I am noticing more and more that weight loss surgery as a solution for obesity is all the rage. It used to be that only people severely obese (on the verge of death due to major health complications and no ability to exercise anymore) would have Bariatric surgery performed to save their life. Its original purpose was to help save lives of those who were struggling severely and had no other options.

Today, there are young people and relatively healthy people having this operation and they sometimes weigh in at 250 or less pounds.

While these operations can be a really good option for folks who really need it, they should not be used as an easy way out of weight loss for healthy people who still have the ability to exercise and diet and lose weight using other tools.

What people do not realize is that there may be major psychological, social, and spiritual affects (depending on your own belief systems).

In the United States, we’ve developed a system of psychological evaluation to address the reasons why someone is having the surgery and test their mental competence, but it can be difficult to impossible to predict what will happen to a person following the operation. The body is not the same as it was before. Drastic physical and emotional changes occur within the body following Bariatric surgery.

Patients have to be extremely disciplined and militant in their self-care following these operations to just live a relatively normal life. The reason is there are going to be vitamin deficiencies and limitations in the body that were not previously there. That means they have to have regular vitamin injections and eat several times a day with extremely small portions among other things like further psychological evaluation and support after the operation. They may be told that they cannot exert themselves like they used to because they could deplete the small amount of water or vitamins they ingest in the small portions they are now forced to live with.

Most patients who decide to go through with the operation may say they are committed to all of this, but are they?

Let’s think realistically. We have busy lives and live in a society that is constantly busy and offers limited time for breaks at work or even at home. This makes it very challenging to stay on top of special diets and other practices that are suddenly part of life post op. And, if someone didn’t do a good job of disciplined dieting and exercise before the operation, it’s not likely they will follow a stringent plan after surgery either, and not doing so could cause major damage to the body and even become fatal.

People who choose to do these operations are choosing to give themselves a health condition with life-long consequences, and they need to be aware of that.

There are hormonal changes related to vitamin deficiencies that could even push people into old age.

There can be profound psychological impacts, some of which are still unknown.

What does the mother with 3 kids do when she has run out of energy and can’t keep up with her kids because she can’t consume enough nutrients?

Further, some people are traveling to other countries to have these operations performed for less money, but the healthcare is not as good and the pre and post op activities are not nearly as stringent as they are in the U.S. They cannot be held liable if they cut too much away or do something that causes a major internal infection in the stomach.

Let’s also take a step back and think about what happens physically, emotionally, and spiritually as well.

To put this into perspective, we have a second brain in our gut. Our gut brain is directly connected to our real brain via the Vagus nerve that runs through the body. When we are excited, scared, angry, nervous, in love, or making major decisions, we always feel it in our gut, right? When our bodies go into fight or flight mode to protect us, we release adrenaline that is felt in the gut. So, what happens when we cut away 80% of our guts, which is the system our body was designed with to process nutrition AND emotion?

Patients simply may not have the capacity to have the stamina or health level they were able to achieve prior to the bypass.

It’s no surprise that losing tons of weight in a rapid amount of time would have a psychological impact on patients. However, it isn’t known how deep that rabbit hole can go. We do not have all the stats we need yet, and there are variables involved as well, so information is not being publicized enough. Medical information around these procedures is in its infancy.

That said, it has been known for years that stomach surgery for obesity frequently has long-term neuropsychiatric effects including Wernicke’s and other encephalopathies (Neurology 1987;37 196-200), depression and substitute addiction.

In the relatively small number of cases I’ve observed, there were instances of stomach infections and other stomach and digestion-related health issues on top of deficiencies. This even resulted in death for some.

The body simply cannot operate the way it did before in many cases. This makes logical sense, as the amount of water that can be ingested by a human who hasn’t had this operation is drastically reduced after because of the size of the stomach. So, people have to choose to eat or drink and have expressed that they are either hungry or thirsty most of the time. This means nutrients is not handled the same way it used to be and that can cause the immune system to have to work harder as well.

Please understand that I am not judging. If you’ve had this operation or your loved one has, please don’t be angry with me. This operation has saved lives of people who would have died from high cholesterol, high blood pressure, and a number of other heart and health complications. I get that.

All I am saying is people need to consider choosing surgery ONLY when they absolutely need to have it and not as a means to lose weight faster or look more beautiful or handsome. Doing that is like burning the whole house down because it’s a mess. There are many options out there for weight loss, which include dealing with the emotional component of eating as well.

I have a short course about dealing with emotional eating, which you can find HERE.

There is still MUCH more work to be done in researching and documenting long-term effects of weight loss surgery. Below are some links to articles on the subject.

(Current Opinion in Psychiatry: September 2014 – Volume 27 – Issue 5 – p 374–379),
(https://www.psychologytoday.com/us/blog/the-truth-about-exercise-addiction/201611/the-mental-health-struggles-weight-loss-surgery)

self-harm (https://www.medscape.org/viewarticle/894158, https://www.health.harvard.edu/newsletter_article/Psychological_aspects_of_bariatric_surgery), new-onset mania (Psychiatry Investig. 2015 Jan; 12(1): 152–154.),

and vitamin B1 and B12 deficiencies
(https://jamanetwork.com/journals/jamaneurology/fullarticle/786290).

**This article should not be used to treat or diagnose any condition related to bariatric surgery. This is written from one perspective based on observation and personal opinion as well as some research. You should seek medical advice from your doctor if you are considering this type of operation.

The sisters, Regret and Guilt, look a lot alike but they are very different.

When Regret makes a mistake she cries, “Oh, I wish I hadn’t done that!” or “Why did I do that?” or “I’m never doing that again!”

But when Guilt makes a mistake she yells, “You idiot, you blew it again!” or “You are such a loser-what’s the matter with you?” or “You might as well give up; you’re never going to get it right.”

Regret makes mistakes all the time. She figures that everybody does, especially when they’re learning something new. Regret doesn’t even really seem to mind making mistakes because she always learns something that helps her do things a little differently the next time. She even laughs at herself and shares her mistakes with others so they’ll learn too. She doesn’t care that other people sometimes do things better-but she wants to be the best she can be so she never gives up trying.

Of course, Guilt makes mistakes too but she blames herself because she believes she should know better. Instead of helping her learn, her mistakes just prove that she is a bad person and that something is wrong with her. She is often angry with herself and sometimes other people. Secretly, she feels unloved and unworthy so with every mistake she resolves to do things perfectly the next time to prove to everyone else that she is good enough.

One day, Regret and Guilt agreed that it was time to make some lifestyle changes. Regret regretted that her energy level was low and she wasn’t able to do all of the things she wanted. Guilt felt bad too-guilty that she was “too fat and lazy.”

Regret. . . messed up, then made a plan.

Like most people, Regret had been on dozens of diets and knew they just didn’t work for her. She decided that this time she would make small changes to the way she ate. She started by paying more attention to her hunger and fullness cues. It sounded simple enough but it wasn’t as easy as she thought, especially when someone brought donuts to the office. After two days of eating donuts mid-morning, she realized she needed to make a plan. She gave herself extra time in the morning to have breakfast and pack lunch. She also made a list of other things she could do when the donuts were calling her. She continually tweaked her plan to figure out what worked the best and congratulated herself on her small successes.

A few days into it, she had a really stressful day at work and was thrilled when she remembered that it was her co-worker’s birthday because that meant cake! She wasn’t hungry but had a piece of the delicious chocolate cake while she celebrated with her friend…then went back for another piece after everyone else returned to their desks. Within an hour she noticed she felt tired and a little sick-but still stressed out. Regret regretted her decision to have the second piece of cake-but not the first! She decided that next time she felt stressed she would take a short walk instead of going back for more.

Guilt. . . disaster struck!

Guilt liked the idea of using hunger and fullness too-but she had failed on so many diets that she doubted she would do any better with this approach. She told herself that this was her last chance to get it right so every time she felt like eating she made sure she was hungry first. She felt great because she was doing it perfectly! After a week of only eating when she was hungry, disaster struck. She had already eaten most of her lunch at her desk when her boss showed up with cake to celebrate Secretary’s Day. She had a piece even though she wasn’t hungry. Within a few minutes she was berating herself for her terrible mistake, knowing that she had failed at this too. She gave up and went back for a second piece. She felt so bad about herself that she picked up a pizza and ice cream on the way home. After all, she couldn’t even get this right so what was the point?

Although Guilt was well intentioned, her unrealistic expectations and the shame and blame she heaped on herself were preventing her from learning, improving, and forgiving herself when she made choices that didn’t work out well. She even felt guilty for feeling guilty!

Perfection is not possible–or necessary.

She finally asked her sister for help. Regret explained that while there’s always room for improvement, toddlers fall down many times before becoming proficient at walking. They may cry but they don’t feel ashamed. Instead they get up, make adjustments, and try again. Her favorite words of wisdom:   Perfection is not possible–or necessary. When you make a mistake, don’t miss the lesson. Small changes slowly add up to big changes.

*This article was originally written by Dr. Michelle May, M.D. founder of “Am I hungry.” This information does not take the place of medical treatment