Diabetes Self-Management Blog

My Big Fat Greek DietBariatric (weight-loss) surgery has recently been touted not just as a way to shed pounds, but also as a potential treatment for Type 2 diabetes. In this excerpt from his book, My Big Fat Greek Diet: How a 467-Pound Physician Hit His Ideal Weight and How You Can Too, Dr. Nicholas Yphantides explains why he believes you should think twice before going under the knife.


My heart always goes out to the morbidly obese patients I see who are hospitalized for complications related to their unhealthy condition: severe diabetes, heart failure, and crippling joint disease, to name a few. Inevitably, I pull up a chair and visit with these hurting folks. When I sense they need a boost of encouragement, I reach into my Day-Timer and show them a picture of me wedged into a seat at a San Diego Padres game.

467 pounds “Do you recognize that person?” I ask.

“No, who’s he?” is the response I generally hear. That’s probably because I had curly, shoulder-length hair atop a torso brimming with 467 pounds.

“That was me seven years ago,” I say.

The responses range from “No way!” to “You’re joking,” to “I don’t believe you.” After the initial shock passes, they always say, “How did the surgery go?”

How did my surgery go?

The supposition that I could only shed so much weight by having a gastric bypass operation (or what the media often calls “stomach stapling”) is largely based on the waves of publicity given to celebrities who have had the surgery and experienced dramatic weight loss. The number of bypass operations has exploded recently, from 23,100 in 1997 to more than 100,000 in 2003, according to the American Society for Metabolic and Bariatric Surgery — nearly a fourfold increase in just six years.

I did not have surgery to lose weight — I did it the old-fashioned way, through diet and exercise. I can only be happy that this operation has helped hundreds of thousands of people regain some normalcy in their lives. My joy is tempered, however, by the serious health risks associated with this surgery, and these risks should be carefully considered before altering one of the most delicate areas of the body, the digestive system.

Gastric bypass promotes weight loss by surgically restricting food intake and/or interrupting the normal digestive process. Surgeons staple the stomach, or bind it with an adjustable band, to create a small pouch that holds 2 or 3 ounces of food. A normal adult stomach can hold 3 pints of food, or around 24 ounces — the surgery reduces the stomach to one-tenth the size it used to be. It doesn’t take a brain surgeon to figure out that you’re going to feel full very quickly. Eat any more, and you become nauseous.

The surgery is generally reserved for morbidly obese individuals who have made numerous, unsuccessful attempts at losing weight through traditional methods: going on diets, changing eating patterns, working with nutritionists, and increasing physical activity. It’s supposed to be the treatment of last resort, but that’s not how it’s being marketed to — or perceived by — the public. I’ve heard of surgeons promoting gastric bypass surgery for people with only 40 or 50 pounds to lose. That’s not a healthy or appropriate choice for these patients.

The surgery is not cheap. You had better have good health insurance, because the procedure costs around $25,000, and complications, if they occur, will drive up the price even further. Many health plans do not cover the full amount; you could be responsible for up to 20%, or $2,000-$5,000 in out-of-pocket expenses. If you’re poor or uninsured, like most of my patients are, you can forget about gastric bypass surgery. In many states, the overburdened public health system doesn’t pay for this sort of procedure. Medi-Cal patients in my state face a 12-year wait. (Medi-Cal is California’s Medicaid program.)

What many people considering gastric bypass don’t know is that you get a “free ride” only for the first year. In other words, it takes your body about a year to recover from the surgery and to get used to the limitations imposed by the surgeon’s knife. Initially, the weight drops off effortlessly, but after a while your body compensates for the changes in your anatomy — suddenly, you stop losing weight. If you fail to practice the good eating and exercise habits that are the basis of every weight-loss regimen, you will regain some of the lost weight. The only way to lose weight and keep it off is to take in fewer calories than you expend. There are no shortcuts to successful weight management!

Up to 20% of all gastric bypass patients need follow-up surgery to correct a complication such as breakdown of the band, a hernia in the abdominal wall, or a stretched-out pouch. Fortunately, as surgical techniques have improved, adverse side effects are becoming less common — but the risk is not gone. Some potential side effects are the following:

Death. The chances of dying from the surgery are rather high in my book, at around 1 in 200. The risk of dying is dependent on factors such as the kind of surgery and the patient’s medical condition at the time of surgery. There have also been cases of patients dying after binge-eating and rupturing their staples.

Nutrient deficiency. Since food bypasses certain key parts of the small intestine, absorption of essential nutrients is interfered with. Nutrient deficiencies can lead to anemia, osteoporosis, and other bone diseases.

Dumping syndrome. This involves rapid emptying of the stomach’s contents into the intestines, potentially causing nausea, cramps, weakness, sweating, and lightheadedness. Oh, and don’t forget explosive diarrhea.

I’ve met and corresponded with too many people who could not stop overeating despite having a stomach the size of an egg. One woman melted chocolate bars in her microwave and sipped liquefied chocolate all day. Others puréed food that isn’t meant to be puréed: Krispy Kremes, Twinkies, birthday cake. Another woman confessed to me that she ground up pistachio nuts and ate them all afternoon. Although these folks couldn’t eat very much at a time, they were constantly grazing. In each case they regained all the weight they had lost.

I understand why people are willing to have the surgery despite these risks — weight loss can dramatically improve quality of life. Nonetheless, I must say that I’m concerned about all the momentum building in favor of surgical intervention. I may be a voice in the wilderness, but I am a visible reminder that dramatic change is possible without surgery. Sure, I know that the chips are stacked against us, that 90% of people who lose weight put it right back on. But obesity is a complicated issue with no easy answers, and stomach stapling should be a last-resort option. Even for those who have the surgery, it still comes down to eating the right foods in the right way.

COMMENT: What are your thoughts on bariatric surgery? Have you had it? Are you interested?

Dr. Yphantides (”Dr. Nick”) is the appointed cochair of the San Diego County Childhood Obesity Task Force. His Web site is www.healthsteward.com.

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Comments
  1. Congratulations, Dr Nick!

    Compared to bariatric surgery, it’s always preferabl to lose large amounts of excess weight through diet and exercise, if you can.

    Like you, I worry about the surgical death rates.

    -Steve Parker, M.D.

    Posted by Steve Parker, M.D. |
  2. I would not consider this an option. I know of a teacher who chose this route and he did not survive. It was a shock to the whole community and it did bring an awareness of the death rate for this type of surgery. I know of another person who wants to have this done to loose weight. Her problem, however, is that she is lazy. She will not exercise or watch what she eats. She says nothing works for her. She is absolutely correct, she has not read or followed the directions.

    Posted by Airborne mom |
  3. I had bariatric surgery 6 yrs and 4 mo ago. I was a size 26 and now I am a size 6. I have had no problem keeping my weight off. I used to eat alot of the wrong foods and alot of them as well. I would rather eat cakes, cookies, breads instead of fruit, vegitables or meat. Now I can eat alittle of this sort of thing and then I get feeling icky so this is a tool to help keep off the weight. No one wants to feel icky all the time. I eat smaller meals and more often 4-6 per day instead of 3 bigger meals like normal folks do. I also eat more protien then the normal person does. When we have this surgery they take out some of the intestines (6 feet of mine) and this is why you get this dumping syndrom if you eat the wrong food. Another tool to keep you from eating the wrong things. I had the rue-n-y (not sure of the spelling) surgery not just staple or band they re-routed my intestines which helps to keep the weight off by using some malabsorption. So you don’t actully get all of the calories/nutrients from what you eat. this is why you must eat good food and take vitamins as well. I would have this surgery again in a heart beat!! I really hope if a perosn can have it they do! It changed my life, my husbands life, and my sons life as well. We were more active, ate better, and healthier then we have ever been!!!

    Please people if you have 100 lb or more to loose and can get the surgery! DO IT!!! and start living again!! Life is too short!!!

    Thank You!
    Cathy

    Posted by Cathyann10 |
  4. I have been overweight all of my life, currently at about my heaviest. I quit dieting a number of years ago, unless I do it when I am committed. Even with losses from that, it is very hard to be stable. Having lost 60+ lbs over 6 months with a heathy eating plan and exercise on numerous occasions, I am very much in agreement with the Dr. The long term affects of the ‘quick’ fix are not worth it. What it does to your ability to live decently and heathy for the rest of your life is ruined! I am tired of every new doctor I have seen in the last 15 years pushing me heavily to consider such surgery - they hit on this so much, they do little to deal with the reason why I am in their office to begin with without my constant re-focusing of them on my current problem.

    Posted by fatallmylife |
  5. I had a friend do the band thing around the stomach, and after seeing what she went through, I would never choose that route to loose weight. Every time we go out to dinner with her, she runs into the restroom to throw up. She is lucky to even get a spoon full of food into her stomach. She had this done because she was afraid of becoming a diabetic. I agree with you that they are giving diabetics a false hope in a cure. Even my own internist doesn’t approve of this method as a form of weight loss. I watched my friend consume half a jar of baby food and throw up, and this was several weeks after the operation. And the stuff she went threw before it, which they said was a prep, was just as awful. She had to be on only water a couple of weeks before the surgery, and then became so weak she about fainted at work one day. And to take handfuls of multivitamins for the rest of her life doesn’t seem like fun either. What amazes me is that the doctor who did the surgery said she was the smallest one he had ever did. I think he did it for the money. I myself am 80 pounds over weight and a diabetic and would never resort to this method just to loose weight. In this case the benefits don’t out weigh the risks. Diet and exercise is the only way to do it, with modifying ones eating habits.

    Posted by Evonne |
  6. I am diabetic and 100 lbs overweight. I had lap band surgery 2 years ago. I did lose a lot of weight quickly, and then hit a plateau. I did everything I could to continue to lose weight but couldn’t. Then the doctor decided to tighten the band to see if I could get started again. Nothing happened so the next visit they tightened it again. This time I couldn’t even swallow water, it was very painful, and I called them the next morning to complain. After going through xray, and seeing that my band had just about completely shut off my stomach, I had a pouch of food that hadn’t been able to get through. I was treated like it was my fault, I obviously ate something after the adjustment.Yeah right, water wouldn’t even go down. The thing is, it was two tight 2 adjustments ago.Food had not been able to get through for quite awhile. They emptied the band and I have not had the desire to go back to them. Not only did I get to pay for the x-ray, the technician to read it and then the doctor at the hospital to read it, they had the nerve to charge me to deflate it. They made it sound ok by telling me at least now they know where the limit of filling the band is and that sometimes that happens, but we were on the right track now. I was not happy with the way I was treated, or the fact that completely shutting off my stomach was very dangerous and they weren’t concerned about that. I will say however, that even uninflated the band does help me. I can only eat so much, and I feel it keeps me from over eating, which is good for me.

    I’m not sure I would recommend it for anyone else, I am living with the decision I made knowing I have to watch what I eat and I am also exercising a lot more. I keep hoping the weight will begin to come off again.

    I would never have the ruen-y but the band has been somewhat helpful for me.

    Janice
    Janice

    Posted by Janice |
  7. I just learned about another surgery gone wrong. My friends mom had this surgery in October she had a total of three surgeries and was in the hospital for 11 weeks and they had to take her off life support on Christmas Eve. The first device did not work and they went in to repair. Now the family is left with half a million dollar hospital bill (after the deductible was met). I can’t even image what the doctor charges will be. I would not want anyone I know to even consider this as an option.

    Posted by Airborne mom |
  8. After reading this article I wish I had had this information six weeks ago when our neighbor had the surgery. This week she was back in the hospital as they tried to treat the vomiting. They have just adopted two young siblings and have made their family complete.

    Posted by tied4161 |
  9. I am a retired nurse and now volunteering as a Parish Nurse in my church where there are 5 people who have had the surgery. I have not been impressed with the results.

    The surgeries were done and there was weight loss but they didn’t fix the emotional and mental problems that exsisted before/ thus 3 of them gained a lot of weight back

    One of my friend weighed 300 pounds and had the surgery and lost 150 pounds and she looked great but then the health problems started: fainting, anemia , heart problems, sodium imbalance at the cellular level plus sever depression and suicidal thoughts

    I never will be for it… eating health giving foods and regular exercise and living a balanced life if the key…. weight loss should be slow and then it will be permanent

    Posted by Maria Pruis |
  10. Congrats to Dr. Nick for his will power to take his weight off! I was diagonosed with diabetes over 6 years ago as a Type II. My doctor told me then diet & exercise and I joked he must be using those old insurance charts for weight standards. But I thought about my wife & children while all the ramifications of diabetes also ran through my head. His advice; much like Dr. Nick’s– eat less-yes, that simple. So I lost almost 24 pounds. I continue to diet & exercise. After the weight loss, many friends commented that I did not look well-although my weight was well within my height range. Obviously most our eyes now tell us 20 to 25 pounds overweight is fit & trim. My doctor also once told me I was not the ‘typical diabetic poster child’ because of my proper weight management, diet, and no medication. It seemed like such an off-handed compliment I laughed and told my doctor thanks. When I grew up as a kid (I’m 50), we came home from school, threw our books down & told mom where we were going, and ran out the door to play tag, football, baseball, etc.. No TV or computer games. You hardly ever saw an overweight child. Now in many schools it is not uncommon to see 20% ( a minimal guess!)of the kids that are overweight!! Our soceity has lost sight of a proper diet and exercise. Rather amazing considering how we idolize our athletes and thin models! I guess we may idolize those persons, but untimately we have put a cornacopia of food on a pedestal above those ideas of sleek athletes & models.

    Posted by 1.5 Diabetic |
  11. I live on a diet. I live on a diet and do five hours of pool exercises a week and have a difficult time maintaining my current weight let alone losing the 60 pounds I have to loose. I’m envious of my friends who gained slender status through bariatric surgery.

    Your article warning of the down side to bariatric surgery was interesting. I’d be more interested in knowing your best tips for losing weight through diet, exercise and willpower.

    Posted by So tempted..... |
  12. I have ordered his book….1.5 Diabetic, I am sure what you are asking for is what the whole books is about!

    Posted by bill |
  13. I look around on my job and see all the people who have had gastric bypass and they are all gaining their weight back rapidly. It seem like it has taken them three years and almost all of the weight is back, They are now considering the lap-band. I say if you have not fixed the initial problem as to why you were over-eating than don’t even waste yoiur time getting the surgery. I beleive in diet and exercise. You’ll be amazed at would walking can do for you.

    Posted by Luvie713 |
  14. At first I have seen so many people going through biatric surgery over the time and I have wondered a big “WHY” they went through that.

    Not until I went to Health Information class related to Biatric surgery last Februrary at large metropolitan hospital. Oh boy I have learned alot.

    I have lost 90 pounds through old fashioned dieting and pyschology changes. And, through excerising, too. I am doing that slowly and are not in much rush to lose that excessive weight and I have aabout sixty pounds left to go, then I will be done.

    I do not believe in gastric surgrey because it will take lot of money for that surgery plus follow up check ups. Most insurances will not cover it. Not worth for its complications that will be most likely to follow you most of the time.

    My husband himself is morbid obese and some neurogology doctor wanted him to have that surgrey. After attending the health information class, I have to say NO to that surgrey the doctor wanted for my husband. Not worth the complications. I told him that there are surest way to lose the weight are through changing on how you eat and excerises.

    Once you establish your way of eating less and have your weight stablized within the normal range for your height and body frame, it will set you up for rest of your life.

    Posted by Maryann |
  15. I had an open RNY gastric bypass 10 yrs. ago at age 62 after a lifetime of extreme weight swings,Weight Watchers,Liquid diets (M.D. prescribed & monitored),and all the other programs. Could not sustain weight lost in all these attempts to lose & maintain. Lost over 100 lbs. (again! My 4th loss of this amount.) and had surgery for breast CA one year after bypass (for which I’m not blaming bypass surgery and it sure was easier to have chemo & radiation at the lower weight.) Over the past 8 years I have slowly regained most of the weight. The Type 2 diabetes that disappeared shortly after the surgery is back (with insulin this time), and the sleep apnea which necessitated a C-Pap before surgery and also disappeared shortly after the surgery, is also back in spades. The arthritis is worse and 2 of my coronary arteries have just under 50% blockage so a stent (or more) is probably in the future. I’m active (a founder and Pres. of a 501c3 high-volume,low-cost spay/neuter clinic which covers 10 counties in SC and GA which has already done over 12,000 surgeries in 2 yrs. and is expanding); travel a great deal overseas although walking is not a lot of fun; do water aerobics and am returning to tai chi classes. But I am still seriously addicted to carbohydrates and no matter how much I overspend, my clothing looks like fat-lady style in good fabrics! But despite all (including a lifelong battle with clinical depression which is contained by SSRI’s and occasional meetings with the prescribing psychiatrist!) I am still determined to ‘do right by me’ knowing that the odds sometimes seem insurmountable. So here I am, about to buy another diet book and somehow find time to ‘Dance to the Oldies’ once again! The gist of this overly long comment is to dissuade the Lap Bands, RNYs and any other surgeries that promise nirvanah. I know some can maintain. I also know most can’t. Life is Good except for this Achilles Heel called compulsive over-eating despite preventive surgery. Make your own decision, but be sure to closely examine BOTH sides of the issue. I close asking all of you with pets to be sure to spay or neuter them because it’s the only thing that works to stop pet overpopulation and end the euthanasias of millions of healthy, adoptable animals in our shelters which have no choice because there will never be shelters large enough to house all the homeless animals in our communities. And that’s a thought for the day!

    Posted by Barbara F Greenstein |
  16. In 2004 I researched gastric bypass and gastric banding. I found bypass usually gained the weight back. I chose banding as the band can be made tight or loose. If I start to gain, the band gets tightened. I was 380 pounds in 2004 when I had it done and today 2009 I am 240. My low post surgery was 220. I have not progressed above 240 since my surgery. Food does get caught in the band now and then so I have to always eat slow and be sure to chew food well. Finding a good doctor is also a plus in Banding. I eat all the things I used to and eat till full just like always. Habits has not changed but I now feel full on a whole lot less food. When you get a band, you MUST chew your food very well and take more time to eat. We do not take vitamins and we both feel good 4 years out. Band has been adjusted a few time over the 4 years. My wife had her band done on the same day as me and while she did not loose as much as me, she did drop 50 pounds and did keep it off today. You do the research. My Doctor, Dr. Grossbard, Zeypherhills Florida.

    Posted by Gene |
  17. I sit here and read story after story of people offered hope (one of them myself RNY 01-13-2000) and getting it, with consequence and wonder….is hope with consequence better than no hope at all?

    I was a young Type 2 diabetic weighing 320lbs and offered hope once, hope to reverse so much I had done to myself. Hope to get out of a bad marriage, have another child, reduce and reverse everywhere I had gone so wrong. I was the smart pretty girl with so much potential…..yada yada yada it always ended with “if you would just lose weight”! Talk about pressure and no where in there was a real lesson as to why. If I lose my weight I can no longer hide from success, what a crock of crap I bought into, or did I?

    I went from a 26 to a 8 at my smallest, and now 10 years later at 35 stay between a 12-14. When I feel down about my size, I remind myself how thrilled I would have been at a size 26 to be me now. Never stop appreciating! For example the seven year old girl I just tucked in and my husband who just text-ed a simple I love you.

    Then there is round two, my consequence. It will have been 10 years this Jan 13, 2010 and I am paying my dues. I am now Insulin dependent by all counts a Type 1 diabetic, living my life attached to an insulin pump. let me tell you its not romantic or fun it is not even cool by any means. I receive Iron IV’s and B12 shots as well as take all my stomach acids and enzymes in pill form when I eat. Have been diagnosed with Fibromyalgia, Ankylosing Spondylititis, Chrohn’s (sp??? sorry I always mess those up) among other consequences that come along with malnutrition/ malabsorbtion.

    Worse…..many meds make me very ill during digestion (if that’s whats happening, doesn’t sound like it based on the dr’s own description). So many are of no help (dr’s and pills), then again I wonder…..

    After watching my father die from consequences of diabetes and AS ….how much worse would I be today if I hadn’t changed it back then? Would my battle then be Kidney Failure and Heart Disease had I not had my bypass? Will my bypass make a difference in the long run? Will I face those anyways, have I just bought time?

    My point? It is a personal choice, there is risk in crossing the street. But foul not the man who crosses the street chasing his dreams. Like all major life changes Gastric Bypass should only be considered after allot of research and thought. Would I do it differently? Depends on what day you ask me!

    Posted by Pamela Cramton |

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