Surgical treatments of obesity
Although there are 21 different surgical procedures for obesity (Kral 1983, 1995), the
two most popular are the gastric bypass and the vertical banded gastroplasty (e.g.
Mason 1987). Halmi et al. (1980) reported high levels of weight loss and maintenance
following surgery, with accompanying changes in satiety, body image and eating
behaviour. Stunkard et al. (1986a) suggested that after one year weight losses average
at 50 per cent of excess weight. In fact, Stunkard (1984: 171) stated that ‘Severe
obesity... is most effectively treated by surgical measures, particularly ones that reduce
the size of the stomach and of its opening into the large gastrointestinal tract.’ How-
ever, in parallel to the problems with dieting, individuals who have surgery may show
complete weight regain or no initial weight loss. In addition, they are subjected to the
dangers of any operation and the accompanying problems of anaesthetics (Mason
1987).
In summary, perhaps, to answer the question ‘Should obesity be treated at all?’, it is
necessary to consider the following points: Obesity is a health risk, but most risks come with severe obesity.
Obesity is caused by a combination of physiological and behavioural factors – it is not
simply a product of overeating.
Treating obesity with dieting emphasizes the behavioural causes and personal
responsibility (‘you can make yourself well’), but may result in overeating, which
could exacerbate the weight problem.
Treating obesity with drugs and/or surgery emphasizes the physiological causes and
places the obese in the hands of the medical profession (‘we can make you well’), but
may result in medical complications and weight regain.
Any treatment intervention should therefore weigh up the potential benefits of any
weight loss (e.g. improved self-esteem, reduced risk of CHD, etc.) against the potential
costs of intervention (e.g. overeating, weight fluctuations).CONCLUSION
Obesity is related to several health problems and a number of theories have been
developed in an attempt to understand its aetiology. In particular, research has suggested
that there may be a strong genetic predisposition to obesity, which is reflected in underac-
tivity and the relative over-consumption of fat. However, the research examining the
causes of obesity is often contradictory, suggesting that the story is not yet complete. This
chapter has also explored obesity treatment in terms of behavioural interventions,
surgery and drugs. Research indicates that all forms of intervention are effective at
promoting weight loss but weight maintenance is particularly poor for dieting based
treatments. Given that all treatments have side effects raises the question ‘should obesity
be treated at all?’. The answer seems to be that it should be treated as long as the costs
and benefits of any intervention are assessed and both physical and psychological
consequences are taken into account.370 HEALTH PSYCHOLOGY