Do I support a family member taking drastic surgery or not?

October 4, 2012 12:28 AM

I’d like to know if any has had gastric sleeve surgery or has a family member who has undergone this type of procedure? Can anyone tell me their experiences, pros and cons, what to expect and how to come to terms with and support someone who thinks this is the right choice for them?

Background info is that a close family member (female, 30yo) has serious weight issues and has had for most of her adult life. She also is diagnosed PTSD and ADD and takes a host of medications since around age sixteen. She is a single mum with a 6yo daughter, their relationship is more like friends than one of parent and child (in regard to lack of discipline). The mother is not really able to perform everyday tasks, she’s highly unrelaiable, she hasn’t worked for around 8-9 years and lives in a bit of an imaginary world. Currently, her BMI is around 63, morbidly obese, (at 160cm or 60inch tall and about 160kg or 350pounds). Finally her many doctors and shrinks are starting to tackle her weight, as such her psychiatrist has been pushing for gastric surgery for a few months now, as a final bid for her to loose weight. She has visited the surgeon who suggests that the best procedure would be what’s called a gastric sleeve.

I am a somewhat concerned family member who isn’t sure if I should be encouraging this drastic surgery or if I should be encouraging her to get herself together and try natural ways to loose the weight. She doesn’t really have the motivation to loose weight through exercise (she has attempted) but prefers to binge eat, smoke incessanctly and drink sugary drinks. For example she claims she has to have a sugary drink when she eats to help digest the food, including when she smokes, so she buys those premix alcohol drinks. Her diet is appalling and so to is her daughter’s (a whole other concern). I’ve seen her eat entire cakes as a late night snack. Most of the family have given up on helping her but at the same time are extremely concerned about her well-being, her quality of life and mostly the impact on and future of her daughter. Everyone agrees that if the mother’s body weight could be changed then many of her problems would become easier to deal with. One of the mum’s major concerns is if she can bear children after the surgery.

I tend to think the gastric sleeve option is a band-aid solution but don’t want to discount and encourage her otherwise if it could be the very thing that will bring some positive change. I actually live thousands of miles from her so it’s hard to have a huge impact (such as implementing diet and exercise regimes with her) instead I am only able to offer words of support from a distance.

Any words of advice from those who have gone through the same would be appreciated.

posted by Under the Sea to health & fitness (17 answers total)

I had a friend have this surgery. I understood she wasn't interested in pursuing 'bad diets' and don't disagree with her on that count. She also isn't interested in giving up eating what she wants, modifying her diet in any way or getting any physical activity. She lost 10 or 15kgs initially and now disappointed with the results as she isn't losing more. The amount of food she can eat is increasing (it is my understanding the stomach can stretch again, I'd put her intake level at 'average person non binging' now) and she can still eat frequently (the stomach empties relatively quickly). I noticed she frequently vomited after eating post procedure as it took a long time to realise how much food was too much. There was a 2 week post surgery period of only having diet shakes while the stomach healed.

It is my feeling that she felt it would be a 'magic bullet' and I noticed she didn't really do any investigative work about the procedure, although she attended an info session by the surgeon.

I'm not saying 'never ever' for this surgery but I think people should make an informed decision about it. Being thinner isn't really enough of a health fix for someone who is completely sedentary and lives on alcopops. She will just be a slightly thinner sedentary person who lives on junk, unless other things change. I can talk more via memail.
posted by Trivia Newton John at 1:29 AM on October 4, 2012 [2 favorites]

I would recommed a Roux-en-y Gastric Bypass.

I know people who have had gastric sleeves and this is for less major weight loss. In my opinon, bypass is the best option for losing weight and keeping it off long term. This is a last resort option but for people who cannot control their food it is a great tool.

I had one in June 2009 and have lost 12stone and kept it off, I choose a 500ml pouch as this is the best option for social eating (i.e. you can eat a fairly normal amount) it has totally changed my life for the better! I know it is slightly more invasive surgery and I have to take vitamins and supplements for life, but a small price to pay for the guarantee of weight loss unlike the sleeve or band.

With the Bypass you really are forced to rethink your attitude to food and deal with your issues around food, I understand that this can lead to replacement addictions such as smoking and drinking. It sounds like your friend is already on this path and will have to deal with psychological issues anyway, giving up smoking will probabily be a necessity before the surgery.
posted by krisb1701d at 2:49 AM on October 4, 2012 [1 favorite]

If she's not interested/able to alter her diet then the procedure will be ineffective. A sleeve will only reduce stomach capacity, it wont prevent her from eating low volume, calorie dense foods and there is the risk of stretching out the sleeve making the whole thing an expensive, dangerous waste of time.
posted by missmagenta at 3:09 AM on October 4, 2012 [2 favorites]

I will go back and read the rest after I calm down, but RIGHT NOW I want to say: NOBODY should ever "push" anyone to have this extremely drastic, life-altering and risky surgery. For a psychiatrist to be pushing it?? Totally unacceptable. Total betrayal of the therapeutic relationship. This person should be helping your family member process her emotions, NOT telling her what to do! Especially given her diagnoses, she needs emotional support, not emotional battering. Find a shrink who does not hate fat people, and who views them as more than their weight. Call NAAFA and ask for a referral.
posted by parrot_person at 3:13 AM on October 4, 2012 [4 favorites]

I am a somewhat concerned family member who isn’t sure if I should be encouraging this drastic surgery or if I should be encouraging her to get herself together and try natural ways to loose the weight.

Neither. Choose option C: show respect for her as an autonomous human being who gets to make her own choices about her own life. Show care and concern for her as a full human being who is far more than what she happens to weigh. Focus on her emotions and inner life instead of her physicality. Having people focus on her weight, and judge her for not "getting herself together" is NOT going to help; what she needs is a focus on her inner self--to be healed of the reasons she uses food as a drug in the first place. And those reasons often (always??) include not feeling cared for.

In short, show your love and stash your impulses to control or judge. Go tell her you support whatever HER decision is, and ask her how you can best show that support in a way that would be meaningful to her. If she is amenable to it, help her find health care that is respectful of her autonomy and her humanity
posted by parrot_person at 3:24 AM on October 4, 2012 [8 favorites]

Bariatric surgery will probably not be much more successful than other forms of diet if the person is not committed to making it work and does not have a supportive, helpful support system around them. My wife has had an amazingly successful Roux-en-Y, but she is the first person to say that losing weight through bariatric surgery is not as easy and carefree as it seems from the outside. Frankly, your family member sounds like a horrible candidate at this point for any kind of bariatric surgery from what you've posted here, I'm sorry to say.
posted by Rock Steady at 6:12 AM on October 4, 2012

I don't know the difference between gastric bypass and gastric sleeve. Check your MeMail for my story about my relative -- I'd rather not put it on here.
posted by DoubleLune at 6:23 AM on October 4, 2012

A friend had gastric surgery (not sure what kind) and after the initial ~10kg loss she stopped losing, and eventually gained it back. She thought it was going to be a magic bullet, but it turns out that you still have to strictly control your diet with gastric surgery and she wasn't in the habit of doing that.

That said, I think that your best option is to butt out. You seem to have very strong Opinions on what and how she eats but I think that's a matter best left for her and her health care providers. If she wasn't getting care at all then yes, as a friend you should do something. At this point in the process I think your responsibility is just to support the health care decisions she makes.
posted by arcticwoman at 6:55 AM on October 4, 2012

I know four people who have had this type of surgery. Two put the weight back on, one has not, and the other I don't know about. The person still has to change their eating habits after the surgery or the weight just creeps back on.
posted by ThatCanadianGirl at 6:56 AM on October 4, 2012

Lap band and gastric sleeve surgery has a pretty bad recidivism rate. These surgeries involve inserting something into the body to restrict stomach capacity... the problem is, the stomach then stretches to accommodate if the underlying issues of overeating are not addressed.

Gastric bypass, (R-n-Y, DS) involves actual modification of the stomach and intestine. The stomach has a significant portion removed, and the digestive tract re-routed, which reduces stomach capacity, removes a significant portion of the stomach that generates the hormones which trigger hunger, and dramatically reduces the ability of the digestive tract to extract nutrients from food. Overeating under any condition is extremely difficult or outright impossible for people with this surgery (but not unheard of!)

The downside is that this is a very risky operation when compared to appliance-based bariatric surgery - if something goes wrong, it goes catastrophically wrong in a hurry. More, people with emotional issues that cause overeating may find themselves in crisis once they can no longer comfort themselves with food. Psychiatric post-op care is highly recommended or even required, depending on your surgeon, health plan, etc.

Which brings us to this point - this is a dangerous, life-altering medical procedure with a risk of death or permanent medical disability. It's not really your place to suggest or encourage her to make the decision to have it.

You can ask if she's considered it, if you're close enough with her where she'll talk about her weight with you. That's about as far as I'd go with even a family member.
posted by Slap*Happy at 9:44 AM on October 4, 2012 [2 favorites]

If she doesn't address the psychological problems underlying the obesity--lack of control over eating, binge eating, dietary habits--any weight-loss surgery is going to be a temporary fix and the weight will come back. The body is surprisingly adaptable when it comes to maintaining homeostasis.

And if she does gain the weight back she will be worse off than before because in a number of these surgeries your ability to absorb essential vitamins and minerals goes to the toilet, meaning you're at dangerous risk for malnutrition. Many (if not most) weight-loss surgery patients will need to maintain a regime of strict supplementation for the rest of their lives. It should be considered a last resort.
posted by schroedinger at 10:43 AM on October 4, 2012

Thanks so much to everyone for all your valuable comments.

Many of you have echoed similar sentiments to what is going through my mind, it's also refreshing to have some other perspectives on how to be more neutral in this situation and somehow facilitate her to control and own her decisions on this. I also agree with some remarks about the psychiatrist (and surgeons) agendas, that is another issue altogether and is well-recognised in our family.

When you have known someone their entire life and witnessed many things it can be hard not to be biased so Im sorry if it the question seemed judgemental. In the last 6-12 months she has started opening up about how she feels about her situation and she has been looking to a couple of us for inputs and support on what she does next. Her life situation since a teenager has been quite devastating and progressively getting worse in recent years. I am flying to visit her in a few weeks and trying to have a broader understanding / open my mind to how I can better support her.

Will be reading the memails and responding too now.

Many thanks again, it is so much appreciated!
posted by Under the Sea at 11:17 PM on October 4, 2012

When someone is that overweight their body is - at quite a fundamental endocrine level - different to a thin person's body. Weight loss surgery has the benefit of helping someone who's very large return to a kind of baseline, a place where diet and exercise can start to have more of an impact.

That said, the question of whether or not you support your family member is... kind of irrelevent. She knows her body. She knows whether or not this surgery is right for her. The idea that surgery is 'an easy way out', or, worse, that an obese person is somehow incapable of making this decision is absurd.
posted by nerdfish at 1:00 AM on October 5, 2012 [1 favorite]

I probably should have better explained that she is quite in favour of the idea of gastric surgery whilst most of the family are more or less against it. That being said her weight is cause of many of her health issues and possibly contributing to ongoing psychological issues, her health inparticular is a grave concern. The surgery is quite costly and will need to be financed by a few us without any input from her side. These factors all tie into the broader context and why I am trying to understand how i can best help her.
posted by Under the Sea at 4:32 AM on October 5, 2012

Not surprisingly this is a complex web of issues. However, as a physician with experience in bariatric aftercare I firmly believe that surgery of a permanent type (i.e. sleeve or bypass) is the most suitable and promising proposition for your relative, and supporting her in word and deed is the best thing all of you can do for her. Weight loss surgery, by the way, is now considered metabolic surgery - i.e. a surgical cure for obesity-related diabetes, hypertension, osteoarthritis, and depression. As such, the Cleveland Clinic has just selected it as its Medical Innovation of the year.

There is no such thing as a guaranteed success, however, and especially with sleeve gastrectomy (which is a fairly new type of operation) the early post-op complication rate is currently still relatively high as surgeons climb their learning curve. On the other hand, bypass tends to have a larger late complication rate, for example due to herniations (bowel prolapses) through tissue windows created during the surgery. Also, both types of surgery can lead to weight regain in the medium term after initial weight loss - this can usually be corrected by a surgical tweak.

The most important contribution the prospective patient's family and friends can make to the overall success of her enterprise is to show support and willingness to help her along her chosen path. Hesitation and criticism are extremely harmful and, given enough accurate info (rather than prejudice), really should not be allowed. While few dispute that there are strong environmental, parental and motivational factors involved in obesity, the single most powerful factor is genetics. Anyone still thinking that exercise and willpower can cure obesity is still living in the 1980s - the latest large multicentre studies confirm that the mean success rate of modern nonsurgical regimes amounts to a 10% excess weight loss in 10% of people. And while at long last there are now some promising pharmacotherapies on the horizon it will take at least another 6 years before they become widely available. So I think she has arrived at the right decision and is likely to benefit from it. Making it possible for her will be an incredible gift you and the rest of the family can give her. In return, she needs to acknowledge the debt she owes all of you, and work towards repaying it by her actions post-surgery.

Best wishes.
posted by kairab at 4:34 AM on November 3, 2012

one of the best sites for information and support is wlsinfo.org.uk.

This is a patient run charity independent of all the companies associated with the promotion of this surgery. I've been a member for years and had held various offices on the committee.
I would strongly urge your relative to join.

I work in the field of developing national policy and standards around bariatric surgery and have had a band for 7 years. There are many people like me for whom bariatric surgery is the answer to a lifelong chronic health condition. It has given me back control of my life, and does for the majority.

However let's not kid ourselves, this graphic gives you some indication of the complexity of the condition called obesity that society still likes to victim-blame, so it stands to reason that surgery alone will not be 100% effective in all cases. Often other therapies are indicated.

what I find most disturbing though is that the cases that go wrong, or where there are additional complications, or where the patients can't comply with the aftercare regime are used, as we see here in this thread, as a warning against this lifesaving and life-altering therapy.

there is a saying that Hard cases make poor law that pretty much says it all for me, and as I speak to thousands of people over the past 8 years, the vast majority of whom have gained control of their illness, I see the exceptions used time and time again to spread fear. These exceptions exist, for example 40% of gastric bands require further surgery in the USA. But not in Australia where lifelong aftercare is offered and the vast majority of surgeries are banding. There the rate is far lower, and relates to the earlier versions of the band where we were still learning lots about the design and optimum placement as well as the operative technique. (e.g.Since the Pars Flaccida surgical technique started to be widely used (here in the UK around 2006) rates of band problems have plummeted and I know many bariatric surgeons now who have a zero mortality & slippage rate. They do so many of these operations and have become so expert in their aftercare, they do then in 45 minutes and patients are done as day case) Banding is less dangerous than having your gallbladder removed in the hands of an experienced banding surgeon.

Many people do not get the support and aftercare they need and one of the largest single reasons is that it is still acceptable to see the condition as a failure of "will-power" and a lack of personal agency. Bariatric patients who do not succeed are sometimes faced with an almost unholy glee from others who say they are supportive but secretly are just waiting to say "gotcha".

the bottom line is that the evidence is now overwhelming that bariatric surgery is the only successful therapy in long-term chronic morbid obesity. I really wish it weren't so and I am awaiting the day when the metabolic scientists working on Ghrelin, Leptin and other gut hormones come up with a therapy that is not invasive.

But until that day comes this is a safe, effective therapy for the majority of patients. It saves the health service a lot of money as a piece of work I was enagaged in shows (UK specific) but it also has to deal with an extremely successful Diet Industry that is making billions of dollars of the back of those effectively suffering this chronic and intractable condition and getting away with offering them snakeoil and then blaming them when it doesn't work.

There is a place for companies such as Weight Watchers, Jenny Craig etc. for people with moderate overweight and along with bariatric surgery they can be very helpful resources for people with obesity, morbid and super morbid obesity. But there is no place for the routine but extremely lucrative scripts for drug therapies as yet. However, they make companies very wealthy so along with societal disgust for the fat, industrial levels of profits from their suffering will continue to ensure that a message is spread that this is a dangerous, drastic surgery that doesn't work.

the opposite is the case.

I'm sorry to hear of friends and relatives who haven't done well in the posts above and would be happy to help out by e-mail or MeMail.
posted by Wilder at 5:15 AM on November 3, 2012

Thank you for those last informed comments.

In our family the discussion is still very open and being thrashed about. Your additional information is useful and highly appreciated. I'll be checking through those resources and passing them along.
posted by Under the Sea at 8:11 PM on November 13, 2012