Obesity is a complex problem. For some, weight loss is a lifelong struggle. It’s calorie counting, tracking macronutrients, fad diets, exercise, and prescriptions that might help short term. But the weight eventually returns. 

Often, when patients have struggled for decades to lose weight, additional medical problems begin to mount. It starts with high blood pressure. Then blood sugars rise, cholesterol medication is introduced, and they are on a slippery slope to a daily medical cocktail without a proper understanding of what’s going on with the body. 

While it’s easy to calculate a person’s body mass index, the traditional medical community isn’t designed or trained to understand all the factors that contribute to or influence obesity. When treated through a strictly medical lens, patients experience frustration, anxiety, anger, and depression, all of which are exacerbated with hard work and no improvements. Patients deserve more than medications; they deserve explanations.

A mixture of contributors influences weight gain and obesity: diet, physical activity, genetics, gut microbiome, surgical history, chronic stress, sleep deprivation, toxins, socioeconomic status, education level, and living location. All of these should be assessed before a patient receives any dietary recommendations. Instead of listening to the patient and fully understanding, we are often too quick to blame weight on mental or psychological factors.

Bariatric surgery is often a taboo subject with a negative stigma attached. Patients are often too scared to ask for help, while providers often have limited knowledge and feel uncomfortable referring. Bariatric surgeries involve surgically manipulating the stomach to shrink its size. Depending on the type of surgery, many patients are at risk of long-term malnourishment, malabsorption, gastrointestinal disorders, and nutrient deficiencies. Because significant weight loss often reverses disease, these surgeries can save lives even with the risks involved. Finding the right registered dietitian to guide you before and after surgery is just as crucial as finding the right bariatric surgeon to perform the surgery.  

Before surgery, long-term lifestyle modifications must begin. Patients must show determination and motivation by implementing dietary changes, starting a daily exercise program, learning to manage stress, and working through pre-operative testing and 

assessments. Because most bariatric patients struggle with a myriad of negative symptoms compounded with chronic disease, each patient deserves a full review of their medical history, surgical history, medications, and symptoms by a knowledgeable registered dietitian to help the patient fully understand how to not only lose weight after surgery, but thrive. 

Bariatric surgery is no quick fix. It is not a silver bullet when trying to lose weight. For most patients, it is a non-reversible surgery that requires lifelong dietary changes. For the right patient, it can change the trajectory of their life. We need to stop the negative stigma associated with bariatric surgery by eliminating judgment and encouraging a more open, optimistic discussion regarding weight loss. Blame is not necessary or deserved. However, in-depth conversations and explanations with a registered dietitian will help the patient properly manage the complexity of bariatric surgery. Bariatric patients have the courage to fight for a healthier life, and they deserve to have the knowledge needed to ensure a long, optimal life after surgery. 

If you have considered bariatric surgery, here are a few of my tips:

  • Consider a consultation with a registered dietitian. This is a judgment-free appointment to review health history, implement small changes that may improve symptoms, discuss weight loss history, and discuss whether bariatric surgery is worth pursuing. Insurance plans including BCBS, Health Alliance, Health Partners, and Medicare often have RD benefits. Call the office for more information.
  • Calculate your BMI. In 2018, the CDC estimated 42.4% of adults have body mass indices (BMI) greater than 30. A BMI greater than 40 is labeled as morbid obesity. Most insurance companies will not cover bariatric surgery until a BMI exceeds 40. If your BMI is less than 40, please consider the Couri Center’s TLC: Total Lifestyle by Couri integrative wellness programs. 
  • Do not accept traditional, non-personalized recommendations. I pride myself on being a non-traditional dietitian with multiple educational degrees, including exercise science and dietetics. I started my career with a dual love for exercise and nutrition. I have focused on health and wellness for over 20 years and spent more than a decade specializing in integrative medicine and personalized nutrition. By relieving the stress of multiple appointments, I can tackle nutrition, exercise, and all things wellness in a single consultation. 
  • Find a bariatric surgeon and registered dietitian team with solid reputations, effective communication skills, and positive office atmospheres. Do not tolerate being treated poorly or settle for a disorganized office. Ask around for recommendations. These can make or break your experience. If you need help finding a surgeon, please schedule an appointment with me to discuss.

Bariatric patients are superheroes. With proper recommendations and guidance by a registered dietitian, they can consume healthy diets of whole foods, reduce medications, eventually train like athletes and help encourage healthy lifestyles in their families, friends, and communities. My goal is to ensure all patients have positive experiences and thrive in their new lives.

Leslie Rusch-Bayer, MS, RD, LDN, is a Registered Dietitian and Certified Personal Trainer at the Couri Center for Gynecology and Integrative Women’s Health.