Obesity is notoriously difficult to treat. Fully one-third of American adults are obese. The most often-prescribed strategies for weight loss include diet, exercise and medical therapy which are dismally unsuccessful.
Only 17 percent of people report maintaining loss of at least 10 percent of body weight for one year at any point in their lives. Yet medicine continues to insist that these conventional strategies are the preferred answer to weight loss. Scientific evidence suggests why diet and exercise rarely "cure" obesity.
The physiology governing overeating is remarkably similar to that of addiction to other substances including drugs and alcohol. Addictive disorders arise from centers in the brain that promote behaviors necessary for survival. Eating tasty, high-calorie food stimulates these brain centers to release a substance called dopamine which causes intense feelings of pleasure that are highly reinforcing. Repeating this behavior alters the structure of the brain making it less sensitive to dopamine. Thus, more eating is required to produce the same pleasure.
The neural pathways that drive eating also become highly sensitized, and permanent neural pathways develop. There are other hormones that are abnormal in the obese, including leptin and ghrelin, which carry messages from the body to the brain about being full or satisfied. Even flora, the bacteria that live in your intestine, send food-related messages that drive appetite both directly and indirectly to the brain.
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Because eating is necessary for survival, the redundant pathways designed to reinforce eating behaviors go into overdrive. You violate your diet because your body forces you to do so, not because you lack moral fortitude.
One must reverse these physical mechanisms designed to maintain overeating. Research shows that bariatric surgery is the only durable solution to weight loss and has excellent success in reversing obesity complications including Type 2 diabetes.
Studies demonstrate that both the gastric sleeve and Roux-en-Y bypass surgery reduce activity of brain pleasure centers when exposed to food, reduce appetite-stimulating nerve activity, and restore normal intestinal flora and function of hormonal signals from insulin, ghrelin and leptin.
In essence, bariatric surgery retrains your brain and response to food through creating surgically-mediated negative experiences associated with dietary splurges rather than pleasure. Bariatric surgery permanently alters processes that govern eating. These dramatic alterations are not seen with diet, exercise, medical therapy or lapband surgery, which likely explains the effectiveness of longer term weight-loss success associated with bariatric surgery.