The surgery cop-out myth!

[WazzuCoug]

I believe most of us who have had bariatric surgery understand that It wasn’t a cop-out, but I did believe that, to a certain extent, in previous years.

I used to think that I should be able to take control, meet my goals, be healthier and stay that way without surgery.

But I gotta as fooling myself. Our bodies are pretty efficient at defending its weight. Obviously, overeating causes weight gain, but it doesn’t happen overnight. It actually takes time and deliberate over eating to override what your body is trying to maintain. When I say deliberate, I am essentially saying that we eat when our bodies don’t really need the food to support proper function. We over eat. When we become obese, our biology starts to fight against our weight loss efforts.

Your brain is actually telling your body that you need more food, even though you don’t, and it also slows your metabolism to conserve fast and burn fewer calories. It is very close to a no-win situation.

on my YouTube channel this week I talk about how the leptin hormone is the primary player in this battle and how it stimulates your brain to tell you to be hungry and to slow the metabolism.

I also give my two week update. Here is the link:

Cheers!

 

[WWWindy]

on my YouTube channel this week I talk about how the leptin hormone is the primary player in this battle and how it stimulates your brain to tell you to be hungry and to slow the metabolism.

Oh, goodie, I'll have to watch. I've been doing a lot of study about the protein leptin and how our body just breaks is down through our digestive system. I've been trying to figure out the best way one could utilize that which our fat cells make other than ingestion. I know the contraindications are interesting too. Thanks for sharing.

 

[LisaLisa]

I understand that ghrelin and leptin are the hormones that fight against us as we lose weight. This fact is why I gave up on dieting altogether. Why fight so hard to lose weight by diet and exercise alone, when the body will just adapt making it more difficult with each attempt. WLS is pretty much the only way we have a chance to lose weight and keep it off. This is my story and I'm sticking with it!

 

[WazzuCoug]

There are actually several hormones that are affected by weight loss surgery both VSG and RNY. Grehlin is definitely reduced in VSG patients, but it really isn't the primary reason VSG patients aren't hungry. With both VSG and RNY your body's "set point" or what it thinks is its defendable weight is changed. There is no way to know what this new setpoint is until you reach it. Prior to surgery, your set point was probably very close to whatever you weighed before you started the pre-op diet. Your body was defending that weight. It's why so many people get super hungry and struggle during the pre-op diet. After surgery, your body is effectively reset. You have a new set point that is primarily set by genetics and probably some other factors that still haven't been discovered.

Your body is now going to defend that new setpoint, and you are going to lose weight without too much hunger until you reach that point. After reaching that set point, you again face more hunger when you lose weight below that point and reduced metabolism. There is no way to predict what that new setpoint is going to be, but it is reliably less than what you weighed before surgery.

How much you weigh is regulated by your brain by tracking hormones in your body. One of the important hormones that do this is leptin, which is secreted by fat. Based on the volume of leptin in the body, your brain knows exactly how much weight it sees as appropriate, and when you try to lose weight, the levels of leptin fall. This lowering of leptin causes you to be more hungry and burn fewer calories.

People want to believe they are entirely in control of their appetite and hunger, but they are not. Hormones rule the world. There are many, many different factors that regulate whether you are hungry or not. In the case of leptin, it is performing as a sort of a bodily thermostat that tells the brain if it needs to defend the body weight or not. The absence of leptin is going to promote hunger and reduce metabolism. The amazing thing about surgery is it resets this to a new level.

Other important hormones are CCK and GLP-1 that are released in the intestines. When stimulated by nutrients, they signal satiety and reduce hunger. They regulate how you feel in relation to hunger minute to minute and date to day. However, lower leptin levels create a situation where you start to ignore the other signals and that leads you to not feel full.

Most people can’t fight this. There are some who can, but when you see someone who has lost 100 pounds without surgery or “gimmicks” you are seeing essentially a unicorn. What they did will not be effective for most people, and it’s a sham when they try to make you believe you can. They are selling bullshit.

Other important hormones are secreted in bile acids (and it doesn't matter if you have a gall bladder or not). After both RNY and VSG the amount of bile acid in your bloodstream increases because your liver does not recycle as much of the unused bile from your intestines after surgery. This triggers other positive responses to hunger and satiety.

There are no guarantees that you are going to get to the weight you want to be, just because of bariatric surgery. You may not get there, but YOU ARE going to have a definitive biological response to the surgery.

Surgery changes the signals, that is why it works. Having a smaller stomach is only part of the full equation, and many doctors and researchers would argue it’s the hormonal changes as a result of the surgery that really makes the difference. If it was just about stomach size, you would still get very hungry because your body would only have a small amount of food in its smaller stomach, but you don't feel that way. You feel less hungry, and that isn't due to the smaller stomach size.

Glucose control, cholesterol, blood pressure will all react, sometimes they will improve regardless of weight loss due to this change in hormones. You are working with new biology that makes it easier to do the right things and make good choices. But reaching your ultimate goal is not guaranteed. You still have to work at it and may not get there because at some point your body is going to reset it’s “defendable weight” and that will be that.

The lap band doesn’t affect hormones, which is why it isn’t promoted as much as it once was. The RNYGB and VSG both do affect hormones. They aren’t identical, but very similar. It is a fascinating area of study with the ultimate goal of research to find a way to make some of these biologic changes in people without surgery or perhaps less invasive means.

 

[LisaLisa]

Thank you, Ryan! This is information is what all regular dieters need to hear! Their current diet/exercise yo-yo cycle will last forever--or until they give up, like I did. When I started listening to Christy Harrison's podcast Food Psych, I became totally depressed and asked myself why I was trying to diet. Mind you there's a whole different message to her podcast: body positivity, Health at Every Size, etc, but she would constantly repeat, "95% of people who lose weight on a diet will gain it back" because of the things you listed above. And the 5% who manage to keep it off tend to let diet and exercise rule their world to the point of obsession. (This is all me paraphrasing.)

Incidentally, most doctors need a refresher on how the body loses weight as well. I can't tell you the number of times I was weight shamed by MDs who just said eat less, move more. I would then get defensive and it wouldn't end well. Thankfully, my GP knew that she didn't know and referred me to a weight doctor who was more "cutting edge" but still trying to manage insulin resistance with will power. She's supportive of my surgery.

I feel like I should (but won't) send your write up to everyone I know who told me to just eat less, Lisa. It's not that hard! Grrr. Thanks again, for your insight. I think it will make a difference for those who are anxious about the surgery. This is the path to health for many of us.

 

[WazzuCoug]

Thank you, Ryan! This is information is what all regular dieters need to hear! Their current diet/exercise yo-yo cycle will last forever--or until they give up, like I did. When I started listening to Christy Harrison's podcast Food Psych, I became totally depressed and asked myself why I was trying to diet. Mind you there's a whole different message to her podcast: body positivity, Health at Every Size, etc, but she would constantly repeat, "95% of people who lose weight on a diet will gain it back" because of the things you listed above. And the 5% who manage to keep it off tend to let diet and exercise rule their world to the point of obsession. (This is all me paraphrasing.)

Incidentally, most doctors need a refresher on how the body loses weight as well. I can't tell you the number of times I was weight shamed by MDs who just said eat less, move more. I would then get defensive and it wouldn't end well. Thankfully, my GP knew that she didn't know and referred me to a weight doctor who was more "cutting edge" but still trying to manage insulin resistance with will power. She's supportive of my surgery.

I feel like I should (but won't) send your write up to everyone I know who told me to just eat less, Lisa. It's not that hard! Grrr. Thanks again, for your insight. I think it will make a difference for those who are anxious about the surgery. This is the path to health for many of us.

Thanks. The who eat less/exercise more fallacy is a hard one to get over. Yes, you can lose weight by doing that, but your body fights against it, and it is very tough to make long term gains. Mind you, eating good foods and exercising is never bad. It's a good idea for people who have been gaining weight to be active, exercise, and eat whole foods and not processed or take out/fast food, etc. Those things will help weight loss, but it will be very, very slow, which is really okay.

The major benefit of the surgery besides weight loss is the effects it has on comorbidities: blood glucose, blood pressure, and sleep apnea to name a few. Some of these incredible changes are still a mystery to researchers as far as how the body knows to do things differently just because the gut has been "rewired" so-to-speak. Did you know your gut bugs (bacteria) also get reset after surgery (both RNY and VSG). It is almost like a bug colony transplant! Again, researchers aren't quite sure why this happens. It's similar to fecal transplants but much more reliable and with a lower possibility of rejection. It is all quite amazing.

Many, many primary care doctors still think the weight loss is due to stomach restriction, but most surgeons who do it understand there are biological changes that occur that are actually more important than the restriction. I also think a lot of people considering the surgery think it's all about restriction as well. There is a role for restriction, but it's just not as important as some people think it is.