Is Surgery a Good Solution?

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Dr. Thomas A. Buchanan is in favor of the “minimally invasive weight-loss surgery” as the solution to the childhood obesity epidemic, and he has said as much in the Obesity journal. Reacting against his opinion, Katherine Gustafson says,

Wow, now I think I’ve heard it all. Here’s a great idea: Let’s not help our too-fat children become healthy by providing them with a better eating environment, regulated food advertising, or better education about living healthy lifestyles. Let’s instead just make them all have surgery. Case closed.

Dr. Buchanan urges the medical establishment to “bring on the big guns.” Apparently, he actually said that. Do you know how many people die from infections in the U.S. hospitals every year? Elective surgery is never a thing to be done casually, especially when the patient is a child or youth. Surgery may be a big gun, but it’s also a last resort, or should be. And why must every human endeavor always be phrased in belligerent terms? Maybe it’s time to stop thinking of healing as warfare.

Okay, in many cases, exercise and a healthier diet are not enough to prevent or cure childhood obesity. But to go straight from those sensible preventatives to gastric bypass surgery — well, it seems like there are quite a few other avenues to explore first. Especially when the surgery is an iffy proposition in the first place. The numbers are apparently not quite ready for prime time.

An uncredited article at Weight Gain makes this unhappy prediction:

Have you undergone weight loss surgery? It is likely that you lose much weight in one year, only to have the excess weight back.

If this happens, the author recommends that the patient adopt sensible eating habits and an exercise program, avoid comfort eating and bingeing, eat only when really hungry, and find ways to deal with stress and anxiety. If the patient were able to successfully do those things, she or he would not have needed the surgery in the first place. And if the patient is unable to do these things, the expense and trauma of surgery will have been wasted.

Patricia Neighmond reports on a recent Kaiser Permanente study that found an alarming increase in extreme or morbid obesity among children and teens. In other words, given the percentage of kids who are overweight, a growing proportion of them are not just hefty, but dangerously overweight.

The question Dr. Pretlow asks is, “If kids are eating so much that they must undergo major surgery in order to regain control of their eating and restore their health — if that’s not addiction, then what is?” Unfortunately, for many of these young people, gastric bypass surgery may be the only chance they have to regain normal weight.

One study found something interesting about people who have lost weight by the old-fashioned diet-and-exercise route, and subsequently managed to sustain their weight losses. Their temptation is just as strong. The parts of the brain that desire hedonic foods still light up. In that way, they are like the brains of the people who cave in to their food cravings, and keep on eating.

Long-term losers are, by the way, hard to find if you want to study them. What is different about them? Maybe the dorsal lateral prefrontal cortex. That’s the brain sector in charge of impulse control, and, in the people who have successfully maintained weight loss, this part of the brain showed more activity.

As for people who can’t stop eating, it looks like their impulses go uncontrolled because this one area of their brain won’t light up. Yes, but why? How can that part of the brain be nudged or compelled into doing its job? And would this be preferable to interfering with the entrails?

Your responses and feedback are welcome!

Source: “Should We Fix Kids’ Obesity Problems Through Surgery?,”, 07/12/10
Source: “How to Avoid Weight Gain after Gastric Bypass,” Weight Gain, 04/29/10
Source: “Extreme Obesity Puts Kids On Unhealthy Track,”, 03/18/10
Source: “Eating to Live or Living to Eat?,”, 07/13/10
Image by Pink Sherbet Photography, used under its Creative Commons license.

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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