Friday, February 09, 2007

WLS - Weight Loss Surgery - the real question is quality of life

One blog that I read, the medpundit, has an excellent article about bariatric (weight loss surgery i.e. WLS). In it the physician gives a very unique point of view from her clinical experience with her patients who have had weight loss surgery.

The interesting thing is that she has observed in her patients the following:

1. none of them regret having the surgery, regardless of the medical conditions they may suffer after WLS, even some nasty stuff like kidney stones every 2 weeks, frequent vomiting and re-operation procedures.

2. The patients' view of their condition of health is quite different from the doctor's clinical view. The patients all view themselves as "healthier" after WLS than before WLS but the physician commented that from her prospective, this was not true from a clinical standpoint. She commented:

>>>If asked, every single one of them would call themselves healthier, but from my perspective their health is worse. They all require more monitoring and more interventions than they did before having the surgery.<<<<
I feel this is significant and should be pointed out to those seeking surgery (and also to physicians advocating this for their patients) based on patient testimony that WLS has improved their health. There is good evidence to suggest robust health after WLS would NOT be the case with the nature of the nutritional deficiencies and other health issues introduced by this surgery and this physician's observations of her post op patients, confirm what one may suspect. I've actually heard this from not only physicians and gastroenterologists but from family members as well. One of the patients of a friend of mine, a patient who was very obese herself, remarked to him that her daughter had had a gastric bypass 5 years ago and had stayed slim but "has been sickly and frail ever since".

I feel that WLS is more of a quality of life decision than a health decision. Health-wise, it would appear that the body, pretty much regardless of size, is totally happy and healthy if the person exercises regularly and makes reasonably healthy food choices and avoids obviously unhealthy things like tobacco and alcohol usage etc. But quality of life-wise, some people find "living fat" so intolerable that they are willing to take at least a few health hits in order to be able to live thin. And that is their decision but I try to point out to them that the bottom line may be that health hits can reduce the quality of life even MORE than being fat. i.e. being slim and having a new set of clothing "off the racks" is not fun if the patient is stuck sick in bed or so fatigued or weak that they don't feel like changing from their night clothing. Likewise the daily inconvenience of having a digestive tract which has been basically surgically disabled, may be more of a dealbreaker than people realize i.e. the concept of taking extremely small bites and chewing to liquify or having things "get stuck" and having to take "food breaks" to wait and make sure the last bite has "gone down" before taking another bite, and having to restrict to certain foods, eschewing many - what we consider - treat foods and every patient, at least occasionally, getting bites of food stuck in the stoma which apparently delivers at least 2 hours of rather intense pain until it either has to be surgically removed or "goes down".

The quality of life index of a GERD patient has been said to be 2 out of a possible 10.... and lately an article suggested that although WLS was effective in many people to keep SOME weight off, their quality of life took a serious hit according to what patients themselves, described about their daily lives. Another study which suggested that WLS patients tended to live longer than fat people who did not have WLS, also observed that WLS patients had a far higher rate of death from suicide and accidents, thus again suggesting a serious quality of life hit.

Some people may be surprised that prospective patients can read about the "hard cases", the so called "gastric bypass gone bad" stuff and then, still have the procedure themselves. I've actually seen patients who have had a "gone bad" case in their own family who still go ahead with the surgery. This may be because it seems that most patients or prospective patients and/or medical professionals will dismiss the hard cases as "exceptions to prove the rule" which may or may not be true.... we simply don't know what the case of the "AVERAGE" patient is on the long term as it is evident that some patients have incorporated themselves into society as slim people, and may not identify themselves as weight loss surgery patients. But yet other patients, quietly die or become ill, and although WLS is pretty likely a factor in their illness or death, it is not documented by medical providers as such.

It may be a far better idea as far as helping the individual make the choice which works best for them, to present information about what the daily quality of life hits may be and also with what the REAL clinical health status may be after WLS, a condition including some concerning health issues, which may greatly different from the rosey patient descriptions.


Anonymous said...

Weight loss surgery can cause some
memmory problems

Unknown said...

Have you heard of Julianne Kennedy's report on Weight Loss Surgery? Well I will give you her site.
There you will what i the truth behind the questions about Weight Loss Surgery can leads to memory problems.