Weight Loss Surgery, Part 4

SunbatherWhy does food have such a powerful effect on people? Overeating and consequent obesity can lead to a juncture in life’s pathway where surgery becomes a very real possibility. The relationship between a person and food can get really twisted. There are people who actually gain weight intentionally, so they can qualify for surgery under the guidelines.

What makes food so addictive? Apparently, it’s only partly the food, and partly our brains. One theory is explained by Wall Street Journal columnist Melinda Beck, whose writing about health issues has won her a plethora of awards:

Some fMRI studies have found that while tempting food stimulates the release of dopamine in obese people, they actually have fewer dopamine receptors than normal weight subjects do, so they may derive less pleasure from actually eating, setting up a craving for more.

The decrease in dopamine receptor levels may actually be due to development of tolerance, a characteristic of all addictions. It may be that people who are using the pleasure and action of eating to cope initially have normal levels of dopamine receptors. The way they develop addiction is that the comforting/coping effects of the pleasurable foods decrease over time, so they must eat larger amounts and higher pleasure-level foods in order to obtain the same degree of comfort/coping, as a 14-year-old girl (5’2″, 201 lb.) describes:

It’s like a drug. What used to satisfy you before now has no effect. I feel like I’ve become immune to the foods that used to comfort me. And like drugs you keep moving on to bigger, worse things in order to get the same feeling as when you started out.

fMRI stands for functional magnetic resonance imaging. It makes pictures of which brain region lights up when the person is doing a mental task, such as speaking or lying. This sounds weird, but it gets even weirder. Other fMRI studies seem to show that somehow, weight loss surgery rewires the brain so that food is less tempting.

Curiously, several studies have shown that some forms of gastric bypass surgery can actually create changes in the brains of formerly obese people —and not just because their stomachs are smaller and fill up more quickly. PET scans also show that bypass patients have more dopamine circulating in their brains, which may help control appetite as well.

Weight loss surgery results in a very small stomach, so that the individual can no longer consume large amounts of pleasurable foods. It’s also possible that once the pleasure centers of the brain stop being over-stimulated, dopamine receptors start returning to the levels before addiction and tolerance development took place. Thus, the individual has fewer cravings.

Several years ago, Oprah Winfrey featured weight loss surgery on her extremely popular TV show. She told her audience that practically one-third of the obese people who undergo surgery soon replace their thwarted addiction to food by developing other dependencies. Oprah interviewed a woman who had lost 125 pounds via gastric bypass surgery and was still desperately unhappy. Pretty soon, she was drinking 20 bottles of beer per day, and her family was calling her an alcoholic. Another guest, Linda, said,

My entire life, I believed that if I could be thin, if there was some magic cure, some diet, my life would be perfect. Becoming thin was supposed to be the answer to all of my problems. And then you finally achieve that goal and everything’s not all better. It comes as such a shock.

Linda chose gastric bypass surgery when she hit 342 pounds. She lost 200, but was still unloved by her husband. Her addiction-prone personality expressed itself by a new and very threatening interest in alcohol, and a string of 14 extramarital affairs. Oprah’s audience learned that for some gastric bypass patients,

…the surgery emotionally bypasses the real reason they were overweight. If a patient drops a lot of weight without confronting why they were overweight, they risk becoming addicted to something else. Experts call this swap of one compulsive behavior for another “addiction transfer.”

A few weeks ago, Melissa Healy told Los Angeles Times readers about a study of 185 patients done by the University of California at San Francisco, one year after either gastric bypass or Lap-Band® surgery. The gastric bypass patients shed 64% of their overweight in that year, while the Lap-Band® patients only got rid of 36% of their excess loads. Which is interesting, but even more interesting will be some solid 10-year reports, when the time comes for that. Of course, there is controversy over this because it looks like the FDA is encouraging the wrong procedure. Healy writes,

Less than a week after the Food and Drug Administration approved the marketing of Lap-Band weight-loss surgery to 11 million new patients, a pair of studies has found that a different, older procedure is more effective and no riskier than either the Lap-Band or another less-drastic surgery, sleeve gastrectomy.

When Andrew Pollack wrote about the same topic for The New York Times, many comments were appended to the article. One person said that treating obesity with bariatric surgery is like treating substance abuse with a frontal lobotomy. Another declared that it’s not a solution for anyone except bariatric surgeons. A reader from New York wrote,

ONCE YOU HAVE THE SURGERY YOU WILL HAVE TO RESTRICT YOUR EATING FOR THE REST OF YOUR LIFE…. do you want to be a prisoner and answer to a rubber band, or to take charge of your life and remain in charge of your own life?… And if you get the gastric band input today, how do you know that your health plan or the government’s health plan will pay to remove it if you have a change of heart 1 or 3 or 5 or more years from now?

Your responses and feedback are welcome!

Source: “ Eating to Live or Living to Eat?,” The Wall Street Journal, 07/13/10
Source: “Suddenly Skinny,” The Oprah Winfrey Show, 10/24/06
Source: “Gastric bypass more effective than other procedures, studies find,” Los Angeles Times, 01/22/11
Source: “F.D.A. Panel Backs Expansion of Obesity Surgery,” The New York Times, 12/03/10
Image by colros (Sandra Cohen-Rose and Colin Rose), used under its Creative Commons license.

2 Responses

  1. This article is really informative. Foods are something that we can’t live without, even for a day. I come to the point that my day is not complete without eating the food that makes my day complete. It is like a drug that keeping you addicted to it and I despise the fact that I overwhelmed by my desire to eat, the temptation is superb. One I tried to diet, but I lost because of my cravings for food. I do not want to have a “weight loss surgery”, but I think I have no choice, I just want to have a normal body and a normal life.

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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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