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When is Weight Loss Surgery an Appropriate Option?

I’ve wrestled with this question for many years: “When is weight loss surgery an appropriate option?” I used to do weight loss research prior to working at Revolution Health. My studies focused on using “natural” methods to reverse type 2 diabetes – in other words, weight loss via diet and exercise. My study subjects were all obese, and most had struggled with weight for decades.

At some point during the trial, people would often ask: “Can’t I just have surgery for this and not have to struggle so much?” And I would gently remind them that surgery was no picnic, and to try diet and exercise first. “But it’s so hard!” they would say. I would acknowledge their difficulties and offer lots of empathy, and firmly encourage them to stick with their diet. In the end I found that only half of my study subjects could manage to stay on the diet for months at a time. So what should the other half do? Give up and let their diabetes ravage their bodies?

My friend and colleague Dr. Charlie Smith rightly points out that weight loss surgery can dramatically improve the health of people who have been unsuccessful at losing weight through diet and exercise. Heart disease, diabetes, and cancer rates were dramatically improved for morbidly obese people after weight loss surgery. So there is a clear benefit for some people to have the procedure.

However, the caveats should not be overlooked. First of all, weight loss surgery does not guarantee long term weight loss. It’s possible to gain back all the weight lost if eating behaviors are not changed. The human stomach is amazingly stretchy, and even if it’s surgically reduced in size, with repeated overeating it can eventually stretch to accommodate large meals again. Secondly, some types of weight loss surgery (like gastric bypass) can affect the body’s ability to absorb critical vitamins. Without enough of these nutrients, one can end up severely anemic, and osteoporotic just to name a few serious side-effects. And finally, the surgery itself is quite dangerous, carrying with it a potential risk of death as high as 1 in 200!

So weight loss surgery can be life-threatening, and is not a quick fix for a long term problem. However, morbid obesity itself is so dangerous (with the increased risk of heart disease, diabetes, and cancer) that it may require this extreme intervention to actually save lives. For people who have more than 100 pounds to lose, and have sincerely tried diet and exercise without success for a prolonged period, then weight loss surgery may be an appropriate option. For those whose lives are not at risk because of severe obesity, it doesn’t make sense to undergo such a risky procedure.

Are some people successful at losing a large amount of weight and keeping it off without surgery? Yes! The National Weight Control Registry keeps a list of thousands of Americans who have lost at least 30 pounds and kept them off for at least 6 years. What’s their secret? You guessed it – regular exercise and a calorie controlled diet. Some other things that these “successful losers” have in common: 1) they eat breakfast 2) they have a cardio machine at home 3) they weigh themselves regularly.

If you’d like to meet a group of people who are working towards long-term weight loss success, feel free to join my weight loss support group. We have weekly challenges, tools and trackers, a vibrant discussion group, and free medical insights to help you along your way. Weight loss is really hard to achieve by yourself. It takes encouragement, support, and a community of like-minded folks who are determined to make a difference. You can do it!… and I’d be honored to support you along the way.

P.S. There’s a special group forming at Revolution Health for folks who need to lose 100 or more pounds. It’s called “Overweight But Not Giving Up.”  Check it out.This post originally appeared on Dr. Val’s blog at

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4 Responses to “When is Weight Loss Surgery an Appropriate Option?”

  1. Dr. Scherger says:

    Dr. Val, there is another interesting question about weight loss surgery, who should pay for it?  I think an important social question is whether the general public, or the part of the public that buys an insurance plan, should pay for someone’s weight lost surgery.  I am not against weight loss surgery for anyone who wants to “buy it”.  I have trouble with asking the public at large to pay for it for people who “have been unsuccessful at losing weight through diet and exercise”.  Anyone can lose weight if they work at it hard enough.  We face trememdous financial problems in health care with insurance being too expensive and Medicare costs going through the roof.  Yet, one recent headline said that Medicare is bracing for 3 million cases of weight loss surgery each year as the baby boomers age.  I think this is crazy social policy.  I know there is an argument that weight loss surgery may even save money over a five year period due to improvement in diabetes and other problems, but come on.  As you say, the complications are high.  People can be healthy if they choose do, and are willing to put in the work.

  2. RH Host Melissa says:

    Hello Dr. Val.  This is a great post.  Thanks for helping shed some light on the pros and cons of surgery.  And for sharing the link to the group overweight but not giving up.


  3. RH Host Melissa says:

    Hello Dr. Val.  This is a great post.  Thanks for helping shed some light on the pros and cons of surgery.  And for sharing the link to the group overweight but not giving up.


  4. Anonymous says:

    Dr. Val,

    I really appreciate the manner in which this post was written.  I’ve been considering this surgery for myself, so I like gather as much information I can on the subject. 

    What I’ve found most intriguing on this post was the commentary and opinion shared by a doctor none the less.  The Dr. was expressing his concern about who should pay for bypass surgery.  If this were an elective cosmetic surgery, certainly I would agree with his comments. 

    However, his suggestion that we could be healthy if we chose to be is completely absurd!  If that were true, he’d be out of a job.  I gathered from his tone, he feels that fat people are just lazy.  I’m glad he’s not my doctor…

    Unfortunately for most of us, it will be our insurance companies who’ll make the final decision as to whether or not a procedure will be covered.  Regardless of our doctors orders or the patients needs. 



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