A recent CrossFit Journal editorial on bariatric surgery for weight loss set off a lively debate on Facebook.
The discussion below the June 14 post included a number of comments, including several from an athlete who had bariatric surgery several years ago and uses CrossFit to keep the weight off.
Jen Dawson was offended by the article but later in the thread added a comment that confirms our point: “(Surgery) is just a tool, and if you don’t address the emotional reasons, most people won’t have long term success.”
Quite simply, surgery is the last tool you want to use. It’s not about fat shaming, nor is it about shaming the medical community. It’s about exhausting all other options before cutting someone open.
Diet and exercise can be used to manage obesity and reduce the risk of chronic disease. We know this, and it’s not debatable.
We also know that some people don’t want to change their diets and recoil from exercise. They simply won’t take any steps to improve their health despite the fact that these steps would keep them out of the hospital or grave. They’d actually prefer a shortcut through the operating room.
The original article we discussed—“D.J. Doctor Dré Is Waging a Public Battle With Diabetes”—highlighted a hip-hop artist’s decision to get bariatric surgery to alleviate the symptoms of diabetes.
In some cases, invasive surgery for Type 2 diabetics might be warranted: 45 medical and scientific bodies have endorsed recommendations made in a June 2016 joint statement on bariatric surgery as treatment for Type 2 diabetes. But a closer look at the guidelines reveals the procedure is indeed a last-ditch measure.
Surgery is recommended for Type 2 diabetics with a body-mass index (BMI) above 40 kg/m2 (6 ft., 300 lb., for example) and for those with BMIs between 35 and 39.9 “when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy.” Surgery should be considered for patients in the 30.0-34.9 range “if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications.”
In this case, you have significantly overweight diseased population whose condition isn’t improved by lifestyle or medication. These people are at the extreme end of the spectrum and might need an extreme response.
But treating surgery as something other than an emergency measure simply ignores the dramatic effects lifestyle changes have on health. And it encourages completely unnatural procedures that are more nonsensical than therapeutic.
Take, for example, the FDA’s recent approval of the AspireAssist, a stomach-draining pump that allows people to leak 30 percent of the contents of their stomach into the toilet before the body has a chance to absorb the calories.
Forget for an instant that the number of calories is not as significant as the source of the calories. Also forget that the Aspire website says “there are no specific foods that are off-limits.” And never mind the list of possible side effects.
Note only this: The product exists to pump food out of the body because someone ate too much.
The problem could have been solved many different ways without drilling a valve into a stomach. The existence of products such as the AspireAssist is proof that shortcuts are often preferred to common sense.
The reasons for obesity, of course, are numerous and complex. Recall Dawson’s advice to address underlying emotional issues.
But that doesn’t change the fact that diet and exercise can reduce obesity and risk for chronic disease. We have a problem of adherence, not a problem of prescription. We know we can adjust a person’s diet and increase his or her activity level and get great results. But we ultimately can’t prevent that person from eating unhealthy food, quitting the fitness program or choosing a shortcut. Shortcuts—like a stomach drain—are merely bandages that fail to address the root of the problem.
As for fat shaming, it doesn’t exist in CrossFit. We’d never shame overweight people we want to help. We want the obese to walk into our affiliates because we know with certainty their lives and health will change for the better. CrossFit trainers will do everything they can to improve health with diet and exercise. They’ll provide motivation and community. They’ll challenge athletes and hold them accountable so they reach their health and fitness goals.
Does that approach work? Ask Ivan Garcia, who decided to forego gastric-bypass surgery in favor of using diet and exercise to drop more than 100 lb.
Bariatric surgery and stomach drains might be options, but they’re certainly not preferred options.
The first option is addressing your lifestyle, and CrossFit trainers everywhere want to help.
Additional reading: Cheryl Blythe passes on a gastric band and loses almost 200 lb. through diet and exercise.
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