(PERSPECTIVE OF A BARIATRA SURGEON)

Many of my patients’ questions are focused on the goal they will achieve with weight loss surgery (WLS), this is how much weight they will lose, and how fast, I respond them  an estimate according to the world literature and the type of surgery to perform, generally what I tell them is enthusiastic and satisfied, because it is quite the expected loss, however none of my patients ask me  how long that result will last, and this is as important in my opinion as the first question.

Weight loss surgery like all fields of medicine is not an exact science and its results are influenced from a large number of factors and variables ranging from genetic inheritance and associated diseases, through surgical technique (the form that  we to do the surgery), to the  habits and discipline of the patient (it is here where the bariatric surgeon can least influence, the patient’s mind)

It is usually those patients with a healthy and positive mental state where bariatric surgery obtains its best results, those who are well informed of what is going to be done to their bodies and who know the scope and limitations of weight loss surgery, are those people who will give the best of themselves to help the surgeon to help them achieve their goals and have optimal results.

saying that with weight loss surgery the surgeon operates the stomach not the brain (or rather the mind) is equivalent to saying that weight loss surgery is not the magic wand with which you can solve your obesity problems during the overnight.

While it is true that weight loss surgery has astounding results, it is also true that it takes work and dedication for the patients to maintain those results.

In other words to perform a weight loss surgery, it would be like acquiring the best tool available to achieve a healthy weight and improve metabolism, but as any tool is required to learn to use it correctly and just put it in the right hands because in the wrong hands could even be dangerous, an example would be that patient who two days after a Gastric Bypass “decided to eat a whole hamburger because he felt good,” obviously the patient suffered from a rupture of an anastomosis with the corresponding intestinal leak and the patient ended up in the intensive care unit very close to death.

Alright, you Already decided to perform the weight loss surgery, because you have already tried all kinds of diets and exercises and the results have been disappointing until now, am I right?

Okay, congratulations, you have already decided to acquire the best tool available to lose weight, improve your health and be a new and better person.

What’s next?

It is very easy and difficult at the same time, to learn to live with it, to acquire better habits, to be aware that the new and fantastic road is just beginning and that you will require motivation and effort to maintain the excellent initial results that you will have with weight  loss surgery and of course you will have to research  how best to use that wonderful tool that you have just acquired, it is in this part where the intervention of a multidisciplinary team will be a great help to achieve your goals, I am talking about psychological therapy and nutritional counseling.

This type of surgeries are contraindicated in those people where their mind plays against them and by that I mean those with compulsive eating disorders, or those who use food as a coping mechanism, also in people who do not understand  which has been modified in their bodies, we speak of mentally retarded, dementia, schizophrenia or people very old or very young children.

But for those people who understand and accept the acquired anatomical changes and believe possible the modification of those bad habits of feeding and sedentarism, then in these people it would be possible to observe the wonderful results that everyone wants for good

It is well known that weight loss surgery is divided into that which restricts the amount of food you can ingest, that which decreases the amount of food you can absorb after having eaten and the combination of both (Restriction and malabsorption).

In my personal opinion  the restrictive factor of surgery is the most important to achieve a lasting change in your bad habits, because it is what in the beginning will make you eat less quantity and more times a day and if you manage to make this a habit then weight loss surgery will be successful for many, many years.

So …. how to use the Tool (WLS)?

Weight loss surgery will initially provide you with the restriction on the amount of food you can eat at one time and this will make you eat more times a day (increasing your metabolism).

If you first get a little aware of this situation and add a little effort to change the junk food for healthier food, and secondly you create of this way of eating a habit, then you can keep that restriction to the amount of food for many, many years thus maintaining a healthy weight.

Remember that the stomach is a muscle and it is elastic, so if every time you eat something you distend the stomach to the limit, then that stomach (Gastric pounch in the Bypass or Gastric sleeve) will be progressively enlargered and in a few years you will lost  all restriction that you had and you will can eat a double-hamburger at dinner.

On the other hand is the aspect of the decreasing the absorption of calories, which we achieve when we do intestinal bypass in order that the food and digestive juices do not pass through all the length of the bowel and therefore is absorbed less of what you eat, with this you surely will lose weight, but again, over the years the intestine despite being shorter the stretch through which food passes will “learn” to absorb more and will absorb everything you eat, if by then the restriction was also lost then you start regaining weight.

That is why weight loss surgeons will make the necessary modifications in your body to have restriction, low absorption, or both.

We will give you the best tool available to lose weight and/or improve the control of your diabetes, how  long  that tool will last will depend entirely on you (here, I insist, you need some help from nutritionists and Psychologists).

Remember that we operate the stomach not the brain (mind).