Why bariatric surgery isn’t successful

Countless people (my patients included) think that bariatric surgery is the answer to dealing with the frustrations of slow weight loss. But that couldn’t be further from the truth.

In fact, I’m adamantly opposed to this surgery in most instances—’My 600-Pound Life’ cast included. Because even if the surgery is successful at first (and it almost always is), what comes next?

The answer, according to one recent study: More of the same behaviors that contributed to weight gain in the first place.

Old habits die hard

This new study looked at factors linked with regaining weight following bariatric surgery—the biggest, lengthiest analysis of its kind.

The range of post-surgery factors ran the gamut, including 21 weight control practices, more than a dozen eating habits, and several aspects of both substance abuse and physical activity. Over the course of 6.6 years, researchers measured subjects’ weight a median of eight times.

Ultimately, five unsurprising behaviors emerged with significant links to regaining weight after bariatric surgery:

  1. Higher amounts of sedentary time
  2. Frequent fast food consumption
  3. Eating when full
  4. Continuous eating
  5. Binge eating and other forms of disordered eating

Let’s call a spade a spade: These are the exact behaviors that likely landed those surgical candidates on the operating table in the first place. So why would you expect these behaviors to disappear overnight?

Researchers also looked at patient characteristics and found that those who gained post-surgery weight were younger in age and had:

  • High triglycerides
  • Venous edema with ulcerations
  • Lower physical function
  • Poor overall health
  • Depression

Last but not least, researchers pinpointed pre-surgical issues that paved the way to weight regain—which included eating seven or more meals daily, as opposed to the recommended one or two meals per day, pre-surgery.

Once again…no surprises here. In fact, it perfectly sums up my main issue with weight loss surgery. Bottom line: It’s a band-aid solution to a much deeper problem—one that’s doomed to return without any real, lasting change.

Simple strategies are the secret

So, what wasn’t linked to weight regain after surgery? As you may have already guessed, it was a lot of the same stuff that I preach about continuously.

More specifically, a dozen key weight control strategies—including cutting out sugary drinks, eating lower carb, boosting veggie and fruit intake, and using meal replacements. (WheyLogic anyone?)

This study also delivers some of the best evidence we have that staying active—even if it’s just with household chores—is crucial to keeping the weight off. And as you might have expected, self-monitoring your status by weighing yourself at least once a week was key, too. (Which is why I give this advice to all my patients.)

Ultimately, these simple strategies—along with ditching fast food, and dealing with compulsive or out-of-control eating—were deemed the most important behavioral targets post-surgery.

And all I can say to that is…shouldn’t these actually be pre-surgical behavioral targets?

I’ll say it again: Obese patients who sign up for weight loss surgery—rather than focusing on consistent lifestyle changes—think they’re in for an easy fix. When nothing could be further from the truth.

If you don’t change your relationship to food and physical activity, you’re only going to wind up right back where you started. And this study is living proof.

I get why bariatric surgery exists as an option. Its benefits, at least in the short term, are pretty clear. But if you’re not willing to accept lifestyle changes as the most important part of the process, then you shouldn’t be getting the operation…period.

The sooner surgeons start working this basic “eligibility” criteria into their pitches, the better.

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Think We Know What Predicts Weight Regain? Think Again.” Medscape Medical News, April 11, 2019. (medscape.com/viewarticle/911671)