The real skinny on holistic bariatric surgery

Dr. Victor Sierpina

Dr. Victor Sierpina

I recently read a really well-done book by a highly successful bariatric surgeon in Dallas and former UTMB medical student.

Dr. Nick Nicholson’s book, “Weight Loss Surgery: The Real Skinny,” is an essential read for those of you who might be contemplating surgery for your weight problem, as well as for your family and friends. Such surgery has become the second most common general surgery procedure after gallbladder removal. So if you haven’t met someone who has had this surgery, you surely will.

Bariatric means relating to weight loss, thus bariatric surgery involves one of several types of procedures to help people lose weight. This is not a minor event. If your six-pack has turned into a 12-pack, you are 10-30 pounds overweight, don’t fit into your favorite dress or jeans, bariatric surgery is likely not for you. It is not a cosmetic treatment like getting a face-lift or getting a boob job.

Your BMI needs to be over 40, or over 35 if you have certain obesity related medical conditions to even qualify for this kind of surgery. Additionally, most insurances, if they cover this treatment, require psychological evaluation, documentation of failed attempts at diet, exercise, and the usual approaches to losing weight.

I have seen numerous patients go through this kind of surgery, and the results are nothing short of amazing. Often, if I haven’t seen them for awhile, I can barely recognize them. Not only do they lose 100 pounds or so, they also usually ditch their diabetes, hypertension and lipid lowering medications. Such significant weight loss decreases risks of other problems like heart disease, cancer, degenerative joint disease, and sleep apnea.

If we thought of severe obesity as a serious condition like cancer, perhaps people would be more supportive of those getting this kind of treatment. Instead, overweight patients are often stigmatized as having poor impulse control, lack of motivation to exercise, and so on. Yet their risk for early death and disability is worse than most cancer patients.

Nicholson’s book offers a realistic, refreshing and holistic alternative view to this severe health problem. It helps patients who are candidates for this kind of surgery understand the complexity of not only the surgery itself, which of course has risks and potential complications, but the bigger picture of how such overweight has affected their lives. And how losing that weight, and maintaining that weight loss will affect it even more.

Before undergoing surgery, people need to understand the challenges ahead, and those behind them. Sexual, physical, and emotional abuse may have preceded morbid obesity as those injured souls stuffed down their emotions with comforts like food and protected themselves from further abuse by a large layer of fatty insulation to distance themselves from others.

People in their lives have become used to their weight and the psychological profile, often of compliance, dependency, depression or victimhood that this involves. When they suddenly start looking more normal, start asserting their independence, their beauty, their inner spirit, others in the family, even close friends and spouses may push back and sabotage their well-earned gains.

Habits like hanging out with friends primarily for food and drinks may need to change to more physical pursuits. This may leave some of your obese friends behind or imploring you not to change as much. These are all tough decisions.

Every meal, every chance to move and be active becomes a critical life choice.

After losing 80 or more pounds following surgery, are you willing to give that up for a dysfunctional relationship, an addiction to a certain food or drink, the emotional trauma of abuse? This is not easy work but it can be done with proper support, education and awareness of the options.

“Weight Loss Surgery: The Real Skinny” is available on line from Amazon. Check it out if you or anyone you know is planning on or has had bariatric surgery. This will help them through the real issues that can help them be successful in getting off and keeping off unhealthy pounds. More on their approach at

My colleague Dr. Myers Hurt had the following to say about this book:

“Dr. Nicholson’s book is a slim, approachable guide ripe with patient quotes that will strike a chord in anyone dealing with weight loss.

“It is refreshing to hear from a surgeon who could easily benefit from a ‘quick fix’ approach actually address the journey that is weight loss on such a holistic, emotional level.

“Instead of focusing on technical procedures, the book highlights emotions surrounding weight loss surgery — from the initial decision to see a bariatric surgeon through realistic goal setting.

“Incredible focus on the emotional journey that is weight loss — both in surgical and nonsurgical patients.”

UTMB has an excellent team at our Center for Obesity and Metabolic Surgery clinic in the Victory Lakes Specialty Care Center. You can call for an appointment at 832-505-1500. Their website is

Contact them if you wish to explore this approach to improving your health further. Keep in mind, the real work begins after surgery.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.

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