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plural noun: decisions

• a conclusion or resolution reached after consideration.
• the action or process of deciding something or of resolving a question

A study recently published in the Journal of the American Medical Association revealed shocking data about weight loss surgery. This study looked at 8,000 morbidly obese people who underwent surgical weight loss and compared them with 25,155 morbidly obese people who tried non-surgical attempts at weight loss. The death rate over 4.5 years among patients who had bariatric surgery was 1.3%.  The death rate over 4.5 years among patients who did non-surgical weight loss attempts was 2.3%.  The health benefits of weight loss are widely known, and the weight loss that results from bariatric surgery is also common knowledge. But seeing those numbers demonstrating that the death rate was cut in HALF by surgery was very impactful.  The 2.3% of those 25,155 represents nearly 600 real people with families, jobs, interests, friends, etc. who are now dead.  According to this data, roughly 300 of them would still be alive if they had decided differently when choosing whether or not to have bariatric surgery.

We make thousands, if not millions, of decisions every day.  Some decisions like what music to listen to on the drive to work are pretty unimportant, and others, like whether or not to put on our seatbelt, are extremely important.  As a community, we need to take the decision of bariatric surgery very seriously. As individuals are we doing everything we can do to be healthy? As family members and friends are we supporting and encouraging our loved ones to consider this procedure that very well may save their lives? As doctors are we educating our patients on the overwhelming evidence of the benefits of bariatric surgery?

There are always concerns about the lifestyle changes required, the stories of some who regain their weight, the fear of a complication, and of course the cost. Those are all valid concerns that should be addressed and thought through carefully. Let’s look briefly at some of these.

The lifestyle changes required to be successful long-term after bariatric surgery are not anything supernatural. You must eat healthfully. You must exercise. You must drink water. You must take your vitamins. You must see your doctor periodically and get blood work. These are things that most of us have been told since we were children. They are the recipe for a healthy life, and one of the beautiful things about bariatric surgery is how inspired patients become to adhere to this recipe when they see the weight coming off!

Everyone knows someone who had bariatric surgery and regained the weight. Studies show on average patients maintain 60-70% of their initial weight loss for over 10 years. That is a tremendous success rate. The long-term success rate of non-surgical weight loss in patients with a BMI over 40 is roughly 5%. Imagine those odds in any other realm of life and the answer is pretty clear.

The risks of complications with surgical procedures is a concern to many. But when we look at the data in articles such as the JAMA article mentioned above, the risks of complications from morbid obesity far surpass the risk of complications from a surgical procedure. Choose a surgeon who is solely committed to bariatric surgery, who has a high volume of surgical experience, and who has a multi-disciplinary program for full patient support.

Lastly is the issue of cost. Many employers offer health insurance that covers bariatric surgery, but not all. The cost of surgery has decreased considerably in the last years thanks to our ability to perform some of the surgeries in Ambulatory Surgery Centers. Currently, Sage Bariatric Institute in San Antonio offers sleeve gastrectomy for qualified patients for as low as $9400. This equates to less than $9 a day for only 3 years.

The astounding evidence of the risks of being morbidly obese are too great to ignore. When deciding on bariatric surgery, perhaps the greatest question one really should be asking is, “Can I afford NOT to do this?”.