With recent news of Carnie Wilson’s decision to undergo a LAP-BAND procedure following her gastric bypass surgery 12 years ago, the risks and benefits of “follow-up” bariatric surgeries are being discussed in the media with renewed interest. While I appreciate healthy dialogue on the subject of weight-loss surgery, I also want that dialogue to be accurate. As we’ve discussed time and again in this blog and in our support groups, weight loss surgery is simply a tool. How a patient decides to use that tool is entirely up to them and those patient decisions have the largest impact on long-term outcomes.
When we talk about bariatric surgery as a “tool,” what we really mean is that it isn’t a “cure” for obesity. The stomach is a muscle. No matter what we do to restrict its capacity, without constant determination and rule-following on the part of the patient, that muscle can and will stretch over time. That’s when we see patients begin to regain the weight they originally lost with the procedure they chose. Now, this isn’t to say that second surgeries aren’t appropriate. For some people they certainly are. But, as we always tell our patients the first time around, ALL surgical procedures come with risks. To the extent we can minimize those risks by ensuring success with the first procedure, that is always our goal.
The most effective way to minimize the risk of needing a second bariatric procedure is four-fold:
1. Maintain an appropriate diet post-surgery: This includes following “rules” about intake quantity and timing as well as a focus on the quality of foods consumed.
2. Eat Slowly: While type and amount of food are important, how quickly food is eaten has a significant effect on long-term success. A good measurement to stick with is 1/2 a sandwich or 4 oz. of food over the course of an hour. Without focusing on this step, one will usually (within 2 years after weight loss) regain weight.
3. Exercise: You don’t need to run marathons. 30-minutes of brisk walking most days per week have helped many of our patients keep the weight off for more than a decade.
4. Get Adequate Support: Bariatric surgery is hard work. Surrounding yourself with people who are experiencing the same challenges can help get you through the rougher patches. We’ve got support groups throughout Southern California. Join one!
As a physician, I also understand that some of these suggestions are easier said than done. Some people need a plan of action. For those who prefer a more guided approach, we’ve partnered with MTEC to provide patients with customized diet and exercise plans, pre- and post-op. The plan will detail EXACTLY how much each patient needs to exercise and eat in order to meet their weight loss goals. And these plans are specially designed for patients at any stage of their weight-loss journey (pre-op, post-op, plateau or regain.)
While second surgeries are a reality for some, I encourage the public to be less inclined to shame the people who undergo them. This isn’t about taking the “easy way out,” “cheating,” or “being lazy.” It’s about getting healthy. I applaud ALL of my patients for taking on major challenges to change their lives. And there’s nothing lazy about that.