Alternatives to Consider for Bariatric Surgery

Bariatric surgery consists of gastric bypass and other weight-loss surgeries such as adjustable gastric bands and sleeve gastrectomy. These surgeries involve making changes to the digestive system in order to lose weight.

Bariatric surgery is typically done when diet and exercise have not resulted in long-term weight loss, or serious health problems are thought to be weight-related. Some procedures limit how much one can eat while others work by reducing the body’s ability to absorb nutrients. Some procedures do both.

Bariatric surgery is a major procedure that can pose serious risks and side effects, which include:

• Risks associated with the surgical procedure can include:
• Excessive bleeding
• Infection
• Adverse reactions to anesthesia
• Blood clots
• Lung or breathing problems
• Leaks in your gastrointestinal system
• Death (rare)

Longer-term risks and complications of weight-loss surgery impact both physical and mental health and can vary depending on the type of surgery. They can include:

• Bowel obstruction
• Dumping syndrome, which leads to diarrhea, flushing, lightheadedness, nausea or vomiting
• Gallstones
• Hernias
• Low blood sugar (hypoglycemia)
• Malnutrition — iron, calcium, vitamin D, vitamin B12, zinc, copper deficiencies are common examples and can impact long-term health (bone health, hair loss, poor immunity, anemia, defects in neuromuscular function). Rare deficiencies can lead to serious complications such as encephalopathy or protein-energy malnutrition.
• Ulcers
• Vomiting
• Acid reflux
• The need for a second, or revision, surgery or procedure
• Food intolerance
• Maladaptive eating behaviors due to pre- or post-surgical eating disorders
• Increased risk of developing alcohol use disorder
• Increased risk of self-harm and suicide attempts
• Persisting disorder in psychological outcomes like depression and body image
• Death (rare)

In order to be successful at achieving long-term health goals after bariatric surgery, permanent healthy changes to diet and exercise must be maintained.

Long-term compliance to health behavior changes is often poor for bariatric patients, and researchers have stressed the importance of participating in multidisciplinary pre- and post-operative therapeutic education programs.

Researchers suggest that patients attend regular and on-going clinical visits and follow-ups that are monitored and coordinated with their general practitioner and a bariatric team made up of their surgeon, obesity specialist, dietitian, and mental health professional/s.

Alternatives to consider for bariatric surgery

Due to the significant risks, both short- and long-term, associated with bariatric surgeries, it is important to consider other alternatives, which optimize both physical and mental health. These alternatives include balanced eating and life-enhancing physical activity.

Engaging in balanced eating and life-enhancing physical activity may require the support of mental health professionals and dietitians who utilize Health at Every Size (HAES) and Intuitive Eating (IE) approaches, which are weight-neutral and holistic approaches to health that focus on health behaviors rather than weight.

Working with these professionals can help pinpoint the reasons you may be struggling with these health behaviors, and they can work with you to overcome these struggles.

According to Tina Laboy, LD, RDN who is a Certified Eating Disorders Registered Dietitian Supervisor, Certified Intuitive Eating Counselor, NASM Certified Personal Trainer, and co-founder of Texas Eating Disorder Dietitians, “Studies show that individuals that engage in bariatric surgery for weight loss or health improvements have actually more malnourishment than those that attempt intuitive eating.”

Laboy continues, “When comparing those that engaged in very low-calorie diets to those that engaged in intuitive eating, at the two-year mark the intuitive eating group had improved health benefits including blood pressure, cholesterol levels, and also improved mental health and body image while the very low-calorie diets had decreased health markers. When we continue to focus on deprivation and restriction as the healing to our health, then we continue to harm it.”

Laboy says, “Getting to the core of the struggle with your food and behaviors can help create a long term solution to your struggle and permanent lifestyle changes.” She explains that this is not only done through health behavior changes, but through tending to mental health as well.

“In my opinion, [bariatric surgery] is a temporary fix. It’s like putting a bandaid over a large wound. In the long-term, it only creates more problems. However, if we can focus on the core struggle and connect to our bodies, then the true healing can begin.”

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Sources:

Mayo Clinic. Bariatric Surgery. Retrieved from https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258 on Dec 14, 2019.

O. Ziegler, M.A. Sirveaux, L. Brunaud, N. Reibel, D. Quilliot, (2009). Medical follow up after bariatric surgery: nutritional and drug issues General recommendations for the prevention and treatment of nutritional deficiencies. Diabetes & Metabolism, Volume 35, Issue 6, Part 2, Pages 544-557, https://doi.org/10.1016/S1262-3636(09)73464-0.

Gletsu-Miller, N., & Wright, B. N. (2013). Mineral malnutrition following bariatric surgery. Advances in nutrition (Bethesda, Md.), 4(5), 506–517. doi:10.3945/an.113.004341

Azam, H., Shahrestani, S., & Phan, K. (2018). Alcohol use disorders before and after bariatric surgery: a systematic review and meta-analysis. Annals of translational medicine, 6(8), 148. doi:10.21037/atm.2018.03.16

Castaneda, D., Popov, V.B., Wander, P. et al. (2019) Risk of Suicide and Self-harm Is Increased After Bariatric Surgery—a Systematic Review and Meta-analysis. Obesity Surgery, 29: 322. https://doi.org/10.1007/s11695-018-3493-4

Jumbe, S., Hamlet, C., & Meyrick, J. (2017). Psychological Aspects of Bariatric Surgery as a Treatment for Obesity. Current obesity reports, 6(1), 71–78. doi:10.1007/s13679-017-0242-2

Association for Size Diversity and Health. The HAES Approach. Retrieved from https://www.sizediversityandhealth.org/content.asp?id=152 on December 14, 2019.

Laboy, T. (2019. Dec 15). Email, personal Interview.

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About the Author:

Chelsea Fielder-Jenks is a Licensed Professional Counselor in private practice in Austin, Texas. Chelsea works with individuals, families, and groups primarily from a Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) framework.

She has extensive experience working with adolescents, families, and adults who struggle with eating, substance use, and various co-occurring mental health disorders. You can learn more about Chelsea and her private practice at ThriveCounselingAustin.com.

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The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published December 20, 2019, on EatingDisorderHope.com
Reviewed & Approved on December 20, 2019, by Jacquelyn Ekern MS, LPC