Misconceptions about weight-loss surgery

Nearly 42 percent of Americans are obese — up from 27 percent just a decade ago. But losing weight, especially when you have quite a bit to lose, can be a struggle.

Recent studies suggest obesity causes changes in the brain that affect losing weight and keeping it off. Eating a nutritious diet and getting adequate physical activity are the two main factors in losing weight, but your genetics, age, race/ethnicity, hormones, and social and environmental factors also play a role in your ability to shed excess pounds.

A proven, effective solution for obesity is bariatric — or weight-loss — surgery. However, many are reluctant to undergo surgery. In fact, only 1 percent of those who are eligible for surgery have it done.

Reasons behind the reluctance may include the perception that it’s unsafe, that it’s too costly or that taking medications is more effective at achieving weight loss.

We asked MultiCare bariatric surgeons Michael Keating, MD, and Mathew Rawlins, MD, to address the most common misconceptions about weight-loss surgery.

Misconception #1: Weight-loss surgery is the easy way out

Dr. Rawlins: Weight-loss surgery is the opposite of the easy way out. It’s actually the most committed route forward. The easy way out is eating whatever you want, whenever you want. Surgery makes it difficult to overeat, and eating unhealthy food can make you feel sick. Surgery forces you eat healthier, more natural foods that make you feel more satisfied.

Surgery is part of an overall plan that includes education and help developing an exercise regimen, nutritional guidance from a dietitian, and mental health care from a counselor before, during and after surgery.

Dr. Keating: Surgery is not a quick fix; it simply starts the process. It is a tool. If weight loss were a fire we wanted to burn for the rest of our patients’ lives, surgery is the match. The logs that keep that fire burning are the healthy habits (diet, portion control, exercise) that our patients do every day.

Misconception #2: Weight loss surgery is dangerous

Dr. Keating: There are risks with any surgical procedure, it’s true, but it is actually quite safe for most patients. We carefully weigh the pros and cons of each surgery to decide what is best for them and have risk calculators available to us if we need more data. It is dangerous to live at a very high weight, as this is well known to be bad for your health in many ways.

Dr. Rawlins: It’s safer to have surgery than to continue being obese, as obesity-related conditions like Type 2 diabetes and high blood pressure can lead to heart disease, heart attack or stroke, among other conditions.

The first gastric bypass was performed in the 1960s, so there are many years of data; it is a very well-studied surgery. Complication rates are very low, and in the last 20 years, surgery has become safer, more effective, less expensive and less invasive. Sophisticated techniques have been developed over the years, making it an extremely safe surgery.

Misconception #3: Weight loss surgery is too expensive

Dr. Rawlins: Most insurance companies, including Medicare and Medicaid, cover surgery. Out-of-pocket expenses typically total around $20,000, but when you factor in the cost of medical treatment for obesity-related diseases, it has been found that surgery pays for itself in about two years.

Dr. Keating: Surgery can be expensive, but many insurance plans cover bariatric surgery as a benefit. And as Dr. Rawlins mentioned, the chronic medical conditions that take a toll on our bodies and wallets (e.g., need for diabetes or blood pressure medicines, dialysis for renal failure, joint replacements for degenerative joint disease) may be prevented or curtailed with bariatric surgery.

Misconception #4: Diet, exercise and/or weight-loss medications are better options

Dr. Keating: Medications are effective for some, but they often don’t get patients to a healthy weight on their own. Diet and exercise are extremely important parts of losing weight, even with bariatric surgery, but they also frequently don’t get patients the results they want or need. Our patients have tried diet and exercise before seeking surgery, and we want them to continue with portion control, healthy eating and exercise after surgery, or it will not be effective.

Dr. Rawlins: Obesity is a disease. Statistically, most people won’t be able to lose weight and maintain it on their own long term with diet and exercise alone. That’s why new medications like Ozempic and Wegovy have grown in popularity and have made the news — they help people lose up to 15 percent of their total weight. If you weigh 300 pounds, 15 percent of your weight is 45 pounds. However, weight-loss surgery is more effective, as it helps people lose 30 to 35 percent of their weight.

Ozempic, Mounjaro and Rybelsus are approved as treatments for Type 2 diabetes; Wegovy is the only one that has been approved so far for weight loss.

These medications have several drawbacks. They have side effects, including nausea, vomiting and diarrhea. And, aside from Rybelsus (a Type 2 diabetes drug that’s taken orally), they require weekly injections.

Also, we don’t have long-term data. Weight-loss surgery has 50 years’ worth of data; there’s only a year and a half of data on these medications.

Lastly, they are expensive — they cost about $1,200 per month — and most insurance companies only cover it for a few months. For most of us who aren’t celebrities, that’s not sustainable, and it’s clear when you stop taking it the weight comes back.

Taking a medical or surgical approach to weight loss

Dr. Rawlins: If you want to lose weight, it can be confusing to know where to start and what your options are. You are best served when you go to one place to discuss all the options. Maybe it’s working with a dietitian, perhaps it’s surgery or medical weight loss; maybe it’s all three.

At MultiCare, we can take care of obesity at any angle. We have built our multidisciplinary program over the years to encompass dietitians, surgeons and medical bariatricians. Our team works together to come up with the best solutions to treat our patients’ obesity.