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Diets Versus Bariatric Surgery

February 23, 2021

Most overweight patients have tried to correct their weight with diet and exercise…usually multiple times.  There are hundreds of different diets.  In principle, a diet plan aims to reduce the caloric intake and/or increase the body’s ability to process certain food like fats and proteins. Most recently, the keto diet has dominated the headlines. 

How the Keto Diet Works

The keto (ketogenic) diet aims to put the patient into a ketotic state where the body burns fat more effectively.  This is done by loading the diet with lots of protein and/or fat.  Keto diets generally fall into the high protein or high fat categories.  In the standard ketogenic diet (high fat type), the diet typically contains 75% fat, 20% protein and only 5% carbs.  In the high-protein keto diet, the diet is approximately 60% fat, 35% protein and 5% carbs.  Both types of the keto diet aim to drastically reduce the intake of carbs and sugars.  Several studies suggest there may be some beneficial effects for the heart and some weight loss.  However, there is generally very poor long-term weight loss once the patient resumes a more normal diet.  In addition, there is increased risk of high cholesterol, high triglycerides, and kidney stones with high fat diets.   They may also put the patient at risk for micronutrient deficiencies.  Therefore, we recommend AGAINST this.

Other types of keto diets include…

  • Very-low-carb ketogenic diet (VLCKD) …
  • Well Formulated Ketogenic Diet (WFKD) …
  • MCT Ketogenic Diet. …
  • Calorie-restricted ketogenic diet. …
  • Cyclical Ketogenic Diet (CKD) …
  • Targeted Ketogenic Diet (TKD) …

If you think about it, the keto diet changes the metabolism based on the high intake of fat.  The body “learns” how to process fat more efficiently.   However, this change does not persist once the diet returns to normal.  Once the patient begins eating more carbs, fruits, and veggies, the metabolism returns to normal and the result is weight gain.

Weight watchers is another commonly used diet.  The ads for Weight Watchers suggest that massive weight loss can be achieved.  The testimonials show patients who have lost 100 lbs.  However, controlled medical studies suggest that this is generally false.  In a study published in the Journal of the American Medical Association in 2005, the authors placed moderately obese patients (BMI of 35) on several different diets.  The weight loss at one year ranged from 4-7 lbs.  Therefore, if you hope to lose 75 lbs or more, it’s very unlikely you will accomplish this with Atkins, Weight Watchers, Zone diet, or Ornish. 

Type of DietCompleting One YearWeight Loss at One Year
Atkins21/40 (53%)4 lbs
Zone26/40 (65%)7 lbs
Weight Watchers26/40 (65%)6 lbs
Ornish20/40 (50%)7 lbs

Bariatric Surgery Is Fundamentally Different  

The size of the stomach is reduced, and the absorption of nutrients may be altered with some operations.  Prior to surgery, with a normal sized stomach, the patient eats about 1-2 quarts of food to feel full.  After surgery, the patient eats only about 1 cup per meal to feel full.  Operations like the gastric bypass and biliopancreatic diversion (BPD) alter the absorption of nutrients.  BPD can be thought of as a pouch with major intestinal bypass.  In general, we recommend against BPD based on high malnutrition rates.

If you’re considering bariatric surgery, you must be willing to make major lifestyle modifications.  We recommend…

  • Elimination of sugary drinks
  • Eating 3 balanced meals per day
  • No snacking in between meals
  • An hour of exercise 3-4 times per week
  • Lifelong follow up with us to help with accountability and prevent weight gain.

Numerous medical studies have shown the superiority of bariatric surgery (with lifestyle change) over diet alone.  It is no secret that patients lose more weight with surgery. In addition, the cure rate on type 2 diabetes is 70-90% depending on how aggressively, the patient modifies their lifestyle.

Even if you need to lose 40 lbs., bariatric surgery may be right for you. Some of our goals are to PREVENT you from gaining more weight in the future and PREVENT you from developing diabetes.

Call today if you want to learn more.  There are no obligations to proceed with surgery.  We hope to teach you about this process.  You will not get a “sales pitch”.  We educate patients about the need for lifestyle modification and explain the risks and benefits of bariatric surgery.  What do you have to lose?

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