Societal Risks of Bariatric Surgery, Part II

Fat has become the evil we avoid at all costs. In our collective world of fantasy, one of only good fortune, endless riches, eternally youth, fat is the source of the evil we avoid. The dream is that remaining thin and perfecting our diet and exercise plan will allow us to revel in what was once unattainable: immortality.

Society has tacitly agreed that fat is culprit of all our woes. Accordingly, we must avoid eating fat (except fats deemed healthy) and we all just avoid fat people. As bias against race, gender and religion decreases on all fronts, bias against fat people is on the rise. They are seen as lazy, ignorant and lacking in all willpower. They represent everything distasteful in the world and must be avoided at all costs. They deserve what they have brought upon themselves.

The diet industry rests largely upon the theory of self-advocacy. With any specific diet, a person will successfully lose weight for good and transform their lives. The data proves that 98% of diets fail, so why would any new diet be more successful than the last? Since diets work by supposedly empowering people, those who fail are to blame. Certainly the diet can not be the failure.

The exercise industry is the same way. New exercise plans promise a life transformation including weight loss, new confidence and personal transformation. Lack of success is always a personal failure. The exercise program cannot be held accountable for false promises.

The medical establishment reinforces the concept of fat as the source of all illness. As doctors arrogantly explain the dubious relationship between weight and health, they offer no solutions mostly because there are no reasonable solutions to be found. Diets don’t work. Weight loss medications won’t work. Doctors easily shirk off any responsibility by blaming the patient.

Inevitably, the demoralized patient believes they are to blame for their weight and that their weight will shorten their lives considerably. The only path left is Bariatric surgery. Medicine pushes these patients towards surgery, and the centers have become large money makers for hospitals struggling to survive financially.

Perhaps Bariatric surgery is barbaric. It’s a last ditch effort to transform a person’s body and life by cutting away most of their stomach and decreasing their physical ability to eat food. The result is forced prolonged starvation: anatomical anorexia. The only way to lose weight is to create an eating disorder by any means.

If thinness is the only key to success in this world and the promises mentioned above, is it any wonder droves of people have signed up for surgery?

Watching people gradually find a way to eat again around the surgery, I have wondered what the long term results will show. I see so many patients eventually eat more regularly or overeat again after their bodies adjust to the surgery.

And how will we reassess the long term effects on so many people undergoing this procedure as they age? Surgery isn’t a permanent solution but only delays our inevitable need to face the judgment and bias around weight. It is a scary view of what the fantasy of thinness has wrought in our world.

Societal Risks of Bariatric Surgery, Part I

The medical establishment posits that Bariatric surgery is the newest and most effective way to combat issues with weight in our society. As previously explained in this blog, our bodies have adapted to the environment created by the food industry, namely processed foods meant to appeal to our most powerful tastes and that also wreak havoc on our metabolism. Rather than face the public health crisis caused by the food industry, surgery, which is now covered by insurance, is the solution of the moment.

The increase in average weight in the country is linked to worsening health. However, this link is questioned by many authorities. Movements like Health at Every Size present substantial evidence that proves otherwise. The power of the food industry has convinced society and doctors that people are to be blamed for their weight which causes poor health and that these people need help to fix their weight problem. There are medications meant to counteract this scourge which have limited benefit, but surgery is the increasingly common recommendation as a quick fix.

Bariatric surgery is essentially anatomical anorexia. Gastric sleeve surgery, the newest iteration, surgically separates 80-90% of one’s stomach leaving a very small, crescent shaped stomach. The result is the physical inability to manage no more than a few bites at every meal, at least for the first 6-12 months after surgery. The Bariatric surgical centers focus solely on weight loss. Their success is measured by the number of patients who lose a certain percentage of body weight over the first year or two. Long-term results, let alone overall health, are secondary.

But surgery essentially leads to drastic food restriction over a long period of time. By any other definition, this looks like anorexia. Any starvation, however it is imposed, can lead to very strong hunger that triggers overeating or binging. Also, restriction over a period of time leads to malnutrition no matter the weight of the person. The surgical programs don’t consider overall nutrition or the health consequences of such prolonged limited eating. Instead, they focus on improved blood sugar and blood pressure, metrics that increase insurance coverage. What benefit is there to swap one set of medical issues for another?

Based on how easy it is to sway medical opinion—the continued manipulation by the pharmaceutical industry is the clearest example, it’s not surprising that other more powerful forces have convinced medicine to take this approach to treat larger patients. But how is it that thousands of fat people blame themselves so much that they endure risky surgery time and again? Why is it that no one is questioning this barbaric practice? I’ll address this in the next post.

The Fallacy of Willpower in Eating Disorders

Clinicians regular conflate eating disorder recovery and willpower. For people with anorexia, they say that willpower is the essential ingredient to be able to follow a meal plan. For bulimia, therapists describe willpower as the main way to avoid binges. For binge eating disorder or compulsive overeating, willpower is the only way to stop eating.

All research into treatment shows that this therapeutic approach is ineffective, yet the theory is pervasive in the clinical community, to the detriment of all those seeking help.

The focus on willpower as a part of eating disorder recovery, despite its clear ineffectiveness, is due to three issues.

First, therapists struggle to manage the helplessness and powerlessness they often feel when treating people with eating disorders. Therapy may include insightful sessions, a clear understanding of the cause of the eating disorder and a definite plan moving forward. Even still, the person may make no or marginal progress. Without any clear culprit, the therapist can easily blame willpower—the patient—for the failure to move forward, absolve themselves of responsibility and avoid more frustration.

Second, the concept of willpower camouflages a therapist’s lack of knowledge or experience treating people with eating disorders. Willpower reflects an aspect of therapy called motivational interviewing first adapted for people with substance abuse issues. Although there is some benefit utilizing this treatment approach for eating disorders, the therapy does not take into account the greatest difference between the two: food. However, it’s a convenient way to explain why someone is not progressing in treatment and instead blame the patient for her illness. It behooves patient and therapist to get a second opinion or try a different course when a clinician is unclear how to proceed rather than attribute a stall in progress to a largely irrelevant treatment modality.

Third, the therapist is unwittingly reinforcing the eating disorder mindset when focusing on willpower. Since this approach is wholly ineffective, it only makes the patients feel more inadequate and more helpless. Rather than trying to find a new way the circumvent the illness, the therapist expresses frustration in the most facile way: leading the patient back to the helpless state of the illness.

When a patient encounters a team focusing on willpower as a core part of treatment, the patient ought to both confront the team about this approach and, more importantly, seek new help. Using willpower as a fulcrum to leverage recovery inevitably fails and only reinforces the illness. Better treatment exists elsewhere.