Choosing a weight loss surgery procedure is like hanging a picture

Ask the next 5 people you see "how would you hang a picture?" It seems like a simple enough question. Of course all you need is a hammer and a nail to get the job done, right? Maybe you would like to use one of those little hooks that nails into the wall. Perhaps you would rather use a screw, which would require the help of a screwdriver or drill. You may even chose to use an anchor, which requires something to bore your hole, the anchor itself, the right sized screw, a screwdriver, and a drill. Seems a little more cumbersome, but it provides a stronger hold. It is also a little more invasive- if you decide you don't like the picture where you made your hole, then you are left with a sizable hole in the wall. You can even consider adhesive- there are some really strong double sided tapes on the market. I guess before you make the decision as to how to hang the picture, we have to consider where- not only the location on the wall, but the type of wall that we are hanging it on. Is the wall made of plaster, of wood, of sheet wood, of concrete? How about the location- do we have to worry about where the stud is? Is it to be centered on the wall? How far down from the ceiling should it be? At eye level? Or is the wall really tall so we want to place it higher to draw the eyes up? Lets consider the picture to be hung. Is it a really heavy piece of artwork that needs extra support or multiple nails/screws/anchors/picture hangers? Or is it an 8X10 light weight frame with the grand kid's picture? What kind of hanger is on the back of the picture? Do you have a wire? A ledge? A grooved plaque? Nothing at all?

I'm sure I haven't exhausted all of the possibilities, but I hope I have shown that what seems like a simple question is usually not a simple question. Take for example weight loss surgery. Certainly there are many options to choose from. Today, in the US alone, you can opt for a laparoscopic adjustable gastric band (Lap-Band or Realize), open or laparoscopic gastric bypass (with at least 10 different variations on each), vertical sleeve gastrectomy, "mini" gastric bypass, biliopancreatic diversion with or without duodenal switch, and vertical banded gastroplasty. The choices today are different than they were last year and certainly next year as this is a changing field with new procedures and options moving in and out of favor and popularity. You may even opt to leave the US, which further expands the possibilities of surgical options (and risks, complications, etc, etc which deserves its own discussion).

Determining the right choice is influenced by our experience, knowledge, and perceptions. When it comes to weight loss surgery, many factors affect an individual's procedure of choice. Although ultimately the decision to have surgery and what type of surgery ultimately rests in the hands of the patient, many things will influence the decision along the way. Advertising, media, and internet definitely shapes the way individuals view different types of surgery. Friends, family members, and acquaintances also provide their own opinion. The family doctor may add her/his perspective. All of this occurs even before the patient has the opportunity to meet with the surgeon, who is perceived to give the expert opinion in the decision process.

Unfortunately, the decision may or may not become any easier after meeting with the surgeon. Perhaps the decision you made prior to your visit has to be reconsidered after the surgeon has advised a different perspective. Ideally, she/he will take into consideration all of the known factors which influence your outcome (both potential success and potential risks) with a particular procedure. There are certainly things which you may not know about your own individual case which can influence your success with different procedures. Admittedly, there are even things surgeons/physicians don't know about that influence your success. This is evidenced by the growing amount of research into intestinal hormones, endocrine hormones, among others which may affect weight loss and response to different avenues of weight loss. As if this is not enough to consider, we have to remember that what we discover about human physiology follows pathways and patterns, but we are all genetically unique from one another so what works for one certainly won't work for all.

Some individuals will try to oversimplify the decision on weight loss surgery. For example, I have many patients who want the band because they saw a commercial for it on TV and the model looked successful. After I have had the opportunity to consider that patient as an individual, I may be left with the task of explaining that this may not be an option, or may not be the best option. It is my responsibility, and the responsibility of any surgeon, to inform, educate, evaluate, and assist you in the decision. But be forewarned: I admit that my own personal bias, knowledge, and experience may impact that advise as well. Any surgeon who tells you otherwise is either stubborn, arrogant, or indifferent to the wealth of varying information available.

What may seem like a simple proposal to some becomes quite complex when we consider all of the possibilities. If you ask your surgeon "how would you hang a picture," beware of the surgeon who answers "a hammer and a nail" before you have told her/him what kind of picture you would like to hang, what your walls are made of, and where you would like to hang it. You may end up with a bunch of holes in your wall and no picture to show for it!