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Surgery provides healthy weight loss through appetite modulation, rather than restriction and malabsorption.


As we have discovered in the past 5-10 years, rather than being able to control weight through calorie balance, our weight is regulated by a preset thermostat.  That means for many of us, it is very difficult to lose beyond 20-30 pounds, because our bodies start turning down our metabolism to work back toward that thermostat weight.


Unfortunately, to truly effect a change in medical problems associated with obesity, 20-30 pounds just is not enough. 


It used to be widely described that the weight loss, or bariatric surgeries, work by causing people to eat  less (restriction) and absorbing less calories (malabsoprtion).  In fact, while restriction may be a factor early on after the surgery, it is not the primary mechanism for how the surgeries work several years later.


In fact, the surgeries work by modulating the weight thermostat to a lower weight.  The way the surgeries lower the thermostat, especially in the case of the bypass and the sleeve, is by delivering food to the small intestine faster.  Most of our appetite is controlled by negative feedback from the small intestine, rather than the size and activity of the stomach.  When we eat, as the food reaches the small intestine, the small intestine sends a “fullness” or satiety signal back to other parts of the body  (including the brain and the stomach), which then signals us to stop eating.  By delivering food to the small intestine faster and in a more concentrated form, the small intestine send a faster and much stronger satiety signal.  


The result of this stronger satiety signal is a decrease in the weight thermostat, to the point that many people have no appetite and have to remind themselves to eat.  Then, as the weight approaches the new set point (typically about 100 pounds less, depending on how much you have to lose),  our bodies start to turn up that appetite signal, so that the weight levels out at the new thermostat set point.  


Therefore, the end result of the surgeries is not to remove one’s ability to eat forever, but rather, to help people continue to eat healthy portions of natural foods which maintaining a healthy lifestyle.  We love healthy food, and we want people to continue to be able to eat and live healthy lifestyles after the surgery.


Unfortunately, while surgery can modulate the weight thermostat and kick-start weight loss, there is nothing about surgery that can change our environment.  There will continue to be readily available processed foods that work to increase our appetites, and the drive towards a sedentary lifestyle and lack of exercise.  Both of these environmental factors will work toward turning up that thermostat after surgery.  In other words, no matter what kind of surgery someone chooses, weight regain will occur with lack of exercise and eating processed foods.  


We at Prestige Bariatric and Surgical Specialists feel that while initial weight loss is important, maintenance of that weight loss is the long-term goal.  That is why we provide a multidisciplinary approach, with the help of dieticians, psychologists, and our support groups, to help maintain weight loss, and set the expectation of lifelong follow-up after surgery.

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