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.

Slim

Dear Slim,

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.

Dr. Eva

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?

AD

Dear AD,

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.

D. Eva