The Truth about Bariatric Surgery

A caveat to the recent posts about weight is the professional dilemma about Bariatric surgery. These weight loss centers, as they are called, have become a profit bonanza for hospitals. People bereft after years of unsuccessful dieting finally capitulate to the pressure for surgery from friends and doctors. It feels like a last resort, the final decision, and one couched in the misguided concept of improved health. The surgical centers are PR meccas able to reel in even the most ambivalent of patients. Once hooked, these people become true believers. 

They say they are done dieting and know they "haven't been able to use the tools of dieting successfully." The language of personal blame, well honed by diet gurus, allows doctors to recommend surgery and also not take personal responsibility when the surgery fails. 

We will all look back one day in shock and horror that the medical world sanctioned slicing off half or more of a person's stomach for weight loss. These surgeries may very well be the lobotomy of our time. When all data shows dieting to be not only ineffective but also harmful with clear proof it leads to long term weight gain, how can we stand by as the diet industry leads these people to a place of hopelessness and the medical establishment leads them into the operating room? The hypocrisy and craven desire for profit are astounding. 

The central issue is to wrest back the conversation from the extremely powerful diet, food and exercise industries which have completely monopolized the conversation. Sadly, the medical establishment has been led to the same conclusion and now acts as unwitting promoters for diets and surgery. 

The answers to this problem lie with medical education. Unless medical professionals understand the basic facts about food and weight, there will be no counterpoint to the marketplace powers which have capitalized on the fear of fat for enormous gain.


Weight, Part III

A friend recently diagnosed with a serious illness told me a story. She is working hard to maintain weight due to the potential for weight loss from her illness, and she heard someone bemoan her need to lose weight. This friend only wished her biggest problem was losing weight. 

It's a truism that poor health puts all mundane worries into perspective, but this story illustrates something more powerful in light of the recent posts on this blog. Worrying about weight is more than just a mundane concern. It represents something more profound about the empty struggles of modern day life. 

Ruminating about body and weight is now an acceptable way to vocalize and internalize daily problems. We all seem to have accepted that striving for thinness is necessary for overall success, and not achieving it can undermine any other, more meaningful accomplishments or realities. 

The problem with this concern is twofold. First, obsessing about weight and food triggers a deep part of our brains. Food obsession is linked with survival and basic needs of being a biological organism. Watching how food motivates pets is an easy way to prove how ingrained food behavior is in all animals. Once this brain circuit is triggered, it can become all encompassing and have a significant negative impact on daily life. 

The second issue is sanctioned starvation, something I have written about extensively in this blog. The diet industry juggernaut capitalizes on our collective desire for weight loss and paints dieting as a prudent way to live. However, the danger of dieting, always followed by compensatory overeating, is to actually precipitate disordered eating and eating disorders. 

If there is anything my ill friend pointed out, it's that our obsession with weight loss mirrors our loss of values. We must work hard to figure out what to prioritize in a world constantly vying for our attention. The important things in life need to reflect our own selves, not the demands of industry, vanity or culture. Weight obsession is a manufactured reality intended to capture our minds. Our deeper values can't be drowned out by this endless noise.


Weight, Part II

Weight is but one data point to assess medical progress during recovery from an eating disorder. When any person eats regularly for over a year, weight can still fluctuate quite a bit due to several factors such as fluid shifts, hormonal shifts, changing seasons and changes in daily routine. The body attempts to keep weight within a range, but that range is much wider than what many people can accept psychologically. 

Weight reflects part of the natural state of balance the body seeks in order to maintain stability called homeostasis. The human body works to stay in a range of weight to promote health but a specific weight is not important. 

People with eating disorders and many people focused on food and weight believe otherwise. They think they can control weight within a pound or even less, with the advent of scales that measure to the tenth of a pound. The psychological and emotional effort expended to maintain a specific number dominates many people's lives and completely takes over the mind of most people with an eating disorder. 

During eating disorder recovery, one's body often needs to switch into a healing mode which can have a significant effect on weight, albeit temporarily. For instance, many people become constipated as their gastrointestinal system heals which leads to bloating, fluid retention and increased weight. Metabolism can slow down to adjust to periods of starvation in all eating disorders which can result in a temporarily higher weight. Normalizing of fluid maintenance, how the body stores water, often leads to fluid retention and weight gain as well. 

These changes are short-term but cloud the use of weight as a marker of health. 

In addition to weight, there are many other ways to assess improvement in health. Regular food intake is the first and foremost sign of recovery. No matter the other factors, improvement in daily eating is a sign of health. People often experience increased energy, higher stamina, normalization in gastrointestinal function, ability to withstand temperature changes and improved circulation, to name a few. These markers of health take more time to follow and assess but give a much more thorough picture of health and recovery. 

The next post will take these thoughts about weight a step further. What are some reasons for our obsession with weight for people with eating disorders and for our society?


Weight, Part I

Medical management of eating disorders revolves around weight. Every day in residential treatment and at every appointment in outpatient care, getting on the scale is the focal moment for both patient and doctor. 

Weight fluctuations are central to many other illnesses and a good data point for progress or regression. But in treating people with eating disorders, doctors act as if weight is absolutely paramount. 

On the one hand, this seems reasonable. Eating disorder thought processes are almost exclusively about weight and body, so weight normalization appears to be key to recovery. Yet clinicians are often as focused or even more focused on the number on the scale than the person with the illness. Frequently, this dual obsession of patient and clinician sets up an unworkable battle. 

In all other illnesses, a clinician's focus is not on a data point but on health. Eating disorders cause many serious medical problems from anemia to kidney dysfunction to cardiovascular collapse. People routinely die from eating disorders. There are many physical signs and symptoms and clinical facts to address in addition to weight. 

In fact weight is often an elusive and confounding piece of information. Daily weights tend to reflect fluid shifts based on many factors. For instance, even a salty meal can lead to 2-3 pounds of extra fluid weight the next morning for anyone. Actual body mass rarely changes by even two pounds in a week, even for very underweight patients in residential treatment. 

So the question I often consider is why is the clinical world so focused on weight?

The first consideration is that abnormal weights upset clinicians, and weight normalization feels like healing a sick person. Most people with eating disorders whose weight has normalized actually suffer more because their eating disorder thoughts are so dominant. Treatment needs to address the psychological part of these illnesses as well, otherwise recovery is for the clinician's well-being, not the patient's. Focusing exclusively on weight reveals the unfortunate ignorance of many clinicians about recovery. 

The second factor is insurance companies. In order to avoid paying for care, insurance companies have limited the amount of care by assessing practical but very short-sighted data points. Weight is the primary focus. If a patient's weight is normal, then insurance companies limit access to care. Since people frequently change health insurance, these companies bank on providing a stopgap measure to save money. Long-term recovery is not a priority. 

If weight is not the central marker of successful recovery, how can clinicians and patients assess progress? I'll discuss that in the next post.