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Comment by akiselev | Hacker News Reader

> The only intervention that does reliably work is bariatric surgery.

My understanding is surgery only works reliably because failure to comply with life style changes post-op is easily fatal and ethical doctors only perform the operation after patients have demonstrated that ability. In all but the most extreme patients, about a fifth to a third of the target weight loss has to happen pre-op for doctors to even consider the procedure. The surgery is essentially a sword of Damocles hanging over patients, reminding them that they'll die much faster than normal if they over eat.

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Failure to comply with the post op diet might be fatal within the first few months of recovery (although I haven't heard of that happening, I'm sure someone has died from eating too much), but after that, you are going to be mostly healed up. And its the long term that will determine if the weight loss sticks. It certainly isn't just because the surgery selects for people with willpower. Because almost everyone who has it has gone through years of losing and gaining back their weight over and over.

Bariatric surgery usually works for 3 reasons. First and most obvious is that it reduces your stomach size so you simply can't eat as much. Second, in most cases, reducing the surface area of the stomach reduces the amount of hunger hormones that get released thus making you less hungry all the time. And the third is malabsorption. Meaning that of the food you do eat, you absorb less of the calories than you did before. So if it were possible, you could potentially eat the same amount as before but still lose weight.

New addictions post bariatric surgery is fairly common. Gambling for instance [1] replaces food.

[1] https://www.researchgate.net/publication/332884264_Gambling_...

best to read the study before commenting on it

In the addiction literature, the development of gambling dependence after bariatric surgery is limited. Mitchel et al. reported that 2 cases presented with post-operative gambling addiction in their 3-year screening study in 201 post-op case (5). In our case, the presence of genetic background may be a risk factor for the develop-ment of gambling

2 out of 200 cases is not that common and close to baseline level

Clinically, what causes the urge to have an addiction? Like in your statement, replacing food with gambling. I would assume that these are fundamentally two different reward systems for the brain, or maybe not?

" failure to comply with life style changes post-op is easily fatal"

My understanding is naive but I always thought it was no longer possible to fail to comply after this intervention?

No, you can seriously damage your stomach, which is now already severely scarred.

You can rupture your GI sutures if you do not adhere to the post-op diet, and risk death.

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