Sleeve myths: Having a sleeve is “the easy way out…”

I asked my lovely LWAS Community members what sleeve myths and misconceptions they wanted me to address in an upcoming blog series and this topic was by far the biggest winner. Responses such as these below forced me to address this whopper of a misconception first… So, is having a sleeve the easy way out? Let’s see…

“WLS is cheating/quick/easy/not right insert whatever judgey mc judge face concept here”

“Why didn’t you just lose weight the proper way and show some self control and exercise?”

“If you just show some self-control you could have lost the weight through diet and exercise”

Do these comments sound familiar? Maybe you heard something similar from a friend or family member, maybe you thought this way previously yourself? Or maybe you blame yourself for not being able to manage with traditional diets and exercise? If so, read on. And please feel free to share so that others who may need a little more education around the disease of obesity, its causes and the current methods we have for managing it! (PS – If you want to cheat and skip to the bottom, I’ve linked to an excellent video which explains things too.)

What causes obesity?

Just before we begin… For this post when I refer to obesity, I am talking about the clinical diagnosis for the progressive disease of obesity. That is – a BMI of 30 or above. I’m not talking about the 1-2 kilograms someone with a BMI of 20 put on over Christmas…

Obesity has many many causes or contributing factors. Obesity is NOT a disease that is caused purely by a lack of self-control. In fact, the World Health Organization (W.H.O.) now recognises obesity as a chronic progressive disease resulting from multiple environmental and genetic factors.

Of course, diet and lack and exercise may be contributors, but so are certain medical conditions, hormonal factors, medications, lack of sleep, environmental factors, cultural factors, chronic stress and psychological distress. These factors accumulate to result in a positive energy balance which leads to weight gain. Also, in many cases, there are multiple factors acting at once, making managing obesity very difficult. If you want to know just how complicated obesity really is and all of the things contributing, check out this amazing diagram by ShiftN that really puts things into perspective.

Why doesn’t eating less and moving more through self-control work?

The first thing you might try to do to lose weight is to eat less and move more, right? If this wasn’t the case, the multi-million dollar dieting industry wouldn’t exist. But, if these diets worked in the long term, the multi-million dollar dieting industry wouldn’t exist either – we would all be stick-thin!

In fact, dieting is a huge part of the problem. When you go on a diet and lose weight quickly you lose not only fat but also muscle mass. This loss of muscle means you are burning fewer calories at rest than you were before. Your body also slows your metabolism in other ways to make sure you survive this diet – it doesn’t want you to starve to death! In conjunction with this reduction in metabolism, your body also wants to encourage you to eat. Appetite is ramped up the longer you diet, increasing hunger and the desire to eat.

This all means that there are significant metabolic differences between someone who has lost weight by dieting and someone who has never dieted, even if their weight and body composition is the same. For example, if two people weigh 80kg, the person who has a history of dieting will be burning fewer calories each day and therefore have to eat less than the person who has never dieted to maintain that weight. It really is a perfect storm working against you.

Why does a sleeve work?

Due to the reasons above, the ASMBS explains that individuals affected by severe obesity are resistant to long-term weight-loss by diet and exercise. They add that the ability to ‘maintain’ weight-loss is nearly impossible for those affected by severe obesity by any means other than metabolic and bariatric surgery.

In contrast, bariatric surgeries, including sleeve gastrectomy, are effective in maintaining long-term weight-loss. In contrast to dieting alone, weight-loss following bariatric surgery does not reduce energy expenditure or the number of calories the body burns to levels greater than predicted by changes in body weight and composition. Some studies even find that certain WLS operations even may increase energy expenditure. Add to that a reduction in appetite, increased satiety, reduced portion size and malabsorption of some nutrients and you’re much more likely to maintain long-term weight loss than with self-control and traditional diet and exercise alone.

But it’s not easy

Whilst a sleeve may help to manage metabolic issues and your hormonal drive to eat, it is by no means an easy way out. Deciding to go ahead with a sleeve means not only dealing with the initial risk and pain of undergoing major surgery, but also a commitment to change your lifestyle in terms of what and how you eat FOREVER. More than that though are the changes to mindset, and your relationship with food and your body, that needs to happen to make the surgery successful in the long term. I repeat – this is NOT an easy way out…

I’d love to hear your thoughts – if you’ve had a sleeve, please comment on the post below so we have some more stories explaining the experience for those who don’t quite have their head around it.