Bariatric surgery is medicine’s best treatment for weight loss. But it fails about 1 in 10 patients.

Obesity doctors now consider bariatric surgery to be the most effective and durable treatment for obesity, a disease that’s erupted into a full-blown epidemic in America since the 1970s.

The argument in favor of the most effective bariatric procedures, the gastric sleeve and gastric bypass, is that on average, they help people lose about 30 percent of their original bodyweight and keep most of it off — a far better outcome than a regimen of diet and exercise. They also have lower rates of obesity-related diseases, such as diabetes and cancer, compared to people with obesity who don’t get the surgery.

The trouble is that doctors still can’t predict who will succeed with bariatric surgery and who will be the one in 10 patients for whom the procedure fails. (To learn more about bariatric surgery, read our explainer.)

Individuals, even in the same family, can respond differently to the surgeries. For nine months, I followed a teenager named Jewel Francis-Aburime, and her mom, Justina, who both got the gastric sleeve, one of the two most popular procedures, around the same time. Justina’s hunger and cravings were dramatically reduced, making her weight loss rapid and somewhat effortless. Jewel, on the other hand, remained hungry and struggled to lose weight even after losing 80 percent of her stomach.

Jewel and her mom, Justina, at Jewel’s high school graduation in June 2017, seven weeks after her bariatric surgery. As of December 2017, Jewel weighed 310 pounds, so she lost 76 pounds. Her mom weighed 224 pounds, bringing her total weight loss to 80 pounds since her surgery in March.
 Courtesy of Jewel Francis-Aburime

Over that same year, I talked to a dozen other bariatric surgery patients, and heard about the myriad ways surgery affected their lives — for better and worse. Some people lost all the weight they had hoped to, but others barely lost any. There were patients who experienced no complications following surgery, while others needed additional operations to fix problems or more rounds of weight loss surgery. Some people felt their appetite fade away; others simply replaced their food addiction with other addictions or found ways to eat more food.

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