Bariatric (weight loss) surgery

People usually choose bariatric surgery as a last resort, after dieting doesn’t solve their obesity problem and they fear their health is in jeopardy. As a rule, the surgery is reserved for those with a BMI of 40 or more. It is the only treatment that leads to profound and lasting weight loss. And, for patients who choose gastric bypass, it’s not just because it makes their stomachs smaller; it’s also because removing a part of the stomach causes profound changes in a complex, interlocking physiological system. (This is not the case for the band procedure, in which a band is placed around the upper part of the stomach such that that part of the stomach quickly gets full. It’s what Governor Chris Christie had.)

The reason gastric bypass works is that it lowers the brain's "fat thermostat"--the amount of fat that the brain wants the body to have. It does this by altering the activity of more than 5,000 of the 22,000 genes in the human body and by affecting the complex hormonal system that sends messages from the gut to the brain, helping to suppress hunger and appetite, and improving the feeling of satiety. It also affects the thousands of strains of bacteria in the intestinal tract as well as the white blood cells, which send their own signals. (White blood cells play a major role in setting a person’s weight by, among other things, helping to control metabolism.) 

The down side of this surgery (besides the initial pain) is that you must take vitamin and mineral supplements for life and you’ll have big flaps of loose skin that can only be removed through plastic surgery. A friend of mine, who lost 75 pounds with the band procedure, reports that he now throws up easily, but that doesn’t seem to be the case for most patients.

Also, you won’t get thin. Because of data collected on thousands of these patients, doctors can predict your body’s new set point. For example, one patient, who, at five-foot-three weighed 295, was predicted to stop losing weight when she reached 180 pounds, and that’s what happened. To lose more than the new set point, it’s back to dieting.

On the up side, patients report more energy, loss of joint and back pain, improved blood pressure, and even being able to do away with diabetes medications. Most, however, still feel fat—and, by popular standards, look fat. Importantly, though, they don’t get the disapproving stares from strangers.

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