Wednesday, April 11, 2012

One surgery or two?

I watched the Today Show last week and saw Carnie Wilson (of Wilson Phillips) discussing her need for a second WLS. In 2001 she had a gastric bypass and lost about 150 pounds.  Due to a weight gain of almost 50% of what she had originally lost, she decided to have a second surgery this last January. That surgery entailed the placement of a Lap Band probably around the pouch attached to the intestine created during the previous surgery. I consulted with my surgeon and he was not particularly optimistic about the value for the additional surgery. I have previously discussed the surgical options available and also their limitations. I have also discussed the role of the individual changing their lifestyles and their eating habits in order to maintain their weight loss.

What it really comes down to is that it is your responsibility to ensure that you have taken all of the steps necessary to lose the weight and keep it of to the greatest extent possible. If you are a compulsive overeater or compensate for stress in your life by eating to excess, you will not have the success that you anticipate after WLS. Your surgeon can give you most of the physical tools to lose the weight and you will initially lose weight. But if you back slide into your old eating habits the weight will return. I have seen it in patients who start out with the best intentions, and who know they have to save their own life. They have the surgery and then in the years following, slowly (or sometimes rapidly) regain the weight. You simply cannot make a soup out of cheesecake in the blender and wash it down with a milkshake and still expect to maintain your weight loss.

The stories about weight gain after surgery are common and are one of the reasons that insurance companies are reluctant to pay for the surgery. Even though the data supports the effective control of diabetes and other health related problems post-surgery, the frequent result of the weight gain holds back the insurability of the procedures.  So what has to happen? Frankly it is time that we as the post-surgical patient stop expecting someone else to solve our weight problem.
We have to honestly look at ourselves and ask:
1) Were we ready to have the surgery?;
2) Did we reconciled why we are heavy and really understand and agree to actively do something about it? ; and
3) Do we have the institutional tools as well as the courage to allow us to succeed with the weight loss as well as to know how to keep it off?

My surgeon told me that he could create inside of me the physical conditions to help me lose weight, but he added that it would be my responsibility to ensure that I kept it off. While I have not been as successful as I expected, I know what I have to do. I need to exercise more  and watch my food habits. I am not eating to excess and I still eat about eight bites per meal. I have not lost the enthusiasm for that amazing change in my body and my health. I simply have gotten sloppy.

So back to Carnie Wilson. Her second surgery may or may not help her. From her words, she has a hard time controlling her diet. Eating seems a bit compulsive for her. I wish her well but I feel that her success (or failure) will depend more upon a psychological change in her behavior and not so much on the second surgical "magic bullet". I wish her well but frankly I am not overly optimistic. Change has to occur in her head as well as in her abdomen.