The Doctor Weighs In

A reader takes issue with my positive presentation of VBLOC. Read on:

"Pat - I am surprised you would be advocating for VBLOC that is in the same category as bariatric surgery and does not "require any change in diet or exercise"! I personally believe that most chronic illnesses and conditions such as obesity are emotion-based - including my own, Crohn's - and that drug/technology interventions -are ineffective or short-lived solutions....of course I am not mainstream in this thinking...”

I think many of you who follow my TDWI posts know I am a strong advocate of diet and exercise. Sometimes, I feel like the diet and exercise nag. But I am also a pragmatist who recognizes that some people can't/won't/will never be successful in achieving a healthy weight with diet and exercise as their only options.”

There are alot of reasons why people fail good old fashioned lifestyle change. Some people have a physiologically stronger appetite drive than others and yes, some people with the thrifty genotype may be better at storing excess energy as fat. Some people preferentially store bad fat (aka visceral fat) and end up with the complications of cardiometabolic syndrome. And some folks have socioeconomic factors that make it harder to lose weight via life style changes alone - they live in unsafe neighborhoods, work long hours, and don't have easy access to healthy foods like fruits and veggies.

I think we make a mistake when we send a message that there is only one right way to lose weight; that is, eat less and exercise more. Yes, we should all do that if we can. But, medical and surgical approaches, including bariatric surgery are viable and valuable options for some people.

"Memoirs of a Fat Broad" by Wendy Hanawalt is a powerful story that opens your eyes to how hard it is to live with fat and its metabolic consequences. Wendy describes in detail what it is like to be really, really fat and she tells us how a doctor who suggested gastric by-pass saved her life. She was suffering so many complications of her obesity that she had contemplated suicide. That is not to say she didn't have problems after her surgery, she describes her life after her gastric by-pass surgery in a follow-up article to her Memoirs....nothing in life is completely free after all but compared to her life before, she says, post-by-pass and post-weight loss, the changes in her life are "miraculous."

So, diet, yes. Exercise, absolutely. But, if you can't get where you need to be without adding something more aggressive, I say keep your options open. Scientifically-proven medical adjuncts to weight loss may help you get to goal.

Pat Salber, MD, MBA