11 - Surgery: Is Weight Loss Surgery Really Reliable?

Hello, welcome to the "Scientific Weight Loss Course." I am Jessica.

In the last lecture, we mentioned that weight loss medications have

limited effectiveness and considerable side effects, so they're not

recommended for casual use. Besides taking medication, are there other

medical methods that can help us lose weight?

Of course there are.

I remember one day, the young nurse at our rehabilitation center's

front desk was urgently looking for me, her face flushed with anxiety.

When I asked, I learned that a Ms. Cao, 38 years old, had come to the

front desk and, after just a few words of conversation, was insisting

on weight loss surgery and wouldn't take no for an answer. The young

nurse was completely bewildered and didn't know how to respond, so she

came to find me.

When I went over to see, I immediately understood why the nurse was

confused. Although Ms. Cao was somewhat overweight, her dress and

demeanor were very comfortable and had the temperament of a university

professor - she didn't seem like someone who would need surgery to lose

weight. After carefully inquiring about her BMI and weight loss

history, especially after learning she had diabetes, I immediately

confirmed that she was indeed suitable for weight loss surgery.

Hearing this, you must have a series of question marks in your mind: Is

there really such a thing as weight loss surgery? Do you really need to

go under the knife just to lose weight? Let me explain these questions

slowly.

Simple but Miraculous Weight Loss Surgery

When it comes to weight loss surgery, many people's first reaction

might be liposuction. Think about the water tank model - since being

fat means there's too much water in the tank, wouldn't directly pumping

out some water achieve weight loss? This is the logic behind

liposuction.

Although it sounds appealing, I must tell you:

Liposuction is almost entirely for local body contouring and was

invented for beauty purposes - it can neither help you lose weight nor

help you gain health. So medically, liposuction belongs to plastic

surgery, which is in the realm of cosmetic medicine.

Why can't it help with weight loss?

First, liposuction only removes subcutaneous fat and cannot reduce

visceral fat. As mentioned before, subcutaneous fat is still quite

useful - it's the visceral fat that truly harms health. Only by

reducing visceral fat can you truly succeed in weight loss. Liposuction

cannot achieve this.

Second, if you don't change your lifestyle, the removed fat will grow

back in about three months. Moreover, it won't grow back in the

original liposuction sites like thighs, buttocks, and waist, but is

more likely to accumulate in the viscera, making people have thin limbs

but big bellies. As mentioned before, this type of abdominal obesity is

more harmful to health.

Therefore, liposuction cannot help with weight loss and is not among

the weight loss surgeries we're discussing. You must pay attention to

this point.

How is real weight loss surgery performed?

Actually, the principle is very simple, and it can even be said to be

the most "foolproof" of all surgeries. Since being fat is due to eating

too much and energy accumulation, wouldn't it be good to directly make

the stomach smaller so people eat less? Yes, weight loss surgery

really does make the stomach smaller through different methods. There

are three classic methods -

The first is gastric bypass surgery, which uses the small intestine to

create a pathway beside the stomach, leaving the stomach unused;

The second is more decisive - directly cutting away part of the

stomach;

The third is placing an inflatable balloon in the stomach to reduce its

capacity.

Isn't it simple and crude? However, although the operation is simple,

the effects are real. For people with a Body Mass Index (BMI) above

40, weight loss surgery is very effective. A 12-year post-surgery

follow-up found that 93% of people were still 10% lighter than before

surgery, and 40% were even 30% lighter than before surgery.

Of course, I must especially remind you here that while the effects are

good, it is still surgery and definitely has certain side effects -

it's absolutely not suitable for everyone. We'll discuss this point

later.

If the story ended here, it would just be a foolproof treatment in

medical history. But in fact, the real show was just beginning - the

"foolproof" weight loss surgery actually topped the list of America's

medical innovations in 2013 and became the third-ranked medical

innovation of the decade in 2015.

This certainly wasn't because all American doctors had lost their

minds, but because after weight loss surgery, doctors conducted 10

years of follow-up observations on patients and found that 90% of their

diabetes had miraculously disappeared. It was truly "cured," medically

called "clinical remission of disease."

Medical Mechanisms of Weight Loss Surgery

This shocked the medical community. Diabetes, this chronic disease with

such complex mechanisms that had never been curable, was actually

solved by a foolproof surgery. Can you understand the medical

community's state of excitement and bewilderment?

Of course, medicine isn't a fairy tale. After the bewilderment, medical

professionals began to calmly analyze the reasons. They discovered that

weight loss surgery caused changes in the body's overall metabolism,

primarily blood sugar metabolism, at three levels. It was these changes

that ultimately led to the disappearance of diabetes.

What are these three levels of change?

The first level of change is physical.

After weight loss surgery, the stomach's capacity becomes smaller, and

the time for food to travel from stomach to small intestine becomes

shorter. This artificially creates malabsorption, reducing the calories

we absorb. With reduced absorption, an energy deficit is created, and

gradually, not only will people lose weight, but blood sugar will also

decrease.

The second level of change is chemical.

After weight loss surgery, a series of miraculous changes occur in the

body's chemical hormones -

On one hand, a hormone called "bile acid" increases. It affects our gut

microbiome, and changes in gut microbiome alter our taste system,

making us less fond of sugar and fat while becoming more accepting of

vegetables and fruits.

On the other hand, a hormone called "glucagon-like peptide" secreted by

the intestines increases. It can slow down our stomach's emptying

speed, reduce hunger, and promote insulin secretion while improving the

sensitivity of pancreatic β cells. Doesn't this help alleviate

diabetes?

The third level is neural conduction changes built upon physical and

chemical changes.

After weight loss surgery, whether it's the gut microbiome or the

hormones mentioned above, they ultimately transmit signals to the brain

through nerves, reducing appetite and thus decreasing energy intake,

ultimately achieving weight loss and blood sugar reduction effects.

This way, weight loss surgery can not only help patients lose weight

but also effectively reverse diabetes. Isn't it miraculous?

However, as mentioned earlier, although the effects are obvious, it is

still surgery with certain risks and side effects, so we doctors don't

recommend that everyone seeking weight loss should undergo it.

Medically, there are clear regulations on the scope of weight loss

surgery use: If BMI is greater than 40, or BMI is greater than 35 with

severe diabetes, weight loss surgery is recommended.

What about normal people with BMI less than 40, or diabetic patients

with BMI less than 35? Sorry, due to lack of post-operative observation

records of more than 10 years and absence of effective data, we cannot

recommend it for now.

Of course, I must add here: weight loss surgery doesn't mean you'll

lose weight immediately after the procedure - lifestyle changes are

still needed after surgery. Only this way can weight loss effects be

maintained steadily.

How American Doctors Promote Weight Loss Surgery

The story is still quite perfect up to this point, but diabetes and

obesity aren't terminal illnesses - not having surgery won't

immediately cost you your life, while having surgery seems like trading

life for weight loss, which breaks through many people's psychological

tolerance. So in reality, weight loss surgery faced enormous

resistance, with patients simply unwilling to undergo it.

This posed a small challenge for doctors: faced with a useful but

somewhat risky new thing, how do you promote it?

On this point, American colleagues gave us a completely new

inspiration. They approached it from a business perspective, innovating

medical services and truly turning weight loss surgery into a product.

First, quality control.

Establish a fully transparent quality control system, as well as weight

loss surgery certification and quality improvement systems. All

surgical centers undergo training and certification before being

qualified to perform surgeries.

At the same time, all safety information is made public, surgical

patients are registered, and lifelong follow-up is conducted. This

minimizes risks.

Second, benchmarking.

Before surgery, they thoroughly explain the benefits and risks related

to weight loss surgery. They're especially good at using comparisons to

help patients empathize.

For example, they say weight loss surgery can treat 47% of depression

cases, 46% of migraines, 71%-94% of hyperlipidemia, and 42%-65% of

hypertension. You might still worry after hearing this, but if they

tell you that currently no single medication or treatment method can

achieve these effects, you'd feel reassured immediately, right?

Third, after-sales service with user experience and sharing.

American weight loss surgery organizations specifically establish

patient clubs. They bring together patients who have had weight loss

surgery with those who haven't, to chat, comfort each other, understand

the feelings and changes brought by surgery, and even supervise each

other to complete post-operative recovery.

This way, the acceptance of weight loss surgery becomes much higher. Of

course, I must remind you once again: surgery has risks, decisions

require caution.

Key Points

1. Liposuction doesn't help with weight loss and is not recommended.

2. People with BMI greater than 40, or diabetic patients with BMI

greater than 35, can consider surgical weight loss. It's not

recommended for others.

3. Weight loss surgery doesn't make you lose weight immediately - it

must also be combined with lifestyle adjustments.