General anesthesia might be neurotoxic, which might permanently cost you IQ points due to brain damage. Surgery near vital organs always has a chance of killing you. Even if it doesn’t, complications from botched surgery can permanently impair your quality of life, even past the point you might rather be dead.
Bariatric surgery should be seen as a last resort. Alternatives should be tried first. Unfortunately, modern diet advice seems to mostly not work for obese people. Fortunately, Semaglutide is now available and seems effective. The risks seem to be lower, but I’m mostly going off of base rates of drugs vs surgery and could change my mind with better data. This was a relatively recent development. There’s a lot more research in progress that could bear fruit if one can afford to wait.
That said, a last resort is still a resort, and there has got to be some point where it wins a risk/benefit analysis, even given the best available knowledge. However, I don’t trust doctors to understand statistics. BMI is statistically useful at a population level, but too imprecise to make this kind of decision. There are more informative tests that can give a more accurate sense of individual risk.
Liposuction is not just cosmetic, but counterproductive, because it removes not just fat, but fat storage capacity (i.e., adipose tissue). Overweight only becomes a serious health concern once fat storage capacity is exhausted, because then fat starts building up where it doesn’t belong. How “fat” a person looks, how much they weigh, or their BMI doesn’t account for this capacity, which varies quite dramatically with individual genetics. Again, these are useful measurements on a population level, where capacity averages out, but an “obese” person by BMI with capacity to spare is taking a bigger risk with surgery.
The mechanism of action for bariatric surgery was originally thought to be simply reduced stomach size causing reduced caloric intake, however, later research seems to indicate the mechanism of action is instead a change in gut flora.
Epistemic status: I am not a doctor or any other kind of medical expert. This has been a second-hand knowledge dump intended to be used as a starting point for further discussion or research, not as medical advice. I may be misremembering what I’ve heard, or those I’ve heard things from may have been ignorant or lying. I’m still confused about what caused the obesity epidemic, because there many plausible hypotheses.
General anesthesia might be neurotoxic, which might permanently cost you IQ points due to brain damage.
Sources on this? I’m not understanding if you’re saying “sometimes general anaesthesia turns out to be neurotoxic” (which is reasonable, I know it can go awry in a number of ways, up to and including killing you) or “it is possible that general anaesthesia is always neurotoxic, and we just haven’t figured it out for sure yet”. The latter seems a pretty serious claim that I’d never heard before.
Summarizing, animal models show the neurotoxicity of anesthetic drugs, particularly on developing brains. In humans that would be up to about 3 years old. I didn’t remember that part, but I expect that candidates for bariatric surgery would be older than this. Also, humans have somewhat unusual brains as animals go, meaning the results might not generalize, and medical anesthesia appears to be more controlled than the animal experiments. The link cited a few studies in humans tempering the concern.
I also found this one: https://www.scientificamerican.com/article/hidden-dangers-of-going-under/ suggesting that postoperative delirium is due to the anesthesia itself, not the physiological stress of surgery, and side effects can persist for years. The elderly appear to be more at risk. But perhaps most candidates don’t survive long enough to become elderly. I’m not sure of the age/obesity demographics.
Ah, thanks! I’m not sure if I should actually look too far into this rabbit hole or treat it as a infohazard since if I’ll ever need general anesthesia it probably won’t be like I’ll have much choice, and if I can’t do anything about it, I’d rather not have additional worries on top. I definitely already was of the opinion that I’d rather avoid it unless it’s for something truly life-threatening, but that’s just because surgery in general always comes with its own share of risks of either death or permanent side effects. I’ve had one total anesthesia surgery suggested for a problem that is merely quality of life, can be somewhat managed pharmacologically AND has a high relapse rates after a few years, plus the surgery itself has something like a 1/1000 or so risk of complications like blindness or death. My answer to that was “yeah no thanks”. It’s difficult to assess precisely risks when discussing with some doctors but I really don’t see how that’s a decent trade off.
I am a physician trained in bariatric surgery but do not do it as part of my practice. That being said, on a population level and until the recent introduction of the GLP drugs bariatric surgery is the only thing that actually results in long-term weight loss for morbidly obese people. It does, however, have significant risk of early and late complications and vastly changes behavior, which some people find it hard to deal with. Early complications include leak with about a 2% risk, death with about 1⁄500 or so, and various and sundry other minor complications that have a risk of about 10%.
I would absolutely undergo sleeve or bypass if my BMI went over 35 with any comorbidities if I did not get adequate results from the new GLP medications, which, in my opinion, should definitely be first line for people without contraindications.
General anesthesia might be neurotoxic, which might permanently cost you IQ points due to brain damage. Surgery near vital organs always has a chance of killing you. Even if it doesn’t, complications from botched surgery can permanently impair your quality of life, even past the point you might rather be dead.
Bariatric surgery should be seen as a last resort. Alternatives should be tried first. Unfortunately, modern diet advice seems to mostly not work for obese people. Fortunately, Semaglutide is now available and seems effective. The risks seem to be lower, but I’m mostly going off of base rates of drugs vs surgery and could change my mind with better data. This was a relatively recent development. There’s a lot more research in progress that could bear fruit if one can afford to wait.
That said, a last resort is still a resort, and there has got to be some point where it wins a risk/benefit analysis, even given the best available knowledge. However, I don’t trust doctors to understand statistics. BMI is statistically useful at a population level, but too imprecise to make this kind of decision. There are more informative tests that can give a more accurate sense of individual risk.
Liposuction is not just cosmetic, but counterproductive, because it removes not just fat, but fat storage capacity (i.e., adipose tissue). Overweight only becomes a serious health concern once fat storage capacity is exhausted, because then fat starts building up where it doesn’t belong. How “fat” a person looks, how much they weigh, or their BMI doesn’t account for this capacity, which varies quite dramatically with individual genetics. Again, these are useful measurements on a population level, where capacity averages out, but an “obese” person by BMI with capacity to spare is taking a bigger risk with surgery.
The mechanism of action for bariatric surgery was originally thought to be simply reduced stomach size causing reduced caloric intake, however, later research seems to indicate the mechanism of action is instead a change in gut flora.
Epistemic status: I am not a doctor or any other kind of medical expert. This has been a second-hand knowledge dump intended to be used as a starting point for further discussion or research, not as medical advice. I may be misremembering what I’ve heard, or those I’ve heard things from may have been ignorant or lying. I’m still confused about what caused the obesity epidemic, because there many plausible hypotheses.
Sources on this? I’m not understanding if you’re saying “sometimes general anaesthesia turns out to be neurotoxic” (which is reasonable, I know it can go awry in a number of ways, up to and including killing you) or “it is possible that general anaesthesia is always neurotoxic, and we just haven’t figured it out for sure yet”. The latter seems a pretty serious claim that I’d never heard before.
I can’t recall the source I heard this from, sorry. It’s been too long.
It might have been related to this issue: https://www.apsf.org/article/the-effect-of-general-anesthesia-on-the-developing-brain-is-it-time-to-temper-the-concern/
Summarizing, animal models show the neurotoxicity of anesthetic drugs, particularly on developing brains. In humans that would be up to about 3 years old. I didn’t remember that part, but I expect that candidates for bariatric surgery would be older than this. Also, humans have somewhat unusual brains as animals go, meaning the results might not generalize, and medical anesthesia appears to be more controlled than the animal experiments. The link cited a few studies in humans tempering the concern.
I also found this one: https://www.scientificamerican.com/article/hidden-dangers-of-going-under/ suggesting that postoperative delirium is due to the anesthesia itself, not the physiological stress of surgery, and side effects can persist for years. The elderly appear to be more at risk. But perhaps most candidates don’t survive long enough to become elderly. I’m not sure of the age/obesity demographics.
Ah, thanks! I’m not sure if I should actually look too far into this rabbit hole or treat it as a infohazard since if I’ll ever need general anesthesia it probably won’t be like I’ll have much choice, and if I can’t do anything about it, I’d rather not have additional worries on top. I definitely already was of the opinion that I’d rather avoid it unless it’s for something truly life-threatening, but that’s just because surgery in general always comes with its own share of risks of either death or permanent side effects. I’ve had one total anesthesia surgery suggested for a problem that is merely quality of life, can be somewhat managed pharmacologically AND has a high relapse rates after a few years, plus the surgery itself has something like a 1/1000 or so risk of complications like blindness or death. My answer to that was “yeah no thanks”. It’s difficult to assess precisely risks when discussing with some doctors but I really don’t see how that’s a decent trade off.
I am a physician trained in bariatric surgery but do not do it as part of my practice. That being said, on a population level and until the recent introduction of the GLP drugs bariatric surgery is the only thing that actually results in long-term weight loss for morbidly obese people. It does, however, have significant risk of early and late complications and vastly changes behavior, which some people find it hard to deal with. Early complications include leak with about a 2% risk, death with about 1⁄500 or so, and various and sundry other minor complications that have a risk of about 10%.
I would absolutely undergo sleeve or bypass if my BMI went over 35 with any comorbidities if I did not get adequate results from the new GLP medications, which, in my opinion, should definitely be first line for people without contraindications.