Weight, Surgery and Disease: We're not in Kansas anymore, Toto

Historic Photo by M Clock

So we are back.

And, not to be too dramatic, I think at least I am changed.

We were exposed to some new thoughts, backed up by convincing studies, with the information really challenging to the Bariatric status quo. Information that needs to be somehow matriculated. Maybe I can start with you, and the PCP perspective, and then we can someday get it to the patient level in a way that's meaningful and accurate.

So, on the slate to be discussed in more detail in this Blog:

*Our description of our surgeries, especially the Bypass, the Gold Standard, as less "Restrictive and Malabsorptive", and much more a metabolic surgery with its effects exerted on multiple levels physiologically, and stil second to none as far as any similar effects from lifestyle alone, and remaining out of current pharmacologic reach.

*Our understanding of 'set points' for weight and what can effect it, both in the positive and the negatives sense.  Once the set point is established, or re-established, the body will defend it- again for better or worse, depending on the situation.

*The net result of weight maintenance, as a sum dynamic effect of environment, activity, and diet.  On the side of weight loss or maintenance, genetics actually play the biggest role, but the other aspects can be altered or 'optimized' to a certain effect, but the genetics have the upper hand in determining weight and metabolism and how your body reacts to the above factors.

*How Diabetes, one of the greatest success stories in the Gastric Bypass world, actually is impacted by the surgeries (not all is known yet...), and how the next realm of major impact to be discussed may in fact be Cancer, as certain types seem to be well below the expected rate in the post-Bypass population.

*The idea of food as a hormone, insofar as the concept that the constitution of food is as, or likely much more important, to weight and health and metabolism, than mere quantification of calories in a diet.  There has been proven, although still probably in its infantile stages, complicated signaling that occurs both in positive and negative side from the types of food we eat, and it is much more impactful than just the amount (calories) that we eat.

*And lastly, but likely not 'leastly', expected rates of weight "recidivism"(regain) which may more likely represent normal physiologic weight gain, rather than 'failing' in the post op period.  From what I heard last weekend, the concept of expecting a patient to remain stable and unchanging at their 'goal weight' is unreasonable, unfair, and does not take into account normal physiologic aging, and its effects on metabolism and weight.

I am sure there may be more, but those are my initial topics / goals to be discussed soon in more detail. As you can see from above, I did take notes, and I intend to use them!  I am sure as I review them, even more will come out.

I will get to work soon!