Weight loss surgery—what do you think about it?
That it’s for people who lack the self-discipline to lose weight on their own? That it’s hugely expensive? That it’s more about vanity than health? If you thought “yes” to any of those then you’ll be surprised to hear what Dr. Kai Nishi has to say on the subject. Nishi is a surgeon at LA’s Khalili Center for Bariatric Care, which aims to make weight loss surgery just the first step in a whole lifestyle transformation that includes education about nutrition, exercise and stress management. Here are a few of the surprising things I learned from him:
Weight loss surgery is not a cosmetic procedure.
“There’s still a perception, even among some primary care doctors, that weight loss surgery is primarily a cosmetic procedure. But the only reason we do it is to make somebody healthier, the goal is never to make them look good. Also there’s a perception that when somebody chooses to have weight loss surgery they are taking the easy road, but people don’t realize that diet and exercise doesn’t usually work long-term.”
For many people, weight loss surgery is the only option.
“If you look at medical literature for dieting there’s a 98-99% failure rate, so it’s just not really a reasonable option for most people. Most of our patients have tried their whole lives to lose weight. I’m not saying that it’s not possible, but to lose large amounts of weight and keep it off for 15 years is next to impossible.”
Weight loss surgery transforms more than your stomach.
“The act of going through surgery is often the light switch that goes on that helps people take better care of themselves.” {Also, I didn’t actually discuss this with Dr. Nishi, because the news broke after our talk, but a new study in the Archives of Surgery found that when an obese individual has weight loss surgery, other obese family members in the same household are likely to lose weight as well, presumably just from being around somebody who is eating less and feeling better.}
Weight loss surgery can cure type 2 diabetes.
“Now it’s pretty accepted that gastric bypass is the only permanent treatment for type 2 diabetes. After this surgery type 2 diabetics usually see their diabetes resolve within a few weeks, even before they’ve lost a lot of weight. NIH is doing studies on it right now. We still don’t understand exactly why it’s so effective, but when we bypass part of the small intestine it somehow affects the pancreas and hormonal mechanisms. I’ve had patients who have been on insulin for ten years, but six weeks after surgery they are completely cured of type 2 diabetes.”
It’s definitely possible to regain the weight.
“It’s certainly possible to regain weight lost after weight-loss surgery. Weight loss surgery is not the magic bullet or the end of the road. There are various reasons why people are overweight. So as part of treatment we teach our clients how to eat more healthfully, and they work with an RD. Surgery certainly makes it easier to eat less food, but if somebody doesn’t change his or her lifestyle at all there’s a risk of regaining the weight.”
Weight loss surgery is usually covered by insurance.
“If you have a BMI of 40 or higher, or even have a lower BMI but have medical problems related to your weight, your insurance company will likely cover weight loss surgery, and Medicare does too.”
