Obesity treatment, from fad diets to surgical interventions, has a long history of exploitation and ineffective solutions. Despite this, bariatric surgery has become increasingly common, with hundreds of thousands of procedures performed annually in the United States alone. While modern death rates are considered “very low” – roughly 1 in 300 to 500 patients – the field’s past is riddled with catastrophic failures and ongoing regulatory gaps.
The Historical Context of Bariatric Surgery
Early bariatric procedures, such as the intestinal bypass (removing 19 feet of intestines), were abandoned after causing “disastrous outcomes,” including fatal liver failure due to protein deficiency. This dark chapter highlights the inherent risks of radical surgical interventions for weight loss. The industry has evolved, but the underlying principle remains: altering the body’s physiology to enforce dietary restriction.
Current Procedures and Effectiveness
Today, the most common surgeries include sleeve gastrectomy (removing most of the stomach) and Roux-en-Y gastric bypass (stapling the stomach and rerouting the small intestine). The latter is more effective for weight loss (63% of excess weight lost vs. 53% with sleeve gastrectomy) but carries higher risks of complications. Many patients pursue surgery believing “diets don’t work,” effectively treating it as an enforced dietary solution.
Regulatory Concerns and Lack of Oversight
A troubling aspect is that new surgical procedures are largely exempt from rigorous FDA approval. This means innovations can be implemented without extensive premarket testing, raising questions about patient safety and industry accountability. The lack of oversight contributes to a pattern of risk where the burden of proof is on the patient, not the provider.
The Broader Obesity Crisis
The rise of bariatric surgery underscores a systemic failure to address obesity effectively. Despite being labeled a “national crisis” comparable to terrorism by one Surgeon General, the response remains tepid, relying on “voluntary initiatives” from the food industry and “small-changes approaches” (like switching mustard for mayonnaise). This inaction suggests either a lack of political will or an acceptance of the problem as intractable.
The Difficulty of Long-Term Success
Like quitting smoking, curing obesity requires sustained effort, often involving multiple attempts. Patients may regain much of the lost weight, highlighting that surgery is not a magic bullet. The key to success lies in commitment, not willpower, as the process is just “something that has to be done,” similar to essential daily tasks.
In conclusion, bariatric surgery represents a drastic measure within a flawed system. While risks have decreased, the history of failure, regulatory gaps, and societal inaction suggest that a more holistic approach to obesity is urgently needed. The current reliance on surgical interventions reflects both the desperation of patients and the shortcomings of public health strategies.
