Talking to Loved Ones about Surgical Weight Loss
In this Gab, I want to cover a topic that is sensitive, personal, and close to my heart. I lost a beloved person from complications related to morbid obesity several years ago. I began to wonder how we never saw this coming. As with most of you, I am sure, I have several friends and loved ones who are very overweight, maybe considered obese, and I am concerned about their health, their well-being, their life. I am more aware now that obesity is a morbid disease that takes years away from people’s lives.
Even as a bariatric weight-loss surgeon, I cannot find a good way to tell my friends who are morbidly obese how worried I am for them or how they can get help. I have no problem telling the patients who come to my clinic seeking weight-loss surgery that this is one of the best things they have ever done for themselves. I have seen the amazing results, the diabetes and high cholesterol go away, and people have told me many times over how much their lives have improved by losing the weight. However, when it comes to approaching my friends and family about having bariatric surgery, I freeze up. Why?
What stops us from telling our loved ones that they need to do something about their excessive weight problem? How long should we wait? What if our friends and loved ones are severely overweight or obese, but they have no medical problems and are otherwise healthy? Should we wait until diabetes has ravaged their bodies, hypertension has damaged their heart, high cholesterol has blocked their arteries, and so on? Should we only intervene when they have begun to suffer with sleep apnea, severe degenerative joint disease, liver failure, depression, or infertility, to name a few problems caused by obesity? No! Shouldn’t we recommend that they do something before these problems arise? As a bariatric doctor, I assure you these problems will come with time. The body is not designed to carry excessive weight like we see with morbid obesity. Preventing the problems that are caused by the underlying disease of obesity is critical to saving lives.
I believe our fear is that we would be too insensitive. What do we say, or how do we start this conversation with them? With that in mind, I began to write this Gab. I am not sure what the right answers are, so I asked for insight, thoughts, and general help from many people to give better understanding into this issue and hopefully empower us all to discern how we can talk to our friends who may need surgery to help them lose the weight. One person I asked to help me with this is Mary Jo Rapini, a well-known licensed psychotherapist in Houston who specializes in body-image, and to whom I refer many of my bariatric patients to before they have bariatric surgery. I truly appreciate her input on this sensitive subject and credit her with her direct quotes in this Gab.
Talking to Loved Ones about Surgical Weight Loss
Even if we desperately feel that our loved one needs bariatric surgery, we are afraid they will be mad at us for telling them so. Perhaps they will feel judged by us. We could preface our comments by telling them how much we love them, we only want the best for them, or that the truth is hard to hear. Nonetheless, no matter how we phrase it, telling someone they should consider surgical weight-loss options will likely hurt their feelings. “When it comes to bariatric surgery patients feel…as though if they were smart enough, strong enough or disciplined enough they would be able to lose weight on their own,” says Mary Jo. It is likely they will tell you that they can lose the weight on their own, but statistics tell us a different story.
According to current literature, diet and exercise plans fail to reduce a morbidly obese person’s weight to healthier numbers in 95% of people at one year. It is very difficult for anyone to lose 10 or 15 pounds. Imagine how hard it would be for a morbidly obese person, who is generally 75 to 100 lbs. over their ideal weight, to lose the weight required to improve their health. When I give weight-loss seminars I ask the people in the crowd how many of them would be willing to lose 50 lbs. for one-million dollars in cash. Everyone raises their hands. “Could you do it,” I ask them? Most of them begin to nod. “Ok,” I continue, “but here’s the catch: if you gain any of that weight back one year after I pay you, you have to give me back the money with 10% interest. Now how many want to take me up on this deal?” Everyone’s hands go down, and I say, “So you can lose the weight, but keeping it off is the problem, right?” They all agree, and there are a few uncomfortable giggles. I pause for a few moments to let that sink in and get everyone’s attention again, then add, “We are dealing with much more than a million dollars here. We a talking about your health. We are talking about years of your life! How much is a year of your life worth? Ten years?” Now, the seriousness of the conversation becomes apparent. “That is why I am standing here, a surgeon, offering you a surgery, to treat obesity. I am a doctor, and my job is to help people live healthier, longer lives.”
The medical implications and the risk to life that obesity causes is the reason that the National Institute of Health published a consensus in 1991 that acknowledge that the risk of continuing to live with morbid obesity outweighed the risk of bariatric surgery. Bariatric surgery was recommended as the only method of delivering and sustaining prolonged weight-loss results to improve weight related comorbid conditions. It is imperative that society stop telling people that obesity is something they did to themselves or can choose to overcome. Obesity is a disease with many causative factors including genetic, social, and environmental variables.
The belief that obesity is a psychological disorder or a lack self-control is simplistic and ignorant. And even if people do not agree with this, allow me digress and mention how smoking is a choice that millions of people continue to make out of a lack of self-discipline. It leads to heart disease which often requires surgery (like arterial bypass and valve replacement). When a smoker develops lung cancer or a heart problem that requires surgery, does society make them feel guilty about seeking surgical treatment? Does society tell them that they are taking an easy way out from their disease, or they should just deal with the problem? Do insurance companies tell them they can’t have their heart surgery until they try to quit smoking on their own for four months? Mary Jo writes, “By the time the majority of people decide they need bariatric weight-loss surgery they have ridden their own personal shame roller coaster. They have been judged, watched in restaurants, humiliated in school sports, and ignored in society.” This is a tragedy!
Buying into this general mentality, we do not want to add to their shame nor insult our loved ones by telling them they have a disease they need surgical treatment for. We are probably more comfortable telling them that they need to try and lose the weight (but now we know that we are suggesting something that only 5% of people are capable of doing successfully, thus setting them up for yet another failure). What is it about recommending surgery that is so difficult? As I said earlier, I have no problem telling patients who come to me about their weight-loss surgery options because they have sought out surgical treatment of their disease. I wouldn’t dare stop a morbidly obese person on the street, give them my business card, and recommend they come see me about surgery. That would be rude, insensitive, and embarrassing for them because, to them, I have no apparent interest in their overall well-being.
Therefore, I would suggest that there are two requirements that must be at the root of our suggestion that our friends seek surgical treatment for morbid obesity. First, this must not be about body image and all about health. I tell my patients all the time, I am not into the pounds, inches, or cosmetic surgery business. I am in the healthcare business. This should be true for all of us talking to our friends about surgical weight-loss options. When I was a surgical resident, I was not exposed to bariatric surgery. I was told from other surgeons that it was a cosmetic operation that it was bogus, that it was a fad to make surgeons rich, that it was not real medicine, and I bought into those lies. When I began my fellowship, was exposed to these surgeries, and saw these patients in clinic, I realized something very different. It is a life-saving surgery, bariatric surgeons work hard, these operations are challenging and true bariatric surgeons strive for perfect excellence, they are the only surgeries that reach across other medical disciplines by curing medical problems like diabetes and high cholesterol, and I am proud to be a bariatric surgeon.
Yes, losing the weight helps people with their body image, self-image, and alleviates many peoples’ depression; but, more importantly, it increases their energy levels, gets them off medications, motivates them to exercise, and promotes eating to live instead of living to eat. If we are genuinely concerned enough about our friends, then our concern is for their health, not their body image. People all look the same to me. We are all someone’s children, or fathers, or mothers, or brothers, or sisters. We are families, and loved ones, and friends, and so on. The problem is rooted in a confused culture which does NOT over-emphasize the “beautiful” body but, instead, grossly underestimates its beauty! Our bodies, our image, is not perfected by the perfect measurements but how we measure ourselves out to others. Our appearances do not make us who we are, we appear to others by how we treat them.
The second intention that should motivate us to talk to our friends about surgical weight-loss options must come from our sincere relationships with them. If we truly love them, we must be willing to cross that line for their sake. We may have to endure their anger, we may have to cry with them, we may risk our friendship with them, and we may lose them as a friend forever; however, if we believe that without such help they may die before their time, then we owe them the advice despite what we may have to suffer. Love endures all things and is willing to sacrifice itself for the other. I know, these ideals are easier said than done but they are worth living by. In fact, I will have to take my own advice soon, but I must because I know that bariatric surgery decreases the risk of a person dying over the next five years by 89%! I know that living with a body mass index over 40 kg/m2 can take ten years off a person’s life. Knowing this, I feel that I am obliged to intervene. I must tell them there is a credible treatment for this disease that can succeed, and that I have personally been a witness to it hundreds of times.
Truth is, even if our friends take our advice, they are probably scared of bariatric surgery. Most fear is caused by ignorance. Patients share stories from their friends with me that leaves me scratching my head, wondering how this information gets out there, but then I think back to residency and wonder how so many surgeons could be so wrong. There is so much misinformation out there about weight-loss surgery. I recommend that anyone considering weight loss surgery find a bariatric support group in their community and go meet people who have had these operations. They can tell your friends face to face the good, the bad, and the ugly of living after weight-loss surgery. It is real information from real people that they can interact with and ask questions to. They can learn what life after surgery is like: how their food cravings change, what they can or cannot eat, how they will cope with the weight loss, how eating in social situations changes, and so on. Potential bariatric surgery patients are generally welcome in support groups, and if you know someone who would like to come then you can refer them to me.
These stories, these myths, are only propagated by other well-meaning, but uniformed family members or friends who try to convince others that bariatric surgery is too risky. It is a blind leading the blind situation; and ultimately, it is up to the individual who is dealing with the obesity to inform themselves with real, reliable information from healthcare professional and trusted websites. Most patients who come into the office to discuss bariatric surgery have done their research. They have considered this option, on average, for three years. They have been waiting for the right time. They have researched and researched trying to alleviate their fears and misunderstanding, and when they have come to the decision to have surgery, they are convinced that this is right for them. Mary Jo adds that these patients “shy away from hearing why it won’t work again from well-meaning people. They know it’s expensive, they know they failed in the past, but they also know if they don’t do something their health, marriage, quality of life and career will continue to deteriorate. They come to the surgeon scared, desperate and hopeful.”
I try to alleviate this fear in patients when I talk to them. The most common myths I hear is about how dangerous the surgeries are. The surgeries do come with a risk of complications, of course. Twenty-five years ago, the risk of major complications was as high as 20%. However, today, the risk of having a complication from bariatric surgery at the hands of an experienced bariatric surgeon is the same as the risk of having a complication after gallbladder surgery. Most of the complications are self-limited and easy to deal with. Major complications occur with a frequency of 1-2% and may increase the length of stay in the hospital or create problems that must be dealt with for months after surgery. The risk of dying from surgery is very low, less than 1%. Personally, as a bariatric surgeon, I have had a few of my own complications and dealt with many more complications from surrounding surgeons and hospitals. As an Associate Professor of Surgery at the University of Texas Health Sciences Center, I have seen some of the worse cases, and I can tell you that all of these patients came through it. I have seen them in clinic months and years out from surgery and asked them if they would do it again. Every single one of them said they would do it again tomorrow, even if meant they would have to go through the complication again. It is that life-changing!
We must not be afraid. We must rid ourselves, our friends, and our society of the ignorance that surrounds obesity and its surgical treatment. Because of societal ignorance, the obese population is one of the last remaining groups of people openly ridiculed and acceptably discriminated against in this country. “How wonderful it would be” writes Mary Jo, “if society could be better educated so the weight loss patient would feel empowered rather than defeated.” How wonderful, indeed, it would be.
Most of us are willing to fight fiercely for our loved ones. We will do anything, endure anything, and risk everything to protect our children, our spouses, our families, even our friends from danger. Or are we? How do we tell our loved ones we want them to do something so drastic as to have bariatric surgery because they are morbidly obese? How will that make them feel? At the end of this Gab, I tell you that I don’t know. I do think, that if we do it with the right intentions, with sincerity and love in our hearts, then they will hear us. They may not like it, they may not take our advice, but they might consider it. Some of them may decide to learn more about it. Some of them may actually do it.
If you need help telling someone, if you need a surgeon to send someone to talk to them about it, or if you want to talk to me about it, then I am available in several ways. I am always an email away, and I do respond promptly to your questions. My website is designed for people to learn more about surgery, to learn about all their options, and to learn about the risk and benefits. Finally, my weight-loss seminars are designed to inform people and answer all their question in a live setting. The seminars are free, and all are welcome. There are no requirements to come and learn about these treatment options. I make myself available to my community as a service of my profession, in good faith, with the hope that in any small way I can make a difference. I am encouraged by the words of Anne Frank who wrote in her diary, “How wonderful it is that no one has to wait to change the world.”
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