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Wednesday, 15 September 2010

Last Chance Saloon - Weight Loss Surgery Revisited

Professor Finer has said forget the diets, they don't work for most people. Weight loss surgery will have to be made available to most people who need to lose weight in the future. He is not talking about the gastric band, this is the full monty - gastric bypass surgery known by various other names by obesity experts.

TV programmes and magazines used to focus on the horror aspect of weight loss surgery. We had stories about people who had to sit and have a teaspoon full of soup while watching their partners tucking in to a banquet at the local Chinese restaurant. Now, celebrities such as Vanessa Feltz and Anne Diamond have succumbed to the gastric band and are telling the world how glad they are to leave behind the struggle of their relationship with food on the cutting room floor. This will mean that many more people who are tired of yo-yo dieting will feel that it is normal and acceptable to choose surgery as the ultimate solution for their weight and eating problems.

Surgeons are getting better at doing weight loss surgery; they are doing more of it and talking to each other about what works best. That can't be a bad thing at all.   I have personal experience of good success stories and I have heard of things that can go wrong - some colleagues who warn us of greatly increased suicide rates among people when all the euphoria of the early weight losses is over. I have also heard stories of weight regain in some people who have done the surgery, in some cases at great personal expense.

Counsellors are very opposed to gastric surgery. They believe that overeating is a symptom of something that cannot be brushed away. There are associations of overeating with managing trauma and dangerous emotions. Fatness can be a useful defence in someone who is posibly afraid of being vulnerable at a lower weight. One person said to me, "if my boyfriend left me, I could blame the weight. If I was slim I would have to blame myself".

Compulsive eating is not a contra-indication for weight loss surgery. Surprisingly, many people who binge eat find that the compulsions disappear after their operation at least for a couple of years.  It is only then that weight loss slows up or eating difficulties begin to reappear. It has to make sense therefore to do some eating disorder counselling for the bariatric patient. But very few get it.

Gastric banders who are compulsive eaters do less well. Because their stomach is still intact the appetite may not wane and we hear stories of people who try to cheat their band by eating foods that slip down easily like ice cream. It has to make sense for these people to have some pre surgery eating disorder counselling too. But very few get it.

Bariatric counselling is a specialist area. If you want the surgery or if you want to help people who are desperate to lose weight, get in touch. The number is 0845 838 2040


  1. With the current promotion (and even legal action!) around gastric surgery solutions it seems that it might not be the 'last saloon' solution in future though.

    I personally feel there is a long-term health timebomb waiting to happen in this area, as not being able to consume good nutritional and calorie intake is not natural for the body (think effects of famine) and as you prelude to, there are also massive psychological effects which are also unmeasured long-term.

    I know someone who recently had a gastric bypass and in a weeks time they are flying to the USA to have it reversed, as their life and mental state has just spiralled out of control since the original operation.

    It's a shame that an increasing amount of human beings are forgetting the fact that they are the most powerful creatures on earth and able to achieve anything they want. They are instead allowing themselves to be programmed to blame external things for their situation and now seemingly making a surgeon responsible for their health and wellbeing.

  2. I was on the NICE obesity guidance process for bariatric surgery and looked at a few individual cases, one I am following long term. Yes there have been new challenges of surgery which have replaced the old challenges of living in a huge and ill body. There is a increase in suicide which we have yet to understand. There are no solutions, only pros and cons which must be carefully revisited as part of the initial decision making process. These people Mark, some of them, have such an internal "schema" of powerlessness that it takes something more than conventional therapy can offer to help them feel like the architects of their own lives. Sometimes NLP or other therapies can flick the switch but the wiring in their brains can get in the way of changing old habits. Its something to which I have given a great deal of thought. Deanne