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The Realities of Bariatric Surgery: What We Don’t See on TV

Files labeled as Obesity, Bariatric Surgery, and Gastric Bypass

When someone with obesity is looking to lose more than a quarter of their body weight — more than five times what is expected through diet and exercise — they often turn to bariatric surgery, also known as weight loss surgery. While bariatric surgery aids with the obvious goal of losing weight, it also is about a full lifestyle change and involves a lot more than what many see on reality television shows.

Dietitian and Bariatric Program Manager Colleen Tewksbury, PhD, MPH, RD, shares how these shows depict a small portion of all the work that the care team and patients do before and after surgery, and the realities of the bariatric surgery process.

600lb Life Vs. Real Life

Many have seen or heard of the show “My 600lb Life,” which follows patients over 600 pounds through their bariatric surgery journey. While a show like this can be eye opening to viewers about the struggles that these individuals experience, it is often dramatized compared to what it is actually like when the cameras aren’t rolling.

It is important to note that these individuals featured on these shows that are above 600 pounds are not usual candidates for bariatric surgery due to health risks and complications, Tewksbury shares. Most candidates in real life are in their early to mid-40s with a body mass index (BMI) of 40 or above and come from various ranges of socioeconomic and education status.

During each episode, viewers follow a patient and see their interactions with their surgeon and may assume the surgeon is the only member of a clinical care team involved, but that is far from the truth. Before even meeting with anyone from a surgical team, patients have a series of informational sessions, and consults with a registered dietician, nurse practitioner, and psychologist.

“What you see on these extreme shows are only one small component of what it is actually like for patients,” said Tewksbury.

Many of these individuals on the show seeking bariatric surgery are given tough love or a reality check when they admit they have indulged in food they shouldn’t or haven’t followed the program perfectly, but Tewksbury explained that care teams would never do that.

“The idea of telling someone who has obesity to just avoid donuts or other unhealthy foods is just inappropriate,” said Tewksbury.

The bariatric care team works to empower patients in making the most effective changes to reach their health goals with professional, compassionate care. Many patients will report wanting to do everything perfectly. But there is no such thing as a perfect approach — each patient is treated based on their personal needs. The bariatric surgery team is there to help patients figure out their specific goals and needs along with how to approach this process in a way that works for them.

What are the Key Factors for Obesity?

On TV, it is easy to perceive that the reason individuals have obesity is because of behavioral factors, such as constantly overeating, which is a common public misconception. Obesity, which effects roughly 72 million American adults, is the end result of a few factors such as biology, behavior, environment, and mental health. What’s more, it has been shown that behavior is not the key driver for those with obesity, but rather biological reasons with environmental factors.

“One thing about obesity is that it does not discriminate,” noted Tewksbury.

And while biology is not entirely to blame, most individuals struggling with obesity have multiple genetic factors that make them more likely to become obese. These genes, which do not completely dictate a person’s weight, can influence appetite control, food intake, and how food is metabolized.

The environment also plays a large role in obesity. Consumer marketing that consistently promotes super-sized portions, fast food, and junk food that require little to no prep work for those who may constantly be on the go can have an impact. Also, individuals may live in an area where it is not safe to exercise outdoors or exercise may not be not easily accessible due to costs or schedule issues. Medications or surgical side effects can cause weight gain that can contribute to obesity, as well.

On “My 600lb Life,” viewers regularly see that most obese individuals suffer from some type of psychological factor, such as depression, anxiety, substance abuse, or even an eating disorder that contributed to their weight. Although that part of their bariatric surgery journey is rarely addressed by the show’s clinical care team, in real life, there is a pre-operative psychological screening, which is an essential part of the process in order to be approved for surgery.

These factors are rarely shown on TV, but are important for understanding that obesity does not solely happen because someone is simply lazy or often eats pizza — as Tewksbury explains, it is much more complicated than that.

Setting Individuals Up for Success

Once individuals have completed all the procedure prerequisites, which can take, on average, four months for testing and medical weight management, they are usually cleared to safely proceed with bariatric surgery. But it does not stop there. Post-operation, their education and set of expectations are rigorous.

Individuals are followed very closely by their care team up to 90 days after surgery and are then followed by a multidisciplinary team lifelong. They are also provided easily accessible resources like support groups, patient chat rooms, blogs for patients, and Facebook groups, which connects patients with a community and patients to help them along the journey.

It is often at the end of each episode that the individual who went through surgery is defined by either a success or fail with weight loss. In real life, patients are not categorized post-surgery by success or failure, because that implies that there is an end, which cannot happen with a disease.

“The surgery is not a cure. Weight management care is long-term and requires life-long follow up,” said Tewksbury.

View the first post from this two-part series on the Penn Medicine News Blog to learn more about what to expect if you’re considering bariatric surgery.

If you or someone you know is interested in learning more, visit the Penn Bariatric and Weight Loss Surgery website or register for a free online information session.

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