More than usual (which is a lot for me) I have been hearing what my patients are saying in the office. Obesity surgery will not work or stop working. Regardless of how much I want obesity surgery to be perfect, I know it is not. I am a realist and practicalist.
In my practice and based on my professional opinion, I have come up with why obesity operations will stop working. Not following nutrition and not doing aerobic exercise This is the number 1 reason. It stuns me when a patient has obesity surgery and then will not follow the very complete and simple ways to be healthy and lose weight.
Most patients jump in with both feet and get right to it. A smaller component do not make the mental and emotional change. Even though pre-surgery psychological evaluations show that these patients understand and have the intellectual capacity to carry out what is needed, they don’t. Their reasons – too busy, too hard, it hurts, do not like the taste. None of these are valid medical reasons. It is important to practice good nutrition and do daily progressive aerobic exercise. Eating small measured portions (1/4 cup, ½ cup, 1/3 cup) and exercise is not just for weight loss, but for good health, for the rest of our lives.
Eating large food portions
Another biggie, number 2 on the hit parade list. Patient will eat until they are uncomfortably full, then stop. Band patients are particularly bad at this. I understand that a patient will think that the operation will tell them when they are done. I teach patients not to do this. I teach them to eat a measured portion of food (1/4 cup, ½ cup, 1/3 cup), then they get up and away from the table and put the plate away. Most patients will still serve themselves a full 8 inch plate of food and keep eating until they feel like they are going to throw up, then they stop. One patient told me, “Dr Dirk! There is just so much food there! It is a waste not to eat it!” I will tell them to eat it tomorrow. The problem with this behavior is that it will beat the operation.
After a period of time, the operation will adapt and will allow the patient to eat a large amount of food.
Traumatic life event
Probably the number 3 reason. Divorce, job loss, car accident with body injury, death of loved one. These are understandable. They take your breath away. They take away your desire to even get up in the morning. I have no good solution to this. I do try to explain to my patient going through these difficult times, that they have important jobs to do. They will only be able to do them if they stay healthy. I encourage them to take a little time for a new routine that includes nutrition and exercise.
With the warnings I give in the office to women of child bearing age (do not get pregnant for 1 to 1&1/2 years AND use 2 different methods of contraception OR get an IUD), this does not happen often. When it does patients can take 2 different paths. One- they continue losing weight with a healthy pregnancy – much to the surprise of their obstetrician. Of course they gain weight at the end, only about 20 pounds.
Then they lose the baby weight once they get back to their routine. Two- their obstetrician freaks out and demands they eat every Baskin Robbins ® store in sight. Just kidding, but I have had patients tell me that their OB told them, they were killing their baby by not gaining weight! Most common, the woman gets too busy and caught up in the pregnancy. Not an excuse, just a reason.
Problem related to surgery / complication
Any problem related to the surgery that made the hospital stay or recuperation longer than expected can throw anyone for a loop. I have been lucky that I am there for my patients and keep encouraging them to get healthy and do what is good for them to be healthy and lose weight. Not all patients have the strength or resolve to carry on. If you have had a problem after surgery, speak with your bariatric surgeon to help you get back on track.
Surgery needs to be fine tuned
Yes, this does happen, thankfully not very often. That is why when any patient comes to see me, I do a series of exams to see if there is any part of their operation that needs to be fine tuned. A gastric pouch that is too big, a bypass that is too short, too long or too big around. A Band that has slipped up or down or is not in the right position. It may not even need surgery.
Adaptation by the human body
This is what the human body does. It adapts and tries to return to a previous state it recognizes as normal. That is why I really get on to patients and encourage them to make the maximal use of their first year after surgery. That first year is when their body is ready make the changes to help them lose weight and get healthy. After the first year, the hormone / chemical changes start to fade.
Once an obesity operation has failed, there are options available. Sometime all that is needed is making some life changes. Other times, surgery is needed. Before deciding that your obesity operation has failed, talk with you bariatric surgeon. This is about your health and your life.