More people should have weight loss surgery than currently do. And guidelines for who is eligible for the surgery are too restrictive. Those are two of the messages from a series of four articles on bariatric surgery published in The Lancet Diabetes & Endocrinology earlier this month.
The studies highlighted in the series detail the benefits to glycemic control and organ health and the potential risks to bone health that weight loss surgery can bring. The studies are based on medical considerations, but implicit is the idea that successful weight loss surgery leads to a better quality of life — and health.
And that is largely — but not entirely — what one earlier Norwegian study, which followed 22 women who actually had weight loss surgery, found.
Bariatric surgery offers a real opportunity for preventing…diseases and complications of obesity. If it is only used as a final resort, this opportunity will be missed.
The five women were dissatisfied with their weight loss surgeries primarily for physical reasons. After the surgery, they felt as if they had no energy at all. They also had persistent pain. Both symptoms made performing almost all their everyday activities, from walking to working to playing with the children, more difficult.
After the women's weight loss surgery some things got better, but new problems, both physical and psychological, arose. And how these women experienced these problems varied greatly.
Weight loss surgery was not a magic bullet or miraculous transformation even for those women who felt it had had a positive impact on their lives. Karen Synne Groven, the author of the Norwegian study, said that for these women, the operation was neither a success nor a failure but something in between. Some things got better, but new problems, both physical and psychological, arose. And how these women experienced these problems varied greatly.
All the women had BMIs ranging from 43-54 and were between the age of 24 and 54 at the time of their gastric bypass surgeries. Some had struggled with conditions such as diabetes or discomfort during physical activity, but most said that they were not having any particular health problems prior to their surgery. Most of the women in the Norwegian study were interviewed twice, first about a year after the operation and then 2-4 years after surgery.
Taken together, the Norwegian and Lancet studies paint a picture of bariatric surgery that is hopeful, but not without problems.
“The surgery should…be available as an option to use when appropriate, and not only when all other options have been eliminated. Bariatric surgery offers a real opportunity for preventing comorbid diseases and complications of obesity. If it is only used as a final resort, this opportunity will be missed.”
Despite the health benefits weight loss surgery can bring, the experiences of some of the women in the Norwegian study should help prepare candidates for bariatric surgery for some of the physical and psychological issues that can arise.
Rapid weight loss often leaves behind loose, sagging skin, and living with it can present quite a challenge.
After weight loss surgery, with a much smaller stomach, food exits the stomach very quickly and is “dumped” into the small intestine. This rapid transfer does not feel right and can lead to many symptoms. Some women had episodes of nausea, tiredness and dizziness, while others experienced intense quivering.
Patients are often told that they can avoid dumping with proper dietary changes, but the causes of dumping can vary from person to person. Eating too much, too little, the wrong food, food that is too hot or too cold or eating at the wrong time of day can all bring on the problems associated with dumping.
So life after surgery can remain just as focused on food as life before it was. The surgery does not automatically reduce appetite.
There are risks to skin surgery, particularly for women who plan to become pregnant. There are also questions as to how effective the surgery will actually be. So it is useful for people considering bariatric surgery to realize that further surgeries may be needed.
Women make up to 70-80% of all weight loss surgery patients, and women who were once practically invisible or the target of derision now draw lots of attention. People want to be around them. Once they had to shout to be heard. No more. It can certainly be a boost to self-esteem. But it also may be a bit too much to handle at first. And some women were bitter that it took an operation to make them visible to men.
Weight loss surgery appears to be the most effective long-term treatment for severe obesity. It can improve overall health and glycemic control, reducing the risks of diabetes and the damage to organs from the pressure of the extra weight. From a distance, the amount of weight that people lose may seem like magic. The experiences of patients, however, clearly suggest that people considering weight loss surgery should be made aware of the physical and emotional complications that are likely to follow a large loss of weight.
It is only in the past decade that bariatric or weight loss surgery has become common. In the early 1990s, only 12,000-16,000 operations were done every year. By 2008, this had increased to about 220,000. Because most surgeries have occurred recently, there hasn't been a chance yet to collect much information on the long-term effects of weight loss surgery, particularly from the patient's perspective.
Karen Groven wonders what such information will ultimately show. “I wonder what happens after five, ten, twenty years. What's the situation with food and eating then? The loose skin? Those who wanted to get pregnant?”
The picture — however mixed it may be — is likely to become clearer as more people undergo weight loss surgery.