Posted by: notdeaddinosaur | May 29, 2011

Bariatric Brilliance

Say you’re a bariatric surgeon. You’d think Americans would be beating a path to your door. After all, this is the land of Instant Gratification! Who wants to just eat less for the better part of a year to lose 50 lbs when one can be cut open and have one’s gastrointestinal anatomy rearranged — resulting in the necessity of eating less, but why quibble — to lose that same 50 lbs (or more)? Changing lifestyles is boring; surgery is exciting!

Funny how it turns out that in order for the surgery to succeed long-term, patients have to commit to lifestyle changes anyway. In fact, before any reputable bariatric surgeon will operate, patients have to demonstrate their dietary commitment by actually losing some weight on their own, prior to surgery. What I don’t understand is why people then go ahead with the damn surgery anyway? Logically, it’s almost like you have to prove you don’t need it before you can have it. Hey, I’ve never said I understand people.

Perhaps overcoming this paradox is the explanation for the behavior of a certain bariatric surgeon, brought to my attention by a mutual patient.

Before scheduling the procedure, the patient must undergo an exhaustive medical workup: sleep study, cardiac stress testing, gall bladder ultrasound, upper (and sometimes lower) endoscopy, and blood testing, not to mention Pulmonary, GI, Cardiac, and psychological consultations. Once you get through with them, you can be pretty sure that you’re in damn good shape. All you need to do is lose some weight.

My patient’s workup was complete. She was all set to schedule the surgery. Unfortunately, she’d gained a few pounds between appointments. The doctor came into the room and began to speak.

“You’ve got to quit eating those potato chips by the bag! What do you do, make a whole pot of mashed potatoes and eat them with a wooden spoon? Hey, I’m a big guy; I can get away with it. But you’ve got to cut down.”

Epic WTF, thought my patient.

Usually a fairly calm, collected personage, she was so shocked, she could hardly believe her ears. Her psyche heard it loud and clear, though. She was so upset and discouraged, she told me, that although she never eats while she cooks, she went home and proceeded to consume half the food she was preparing for a large family dinner. She eventually calmed down (I like to think telling me about the encounter was helpful) and consulted me on the advisability of going through with the surgery.

“Excuse me,” I said to her. “Why on earth would you allow someone who talks to you like that to cut you open?”

She concurred.

No procedure was scheduled. Interestingly, she has continued to come to me monthly, demonstrating a steady 4-5 lb weight loss each visit.

Still, I was struck by the man’s brilliance: humiliate your patients into morbid obesity. A unique marketing strategy, to say the least.



  1. Working with Americans, a huge percentage of whom are bariatric patients, requires an understanding that many behaviors that we deem “voluntary” are a bit more complicated, such as drug and alcohol use disorders and disordered eating.

    At this points studies show pretty plainly that bariatric surgery is safe, effective, and cost-effective in the right patients.

    No patient will be “cured” simply by having surgery, but it will give them about 2 years to change their behaviors as they will not be able to resume their normally maladaptive eating habits during that time.

    There is much to “adherence” that we as physicians fail to understand and to take into account.

  2. So you approve of humiliating and degrading patients into sabotaging their behavior modification efforts in order to consummate the surgical relationship? Please!

    I’m not talking about adherence, nor about bariatric surgery itself. I’m calling out a colleague (ashamed as I am to call him that) for his inexcusably rude treatment of a patient.

  3. Sadly, the behavior of your rude colleague is not at all unusual. I had a similar experience not long ago with an orthopedic surgeon. I am morbidly obese and need a new hip. As have several other 1st order relatives of normal weight. This surgeon knows me, having reconstructed my husband’s shoulder, yet *invited* me for a consult. The sole purpose of which seems to have been to berate me about my weight. I went home and ate an entire key lime pie, in tears. I, and my overweight and obese friends, have come to expect this from the medical profession.

    Fortunately, I’m having the surgery in 2 weeks. I saw another surgeon at a different practice. He also wanted me to lose weight before surgery but asked in a respectful manner with reasonable goals. Since December I’ve lost 10% of my body weight.

    As for weight loss surgery, it provides a constant reminder and reinforcement of your goals. I would not have lost the weight I have without the constant pain and hope of relief to keep me on track when my body is screaming to be fed. I would love to have had lap band and lost more, but my insurance does not cover it. I’m not sure what will happen with my weight after I recover from surgery.

    I do know that my husband has lost 100+ lbs with his lap band. He’s had a life-long struggle with his weight and this is truely the only thing that has worked. And it’s not lack of “will power”–he quit smoking cold turkey after our 3rd date because 2 of my daughters and I have asthma. I wish he’d had it sooner, before Type II diabetes damaged his peripheral nerves and blood vessels…

  4. The problem, as you point out, is the long term effectiveness of the surgery. I have patients who have done quite well for a long time and I have also seen a really heavy guy wearing a t-shirt that reads, “I beat bariatric surgery.”

  5. […] Closing: porn; abortion; blast from the past; War on Drugs; humiliation; security; and […]

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