What's up with bariatric surgery?

The joke is so nice. I said it twice. Uh So we should issue a trigger warning before this episode because we are talking about bariatric surgery, which some people refer to as weight loss surgery, and the topic of food and weight and weight loss and obesity and weight loss surgery could be very triggering for people. So if you want to listen to this one, great, we're gonna just break it down like we usually do. But if it's something that you don't want to listen to, we

totally understand. Yeah. I mean, after researching this, I totally get why, like a fat positive or somebody who would be triggered by talk of that could be upset by it because there's a there's a pretty substantial argument to be made that bariatric surgery is conducted just to make obese and overweight people acceptable to society. That that's basically the upshot of of why people get this surgery done.

That's not necessarily true for everybody, but there's a whole there's a whole school of thought that says, you know, this is this is a medical form of fat shaming for some people at least. Yeah. And there's another school of thought that it's uh, you know, uh, disease solving surgery. Uh. And the evidence plays out that it really does help with things like diabetes and hypertension and can be very successful.

The reason I thought of this to begin with was I saw a Box article called We're barely using the best tool we have to fight obesity, uh. And this sort of cruxt of that article, which we'll talk about here, is that only about one percent of people who qualify

for bariatric surgery use it. And the Vox article was all behind it and basically said, we have this great tool, uh for people that cannot seem to get down to what is a healthy weight for them who are suffering from hypertension diabetes, And they were saying, like, people should use the surgery more. And there's a lot of reasons

why people don't, which we're also going to talk about. Yeah, I mean, there's one thing that everybody can agree on, like bariatric surgery works for weight loss to to it's like a spectrum of how much it works, but it

definitely works. There's substantial results once it happens, and understandably so, because it is a radical surgical procedure where you're like really profoundly altering your internal anatomy so that you can, in some cases except less food, in some cases digest food less or have less of a chance to digest food. And we should point out we're talking about modern bariatric surgery because even ten years ago, results were wildly different.

The preferred surgeries were wildly different. And uh, they've come a long long way in the past even ten years. Yeah, it definitely has hit its stride in the last ten years for sure. Um, but there's uh, as far as the history of this whole idea goes, it's not a new concept. Um. It goes back at least to the end of the nineteenth century. Some people say it goes back as far as the tenth century, which is amazing

to think about. And you know what, Olivia helped us with this, and I had a feeling when I said, hey, let's cover the history I was like, there's got to be some you know, hundreds and hundreds of year old procedure that somebody did. And if you believe the story, in the tenth century, there was a King Sancho of Leon and Sancho was so big. And this is when Ed McMahon chimes in, how big was he? He was, oh big that he couldn't ride a horse or walk

ouch as the story. As the story goes, so the doctor did the most basic form of weight loss surgery at the time, which was the suture King Sancho's lips shut so that King Sancho could only ingest a liquid diet and apparently lost about half his weight and got the thrown back. So that's a nuts so story. I find something else that comes later chuck even more nuts so. No. Um, In the twenty one century, there was a push um

to basically reintroduce jaw wiring. Oh yeah, yeah, it's so this whole thing with King Sancho, one of the original kings of Leon. Um Like it got picked up like a thousand or so years later. Um, even though it's been shown nut to work, as we'll see, But the whole like modern bariatric surgery um actually was born in the nineteenth century out of um uh the same kinds of procedures, but for a totally different purpose. UM. A guy named Caesar rue came up with a surgical technique

called the ruin why and UM. It was used in case you had like some sort of like um bowel or gastric obstruction. He figured out how to bypass it um and and connect your stomach to a different part of your intestine to get around the obstruction and yet you would still have functioning parts UM. And that was where the idea of um of gastric bypass surgery came from, or the name of it, yeah, which all the way back in nine two, which is really hard to believe,

but it uh. They called it ruin why because I believe it's sort of forms y shape when you're finished. And that was about mortality rate initially in no surprise, but they got that down to about eleven, which is really great for the time period, I think. And then you know, things kind of went along as people were experimenting with those obstruction UH surgeries. There were doctors that started to say, hey, wait a minute, we now have a thing called a scale and humans we don't just

need to put grain on it. Humans can stand on it so we know how much we weigh. And everyone went, what hey, that's a great idea. I can't wait to weigh myself every day, is what everyone said. I haven't

weighed myself in a long time. I kind of quit me either, me too, But hard to believe, but yes, humans started weighing themselves, and all of a sudden in the nineteen twenties and thirties, doctors started in patients started paying attention to their you know, to their little literal weight, not just like how they looked and how they felt right weight gain and um being overweight and I'm using scare quotes here, um or obese again, scare scare quotes.

Um became medicalized at point, like it became a medical issue, a problem to be treated. And it's just that whole idea, and that whole concept has has taken off since then. It's just so so fully ingrained in our our society that it's really interesting to think, like it's only been around for maybe a hundred or so years. But um, they basically would give you anything that you wanted to lose weight, like amphetamines, laxatives, UM, just anything. You just

go to the doctor and he give you whatever. UM. But it wasn't until the nineteen forties that that whole idea of medicalizing um being overweight, uh like, really kind of spread into society at large, when the insurance companies got involved. Yeah, and I should point out to you you're using scare quotes when you say things like overweight and obese because there is so much individual variation in in body weight and how people carry it and how

healthy they are. And we understand this, I mean, we sort of understand this now as far as people accepting it, but there's still not a lot of acceptance around it. That's why when you calculate something like a b M I that is for you know, to judge a population that does not take into an account take into account of an individual or their muscle mass or you know,

their body shape. So they kind of throw these tags on overweight and obese and b M I that are useful in a certain sense, but also not useful in a certain sense. Yeah. And the b M I scale was invented in the nineteenth century by a guy named Adolf quite Alet. He was a sociologist and he based exclusively on white Western Europeans. So in a way, you could say the b m I scale has created the ideal body form is a average sized or whatever the

b m I says, the average size white European. The problem is that's that's a problem in and of itself, because you now have a compartment that you're trying to shove everybody in regardless, and if you're not in that compartment that you're supposed to be in, you have a problem, um, a medical problem even maybe even a life threatening problem. Um. But more than that, if you're not white and Western European,

that scales shouldn't really apply to you. But that hasn't kept humanity or people from plugging all of humanity into that same b m I scale. So there's a lot of questions about the bm I scale itself, and especially in recent years. Yeah, and I hope everyone understands when

we use those terms. All of this goes into that. UM. As doctors were looking at uh, you know, still kind of performing these surgeries, they noticed that, hey, you can lose weight, you know the initial ruin why when you had an obstruction, They were like, wait, this is good for weight loss? Too, because quite simply, your stomach is smaller and your body is not absorbing. You can't eat as much and it's not absorbing as many nutrients and

in you, they believe. The very first real deal weight loss surgery occurred again from a Swedish surgeon named Victor ein Rickson, when Victor removed a hundred hundred three centimeters of small intestine from a woman, a thirty two year old woman who didn't lose that much weight, but supposedly it improved her life quality. Yeah, and just the next year UH an American named Dr Richard Varco created a slightly altered, ruined why procedure called the j juno ilio bypass.

I practiced that so many times. My brain just says, Nope, you're never gonna get it right. The first time, I think that was probably close. It was close, but there was like a hitch and a stumble in there too. Ju Juna lial is what I would say, oh, showing off a but then may not be right either, and that comes from I'm sorry, that's that's what the first time. They called it bariatric surgery, right, yes, And bariatric is from the Greek for weight or heavy UM. So they said,

I guess this is surgery for heavy people. Maybe I'm not sure, but that's where that's that's about. The fifties is about when that that name became applied to it UM. And then in the sixties UM they were starting to do studies and experimentation with it. And there was a study that found that UM a temporary procedure where you would have like your stomach moved to a different part of your small intestine. Temporarily you lose the weight and

then they go reverse the procedure. They found that patients just basically gained the weight back after the procedure was reversed. And at that point in the early sixties, these surgeries started to become permanent in nature pretty much across the board. Yeah, you know, that was my first surprise in this research. I thought, even modern bariatric bypasses and stuff, I thought that was all a temporary thing, and that like, you don't live with an egg sized stomach for the rest

of your life, and that's not true. You live with an excized stomach the rest of your life. Yeah. They as we'll see, they remove a significant portion of your stomach in either one of the surgeries that you get, and that when they do that, that's that's irreversible, that part of your stomach is gone. What's amazing to me is that they've gotten good enough at it that it has tremendous results, and the complications have kind of died down over the years to where the risk of death

is now down to about point one percent. Uh. In the twenties, it's gotten that low, but just around two thousand, twenty years ago, it was still up at one percent, which is really high for a surgical procedure in the Western world in the twentieth century, but they've they've whittled it down ten times lower than it was twenty years before because they started using lap of scopic surgery. That's right.

Olivia points out that point one percent is less than knee replacement surgery, just to kind of put that, you know, to frame that. Yeah, and also I want to correct myself. It wasn't in the twenty first century. It was in the mid twentieth century that they tried to bring back jaw wiring, but it just doesn't work, that's right. And as a result of the success rate and the obviously

whittling that death rate down to point one. UM surgeries now are crunching up towards a three hundred thousand per year. I think two hundred and fifty six thousand was the last year that we have a number four, and that was in twenty nineteen, as opposed to about twenty thousand a year in the nineties and about a hundred and fifty thousand and change in the mid two thousand's because they said, hey, everybody, we don't killed nearly as many of you as we used to come and get it.

Should we take a break? Sure? All right, that was a good setup. So let's take a break and we'll be right back. Okay, Chuck, So we're back, and I think it's high time that we actually talked about how a bariatric surgery goes UM. And there's a couple of different ways you can go UM. Some are more popular than others. It seems like one that used to be more popular than ruin why the bypass has become less popular in favor of one called sleeve. Guests Guests direct

to me, See, I can never get it. The first time you want to say gastronomy, I did. I wanted to say gastro pub Uh yeah, this is easily the most common um performed today. This is the one that's very very popular right now. They remove about eight of your stomach and basically the stomach, instead of being a large pouch, becomes a narrow sleeve. That's why it's called sleeve. Gets struck to me, and it's it's very very simple, and that you have a much, much, much much smaller stomach,

so you can't eat as much. You will feel full more quickly. But what also happens is and I'm not sure if they had a hunch this would happen, or if they knew this would happen, but it also tricks the body into releasing a few of those hormones that say that you're hungry. So it's not like, oh, I'm still hungry all the time. Like you just have a smaller stomach. You eat less and you're satisfied. Yeah, you eat less and you have the desire to eat less on top of that. So, I mean you can imagine

that this has tremendous results. And I think that they did know that that hormone um effect was going to happen because they specifically remove a part of the stomach called the fundest and that's the portion that expands when you eat a lot of food, So your stomach can't expand when you eat food. You got to keep that in mind. And then also the funnest is where grellan is largely made, and that's that hunger hormone. So you're producing less grillan and you just can't physically fit that

much food into your stomach anymore. Right, And like I said, it's the most popular form today. I think in the mid two thousand's it was about eight bariatric surgeries. Now or in twenty nineteen it was it's even more than that two. I just don't have the most recent number. I was, um, I just got back from vacation in Mexico and one of the two families that we kind

of hung out with him buddied up with. I was chatting with the guy and I was like, so, what do you do and he said, I'm a bariatric surgeon and no kidding. And I was like, what, We're about to do a podcast episode on that, and he said, what's a podcast. I'm just said, well, what's a bariatric surgery? Now? He didn't ask that because we had already talked a little bit, but he uh, very nice guy from Texas

and he um talked a little bit. I didn't like want to bother him too much about it, although he really really enjoyed talking about it because he's not only a bariatric surgeon, but he's very much a wellness doctor and he believes that it's just part of a wellness plan for your life. Um, not just like all right, we'll do it and then have fun in the world. Um. So he was a good guy to talk to you.

But he talked about sleeve gast direct Uh here there I went again, sleeve gastro pub being the most popular gastro pub. Yeah, it is the most popular gastro pub of all time. So what how does that surgery go? Though? Um, it's pretty quick for one Yeah, I think it's like forty to seventy minutes, not that long. You stay in the hospital for a couple of nights. They keep an eye on you. And one of the reasons they're keeping an eye on you is because for two weeks afterward,

you can have nothing but a liquid diet. Because if you go look up sleeve gastrectomy videos, Um, there's a lot of computer animations out there that show you what they're doing, so you can imagine that if you remove probably doably, I think maybe of your stomach um, it needs to heal. And the way that you help at heal over the first two weeks is by just drinking like broth, water, um, maybe some gatorade if you're feeling spicy. Um. But again, remember like you're not sitting there going bonkers

wanting food. Um. Most people who have a sleeve gets tructomy report having to make themselves eat. They have to keep a strict schedule because they don't want to eat like they used to, like most people want to eat. Yeah, And I mean we'll talk a little bit about maintenance later, but I think in the end they recommend you eat like, you know, four to six very small meals a day, Like there's no way around it. You're you're going to change you're eating habits in your lifestyle in a big,

big way if you have this surgery. And I read a lot of first person accounts of like, you know, can you ever go out to eat again and said down with your family and enjoy a meal, because if you're filling something the size of an egg, it's like can you even order a meal? And you know, everyone that I read was it's like, yeah, you know, you you get used to it. You go to the restaurant, you order an appetizer maybe, and you don't even eat half of the appetizer and you take the rest home.

You do a lot more talking at dinner, and you don't drink alcohol. You can't drink liquids while you eat at all. Um, they're saying, you know, you drink liquids no more than thirty minutes before you have a meal because there's so little room. Uh. I did see some people say they could drink a little alcohol, but it's really recommended you basically quit drinking. Certainly, you don't want to drink beer when you have a tiny egg stomach. God, oh my god, that sounds terrible. It does, um, but

you there's no way around it. You are changing your lifestyle. But across the board, when I read all these first person accounts, everyone was like, you get used to it, and the trade off is for them the they are much healthier and happier and generally didn't have the regrets. I'm sure you could find some people that had regrets and were like, I missed sitting down and eating big meals with my friends and family. But I mean, most of the people that I read were pretty satisfied with

the surgery. So um, after you get surgery too, and I can imagine they're satisfied because when you get a sleeve guests trick to me UM, the doctors who performed this these kind of procedures they use as something called excess weight to qualify the success of the surgery. And excess weight is the difference between your ideal weight and what you weighed before the surgery and eighteen months after the procedure, patients typically have lost about seventy percent of

their of their body weight after after the surgery. Within a year and a half, their excess weight, right, Yes, they're excess weight. Yeah, And you know, generally it's not like uh, the days of your with gastric banding, which has really gone out of favor, UM a lot of complications, the weight generally did not stay off. But with sleeve gastrectomy and then as we'll see with gastric bypass, the weight does tend to stay off for years, although people

do gain some of the weight back. UM. One study saw after twelve years about forty percent of patients had maintained a thirty percent weight loss or more compared to their original total weight, and where at least ten percent lighter than they'd been. So sixty percent of people gain back more than thirty percent of their weight. Is that a way to say it? Yeah, I have to admit you just made my brain do a somersault. But yes,

that's the that's the that's the converse, I guess. Huh. Yes, So sixty percent of people gain back more than that thirty percent, But it doesn't mean they gained all the weight back that could have been. No, because again, like you said, sent or at least ten percent lighter than they've been before a lot of percentages flying around here. Yeah. So, but the upshot is is that you are definitely going to lose weight if you're a physician, UM, especially if

you're a bariatric surgeon. You consider bariatric surgery the gold standard for rapid and sustained weight loss. That like, that's if if you have a patient who is um like again obese UM to a to like maybe say three hundred four hundred pounds or more UM, you would say, look, you really need the surgery and it's going to change your life. It's you would probably also tell them it's going to save their life too. Again, it's questionable, but

that's the medical stance, that's right. Uh. Then we have the gastric bypass, the original rue on y or r y GB surgery. Uh. They staple off part of your stomach. They reduce that remaining part too. Again about this as an egg, and then they attach it to that rue lamb of the small intestine and you're you know, most of that stomach and the upper small intestine is now bypass.

That's why they call it bypass surgery. And this one is I think there are a few more complications now and that's why this one's fallen out of favor a little bit. Compared to sleeve guest struck to me, right, Yeah, the impression I have is that sleeve gets struck to me, is much more um or much less complicated afterward, because you're not messing with the original plumbing. All you're doing

is removing a large section of the stomach. Everything else remains as is, so you still have like a risk of developing an infection or leakage in your stomach or all sorts of stuff. UM, but you're not like bypassing, you're not detaching the stomach and then reattaching it elsewhere, which adds an entirely different dimension to that surgery. And

that's what ruined. Why is and when you're doing that, Chuck, The reason why you're doing that, UM is because you're you're basically, UM keeping the small intestine from being able to digest as much like fats carbohydrates all that stuff from the food you eat, so you're eating less, but you're also digesting less of it or absorbing less of it,

so that leads to rapid weight loss as well. That's right. So, like we said, as far as this being an effective thing, uh, you know, losing weight for some people is really really really hard. So for some people it is a mountain that they cannot overcome. Uh, diets, you know, I think the verdict is in across the board on diets, which is diets are a quick fix and it's very hard

to keep that maintenance. Everybody basically agrees that UM, long term weight loss involves life complete lifestyle change and not some kind of crazy diet that you're doing, or even not crazy diet that you're doing. UM. Exercise we've talked about on the podcast is great for your body, but you cannot exercise the weight off if you don't change

the food and drink portion of your life precisely. And even even when you do diet like um, you you may actually change your body so that you aren't able to lose weight after a point, and when you stop dieting, you may gain back more weight than before, So that could be dangerous for sure. You don't want to mess with your metabolism too much. Um and I would direct

people to our Intuitive Eating episode. We talked a lot about that, but um that like that, Like you said, the verdict being in on dieting has really kind of supported the idea of bariatric surgery is not only the gold standard but really the only real option you have if you want to lose a serious amount of weight.

Um and so uh A lot of people have been studying like just how how effective it is, and like you said, um, you know, there's there's lots of percentages flying around and how many people kept how much weight off, But there was this one study that looked at people who have gastric bypass surgery and contestants on the biggest loser UM, which is a weight loss competition that's been on TV forever UM and they use them because it's hard to find a group of people who lose about

as much weight as you would lose with the gastric bypass surgery UM, but without using gastric bypass surgery, So they made like an ideal control group. That's right, uh, And what they found is really super interesting. Both groups lost about the same amount of weight, or at least similar amounts. But the biggest loser group I hate even

saying that, I hate that dumb title. The biggest loser group experience what's called metabolic adaptation, which is to say that their metabolism slowed down and it made it harder to keep that weight off. So six years on down the road, that control group with the biggest loser uh bunch had regained a lot of that weight, but their metabolism was still really low uh and lower than and slower than it was to begin with, So it kind

of permanently altered. It seems like I don't know about permanently, but at least six years later had had altered their metabolism. It's not permanent, no, but they will have to go through the process of retraining their body to not store as much fat or burn energy slower um in order to get back to normal. But that's what dieting can really do to you. But what happened with the other group, Well, the other group, the bariatric surgery patients. They they're metabolism stabilized.

So there's a lot of rapid weight loss just because you're you're taking in less, but also because your body is not producing hunger hormones like growing and it may actually actually produce more of the satiated um. Is that right? Satiated satiety, sure, sitcom um sat safety hormone leapton so um, they're metabolism. Actually, it just stabilized. So eventually they stopped losing weight, maybe gained a little bit back, but typically

kind of hold um. What's what's referred to as a baseline weight, basically the weight that your body and your metabolism says, this is how much you should weigh. Try as you will, we're always going to try to get back to this, and if you mess with us, we're gonna make it harder on you than ever, right, Which I mean, that's study really makes a pretty good case

for bariatric surgery as an option for people. Right, Uh, so does this There was a meta analysis in that saw certain we talked earlier about, you know, health complications from caring too much weight UM, that bariatric surgery reduces the risk to develop type two diabetes by h and hypertension by six and if you already had those conditions going in, which can be one of the criteria to get the surgery to begin with. Uh, the surgery was

associated with remission. Even so, just to take a little sidebar, I didn't understand how people can say, okay, if you if you have if you're faced with data like that, how can you possibly say that obesity um is not necessarily linked with poor health, or that there's a concept called healthy at any size, which I want to do an episode on eventually. UM. And the thing that I saw the explanation is, yes, these things are associated with obesity,

with being overweight. But it's the point is is if you're a b obese or overweight, you're not automatically going to get type two diabetes, not automatically going to develop hypertension. And in much the same way that smokers may or may not develop lung cancer. People who are overweight or obese may or may not develop type two diabetes or hypertension or some of the other um maladies I guess associated with being overweight by the medical establishment. Yeah, yeah,

it's a good way to look at it. Yeah, I just wanted to add that. Sure, but Chuck, the thing is it is it is evident that yes, if you do have those maladies, Yeah, gastric bypass surgery bariatric surgery will definitely help your health outcomes as a result. Yeah, or headed toward those, And it's not like if you get regular physicals, you know when you're headed toward those,

towards type two diabetes and hypertension. It's not like a switch is just flicked and you're like, all right, I've got those two conditions now, Like you know the blood tests that they give you, and trust me, I've been I go every year now, Like I want to know about my body. I'm not one of these guys who is overweight and like just buries my head in the sand, probably to my detriment. Want to get too many tests done and things like that, because I want to know

what's up. But you know, I've seen my own health like creep up towards those numbers two levels that I don't like, So then I have to work to like get those numbers back down. And it's all it's all data driven, and it's all from blood tests. And I just encourage people to go get their physicals every year. There's no I know people that bury their head in the sand and are just like, I just don't want

to know about that stuff. And I just think people should really be uh advocate for their own health and and uh, what's the word I'm looking for when you are just sort of preemptively um, sort of getting tests to find out where you stand, you know, um taking action, Yeah, well taking action on the medical side. Uh, so you can take action you know at home. Yeah. It also you know, you don't have to go to a doctor

to get blood tests. You can you can order your own basically and just go to like quest or lab Corps or something. Oh yeah, just like do your own blood pail. Yeah yeah, and they have you know, the results show if you're in like a normal range or whatever over for everything. Yeah, or if you cut yourself, squeeze a little bit on a piece of white paper and just look at it for a while that's right, what does it look like? It's like reading tea leaves or chicken guts? Uh, what was I gonna say? Oh?

There they did. As far as the meta analysis another study with that analysis, they found about half the people with type two diabetes that had the surgery had enough improvement that they could get off their medication. And that's what remission basically is. It's sort of like you're always an alcoholic even though you quit drinking, Like technically you're still diabetic, but if it's in remission, that means you've gotten your numbers down to a safe level, you can

get off the medication and stuff like that. So um. Also, by the way, there's that's questionable as well as whether you're still an alcoholic after you quit drinking. Well is it? Yeah? I mean it's sort of just terminology though right, No, not necessarily. I think there's a there's definitely a school thought that's that's once an addict, always an addict, Like you will always be addicted. Even if you for the rest of your life fifties sixty seventy years without ever

taking another drink, you'll always be an alcoholic. Other people say, no, that's that's not true, And that's a whole mindset that keeps people trapped in this idea that they're addicted or an alcoholic when they aren't any longer, and it produces

a lot of unnecessary shame and hardship. You know. I'm glad to hear that because I always thought that was weird when someone who like quit drinking twenty years ago says, I'm still an alcoholic, And I just thought that's not for me to judge, Like that's their terminology that they need to use. But I always thought that was a strange way to think about it. So, but I think that does apply for some people. I'm not saying for

all people. Yeah, it's just the opposite is true as well. Um, just because you're an alcoholic, it doesn't mean you're always going to be an alcoholic for everybody. Okay, I got you, so, chuck chuck chuck. Yes, I say we take a break. All right, let's do it. I'm gonna go into remission and use the restroom. All right, we're back. I'm glad we cleared that up about alcoholism. Yeah, I didn't know that that was going to pop up. I didn't either,

And I'm glad you said something though, that's that's good information. Yeah, I might say it stuff you should know. I just used the line that I hate that everyone else uses when you first meet them and tell them what you do. Oh yeah, at some point when you meet someone new and you tell what you do in the name of the show, at some point they say, oh, that sounds like stuff you should know. Right, Yeah, they definitely do, or they'll hit you with So tell me something I

should know. Yeah. I also realized just this week why some people who right in abbreviate the show s U s K. I've never understood what they were doing. I finally noticed the why and the you are next to each other on the keyboard on a querity keyboard. Oh you think that's what it is. It's got it's got to be. I just figured people were doing the Prince thing or just you know, internet shorthand for you as you right, But it doesn't make Oh yeah, I guess

it does. It does. Okay, Well, maybe back in the wilderness as much as I was before. Um, let's talk about some risk factors. You did talk about leakage always is, you know, just with any kind of abdominal surgery, you might get there's a risk of infection and clotting, hernia, ulcer, gallstones,

botwel obstructions. I think most I think you find more of those specific ones in the gastric bypass rather than the sleep eve and then explain to everyone with these two great words together mean dumping syndrome one of the most unfortunately named medical conditions that has ever been put. I think so dumping syndrome is where you basically um, when you're eating after gastric bypass surgery or bariatric surgery. UM, the food just moves out of your stomach too quick.

It's not it's not predigested enough, so when it hits your um guts, it causes cramps, it can cause diarrhea. There's another variation called late dumping syndrome, where if you eat a an overly sugary meal or snack or whatever, um, it can drop your blood sugar precipitously because so much insulin gets released because again it wasn't predigested or pre absorbed in any way. It just kind of shows up in your gut like here, I am, I'm a bite of steak. Let's see what we can do. Yeah, the

other thing you're gonna have to do is potentially takes supplements. Uh, you know, just because you're eating so little, you're also getting a fewer um good things into your body. And you know, hopefully you're eating good things if you continue to eat just very small amounts of bad stuff. And again we're using scare quotes, but you know, if if I get this and I continue just to eat fried chicken and mashed potatoes, then I'm not giving my body the nutrients that it needs, and you might need to

take supplements. One thing you definitely have to do is eat really really slow and chew like you've never chewed before. Yeah, you gotta chew like um, Dr Kellogg. Yeah, I mean I think you're essentially trying to trick your body into thinking you're on sort of a liquid diet. Still. Yeah, but I think also your body is sending you signals like please please stop. The three bites of steak is too much, you know, like it's sending you those signals.

So you're you, Yeah, And I think it's from what I understand, take some um some working out on figuring out how to eat under this new under these new circumstances. It's a little bit of trial and error, but that people you know, work it out over time. I bet you really appreciate food. Yeah, I could see that being, uh, an effect of it. I could also see becoming totally neutral towards food being in effect of it as well. Yeah.

I mean they're definitely psychological impacts. And that is played out with another interesting side effect, which is and I saw this in a few places, is that you are more likely to get divorced then if you didn't have the surgery. And I think there was one study. There's been plenty of studies, but there was one that found nine got divorced after the surgery compared to six percent of the control group. And there are a lot of ways to look at that one. Certainly is it it? Uh?

Maybe you have the increased confidence to leave a relationship you didn't have the confidence lead before that you should have leaved, like a bad relationship. Apparently you get married or in a relationship more if after you get the surgery, which also could make a lot of sense. Yeah, which is nice. I like that one. That's the silver lining to the other cloud. You know. Um so if you if you said, okay, what about me, how do I know if I qualify for bariatric surgery, because I don't

know if we said or not, chuck. Um insurance will cover it, Medicaid, Medicare, and private insurance will cover under certain circumstances. Because again, obesity has been medicalized and is this is seen as a disease or um a syndrome or symptom of disease right or associated with disease, if not a disease itself. So they've said, okay, we'll cover this if you have a b m I of at least forty or you're more than a hundred pounds overweight. I was surprised it was just a hundred pounds. I

it have thought it would be more than that. Yeah, um, Or if you have a b m I of thirty five and you also have type two diabetes or sleep apnea or hypertension or fatty liver disease, it's not from alcohol, uh osteo arthritis, lipid abnormalities, heart disease, or gastro intestinal disorders gastro pub disorders along with that thirty b m I. Or if you have tried to lose weight with several multiple efforts and are unable to UM and I think that's included with the b M I right, yes, yeah,

and that's actually I mean, they'll they insurance companies will make you jump through a lot of hoops, and one of them is, um, you need to try to lose weight and show that you can't before they'll ensure you. In some cases, there's a lot of meanness to it. Really if you step back and think, like, um, that like that you're treating somebody like that, not because of any medical condition, but because they're overweight. Um. But that's that's what insurance companies do to get to pay for it.

And if you pay for it yourself. Roxane Gaye got it done and wrote an essay about it, and she said that she paid out of pocket because she didn't want to have to jump through any hoops or red tape, and she said that the cost was breathtaking, as she put it, really so yes, I would get the impression that the average person would not be able to afford it out of pockets. So there are hoops you're gonna

have to jump through. Apparently, according to paper by Boston Medical Center, UM, fewer than one percent of patients, like we said, get the surgery that qualify and one of the big reasons is a lot of physicians PCPs still do not recommend it. Apparently you were five times more likely to get it if it is recommended by your

primary care physician, but it just doesn't happen as much. Yeah, And I think, um, a lot of the PCPs aren't up on the advances that have been made in things like mortality rates and the fact that it's moved over to laparoscopic. So if you get like kind of old and said in their ways a married care physician, they might not know that bariatric surgery is much safer than it used to be and you know, much less invasive. Um like here, just have a sody pop and it'll

be fine. Exactly, have a diet coke. Um. So if you if you do get bariatric surgery, there's a chance, an eight percent chance that you are a woman. Right, That's right. Even though um obcit rates are the same for men and women, women are way more likely to get the surgery. Also, when women get the surgery compared to men, they are younger than their male counterparts. And I think that it's more like referrals. You're more likely to get the surgery because you've been referred by someone

who got it rather than coming from your doctor. Uh. And it also shows that women in this is sad and and not surprising at all that of women listed psychosocial concerns as one of their biggest motivations, even over related concerns. Yes, but um uh. Infertility has also been strongly linked as far as I understand, to um being overweight or obese. So it's possible that some of the increase in women who get it, or the disproportion of women who get it, could be because they're seeking to

have a family or have an easier pregnancy too. Right. And again on the sort of general shaming outlook of this surgery, there was a survey about five years ago in a poll I guess that in the US, um almost people responded that bariatric surgery was the easy way out rather than just like losing weight the old fashioned way. Yeah, because that's and that's just so that's such a crock because it's like, hey, you should really lose a bunch

of weight. Oh you're getting bariatric surgery. That's the easy way out. And that really underscores how much people look at being overweight as an individual moral failing that there is ah, there's something wrong with you, yeah, or a choice um or um that you just you're just lazy or you just can't help yourself, whatever, so much so that that just people who are overweight or obese or just look down upon. They don't they're not treated with the same kind of dignity that an average sized person

would be. And this actually shows up in medical settings too. Apparently doctors um will not pay as much attention to health indicators like UM cholesterol level or UM glucost levels or whatever um, and instead just pay attention to the appearance of an overweight or obese patient when they recommend gastric bypass or bariatric surgery. So they're it's they're not saying it's because you're hypertense or because you have diabetes.

They're essentially saying it's strictly because you're overweight. Yeah, and sort of. The one thing that's obvious to me is everything that I've seen about the surgery, the recovery, your lifestyle afterward for the rest of your life. There's nothing easy about it. It is not the easy way out. It's not like, well, it's a forty minute surgery, then you're good to go. It's it's not an easy thing and it is a not something to go into lightly.

It is a major surgery that will completely alter the way you eat, and a lot of people the way they eat is a big part of their lifestyle in their life and it will alter that forever. And it's a big, huge, monumental change and there's nothing easy about it. But it is your decision. It's up to you. UM. From what I've seen about the fat positive activist community, UM, they would probably recommend that you reflect on exactly why you want the surgery. Is it because you are being

pressured by family, friends, society, um? Or is it just for whatever reason? And whatever reason you have, it's your again, it's your decision. No one can tell you that it's right or wrong, but you should definitely educate yourself on you know, the risks and the benefits and everything about it, and then just make your decision and feel good about

it either way. Yeah. I agree. I hope this. Uh. I think this is like one of those topics that you know, people might research, you know, late at night even and feeling shamed to even look into this kind of procedure and hopefully we could clear up some of this stuff and if if something people feel good about, then they can own it and move forward with their head held high. Very nice. You got anything else? I

got nothing else. Well, since Chuck said he's got nothing else, that of course means it's time for a listener mail. I'm gonna call this just a new listener from Canada. I don't think that's how they see it. I'm a new listener. Just want to say how much I enjoy the show. My husband told me about stuff you should know, and I kind of brushed them off, thinking this was just another boring podcast trying to teach me boring thing. But I finally gave it a shot and was hooked.

After the very first show I listened to you guys have great chemistry, and I heard another listener call you burten Ernie type of burten Ernie type. I feel that I'll take that you have a great mix of random knowledge and important knowledge, and I'll love your true crime episodes to hope you keep going forever. And you should know my husband is not letting me live this down that he is the greatest podcast taste that is. From Autumn in the Thunder Bay, Ontario, Canada, North America. Planet

Earth very nice thought them. Thank you very much, and we're glad that you're with us, even though it was your husband who made you do it. That's right. If you want to be like Autumn and get in touch with us, we would love that you can send us an email. That's the best way to do it. Just wrap it up, spank it on the bottom lightly, and send it off to Stuff Podcasts at iHeart radio dot com. Stuff you Should Know is a production of I heart Radio.

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