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My Perspective of Weight-loss Surgery

In Citrus County and other parts of rural Florida, sleeve gastrectomy and gastric bypass have become more popular methods in the medical treatment toolbox for obesity. As a dietetic student, I was not part of that camp that promoted weight-loss surgery and even advocated against it. Since becoming a dietitian and working as a Bariatric Coordinator the past two years, my revised opinion is that Bariatric surgery can be a positive, life-changing procedure...for some people.

Why choose weight-loss surgery in the first place? Why not just diet and exercise? As it turns out, diet and exercise alone is not enough for half of my patients. They may be needing another surgery, such as a knee replacement or hernia repair and weight-loss is required prior to that surgery- which exercise is extremely limited in this population.

The first encounter with patients I introduce myself as their friendly dietitian. Many people view us as the food police and I want to break that ice immediately. After we chat about last night's Taco Tuesday and rapport has been established, I empathize that this procedure is not a quick-fix or Magic Bullet. Long-term diet and lifestyle changes are required in order to sustain healthy weight and from putting those pounds back on.

A good majority of my patients understand that change is necessary for success. Dietitians and other healthcare professionals use a Transtheoretical Model of Behavior Change to determine how ready the patient is about making positive changes. Many of my patients are already well in the Action stage, and some haven't even started to consider change (precontemplation). They need a little motivational interviewing.

If you truly don't want to give up soda, fast food, or incorporate more plants into their diet, long-term weight loss maintenance is impossible. You may defend, "it's just diet soda", or, "health food is expensive and fast food is cheap". However, soda and other carbonated beverages will stretch the stomach right back out to it's original size and you might gain back even more weight than you had been prior to surgery. It takes genuine drive to begin shifting perspective and adopting more positive, healthier lifestyle practices.. the practitioner can only guide and educate.

From a mental health perspective, underlying eating disorders of all kinds, especially binge eating disorder, need to be addressed and treated prior to surgery. "Behind an eating disorder is trauma...", explains Deborah Martin a licensed mental health counselor that runs an office out of Crystal River. All patients must undergo a psychiatric evaluation prior to surgery to ensure that any opportunities for counseling are identified. If the counselor feels the patient needs to hold off until the issue is addressed or resolved, they will communicate this with myself or other members of the patient's care team.

. Charlie Gooding and Archie Gooding are patients of mine and the surgeon who performed their gastric sleeve procedures. They are two of many patients that share their positive post-op experiences. Charlie, now down 157lbs from his heaviest, states he is most appreciative of having his life back and being able to walk his daughter down the aisle one day. His brother Archie is down 60lbs since his procedure less than 3 months ago. He is also looking forward to having the energy to be a better dad.

I can confidently say that I see more success than failure. Patients that begin true change and stick with it will undoubtedly be successful in reaching their goals. Following up with myself or other dietitians and doctors keeps them on track. Relapse happens, but getting back in it is what separates success from failure.

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