Why?

Thursday, April 22, 2010
Why would someone go through the trouble, pain and recovery of gastric bypass surgery, and then gain all the weight back?

I'm not being judgey. I really want to know, and I have no point of reference. No one in my family has ever been morbidly obese (although we tend to get heavier as we get older), and I've never been close to anyone who experienced that particular health problem.

I'm not talking about those of us who need to lay down the dessert fork and spend a little more time on the elliptical (myself included). I'm talking about people whose daily activities were so compromised by their weight they went through the surgery to correct the problem, and then gained it back, and found themselves in the same boat they were in before.

Please don't tell me they're undisciplined slobs, or don't care about their health, or some other thoughtless explanation. If that's your opinion, then feel free to express it elsewhere. I'm very interested in this, as I think it relates to self-destructive behavior in general. Does anyone have any insight on this issue?

22 comments:

Random Michelle K said...

My guess would be that the bypass surgery didn't address the underlying problem, which would be the relationship the person has with food.

If one sees food as a source of comfort, then weight issues can make a horrible negative feedback loop: put on weight, feel bad about yourself, eat for comfort, put on more weight.

Add to that a society that devalues overweight individuals and you have an ongoing disaster.

There are also matters of education to consider--if someone truly doesn't know how to eat in a healthy manner, then all the surgery in the world will simply lead to more weight gain.

As a related aside, Jamie Oliver did a project/show/whatever you want to call it in Huntington in south central WV last year (I think it aired recently). The short of it was that he wanted to teach people how to make healthy food--to overcome the idea that healthy food is expensive and difficult and time consuming.

I think he has a good idea. It's not a simple fix, but it's a step in the right direction.

The Mechanicky Gal said...

Literally a food addiction? You can do without the alcohol, and the drugs, but if you are addicted to food, then you have a constant struggle.
That's just my guess, of course.

Eric said...

Because gastric bypass surgery is sort of a con. Individual weight increasingly appears to be a combination of genetic predispositions and individual behavior; regardless of the role of the former, one loses weight by burning more calories than one consumes (this may be more difficult to do depending on genetics, but it's still what it is).

Shortening the gastrointestinal tract without changing behavior--eating less and exercising more--isn't going to do a damn bit of good. And if you're able to exert whatever behaviorial changes are necessary to lose weight, however extreme they may be in your case, you probably could lose weight without the surgery. Conversely, if you decided to accept the hand your genes and/or behaviorial patterns have dealt you and feel comfortable with your weight, you probably wouldn't bother with the surgery. Which means the surgery is an attractive out for people who have a combination of a weak will and poor self-esteem. Thus it changes nothing except the ability not to shit fat if you ignore your doctor's instructions about the dietary limitations of having a short gut.

That answer the question? :)

Jeri said...

I have an acquaintance who was along on a weekend girls trip. She'd had a lap band, but it had been unsuccessful.

Why? She'd managed to learn exactly how to eat around it - what times of the day it was tight, and when it was loose, and what rich sugary foods were tolerated and what were not.

Other than an abstemious breakfast, she didn't eat much differently than the average indulgent woman.

And still had a session of painful illness in the bathroom after overdoing it one dinner - which didn't seem to deter her the next day.

All that saying - I think the compulsive eating is a HUGE factor. I was one at one point in my life. You're just not sane about food, at all.

Random Michelle K said...

Eric--an exception to your comment "And if you're able to exert whatever behaviorial changes are necessary to lose weight, however extreme they may be in your case, you probably could lose weight without the surgery"

Of the women I know of who got the surgery (don't know personally) inability to get pregnant because of their weight was a huge issue. If your biological clock is ticking, you may not have the time needed to get the weight off without help. In that case, if lap band surgery is used WITH behavioral changes, then it's a good thing.

Eric said...

I'm not completely sure I'd count that as an exception, Michelle: the example you offer raises all sorts of questions in my mind about the wisdom of getting pregnant under those circumstances. It's not my place to judge, but I reserve the right to raise an eyebrow.

Like so:

O.o

Geek Goddess said...

Most reputable bariatic surgeons require their patients to go through extensive counseling before, and to participate in counseling and/or behavior therapy after.

You are restricted from overeating for a long time, with gastric bypass, but gradually your tiny pouch can stretch, and your remaining intestine can grow additional cilia to increase food intake. It's not just a matter5 of 'weak will'. Look through all the studies - someone who needs to loss 200-300 lbs will likely never be able to do it without surgical help. A recent podcast with on obesity (Skeptically Speaking) had doctors talking about that only losing about 10% of your body weight is the most likely or achievable goal.

I know a number of people with the lap bands. Yes, you can learn to 'eat around it' but it is also adjustable and less life threatening. One friend told me that, again, it is being highly motivated and knowing that it's your 'last chance' after a lifetime of dieting. She has lost over 100 lbs in the past 3 years and had surgery to remove excess skin.

But without continual follow-up care, and behavioral therapy, most people will gain some of their weight back.

Dr. Phil (Physics) said...

As someone who could be considered morbidly obese, my opinion of gastric bypass and lapbands is that they are too often used as a license to indulge. That the surgery "will take of it" and they can eat without limits, all without changing lifestyle and activity levels, genetics, and the sources, quality and quantities of food. It's like the smoker "trying to quit" who both smokes and uses the patch.

Dr. Phil

TheOtherOne said...

I heard of one acquaintance-of-an-acquaintance who proceeded to eat as normally as he could get away with as quickly as possible after the surgery. He also never put any real work into exercising. He never lost any substantial weight, and quickly went back to being able to eat a large pizza at one sitting. I think he thought that the surgery was going to be some miracle cure that would fix everything without him exerting any effort or willpower whatsoever.

Now, the people I've known who really put work into it have managed to lose significant weight and then stay within 10 pounds or so of that end weight for years. But they have to continue to be careful about weight creeping up on them, and have to continue to put in time exercising and watch how much of what they eat.

That said, these are people who really had tried to lose weight in other ways, and the bypass surgery was the one thing that made it possible for them to lose substantial weight in the first place. It didn't make it easy, but it made it possible.

Carol Elaine said...

Another thing about gastric bypass: if you're not careful about what you eat, you can end up in emergency room. My ex-boyfriend's (HSTeacher) estranged wife had a gastric bypass and still ate like crap. She ended up in the emergency room twice. Both times she called up the ex (after they'd been separated) to help her out because she had alienated even her own family.

Personally I'd rather learn to eat correctly and exercise more (both of which I'm working on - and sometimes succeed at). I do not ever want to be cut open unless my health is seriously in jeopardy. And while some may argue that gastric bypass can save lives, without addressing the underlying causes (as others have mentioned), it's not going to do much good at all. And may end up making things even worse.

TheOtherOne said...

Carol Elaine - you're right about eating right and working out, BUT... When you're that heavy, it's not easy to work out. Work out, you get hungry. Slip up and eat some sugar, get those cravings, eat more stuff you shouldn't...

Get the bypass, and you don't get as much of the calories out of what you eat, plus you have built-in negative reinforcement against eating tons of sugar and fat. Drop even the first 20 pounds, it's much easier to exercise and the difference in calories in/out is bigger because of the surgery.

Janiece said...

Thanks to all for your comments and insights, and welcome TheOtherOne.

From my point of view, it seems like it's really just a "pick you poison" scenario. Some people can't quick smoking (I couldn't - for years and years), some people can't stop making poor food choices. I suppose Gastric Bypass is simply a tool in the arsenal of healthy living. Like all tools, if you don't use it, it doesn't work.

Darren said...

Gastric bypass surgery is meant to control a specific kind of over-eating: people who eat too much at a single sitting because they don't feel full. The surgery makes people feel full sooner when eating.

Unfortunately, a combination of poor pre-surgery counselling in far too many cases, and a general patient belief in gastric bypass as a "magic fix" lead a lot of people to get such surgery instead of addressing the real causes of their obesity.

@Random Michelle K had it right, I think -- it's the "relationship... with food" at issue. Someone who has a bypass and gains the weight back was not obese because they didn't feel full -- their obese because they have either an eating disorder, a basic lack of self-control, or both.

I can say this confidently, because I have a basic lack of self-control when it comes to food; but, fortunately, I also have a very good doctor. She referred me to a counselor, who is helping me to change my habits and approach to food; and the weight is coming off (slowly and safely).

I feel bad for people who, for whatever reason, are unable or unwilling to fix their real problem, and end up getting surgeries that ultimately don't work.

Steve Buchheit said...

It could be a number of things. "Eating around the bypass" is certainly possible.

However, from my own experience, because my insulin wasn't working well (a part of being overweight), I had tried to lose weight. And while I did start to lose it, only when I took metformin did I start really dropping the pounds (and except for cutting out pop on a regular basis, didn't change much else). Dropped 50 lbs that way. Now I'm having a problem with 300lbs. So I'm exercising more and trying to eat less.

Also, using metformin, my dr switch me to the extended release formulation. Instantly started putting on the pounds even though the ER formulation is better for you (ie. even levels in the blood stream over the day). With his consultation I adjusted when I took it (before meals instead of after). Pounds started to drop off again (again, without adjusting what I ate or exercise levels - actually I exercised a little less because I was losing weight).

Now with the unemployment I'm having problems (because of the less activity - and propensity to snaking).

So, long about way of saying, sometimes it is hormones, not a lack of will.

GeraldF_Rotter雅慧 said...
This comment has been removed by a blog administrator.
Venus Vaughn said...

I watched a fascinating PBS thingy one night on types of over-eating and options related to doctor-intervention weight loss.

Like Darren said, gastric bypass is best for folks who chronically overeat. But then there are others who take in a lot of calories, but it's not a matter of overeating. "Grazers." They eat a little bite here and there, and keep eating all day long.

I'm a grazer. I'm round, but not in the morbid range. Gastric bypass would never work for me, nor would the lap band. I can be happy with "just a few bites" 20 times a day. It would totally defeat the purpose.

The PBS show I watched was experimenting with low-level electrical stimulation of some kind to combat the random feeding patterns of a grazer.

(OK, I looked up the show because I couldn't stand being so vague. It was an episode of Scientific American Frontiers with Alan Alda called "Surgical Slimmers.")

nzforme said...

Oh sure, go ahead and post about overeating on the day I received the jam. Now I've gotta be good and invite someone over rather than eating a half-dozen scones smothered in this stuff all by myself.

(Thanks much, Janiece! Sadly, one of the four jars didn't survive the journey. :( But the remaining three and I will have a nice wake for it.)

Janiece said...

*TONG*

Janiece said...

nzforme, this is the first time I've had a jar not make it to its destination in one piece. I was wondering about your box - things actually moved in your box, and usually I pack them so tight nothing moves.

Live and learn - tighter is better. Which flavor didn't make it?

Fathergoose said...

How many psychologist's does it take to change a light bulb?

Only one, but the light bulb has to want to change.

Alex said...

I don't know about everybody who has the surgery, but I know my father had it and has gained back most, if not all of the weight he lost. In his case it has to do with convenience, cost, and availability. He is constantly out and about somewhere so fast food is what is cheap, easy, and available. He could get salads and the like, but that isn't what is easiest to eat on the go in a car or something where a burger is easy to wrap and eat when driving if you have to.

My mother doesn't help much because she always tends to not eat much so regularly has things like chocolate and sugary foods around because she has the automatic self control to just take a couple out of the package and she is done.

Sadly eating healthy is not an inexpensive proposition. Fresh fruit and vegetables are anything but cheap compared to high starch, high sugar foods that keep almost indefinitely.

I have been working on a diet for a while that seems to be working out, but it gives you an idea of how hard it is to go out and eat reasonably healthy items in any restaurant. Most of our meals out today run almost 1000 calories per meal easily. If you don't have the time or aren't willing to sacrifice something else to make the time to prepare your own meals it gets very difficult, even with surgery helping, to adjust your eating habits appropriately.

Sadly any kind of weight loss means you have to change your habits in your life. See your post below about Same actions keep producing the same result.

nzforme said...

>Which flavor didn't make it?

I'm not sure as I didn't unwrap it -- the mess was nicely contained in its own personal bubble wrap. I got the Apple Butter, the Strawberry and the cranberry walnut (yum!)