One of the chief complaints of bariatric surgery patients is that after several years, they often gain back the weight they lost, just as they might if they dropped it the old-fashioned way, by dieting. According to a 2005 review of dozens of earlier studies, eight years after bariatric surgery, patients had kept off, on average, only 46 pounds. “The surgery can change your physiology but not your psychology,” said a Washington, D.C.–area woman, who asked not to be identified. She went from 300 pounds to 140 pounds after having a gastric bypass in 2001, but when an injury disrupted her exercise routine, she started gaining and is now back to 260 pounds.
“The surgery didn’t change my head,” she says. “I’m a compulsive eater, and you can’t change that overnight.” Since her small stomach couldn’t accommodate a large quantity of food at once, she said, she ate small high-calorie snacks and sweets throughout the day. Other patients have said they drink milk shakes if they can’t handle solid food.
“It’s not a magic pill,” says Nuha El Sayed, MD, an endocrinologist with the Joslin Diabetes Center in Boston, who recommends surgery to some patients but advocates healthy eating and exercise for most diabetics. “People have to understand what the consequences are and what kind of long-term commitment to lifestyle changes they have to make after surgery. It’s not like doctors cut you up and you’re set for the rest of your life.”
What Price Success?
But for Sweeney, who credits the surgery with saving her life, the side effects she has experienced have been eclipsed by the health benefits. Since her diabetes has dissipated, she no longer worries about losing her eyesight and with it her ability to write, edit and drive. She isn’t thirsty all the time, and she doesn’t lose her cool as quickly as she used to, which can happen when blood sugar soars. A digestive disorder linked to diabetes has also improved.
Yet bariatric surgery is much too complicated to be a mass public health solution, like putting fluoride in the water. It costs at least $14,000 and requires that patients be carefully screened beforehand and followed afterward. “The surgery has a remarkable, almost miraculous effect on diabetes, but that doesn’t mean it’s appropriate for everyone,” says Mass General’s Kaplan. “Whether it works is only half of the equation. The other half is, at what cost? You have to take into account the risks and the fact that there are other forms of therapy. The number of people who officially qualify for surgery is in the millions. The aggregate risks of operating on them all would be too high, and the cost would bankrupt us.”
Medical experts are torn between the need for slow and careful research and the huge potential of the surgery. “There are important risks associated with these procedures, and we need to deal with them in a gradual and staged manner,” says Allison Goldfine, MD, director of research at the Joslin Diabetes Center, who is doing a study of diabetes patients that compares gastric bypass surgery with medicine and intensive weight management. “But let’s say it really is going to be the cure for a devastating disease. Should doctors withhold it?”
Roni Caryn Rabin is a regular contributor to the New York Times science section and the author of the book Six Parts Love: A Family’s Battle with Lou Gehrig’s Disease. She lives in New York City.
Originally published in the September 2010 issue of More.