Gastric bands and gastric bypasses are now common methods of treatment for severe obesity. A few years ago, I myself had a consultation about having one of those operations. I decided against it at the time. In both procedures, the stom- ach organ is reduced in size so that only a limited amount of food can be in- gested — about the amount contained in a yoghurt pot. A gastric bypass usu- ally also includes removing a section of the intestine, so that any food eaten cannot be digested completely. Both procedures are performed under a general anaesthetic. These carry the usual risks of these kinds of operation — the Ger- man Self-Help Organisation for Obesity Surgery quotes a mortality risk of 0.3 per cent for this operation.
The altered digestive system usually leads to severe or less-severe side effects such as digestive problems (especially severe diarrhoea, the so-called dumping syndrome) or problems with the absorption of nutrients.
The belief that obesity surgery is the ‘easy option’ is very common. It’s also the reason why people who have lost weight as a result of such an operation often face similar stigmatisation to overweight people.
It’s thought that they have ‘taken the easy way out’, that they are ‘lazy’ and ‘weak-willed’ — similar clichés to those associated with being overweight.
Carels et al. (2015) found that employers were less likely to hire people who had lost weight through obe- sity surgery than people who lost weight without the aid of surgery.
Occasionally, people argue paradoxically that obesity can’t possibly be cured ‘just’ by cutting calories, because the illness is so colossal that an operation is often the only thing that can help.
The paradox is that they don’t make reference to the psychological difficulties associated with maintaining a daily calorie deficit, but to physical difficulties instead. Many people don’t seem to realise that the surgery is simply a way to help them eat less.
Surgery merely limits the amount of food that you can take in, and the high success rate, including among people who have ‘already tried everything’, speaks for itself, or for the effectiveness of calorie reduction.
The effects of obe- sity surgery are no different in principle from those I experienced in the first six months of my weight-loss process, when my intake was restricted to 500 kcal per day. The effect is the same, irrespective of whether you ‘just’ choose to se- verely restrict your caloric intake, or you are forced to do so due to a surgical reduction in stomach size.
My advantage, or disadvantage depending on the way you see it, is that I still have the option of stuffing myself. As I now do a lot of sport, I am very happy that I still have the option of eating large amounts (this freedom, of course, in- cludes being able to regain some weight). I also have the advantage of being able to control my nutrient intake better. Deficiencies such as protein insuffi- ciency are common in people who have undergone reduction surgery because the incomplete uptake of nutrients and the diarrhoea often make it difficult to control how much the body actually absorbs from what it is fed.
This also means, of course, that some of the calories are not actually consumed by the body and it’s easier to achieve a deficit — but at the expense of personal con- trol over your nutrient supply.
All of this shows that surgery is by no means ‘the easy way out’, but simply a way of supporting people in doing what everyone who wants to lose weight has to do: eat less. The same principle continues to apply on a physical level, surgery just makes the psychological side easier, because it’s not possible to overeat (so easily) any more. But that’s not entirely true, either.
Approximately 20 per cent of those who undergo surgery fall short of expectations and either don’t lose weight (sufficiently) or eventually put on weight again (Crowley et al., 2011). Surgery by no means guarantees weight loss, despite what many people think.
The limitations of the stomach’s capacity after surgery can also be ‘tricked’, and you can still achieve an increase in calories. Sugary drinks, alco- hol, and ice cream, for example, are not restricted by a gastric band or bypass, but ‘slip right through’, and so you can still ‘smuggle’ an enormous number of calories into your body via a reduced stomach. You can also consume sweets and other high-energy foods (nuts, fats, etc.) in sufficient quantities to lead to weight gain. So even after this kind of operation, it’s important to change your eating habits accordingly, because weight loss doesn’t come ‘easily’, or ‘au- tomatically’, or ‘of its own accord’ after surgery.
A surgical intervention doesn’t mean that patients no longer have to put any effort into losing weight.
I’ll stick my neck out and say a large part of the success of obesity surgery is thanks to its psychological effect. People are more likely to take advice when they have paid a lot of money for it than if it is free.
We tend to defend large in- vestments. Investing in a life-threatening, painful operation can be the trigger for a serious change of diet, so that all that pain you suffered will not have been for nothing.
The psychological mechanisms discussed in the previous chapter also contribute to the great success of obesity surgery: by selling it as a guar- antee of weight loss, self-efficacy expectations are given enormous impetus, and a powerful self-fulfilling prophecy can develop.