Weight Loss Surgery

by Paul Ernsberger, PhD.

Paul Ernsberger, PhD, Case Western Reserve School of Medicine, wrote this commentary in response to a reporter’s request for information on the controversial subject of weight-loss surgery. November 1999.

This is an issue where it has been very difficult to get a balanced perspective. In my experience, most physicians, especially academic physicians, disapprove of these operations. However, they will only admit this in private, because of an unwritten law in medicine that forbids one to speak ill of another’s procedure. Thus, there is no one with an MD after their name who will appear on camera and criticize the operation. If you do persist in trying to find one, I suggest talking to some gastroenterologists. These are the specialists who have to take care of patients suffering long-term complications from the operations. The surgeon typically only sees the patient for a few follow-up visits –the ones who suffer complications or regain the weight are too angry or ashamed to return to the surgeon. So the surgeon gets a biased picture –only the successes come back. Part of this is because it is drilled into the patient that if the surgery fails it is “their fault” because they “out ate” the surgery (i.e. consumed more than 3 ounces of food per meal).

1. All of the operations, old and new, are based on an incorrect assumption: that the stomach is no more than a passive sac for receiving food. In fact, it is a critical digestive organ and cannot be cut away or bypassed without compromising the digestive process.

2. The operations work by forcing the patient to consume small meals. If a meal of more than 3 ounces is consumed, the patient will vomit. Vomiting is very frequent for some patients, but they will not often admit it, because they have been told that the vomiting is “their fault”. The operations follow the same concept as wiring the jaws shut–an involuntary restriction of food intake.

3. The stomach is very expandable, and over a period of years will regrow. If part of the intestine is bypassed, the remaining intestine will also adapt. The result is that weight loss peaks at about two years after the operation (versus one year after older types of surgery), and then there is a gradual but accelerating regain of weight. Certainly, surgeons can bring forward patients who have kept the weight off, but the same is true for every weight loss plan. The difference with surgery is that the rearrangement of your digestive tract is permanent and so are the side effects –even though the weight loss is temporary. This is an important point because the typical persons getting the operation is a 30-year-old woman. Extremely obese 30-year-old have 40 years of life expectancy (versus 45 years of they were thin). Thus, to actually extend lifespan the surgery must keep weight off for life. This is not likely unless new operations are done every 5 to 10 years.

4. Almost every surgeon does a different operation. This should tell you that there is no ideal operation. If the surgery was so wonderful, why are all the surgeons experimenting with different techniques? Also, why has there been no animal testing of these operations, as there is with every other kind of surgery?

To summarize about the new surgeries, they all follow the same principle as the old surgery. The laparoscopic procedure is faster and will allow surgeons to do a greater number of operations in less time, but the effects on the digestive tract and the absorption of nutrients into the bloodstream will be the same.