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Gastric Bypass or Laparoscopic Gastric Band?

There isn’t a surgery yet that can change diet.

Theodore Dalrymple


November 19, 2013 - 11:00 am
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Gastric Bypass

When I was a very young doctor I had an enormously fat patient – in those days it was rare to be so fat – who was admitted to the hospital for a long time to try to get her to lose weight more or less by starving her. I still remember her semi-liquid form flowing over the sides of the bed. I tried to be nice and understating.

“I suppose you eat for comfort,” I said to her.

“No, dear,” she replied. “I just like the taste.”

I did no know then that she was (if I may be permitted what in the circumstances is a slightly ridiculous metaphor) the canary in the mine, and that only 40 years later many human mastodons would bestride the world, at least in America and Britain.

With this epidemic has grown a new surgical speciality: bariatric surgery, that is to say surgery to correct obesity. A paper in a recent edition of the Journal of the American Medical Association reports on the results of two types of such surgery to treat obesity, gastric bypass and laparoscopic gastric band.  (How long before a rock group calls itself the Laparoscopic Gastric Band?) The authors conglomerated the results from 10 hospitals so that the results should reflect average practice, not just the very best practice.

Gastric bypass proved to have better results all round than gastric banding, except that there were a small number of deaths immediately after surgery. But the results were distinctly variable even for the same procedure; for example, at three years after operation those who had had a gastric bypass varied between having lost 59.2 per cent of their baseline weight and having gained 0.9 per cent. Those who underwent the gastric banding varied between having lost 56.1 per cent of their original weight and having gained 12.6 per cent. On average, however, the two groups had lost 31.5 per cent and 15.9 per cent respectively of their original weights after their operations.

Most of the weight loss was within the first year after the procedures; one sub-group among the patients began to regain weight after six months, and all began to regain weight after two years. The weight they gained after two years, however, was slight by comparison with what they had lost.

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All Comments   (11)
All Comments   (11)
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I once heard a doctor recommend another approach to weight loss - bury yourself in vegetables and eat your way out.

In other words, except in the very rare cases of actual endocrinal problems (which DO exist), the cure for obesity is in what you eat. No surgery needed.

If you want to change your obesity and/or diabetes, forget the surgery and the fads. Check out Dr. Furhman. Normally, any eating regimen associated with some doctor's name is a fraud, or at the very least, an unbalanced, unsustainable, and unscientific fad that may work for some people for a while.

Not so with Dr. Furhman.

And if you feel you need emergency help, check out Fat, Sick, and Nearly Dead, the story of two men who followed Dr. Furhman's advice with a vengeance.

And no, I have no financial connection to either one.
1 year ago
1 year ago Link To Comment
Neither procedure would improve the mental acuity of Chris Christie.
1 year ago
1 year ago Link To Comment
There is nothing wrong with his mental acuity. He's a smart man.

The problem with Christie is his values.

1 year ago
1 year ago Link To Comment
But both bypass and gastric banding change the metabolism in ways that can't be accounted for merely by less food, and ameliorate T2DM. See, eg, and

I don't think -- given the diets in Continental Europe and the increases in obesity in China and Japan -- that we can assume that "deplorable diet choices" are the root cause.
1 year ago
1 year ago Link To Comment
The one essential factor to the superobese that no one ever spells out is the presence of family members waiting on the afflicted hand-and-foot.

Unlike drug and alcohol addiction, you cannot become super-duper, Fire Department knock-out-the-wall, crane-and-flatbed obese without enablers.
49 weeks ago
49 weeks ago Link To Comment
My best friend just had a bypass and she was off all her type II diabetes meds within 24 hours. Clearly, the surgery changed how her body is working.
1 year ago
1 year ago Link To Comment
Yes, it did.

But for the better?

You don't know from your friend's very short experience.

The long term is what counts, and the long term isn't looking good.
1 year ago
1 year ago Link To Comment
It depends on the alternatives.
Diabetes is a pretty bad thing, it's hard to argue that all the unpleasantness inherent in a gastric bypass stacks up.
And that's by no means the worst alternative out there. My wife had one because it's the only known treatment for the endocrine disorder that was destroying her liver. Without a gastric bypass, she'd be looking at a series of transplants, at best.

The problem with the procedure, is that some people think medicine is magic. The procedure isn't a panacea.
1 year ago
1 year ago Link To Comment
"It depends on the alternatives. "

Yes, it does. As an alternative to a series of liver transplants, it's looks pretty good. For such a person, I'm glad it's available.

The problem is, as an alternative to learning to get off your butt and exercise a bit and stop stuffing your face, it looks pretty good to far too many people.

There are very few people who have genuine endrocinal problems.

There are a lot of people who are just gluttonous and lazy.

1 year ago
1 year ago Link To Comment
Call me politically correct, but I deplore the use of the term "human mastodon." Human beings, whether obese or skinny or somewhere in between, are human beings, made in the image and likeness of our Creator. Our worth and value comes from that, not from our weight. We should speak of each other and treat each other accordingly.
1 year ago
1 year ago Link To Comment
I like and respect Dr. Dalrymple as an insightful writer, but concur that using such terms is disrespectful.

The French, by the way, seem to like food as God intended it to be -- filled with rich fats and not so over-abundantly blessed with the presence of refined sugars or processed white flour. Except maybe their baked goods -- and even those are loaded with butter fat.

Fat doesn't make you fat. Some of us are just not biologically geared to obtain most of our sustenance from easily-digested carbohydrates. But those are precisely the foodstuffs that are cheap and plentiful, and (since about 1980) pushed on us as the healthy alternative to fats. And that was about when this so-called obesity epidemic started. Just sayin'.
1 year ago
1 year ago Link To Comment
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