Dear Dr. Eva,
In your column about
weight loss, you didn’t discuss surgery. I can tell you from experience that
there are some of us for whom no diet works and surgery is the only answer. I
lost 120 lbs after my gastric bypass and while there are some limitations from
the surgery, it has been well worth it to me. My diabetes, which had gotten to
the point I was on the verge of needing insulin, is now under control with no
medicine. Please give some space to this important option.
I’m glad the surgery
worked for you and that you don’t mind the limitations resulting from it.
However, most people can lose weight without having surgery and without risking
the complications of surgery. The most common complications of gastric bypass
surgery are chronic diarrhea and malabsorption. Malabsorption means inability
to absorb essential vitamins and minerals, especially calcium, iron, and
vitamin B12. The lack of these minerals and vitamins leads to other
complications, including anemia, kidney stones, osteoporosis, and abnormal
nerve function. Even when there is no malabsorption, after bypass surgery
many people feel tired, achy, and cold much of the time. Many also experience
dry skin, hair loss, and mood changes.
There are also medical
risks associated with any major surgery, and the risks are higher for seriously
overweight people. These risks include death during or after surgery, heart
attacks, and blood clots in the legs and lungs.
Weight loss surgery is
not magic. The surgery causes weight loss by greatly decreasing the size of the
stomach so a person feels full after eating a small amount of food. If the
person tries to eat more, they will vomit. After gastric bypass surgery or
gastric banding, a person can eat only a very small quantity of food. Many
healthy foods that are more bulky, like raw fruits and vegetables, cannot be
eaten at all or can be eaten only in very small amounts.
Weight reduction surgery
works by forcing behavior changes – forcing a person to limit their food
intake. If that person can make the same behavior changes without having
surgery, they can achieve equal, and equally lasting, weight loss without the
financial cost and medical risks of surgery.
Weight loss surgery is
most appropriate in cases like yours, when a person has major medical problems
such as diabetes that are directly linked to weight, and has been unable to
lose weight after working with a dietician. If there are no serious
weight-related medical problems, I encourage people to work on changing eating
habits as a simpler, safer, cheaper and healthier way to lose weight.
Dear Dr. Eva,
You recommended diet
sodas in your recent weight loss column. I have heard many bad things about
diet sodas, including that they increase cravings for sweets and even that they
can cause strokes. How can you recommend them?
It’s a question of
choosing the lesser evil. I would not recommend diet soda to a person who did
not already drink soda on a regular basis. However, for a person who is
overweight, a change from sugared to no-calorie soda will decrease calorie
intake, which is key to their health.
Water is the
certainly the healthiest and least expensive drink. Tap water is fine - there
is no health reason to drink bottled water. Teas and infusions are generally
fine as well. Fruit juice has a surprising amount of calories. There are more
health benefits in eating the whole fruit rather than drinking the juice. There
are also far fewer calories – remember that it takes a least three oranges to
make a cup of juice.
Eating or drinking very
sweet food or drink does seem to trigger cravings for more sweets. This is
equally true for diet and non-diet sodas. As far as strokes, there has been a
single study that showed an association between drinking at least one diet soda
a day and an increased risk of stroke. However, the study did not control for
many other possible explanations of the increased stroke risk in the diet soda
drinkers, such as weight, smoking, and health care. The study did not show that
diet soda caused strokes It has received a lot of criticism from public health
specialists. At this time nutritionists and doctors who study nutrition are not
recommending that people change their habits based on this one study.
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