Bariatric surgery seems like a no-brainer for most morbidly obese people

post by lc · 2023-09-27T01:05:32.976Z · LW · GW · 12 comments

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Procedures like gastric bypass have been around a long time; long enough that their effects are measured by virtue of their impact on overall health. If your goal with weight loss is to lose weight, and not perform a ritual of self-actualization or make scientific discoveries, you should probably seriously consider it.

From wikipedia (emphasis added):

Long-term studies from 2009 show the procedures result in significant long-term loss of weight, recovery from diabetes, improvement in cardiovascular risk factors, and a mortality reduction from 40% to 23%.^[12] A meta-analysis in 2021 found that bariatric surgery was associated with 59% and 30% reduction in all-cause mortality among obese adults with or without type 2 diabetes, respectively.^[13] This meta-analysis also found that median life-expectancy was 9.3 years longer for obese adults with diabetes who received bariatric surgery as compared to routine (non-surgical) care, whereas the life expectancy gain was 5.1 years longer for obese adults without diabetes.^[13] A 2013 National Institute of Health symposium summarizing available evidence found a 29% mortality reduction, a 10-year remission rate of type 2 diabetes of 36%, fewer cardiovascular events, and a lower rate of diabetes-related complications in a long-term, non-randomized, matched intervention 15–20 year follow-up study, the Swedish Obese Subjects Study.^[14] The symposium also found similar results from a Utah study using more modern gastric bypass techniques, though the follow-up periods of the Utah studies are only up to seven years. While randomized controlled trials of bariatric surgery exist, they are limited by short follow-up periods. The risk of death in the period following surgery is less than 1 in 1,000.^[15]

Yes, the above are observational studies, and they probably overestimate the benefits to some degree. Nevertheless, the proposed mechanism of action here seems so obvious, and the effect sizes are so large, that I think it's an overdetermined choice above a BMI of 35. The up-front payment and recovery periods are not a serious blocker for most people when compared against the reduced healthcare costs and QALYs, setting aside any social or romantic benefits of being thinner. 

I'm confused that surgery is not a more heavily discussed option for weight loss, given that it's the only thing that's been shown to reliably work. Most morbidly obese people in my social circle are programmer-adjacents who are desperate to lose weight and can afford the procedure. They are not the type of people to fall for some sort of naturalism bias, and they'd not indicated to me ever considering these options. I assumed they had good reasons for not doing so, and asked them about it. 

One of two things happened when I did:

1. I had to explain away a mistaken impression that bariatric surgery was simply cosmetic, like liposuction. Liposuction, which is not bariatric surgery, removes fat from your body without fixing your appetite, so ceteris paribus you regain the weight later. Gastric bypass (in addition to other things) physically modifies your stomach so that your metabolic set point moves down.
2. They told me that they thought that weight loss surgery was "cheating" and should be an absolute last resort. They seemed angry that I brought it up, not because I suggested they wanted to lose weight (this is a frequent conversation topic) but because they thought it sounded "weak".

To put it frankly, number two seems like a really stupid reason to kill yourself, and I'm curious if anybody in the comment sections has any actually good objections. I get the sense that some people feel a bizarre sort of shame about fixing this particular medical problem with medicine; possibly they anticipate that others will judge them if they spend a lot of money on a surgery that has a cosmetic component, also possibly they've invested so much mental or physical energy in pursuing weight loss that finishing they don't want to finish the journey in a narratively unsatisfying way. Regardless, those feelings should take a backseat to not dying at fifty of heart disease. There is basically one somewhat-consistently effective weight loss intervention and that's surgery. Not keto, not intermittent fasting. Even if diets worked, surgery seems plainly better to me than any diet, because it simply reduces your need for food instead of requiring you perform a sispyhian task of self-regulation.

If I had never tried to diet before, and I qualified for one of these surgeries, I would try to diet for six months, and then immediately attempt it if nothing worked. I've personally shed a lot of weight on a very-low-calorie rice diet in recent months, but if I rebound (as most people seem to do) I will try to convince a doctor to perform it, even if I'm under the normal weight of people undergoing gastric bypass. 

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