being told anything different is really being done a terrible disservice. I get so angry and annoyed at people who attribute chronic obesity to 'poor life choices' or a failure to exert adequate will power, etc. While it's somewhat forgivable to hear this from medical "civilians," it's really depressing and irritating to hear the same tired advice being proffered by medical doctors.

I'm a clinical psychologist and I see many patients who struggle with obesity issues. I won't even begin to get into the psychological correlates of chronic obesity (depression, lack of self worth, job discrimination, etc.) as I think most of us are all too familiar with these, but I have been very clear with my patients that they can diet to their heart's content, but every single piece of valid and reliable data would suggest that there's less than a 2% chance of maintaining that weight loss over 1-3 years post-diet. I tell them flat out that their choices are really not that complicated -- either try and accept yourself at your current size and make the best of it, or go speak to a bariatric surgeon about WLS as it's the only tool that exists (right now, at least...who know what might be around in 10-20 years) which will give them a [very good] chance of achieving for themselves what they're hoping for.

The sanctimonious, self-righteous and frequently, condescending "advice" to "watch what you eat and exercise more" crap really needs to stop -- from medical professionals more than anyone. WLS is NOT "the last resort"....it's the ONLY resort that conforms to the data and the only choice that makes any sense. So, in my view, it's the FIRST AND ONLY resort!!!

Rant over. Sorry to bore you, but I really had to get this off my chest

I think the phrasing is correct. If, hypothetically, you had someone who had NEVER dieted in their life? Yes, you would tell them to watch what they eat before you rearranged their insides.

If a woman who had always had a healthy BMI gained weight after pregnancy, would you immediately refer her for bariatric surgery?

For people who are not chronically obese, are otherwise healthy, and have experienced weight gain for the first time in their life, yes, I believe "watch what you eat" is appropriate advice. I agree that it is not appropriate guidance for those of us who have been obese for most of our lives, but it may be appropriate for some.

That's why I stated, chronically.

I certainly have never met an overweight person who hasn't tried a number of diets!

I was very glad that neither my insurance nor my surgeon required a medically supervised diet.