Bariatric Surgery, Qualifications, and Conscience

The previous post discussed an article published by The Journal of Lancaster General Hospital, written by Jennifer C. Collins, M.A., M.S. and Jon E. Bentz. The authors recall a National Institutes of Health panel discussion of decision criteria for metabolic and bariatric surgery (MBS). Does the candidate possess and demonstrate the following qualities?

(1) awareness of the procedure and capacity to give informed consent;
(2) motivation for surgery;
(3) awareness of and capacity for compliance with post-surgery restrictions and behavior change;
(4) current stressors, behavioral and eating practices that might be barriers to the life style changes that are necessary for a successful outcome; and
(5) current psychological well-being and stability, self efficacy, resiliency and coping resources to manage stress.

Obviously a seven-year-old can not be fully aware of what the procedure entails. Additionally, operating on an obese patient involves special challenges to the medical staff. She or he is more difficult to move, and to position in whatever way is required by the specific procedure. The insertion of breathing tubes and management of airways is more difficult. Establishing the correct level of sedation is trickier. For scalpel or scope, body fat can hinder access to the patient’s internal organs. Because of factors like poor blood supply to the wound, the chance of infection goes up.

One expert enumerates the physical problems that may arise after a gastric bypass:

[…] low blood sugar […] constipation, dumping syndrome (nausea, vomiting, and weakness caused by eating high sugar meals, sodas, and fruit juices) […] possible leaks in the new connections […] body aches or fatigue (vitamin or mineral deficiency may be the cause). You may feel cold. Dry or sagging skin, hair loss or thinning, and the inability to process certain vitamins (B12 and D) and minerals (iron, folate, calcium)…

In the short term, incision care is an important responsibility. Depending on the technique and other factors, internal and external scarring can be a problem. The body might reject any inserted device, like the band in lap-band. The post-op patient may need to taper off from pain meds, and/or stick to a liquid diet for some time.

Any surgery described as “minimally invasive” involves the insertion of carbon dioxide to create space and spread things out so the surgeon can visualize the organs and maneuver the instruments around. Here is Elizabeth Wolinsky’s description of her immediate post-op days:

Even though you just got out of surgery and you’re tired and in pain, you have to keep walking. You feel the air travel upward, toward your shoulder. It’s 10 times more painful than your body actually healing from surgery.

(To be continued…)

Your responses and feedback are welcome!

Source: “Behavioral and Psychological Factors in Obesity,”, Winter 2009
Source: “Operating on the obese: what can go wrong,”, 05/09/18
Source: “What You Should Know Before Undergoing Bariatric Surgery,”, 01/31/18
Source: “9 Things I Wish I Knew About Gastric Bypass Surgery Before I Had It,”, 01/18/17
Image by GPA Photo Archive/Attribution 2.0 Generic (CC BY 2.0)

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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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