The radio and television ads are now promoting bariatric surgery. It is January, after all, and any intervention that will result in a lower weight is being eagerly peddled. While the appeal of surgery is understandable and, in many instances, medically advisable, does it justify removing the ability of the stomach and intestinal tract to digest and process more than tiny amounts of food? Weight intervention surgery often causes very rapid weight loss, and one procedure, the gastric bypass, can also help reverse Type 2 diabetes. What's troubling is that the newest surgical procedure to reduce food intake, a sleeve gastrectomy, makes sure that very little food gets through the stomach by removing about 85 percent of the pouch.  This procedure is irreversible; patients are left with a long, banana-shaped stomach that gets filled up after only an ounce or two of mushy food is consumed.
A distant relative alerted me to this new weight reduction procedure, as he was interested in having the operation. Half-hearted dieting attempts and erratic exercise made him doubt that he would lose weight following a conventional weight loss program. His excess 200 pounds made him fearful of not living a long and healthy life. As he told me, the operation was usually done laparoscopically, and since no muscle was cut, recovery was much faster and less complicated.
But the newness of this procedure meant that no information on long-term weight loss was available. Could a determined overeater eventually stretch the "banana" shape of the stomach into an "apple" shape by eating larger and larger quantities of food? This is, of course, how so many recipients of other bariatric surgeries managed to gain back their weight and sadly experience a recurrence of their Type 2 diabetes. 
My relative was like so many others struggling with obesity, an emotional overeater. His job only added to the predictable sources of stress (family illness, financial worries, three small children, a sick parent), as there were times when he worked for weeks without any time off. I pointed out to him that finding the correct foods to eat post-surgery and scheduling time for regular exercise would be very difficult, given his demanding work schedule. And just as important, how was he going to deal with his tendency to turn to food to decrease emotional distress? If food made it possible for him to cope with his many problems, what would take its place? Indeed, anecdotal reports from patients who had bariatric surgery confirmed to me that the procedures changed only the ability of the stomach to receive food. It did not change the need of one's mind to use food for emotional comfort.
Ideally, prospective candidates for bariatric surgery ought to spend a year learning why they overeat and with professional help, see whether they can deflect these triggers from making them eat excessively. Indeed, a more basic goal might even be: Are they even willing to change their eating behavior?
Years ago, I had a client who insisted on going to a food court for lunch every day and eating two immense meals, one right after the other. He never was hungry for the second lunch and never could articulate why he needed to eat it. But he became agitated at the thought of eating only one lunch, even on a diet. (He lost no weight, of course.) He is an example of someone who probably would not benefit from bariatric surgery, since eventually he would find a way to stretch his stomach to receive large quantities of food that he felt he had to consume.
We have moved so far from eating only to sustain life that sometimes it is hard to remember that food's basic purpose is to keep us alive, allow us to reproduce, and maintain us in good health. And if we stopped eating the instant we were no longer hungry, none of us would be overweight or obese. Our minds seem to have taken over from our stomachs, however, when it comes to determining how much, what and when we eat. We pore over menus to see what item might entice us, we accept food at social gatherings because it is polite to do so, we nibble our way through frustration, boredom, anger, and exhaustion, and make food the surrogate for lonely evenings and failed companionships.
There is no surgery, no drug, nor herbal remedies or diets that surrender total control of our eating to the stomach. Our minds are always involved. Surgery to make the stomach look like a banana rather than an apple will be the answer to permanent weight loss only when we understand why we are overeating.
Ideally, then, if the mind and stomach can get together to figure out how to stop it, the surgery might succeed.
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