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A New Study of Facts and Feelings in Bariatric Surgery

The gap between facts and feelings about bariatric surgery never ceases to amaze. In 2016, we were presenting at a CDC conference in Atlanta, when a prominent family physician interrupted. He wanted to tell us that surgery usually leads to patients regaining all their weight. Or too often, he said, death. We responded by asking if he had read recent, large studies. “Perhaps I should,” he said. But we know that is unlikely, because when it comes to bariatric surgery, facts are often no match for strong feelings.

Nonetheless, we soldier on because the facts are so compelling. A new study in Annals of Surgery illustrates this quite well. In a cohort of patients from the STAMPEDE study, the difference that bariatric surgery makes is quite clear. Life is better because of this surgery – less pain, better physical health, more energy, fewer daily problems from diabetes.

Diabetes and Obesity Have a Big Impact

The STAMPEDE study was a randomized controlled study of bariatric surgery in patients with obesity and type 2 diabetes, with five-year medical outcomes published in the New England Journal of Medicine. The present analysis is new, appearing in Annals of Surgery in June. This analysis looks specifically at patient-reported outcomes for quality of life.

Sangeeta Kashyap is an endocrinologist and a co-investigator on the study. She explains why the impact on quality of life is so important:

“Patients with long duration of diabetes tend to have poor quality of life, especially when they develop microvascular complications like eye and kidney diseases. When diabetes is coupled with obesity, the impact on lower quality of life can be related to the mechanical effects of obesity as well, which leads to poor mobility and bodily pain. Significant weight loss and insulin independence following metabolic surgery drive the improvement in general health measures and quality of life for patients with type 2 diabetes.”

Dealing with Feelings

We can complain that these compelling facts should drive the conversation about bariatric surgery. But that is not the reality where we live. Right now, the world is full of people who have the same bias expressed by that family physician we encountered at CDC. Their feelings about obesity and bariatric surgery are strong. We must meet them where they are, deal with their feelings, and acquaint them with real stories about the real feelings and experiences of people living with obesity.

Psychologist Gretchen Ames explains that facts are not enough for many people she encounters in her practice. For their entire lives, they’ve heard only about the singular virtues of diet and exercise. They accept as an article of faith that it is the only option that really works – but only if they try hard enough. Such deep convictions do not quickly yield to facts, she says:

“Changing lifelong, deeply rooted beliefs about obesity and acceptance of bariatric surgery will take some time. I am learning not to get too far out ahead of where the patient is in the moment.”

It will indeed take time, personal relationships, and trust to change those deep and misguided feelings.

Click here for the study in Annals of Surgery and here for further perspective from the Cleveland Clinic.

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July 27, 2021