Bariatric Surgery, A Televised Cautionary Tale

CNBC’s One Nation Overweight  – a telling recent documentarysummed up Americas  current gung-ho bariatric surgical mind set. Reporters went to the Cleveland Clinic - a leading academic center – that’s aggressively pushing bariatric surgery to  the American public. Their doctor “expert” boasted that “for patients with 100 lbs or more to lose, bariatric surgery is the only effective durable treatment. Period.”

Apparently he’d never seen, read or inquired into reports of very favorable comparisons between gastric bypass patients and those undergoing aggressive exercise-centric weight loss.

The film crew proceeded to follow bariatric surgical candidate Henry Bolton, a 330 lbs 62 year old military man. He presumably was cherry picked from the overflowing population of Cleveland Clinic gastric bypass patients, a common practice by hospital PR departments. True to the beaming Cleveland Clinic surgeons prediction, Henry lost a good amount of weight in the first two months after surgery – although no one ever mentioned whether the lost weight was fat, muscle or water!!! That’s important information cause studies suggest gastric bypass patient lose  30 plus percent of their muscle! And losing muscle is an open invitation for disease and disability.

Henry was interviewed post-operatively; he appeared proud of his weight loss, even opining he felt better.

Then on day 64th day after surgery – disaster struck.  He suddenly dropped dead.

Sadly, since Henry died more than 30 days post operatively, his tragic death will not be reflected in Cleveland Clinics advertized  “post-operative” death rate!!!  Cleveland Clinic doctors, like other bariatric surgeons, publish their death rate within 30 days of surgery – a number that for relatively healthy patients with BMIs less than 50 is usually pretty low. However the death rate  at one year is typically 1-2%. For those with BMIs greater than 50 with other medical disease – like diabetes – present, the expected one year death rate can be over 5%. And the inevitable early post op complications as well as delayed nutritional and psychiatric complications are routinely swept under the rug as well. Suffice it to say, bariatric surgery is no walk in the park and hospital statistics do not reflect the true danger of this major surgical intervention. I’ve never forgot what I learned in the halls of the Massachusetts General Hospital while a Harvard Medical student – “Once a surgical patient, always a surgical patient”.

There currently exists an aggressive non-surgical, non-drug approach to obesity studied in hundreds of patients – exercise-centric fat loss. This approach appears to be safer,  more cost effective, more mood elevating and offers superior body composition changes compared to  gastric bypass at one year.

An aggressive non-surgical, non-drug approach – properly prescribed exercise, individualized caloric restriction, sleep and psych evaluations should always be the first step.

Bariatric surgery is a surgery of last resort.