Empowered Health Course · Lesson 19 · 7:11
Bariatric surgery. When I bring it up, it's often a bit of a shock. I feel comfortable talking about it for two reasons: first, it's a genuinely useful tool and treatment for a real, chronic, progressive, and relapsing disease; and second, for people who meet the criteria, we know that, in general, they enjoy better quality of life, longer life, and fewer complications from obesity than those treated with the best medical and lifestyle management alone.
In Nova Scotia, bariatric surgery is approved for people with a BMI over 40, or over 35 with a complication like type 2 diabetes. I think of it as your tool to understand and consider — it isn't up to me what's right for you. My role is to provide education: what the tool is, why it's being considered, and its risks and potential benefits.
The main surgery we do here is a vertical sleeve gastrectomy — a laparoscopic procedure that takes about 45 minutes, done in Halifax, removing roughly 80% of the stomach. It works by reducing certain hormones, like ghrelin, and increasing a host of others, including GLP-1 — the same hormone the drug companies have harnessed. The intestine is an enormous endocrine gland; after surgery, nutrients reach it faster, increasing hormones that tell the deep brain it can be satisfied at a lower calorie intake. So after effective surgery, a person doesn't have to restrain from eating — they're naturally more full and satisfied.
Some say that sounds extreme. I often ask what they'd think about removing a gallbladder for a stone — many people have had that done and benefited, though there can be complications like diarrhea or stomach upset. Bariatric surgery isn't very different: a similar complication rate to gallbladder removal, but with a great deal of benefit — reduced risk from arthritis, sleep apnea, fatty liver, type 2 diabetes, and heart disease, plus improved quality of life and longer life. For those who meet the criteria, it's a very effective treatment — a fitting treatment for the chronic disease of obesity. Because of bias and stigma — the idea that obesity is a choice — people often misunderstand the role of surgery. It's simply an effective treatment, and it's yours to consider.
There are risks: bleeding and infection, and you go through a preparation process — meeting a dietitian, learning the protocol, and following an all-liquid diet for a week or two (not easy — I lasted two days, but many patients do it just fine, which speaks to their motivation), then a low-calorie diet up to surgery. I usually recommend eating a healthy pattern at the lowest calorie level you can still enjoy. Weight loss should not be a prerequisite for surgery — people have the same effective weight loss whether they lost weight before or after.
If you choose to go forward, I'd recommend the Halifax Obesity Network, as well as an interview I did with Dr. Ellsmere going through the details. There are other procedures besides the sleeve — a Roux-en-Y or a duodenal switch — which I won't cover today. At this time the waitlist is about one to two years, so there's plenty of time to think, learn, and prepare, and you can opt out later if you decide it's not right. After surgery, allow time to recover — at least a couple of weeks physically, and up to a month to resettle — and continue a healthy way of eating, including a period on a liquid diet. This was a longer video, but an important one, and we'll talk more.
This transcript has been lightly edited from the video for readability. For the complete experience, please watch the video above.