If you would have asked me about bariatric surgery a few years ago, I would have argued against it. I’d have said it’s an easy way out for people too lazy to actually change. I even would have questioned the morality of surgeons who conduct the procedure.
But then something happened: I changed my mind.
I started working with clients who’d had bariatric surgery (a collective term for the many types of weight-loss surgery) or who were preparing to have it done. And I saw firsthand how motivated they were.
So I started asking questions and delving into the research. Much suggests that bariatric surgery not only works but might just be the best defense against severe obesity we have today.
Surprised? I was too. Trainers tend to think about obesity treatments differently from the way medical researchers do. Which makes sense; we put our faith in diet and exercise, as we should. That’s our wheelhouse. Surgery certainly is not.
But part of our mission is to help obese people reclaim their lives and their health. To that end, exploring a broader perspective on bariatric surgery behooves you. You might just have a client one day who’s had the surgery, and knowing a little about it will help you help them.
I tend to hear the same four arguments against bariatric surgery over and over. I understand them because I used to believe them, but like I said, my thinking has evolved. I won’t pretend to have definitive answers, but I do have a lot of thoughts. Hopefully, some of those thoughts will make you think too.
Argument 1: Surgery doesn’t work because it doesn’t address the real problem
This might be the most common argument I hear. After all, you don’t just wake up one day and—boom!—you’re fat. That level of weight gain is the cumulative result of poor lifestyle choices over time, and unless you ditch those bad habits you’re only treating symptoms and not the root of the problem. And it’s only a matter of time until the weight comes back.
On its face, this logic makes sense. But the research doesn’t support it. Quality long-term studies show that obese people who undergo bariatric surgery can drop dramatic amounts of weight and often keep much of it off years later.
In one recent study, gastric bypass patients had dropped over 80 pounds (or about 30 percent of their pre-surgical weight) seven years after the surgery. In another, they lost 21 percent more body weight after 10 years than obese subjects who hadn’t had surgery. What’s more, only 3 percent had regained the weight after that time.
Those numbers are fantastic.
In my experience, surgeons do a good job of explaining to patients that surgery is not a magic pill, and take extensive measures to ensure each patient’s success. Candidates are carefully screened and must commit to healthy lifestyle changes in order to qualify. And treatment centers often provide on-site dietitians, monthly support groups, informational meetings, and referrals out to licensed counselors for psychological support.
Remember, weight-loss surgery is reserved for the severely obese, those at risk for life-threatening weight-related health problems like heart disease and diabetes. That kind of health scare can be very motivating. I’ve seen it for myself. Pre- and post-op bariatric surgery patients are among the most driven clients I train.
So don’t assume that bariatric surgeons are not addressing the root of the problem. Most of the time, they are, and from a great many angles.
READ ALSO: Five Ways to Help Your Clients Lose Weight
Argument 2: If you manage to lose a little weight before surgery, why not keep going?
A lot of bariatric surgeons require that the patient lose a set amount of weight (say, 20 pounds) before they can qualify for surgery. Well, shoot, if you can lose the first 20 on your own, why stop? Why not continue using those strategies to lose all the excess weight?
I personally have helped very large people lose massive amounts of weight. I’m a trainer. It’s what I do. So I know it’s possible.
Still, it may not be possible—or at least plausible—for everyone. In many cases, these patients have tried to lose weight again and again, and each time the weight returned. Some people call it yo-yo dieting. Doctors call it metabolic adaptation: when an obese body starts to defend itself against weight loss by reducing its metabolic rate. Bariatric surgery seems to trigger hormonal and metabolic changes that diminish this effect.
So even if you can lose the first 20 pounds by yourself, bariatric surgery may still be a wise decision given its well-documented success. If you’d tried (and failed) to lose weight several times already, and your life was on the line, what choice would you make?
Argument 3. Obesity is self-inflicted, and people should live with the consequences
A few years back, the AMA declared obesity a disease. I personally don’t think of it that way. To me, obesity is not an illness. It’s a consequence. Even though nearly 100 gene variants are linked to obesity, in most cases, it’s also the result of personal lifestyle choices. Which means that, yes, people do have control over their weight.
They also have control over their sex life, yet we still treat people for STDs. And what if a base jumper breaks his arm jumping off a cliff? Do we not treat him because his broken arm is a direct result of his decisions? Of course not.
Even if you don’t believe obesity itself is a disease, it’s unquestionably a risk factor for a long list of diseases. Just because someone’s actions contributed to it doesn’t mean we shouldn’t use modern medicine to treat it.
Argument 4: Surgery is risky
Yes, it is. And as we’ve established, so is living with obesity—or not living, as obesity, especially at higher levels, is linked to a higher risk of death from any cause over a given period. Every trainer should understand this by now.
So consider that bariatric surgery has been shown to reverse or eliminate high cholesterol, hypertension, and sleep apnea. It decreases heart disease risk in obese people, reduces the risk of obesity-related problems during pregnancy, lowers cancer risk in obese women, eases joint pain, and may even lead to longer life and increased quality of life. That’s a lot of benefits.
The research on type 2 diabetes is especially compelling. In one study, Swedish researchers found that bariatric surgery was very effective at putting the disease into remission, slowing or preventing the life-shattering damage it can do to your kidneys, blood vessels, heart, vision, and nerves. Even after 15 years, about a third of the surgical patients were still in remission, compared with just 7 percent of those who’d received lifestyle and pharmacological interventions instead. Other studies have shown similar results.
People with diabetes are at risk for heart attack, amputations, or stroke. Ever seen what a stroke can do? It can paralyze you, turn you into a mute vegetable, or handicap your mental capacity. It’s hard to watch, and even harder to witness the effects on a grieving loved one.
As with any major surgery, this one carries risks, as I said. And life after surgery is an adjustment. You must learn new ways to eat or else you’ll experience “dumping syndrome,” which can cause vomiting, lightheadedness, nausea, diarrhea, palpitations, and sweating. But compared with dying from a weight-related issue, in most cases these are risks worth taking.
READ ALSO: How to Help a Client Who Has Diabetes
Lately I’ve been training more pre- and post-op bariatric patients. They’re often highly motivated to succeed. They want to do things with their friends again. They want to feel comfortable in public again. Fathers hope to walk their daughters down the aisle one day, and grandparents dream of chasing their grandchildren around the yard.
So they make the decision to do what it takes to achieve those goals.
They’re not so different from your other clients, who pay for your services to help keep them accountable. Surgery is a more drastic option, but that only means the stakes are that much higher.
These clients aren’t looking for the easy way out, as I’d initially assumed. They’re willing to make life changes for the long haul. They train more consistently than most of my other clients, and are often willing to work harder as well.
Bariatric surgery, ultimately, is a personal choice, and I no longer fault people for making it. I do what I’m supposed to do as a trainer: encouraging them and helping them thrive.