Weight Loss Surgery, Part 1

Surgery Morning

We have speculated before on why highly pleasurable food gets such a hold on people that they let it impair their well-being, to the point where surgery is then necessary to control their overeating and restore health. We have suggested that any habit which leads to surgical intervention could fairly be called an addiction. That includes eating.

The logical corallary is that classical addiction treatment would be better, and could be commenced much earlier, eliminating the need for surgery. Obesity has not gone away yet, and people are still debating about the surgical alternative. The woman on this page already had her mind made up, and is shown on the day of her surgery, when she weighed 446 pounds. The note with the photo says,

Believe it or not, I really was in a great mood, but I guess having my picture taken — even if I knew it was the last time I would be that big ever — was just not a happy thing.

Bariatric surgery, weight loss surgery, and WLS are umbrella names that cover several operations that were invented to solve obesity. Some are laparoscopic procedures, which are done by looking through tiny cameras while inserting instruments through other incisions in the patient’s body. The restrictive kind of bariatric surgery involves staples, bands, sleeves, balloons, and other physical obstructions designed to reduce the amount a stomach can comfortably hold.

There are variations. A sleeve gastrectomy, for instance, is supposed to remove the part of the stomach where hunger-producing hormones are generated, although the permanency of this result is questioned. The category called “mixed procedures” also includes malabsorption techniques, changing things so the body just doesn’t soak up as many calories from the food that is put into it. Of course, then it also doesn’t soak up as many nutrients, so the patient is obliged to take supplements forever or risk malnutrition.

For details on these various approaches to combating obesity, the WebMD site is very informative. Here we learn, for instance, about adjustable gastric banding, which is minimally invasive and reversible, but which can slip or leak.

In sleeve gastrectomy, three-quarters of the stomach is removed, so it’s gone forever. Also, this technique can lead to a leak, or even to the formation of blood clots. Actually, this is often a “starter surgery,” which is relatively simple and paves the way for further interventions after a year or two, when the patient has made the first initial leap of improvement:

Usually, a sleeve gastrectomy is a first step in a sequence of weight loss surgeries. It’s typically followed up by gastric bypass or biliopancreatic diversion, which will result in greater weight loss.

The gastric bypass, or Roux-en-Y, is a combination of restrictive and malabsorptive methods. Part of the stomach is cordoned off and the very minimalist remainder of it is routed directly to the small intestine. This operation is considered irreversible, and the patient might get a hernia, or need to have the gallbladder removed.

Then there is biliopancreatic diversion, an extreme adaptation of the gastric bypass, where most of the stomach is removed and part of the small intestine is bypassed. This one is relatively complicated, and risky. WebMd offers a nifty little slide show with some animated frames, to give a basic and relatively un-gross view of what goes on inside a WLS patient’s abdomen. The thing is, all these procedures are recommended only for patients who have tried to lose weight by other means, and failed. They are warned,

Perhaps most importantly, you need to be mentally ready. Weight loss surgery can be lifesaving, but it is not a cure. Instead, it’s the first step in a lifelong commitment. For any surgery to help, you need to be dedicated to making dramatic and permanent changes to how you eat, exercise, and live.

Exactly. The patient can still screw it up. The patient can still have an addiction mentality and a habit that hasn’t been broken yet. Dr. Pretlow believes that insurers, before going directly to surgery for young people, ought to cover treatment in residential settings where their addiction can be definitively dealt with, and they can learn coping skills to take the place of comfort eating and stress eating.

When doctors go ahead and recommend surgery for obese young patients, are they always certain that everything else has been tried? Has an inpatient facility with a 12-step program been tried? Because, chances are, underlying issues drove that person to self-medicate with food, all the way into a state of addiction and morbid obesity. If those issues have not been resolved and healed, more trouble is on the way.

Your responses and feedback are welcome!

Source: “Choosing a Type of Weight Loss Surgery,” WebMD
Source: “Weight Loss Surgery Slideshow,” WebMD, 05/25/10
Image by DDFic (Tina Lawson), used under its Creative Commons license.

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Profiles: Kids Struggling with Weight

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The Book

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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