Weight Loss Surgery (WLS) is often viewed as a quick fix for morbid obesity. One day a person is fat, the next they are not. While it may appear to onlookers that a gastric bypass patient is losing the weight without personal struggle or effort, this really isn’t true. WLS patients must follow four rules for success and they experience four phases of growth following surgery.
The four rules for successful weight loss and long-term weight maintenance are: Eat protein first; No snacking, Drink lots of water and Exercise daily. Adherence to these rules moves the patient smoothly through the four stages of bariatric growth which I define as: Conception, Infancy, Adolescence and Maturity.
Conception begins when patients consider surgery as a treatment for morbid obesity. It could be prompted by a life threatening illness such as heart disease, diabetes, high blood pressure or high blood cholesterol, asthma, heartburn or sleep apnea. Or perhaps lifestyle prompts it – a person may lack the energy to play with their children or pursue the activities they love. Maybe self-esteem is so low because of obesity that a drastic measure – surgery – is needed to restore a sense of self-worth.
Conception is followed by birth, an event left entirely to a carefully selected surgeon and staff of healthcare professionals. The surgeon partitions off most of the stomach creating a pocket or pouch that will hold one ounce of food. In most gastric bypass surgeries the digestive system is re-routed to bypass the intestine and shortcut to the bowel. This prevents too many calories from being absorbed and stored by the body in the form of fat. The patient wakes from the surgery a bariatric infant.
Infancy On the second day of my WLS infancy my surgeon stood at my hospital bedside and showed me a cup, the size in which sacramental communion is offered and he said “This is the size of your stomach now.”
Just like bringing a newborn home from the hospital the bariatric patient brings home a tiny newborn tummy that has all kinds of requirements and restrictions. This new tiny tummy is completely foreign to the behaviors and habits that caused obesity. There is not one single thing an obese person has done in the past that they can continue doing. Patients who strictly follow the four rules quickly become acquainted with their new tiny tummy. This is the time of rapid weight loss. For the first time most morbidly obese patients are consistently losing lots of weight, something they have never experienced before. Infancy for most bariatric patients lasts from nine to 18 months.
Similar to parents of a firstborn child who focus completely on their new baby, during bariatric infancy patients completely focus on their new tiny tummy. Then one day, without fanfare, they wake up and rediscover themselves. They enter adolescence.
Adolescence Adolescence is the stage when patients test the system. Many patients don’t dump, vomit, snack or eat the forbidden foods until they reach adolescence. But once they approach or reach target weight a mental bad boy shows up in a shiny black corvette saying take a ride on the wild side. So a patient jumps in the bad boy’s fast ride and speeds down a dangerous road. They break the rules! Perhaps they eat sugar which results in a blood sugar imbalance called “dumping” or they may stuff themselves with starchy carbs causing vomiting. In the worst case, a patient returns to snacking, a little treat of hard candy here and a handful of popcorn there. Mark my words, nothing stops-short weight loss or maintenance more quickly than a little bit of rule breaking. But like any teenager, we all have to learn it on our own.
The good news: the duration of adolescence is up to the patient! A patient only hurts themselves when they break the rules. Successful WLS patients commit to themselves early to be in control of their own gastric bypass growth cycle. However, some WLS patients get stuck in adolescence. I’ve heard many say, “Oh, I can eat anything I want, just not much of it.” Don’t believe it for a minute. They aren’t saying how often they vomit, or dump or how they never quite achieved their weight loss goal. Weight loss patients who eat anything they want are abusing their tool and stuck in perpetual adolescence.
Maturity At maturity a patient understands the gastric bypass system and is living the life they dreamed. They have achieved desired weight loss and are maintaining a healthy weight. A diligent patient can enjoy this phase for the rest of their life.
I believe WLS maturity is reached when patients understand one word: respect. Respect for the tiny tummy, respect for the science of the body, and respect for oneself. Sure, we all experience an occasional lapse of judgment; that old lover of ours – food - is flaunting temptations every single day. But the gastric bypass patient is a brave and powerful person.
Successful patients build on infant and teenage experiences and become an adult embracing all the good things gastric bypass has facilitated. The battle against obesity isn’t easy; patients will fight old habits for the rest of their life. Gastric bypass is a tool, a weapon in the battle against obesity, but it is the patient who wins the war.