"I think if I gain another five pounds, " said a friend, who was about 15 pounds overweight told a group of us over dinner, "I will be eligible for the new weight-loss surgery." She was helping herself to a piece of luscious chocolate cake that the rest of us were trying to avoid eating.
"Don't you have to be at least l00 pounds overweight before you can have bariatric surgery?" I asked.
Apparently not. She described a suddenly popular new surgical technique that shrinks the stomach by folding the stomach lining and stitching it in place. Patients who want to lose as little as 25 pounds are going through the procedure because although it requires general anesthetic, there is no cutting of skin or muscle. As some of us gagged, our friend told us that the procedure called POSE, or Primary Obesity Surgery Endoluminal, uses an endoscopy tube that passes through the mouth and esophagus to reach the stomach and then makes tummy tucks.
POSE is so new that it has not gone through rigorous clinical testing to see whether it is more successful than other surgical techniques in producing permanent weight loss; nor has it received FDA approval. Nevertheless, people who want to be thin are using this procedure to get rid of weight that does not respond (so they say) to conventional diets and exercise. Our friend said that she had considered liposuction to get rid of some of the fat she could not seem to diet of,f but the stomach-shrinking technique seemed a better option. "This way I will never be able to eat very much, so losing weight and keeping it off will be easy."
Is POSE the so-called magical weight loss option every overweight person has been seeking? Is its relatively quick and non-surgical procedure the answer to a permanent way of keeping off weight? It is much too early to tell. Other surgical procedures to reduce the amount of food that can be swallowed and contained in the stomach have been effective in producing massive amounts of weight loss in the first year or so after the procedure. Yet long-term outcomes are inconsistent. Patients have found that if they consume high-calorie liquids food like melted ice cream, or gradually introduce large amounts of food into their stomachs, they can enlarge its size. Eventually, they are able to eat enough to regain the weight lost during the first year after the operation.
The question I would have liked to ask my friend who is considering the POSE procedure was this: Why couldn't she lose 20 or 25 pounds the conventional way? I didn't, of course. There are some things one cannot discuss, even with close friends. But I think I know the answer. She, like so many others, is consistently inconsistent in her weight-loss efforts. Weeks of a stringent diet and exercise will be followed by an equally long periods of paying little attention to calories and avoiding the gym. Not surprisingly, at the end of every diet year, her weight has not changed by more than a few pounds. She did lose some weight for her daughter's wedding, but put it on a year or so later when her mother was diagnosed with Alzheimer's disease and her father had a stroke. Like it is for so many of us, food became her source of comfort.
She claimed that diets simply never worked well enough to get her to lose 25 pounds. But we all know that under the right circumstances, we all can lose weight. I am sure that if she were shipwrecked and forced to live on raw fish and coconuts, she would be a size 0. She had been on diet programs so many times, she could recite the list of foods that should be eaten every day and could demonstrate how to use the exercise equipment at the gym. But time and again, she abandoned these positive habits, ate whatever she wanted and never went to the gym. How can an operation on her stomach have any effect on making her choose healthy foods and engage in regular physical activity?
What was also worrisome was that she automatically turns to food when she is stressed, eating large amounts of carbohydrates, like potato chips and cookies, that are packed with fat. Will the surgical procedure stop her emotional eating? Can any surgical procedure to reduce stomach size accomplish this?
Our brains are behind our overeating when winter darkness makes us depressed, when PMS causes major mood swings, when we are exhausted from too much work or too little sleep, or stressed to our limits because of financial, family, or health problems. How can a smaller stomach make these stresses less painful and upsetting?
We have learned, perhaps unconsciously, that when our brains respond to our consumption of carbohydrate by making new serotonin, the edge is taken off the stress. We are able to cope and become calmer, more focused and able to handle or endure whatever has upset us. The amount of fat-free or low-fat carbohydrate that has to be eaten to increase serotonin contributes less than 200 calories to our daily food intake. Moreover, the increase in serotonin also has the added benefit of making us feel less hungry.
Bariatric surgery may be lifesaving for people whose weights are propelling them into life- threatening medical disorders. But bariatric surgery, whether a stomach bypass operation or sewing together bits of a stomach lining, is not sufficient to prevent emotional overeating or the failure to accept a permanent commitment to health eating and exercise.
The only solution -- and there is nothing magical about it -- is to understand how to use serotonin to stop emotional overeating and to employ self-discipline for healthy eating and exercise as a program for life.