It always drives me crazy as a personal trainer whose career is devoted to helping clients get fit and health through exercise and healthy eating, when the BBC and the rest of the media blindly promote weight-loss surgery without analyzing the fundamental flaws in this so-called solution to our obesity crisis.
There are 1.4 million morbidly obese people in the UK, and 600 million obese adults worldwide. Is the solution really to give millions of people expensive surgery, or would it not be better to solve this problem with fundamental lifestyle changes and attitude shifts, healthier eating, more activity and exercise, more personal responsibility for one’s own health, and less resorting to excuses and quick-fixes?
Research Published in PLOS Medicine
The research paper, “Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss & Clinical Outcomes in Routine Clinical Care” was published on 22 December 2015 in the Public Library of Science Medicine (PLOS Medicine).
The lead researcher was Dr Ian Douglas (London School of Hygiene and Tropical Medicine). He told the media, “Obviously we would love to help people lose weight in other ways, through exercise and healthy diets, but that’s difficult. Diets do not always work well for everyone.”
This was a very revealing statement, and it’s a shame that no journalist questioned him in more depth. In what way is exercising and healthy eating more difficult than removing most of someone’s stomach by major invasive surgery and completely re-plumbing their insides? Why does the NHS not help people lose weight in other ways?
Disturbingly, Dr Ian Douglas seems to confuse diets with healthy eating. “Diets do not always work well for everyone,” he said. That’s because dieting never works. Dieting is an unhealthy and ineffective way to lose excess body fat and keep it off long-term. It leads to the body’s metabolism slowing to a crawl, “starvation mode” in the face of a drastic reduction in nutrients. Surely a doctor should know this?
Healthy eating vs eating very little
Advocates of weight loss surgery (whether it is gastric sleeve, gastric band, or the complete mutilation of your stomach and intestines known as gastric bypass) always confuse healthy eating with eating next to nothing. This complete misunderstanding of what healthy eating means, leads them down the false path of bariatric surgery as a “solution” to obesity.
Bariatric surgeons say it’s a last resort. They say that people are only offered bariatric surgery if all attempts to lose weight through healthy eating and physical activity have already been tried and not worked.
This statement is totally nonsensical. Someone who eats healthily and exercises regularly over a sustained period will inevitably lose excess body fat. The flaw in the argument is the notion of “already tried and it didn’t work”. This simply means they didn’t eat healthily, they dieted instead, or didn’t sustain the healthy eating for long enough, and they didn’t exercise effectively but just dabbled. NHS resources should be focused on helping obese people lose weight naturally and healthily, and this should include mental health treatment, as many cases of obesity have psychological root-causes.
The bariatric surgery industry is very quick to buy into the “I tried to lose weight but it didn’t work” argument. I guess they have a vested interest in promoting the surgical solution.
Most people who have had weight loss surgery will say they tried everything to lose weight and it didn’t work. But when you question them further, what they “tried” were ineffective techniques in the first place.
After a gastric bypass you will only be able to eat a small fraction of what you could previously eat. This is not a good thing, despite what the bariatric lobby claims. The key to healthy eating is not to eat as little as possible, it’s to eat the optimum amount of the right foods. Gastric bypass restricts your food intake to well below the optimum amounts of protein, vegetables, and foods containing healthy fats.
As a personal trainer to obese clients in London, I find that one of the main problems obese people have is that they are not eating enough of certain foods, mainly vegetables. If you eat more vegetables, and make this your top priority, you’ll lose weight. But gastric bypass victims are forced to eat less of everything, and end up malnourished.
Healthy eating for obese people requires eating more of certain foods, and less of others. Eating less of everything is not healthy.
The research compared 3,882 obese people who had undergone bariatric surgery with 3,882 obese people who had not had surgery, and tracked them for 4 years.
The research found that those who had been given weight loss surgery reduced their risk of heart attacks, type 2 diabetes, and high blood pressure.
The major flaw in these findings is that the control group, simply obese people who did not have surgery, was not a group which underwent the healthy alternative to bariatric surgery, namely a sustained 4 years of healthy eating and regular exercise. Surely it would make more sense to compare the outcomes of bariatric surgery against the outcomes of a group who were given this healthy alternative programme? The reductions in heart attacks, type 2 diabetes and high blood pressure would probably be just as good for this group as it was for the bariatric surgery group, without all the negative consequences of bariatric surgery.
The conclusion also states: “Bariatric surgery as delivered in the UK healthcare system leads to dramatic weight loss.”
When I did my diploma to qualify as a personal trainer, we were taught that dramatic weight loss was inherently unhealthy, and that we should encourage obese clients to lose weight slowly and keep it off long term. There are many downsides to rapid weight loss, from metabolic problems to the issue of loose folds of skin which the body cannot rectify if excess weight is lost too rapidly.
In the conclusion, the research paper stated: “We were unable to look in detail at the short-term adverse outcomes associated with surgery.” So no detailed analysis of the problem of excess loose skin and subsequent surgery to remove it.
I had a personal training client in south west London who had had a gastric bypass several years before I met him, and he regretted having the surgery. His rapid weight loss following the surgery resulted in folds of loose skin around his upper body, which became sore and painful particularly in the summer. He had further surgery to remove the loose skin, but got infections afterwards which took a long time to resolve. All this could have been avoided if he had lost the weight slowly over several years through healthy eating and a varied and sustained programme of exercise.
This is one of the fundamental problems with the whole ethos of weight loss surgery and those who advocate it: the notion that rapid weight loss is a good thing.
The researchers claim that if all the 1.4 million morbidly obese people in the UK were given bariatric surgery, over a 4 year period it could avert 5,000 heart attacks, 40,000 cases of type 2 diabetes, and 80,000 cases of high blood pressure.
However, if all these 1.4 million morbidly obese people were instead given a course of healthy eating and exercise over the same 4 years, the same positive results could be achieved, and in addition these people would be fitter, physically stronger, able to eat properly, avoid the cost and pain and inconvenience and multiple side-effects of bariatric surgery.
The whole bariatric surgery industry is based on false arguments and false choices.
Co-author Professor Rachel Batterham (University College London) told the media: “Bariatric surgery is safe and produces un-rivalled health benefits that are life-saving for patients and cost-saving for the NHS.”
Yet in the research paper there was no comparison made between bariatric surgery and the healthy alternative of good nutrition and exercise. So how can anyone claim that bariatric surgery has “unrivalled health benefits” when the main rival to this method, namely good nutrition and exercise, have not been analysed in the study with a control group?
And in what way is bariatric surgery “cost saving” for the NHS when good nutrition and exercise can massively reduce the risk of heart attacks, type 2 diabetes, and high blood pressure all without any surgery? What about the costs to the NHS of osteoporosis? What about the costs of skin-reduction surgery? And the massive costs of bariatric surgery itself?
Weight Loss vs Change in Body Composition
Another major flaw in the bariatric surgery argument is that it focuses exclusively on weight loss, not on fat loss and the effects on muscle mass and bone density.
Weight loss is a crude measure. The research findings above are based on changes in BMI, which is simply a height/weight ratio, which doesn’t take into account body fat percentage, or changes in muscle mass, or reductions in bone density. My personal training diplomas course in London emphasised the dangers of relying on BMI as a measure of “improvements” in health. Perhaps the medical profession should be trained to recognise the gross shortcomings of using BMI as a measure of health outcomes. BMI is a crude, outdated and largely useless measure.
What if the 3,882 people in the study above had been given body fat analysis before and after, rather than BMI? It may well have highlighted the loss in muscle mass and bone density which results from bariatric surgery.
The costs of osteoporosis
I searched the research paper for a discussion of the effects of bariatric surgery on bone density and the increased risk of osteoporosis, but couldn’t find any mention of this. Surely this needs to be factored into any cost/benefit analysis of weight loss surgery.
Bariatric surgery and high blood pressure
One of the biggest causes of high blood pressure is excess salt consumption. Bariatric surgery does nothing to reduce the amount of salt someone is able to consume post-surgery. High salt snacks are very easy to eat after weight loss surgery. Another major cause of hypertension (high blood pressure) is stress, and there is no reason to believe that bariatric surgery reduces stress levels, indeed there are many reasons why stress levels would increase.
Loss of muscle mass and ability to exercise effectively
One effect of major surgery is that you have to rest for a sustained period, and certainly not perform vigorous or high-intensity exercise, or exercise with resistance (whether it’s with body-weight, or dumbblls, or exercise machines) for several months afterwards. This is ironic, given that one of the most effective ways to lose weight is precisely this form of exercise.
You lose a lot of muscle mass post-surgery, and this problem is compounded in the case of gastric bypass, which prevents you eating in quantities that ensure you’re getting enough protein to build and repair muscle. Indeed, gastric bypass operations prevent you eating healthily ever again. Eating tiny amounts does not equate to eating healthily. Nor is there any guarantee that the tiny amount you can eat after a gastric bypass will be healthy food.
As a personal trainer with several clients who have had weight loss surgery, one thing I’ve noticed is that they fatigue very easily. This is largely because they are unable to eat sufficient amounts of healthy food to sustain an intensive workout.
Effects of alcohol
I must have missed the discussion in the research paper about the effects of alcohol consumption after bariatric surgery, because I couldn’t find it anywhere.
After a gastric bypass, the effects of alcohol on the body are far more damaging on the much smaller stomach. You get drunk faster, you sober up far more slowly, and it is the easiest way to gain visceral fat (toxic fat around the organs) as alcohol is a concentrated source of calories in liquid form, which is far easier to consume after weight-loss surgery than solid food.
This is another misconception of the bariatric surgery brigade. They seem to think that it’s solid food that’s the only culprit in obesity. In reality, sugary drinks and alcohol are major contributors to obesity, and both these things are just as easy to consume in large quantities after weight-loss surgery as compared to before surgery.
There is also the psychological effect of surgery and the increased risks of turning to alcohol as a copying mechanism. The pain and discomfort post-surgery, the reduced energy levels, the unsightly appearance of loose skin, the inability to eat normally and the socially isolating effects of this, the inability to exercise properly, can all push the patient into seeking ways to cope, and alcohol is an all too easy route to take.
Dominic Londesborough is a personal trainer in London who helps obese clients lose the excess fat and get strong and healthy.