The other commentators all come from a concerned point of view. Some helpful, some less so. The specialty of Bariatric Surgery still has a long way to go to get things right. I am a Peri-operative Nurse who, for the past 35 years has been working with bariatric surgeons performing various types of surgery with quite variable results.

Most forms of surgery have been based on the premise of reducing stomach size thus making it difficult to eat large amounts of food. Firstly, this was through 'stomach stapling'. Using a row of staples placed about 3/4" from the lesser curvature of the stomach. This often lead to disastrous results as the education leading to altered eating habits was not developed as well as it is these days. Secondly, the 'Lap Band' came along. This procedure is still performed these days, but more lap bands are being taken out than being put in. Lap bands are often being taken out when a 'Laparoscopic Gastric Sleeve Resection' is being done. This is the third development. The Gastric Sleeve is similar to gastric stapling in concept but is done under direct vision using the laparoscope rather than just by feel as was done in the past. A gastric stapling looked a bit like the philopino faith healer trick of last century.

A recent development has been the Endoscopic Suture Gastroplasty. This is the procedure I might consider. The gastric sleeve procedure comes from the outside of the stomach and involves removing a significant portion of the stomach never to return. I am referring here to the stomach, the hollow organ that is located at the bottom end of the oesophagus and not the general concept of the abdomen as a whole. The ESG works from inside the stomach via the mouth, to create, using a suture technique to functionally achieve what the gastric sleeve does but without removing any stomach tissue. These sutures can be removed at a later date and your stomach returns to it's previous anatomical shape once you have established an effective healthy eating regime and weight loss has been achieved.

The other procedure 'Gastric Bypass' has come out of the history of gastric cancer surgery and is quite significant in the way it alters gut function and physiology. I am yet to be convinced that this form of surgery is at all an improvement on quality of life. The complications that can arise from this surgery are significant and leave me wondering why on earth someone would do this just because they were overweight. The complications of obesity, as many as they are, would be more preferable to the complications of gastric bypass surgery.

Obesity is a simple arithmetic equation. We eat to provide the energy for activity and for staying alive. If we eat more energy than we expend through physical activity then the body stores that energy, in the form of fat, for use at a later time when our food source may not be so plentiful. More food in, without the compensating physical activity, equals weight gain. I could go on about the food marketing strategies of western culture over the last 150 years or so, but I will leave that for a different sermon.

Basically we must re-educate and re-habituate ourselves into a different eating lifestyle to achieve weigh loss. Surgical approaches to weight loss are only ever successful if the new eating habits become established for the long term. Most forms of bariatric surgery are quite destructive to the gut and interfere with the hormonal function of the stomach and the relationship it has with the rest of the nutrition process including the liver and it's functions.

Bariatric surgery is not the answer to morbid obesity. It is not a 'pill' that we can take to resolve our obesity issues. Bariatric surgery is, at best, a tool that can help in losing some of the excess weight gain that has come from unhealthy eating habits. Bariatric surgery has helped in many patients who have viewed the surgery as just one step on the road to healthy eating habits. There are medications available, such as liraglutide, that are tools that can be used to boost the effectiveness of healthy eating plans for weight loss goals. Such tools are only effective when we change our brains approach to eating. I have lost over 20 kilograms of weight in the last 12 months by following a very low calorie diet. I recognise that I have to change some very poor eating habits by changing my choices to healthier options. Eating more vegetables rather than cookies and/or ice cream. Walking 500 metres to the shopping centre rather than driving the car. An honest bariatric surgeon will tell you that bariatric surgery will, at best, help you to lose 60% of your excess weight. The rest has to come from brain power, and those of us with GD know just how difficult it is to change the brain to suit the body...