When Obesity Surgery Wasn't Cool

One might say that I have been around for a long time. Working in this business for over 30 years I can say that I remember working with bariatric surgery patients when surgery for weight loss definitely was not cool. I can not remember how I became so infatuated with this business but somehow the intrigue, the frustration, patient enthusiasm and being a part of helping others became my life’s ambition.

It was back in the early 1980’s after working with a surgeon doing vertical banded gastroplasties that I decided to attend my first annual meeting of the American Society for Bariatric Surgery. Although the society began in 1976 the few of us who would be known as the Allied Health Sciences group had our first “formal meeting” that particular year. Perhaps there were ten of us sitting in a round circle. We looked at each other and as funny as it seems today we didn’t really know what we were doing or even going to do from that time forward.

I can remember very well that as a registered nurse a topic of conversation as to what type of nursing I did always used to come up among new acquaintances. At first I thought it sounded as though I had a very important job so I never hesitated to let everyone know that I worked with patients who had experienced bariatric surgery. First I had to explain what bariatric surgery was then I had to hear what the people around me had to say about “that surgery”. One gentleman who felt he should educate me about the bad things he knew about weight loss surgery told the story of his friend’s mother who knew a woman who’s mailman’s sister’s friend had “that surgery and died”. It was one of many stories that I was forced to listen to and somehow force myself to be politically correct in my response. After awhile of hearing so many convoluted stories I became hesitant to discuss my profession with anyone. A few of my friends were sympathetic and would listen but even they would have a tendency to question why I would be in such a strange profession that no one really looked at as an acceptable treatment for obesity.

When the first small group of us sat together at that meeting to discuss what we would like to accomplish with the Allied Health I felt as though these were the only people who would ever understand this profession. It was, as I would refer to later, the best therapy session I would ever attend. Many of us still look at the Allied Health Sciences, now known as Integrated Health, that way even to this day. We network throughout the year and on occasion cry on each others shoulders.

As the years passed and Allied Health grew in numbers, bariatric surgery still remained a sensitive subject to the outside world. There were more surgeons deciding to do surgery but many had to learn the hard way that in order to do the business and the patients a service they would have to develop a multidisciplinary team to make these operations long-term successful. It was often a painful process and one that would not go without media attention. It always seemed to be the bad stories that ended up on the talk shows. I remember watching a talk show with the captions under the names of the four individuals to read: “How bariatric surgery ruined my life”. The outrageous and generally outlandish stories screamed out shades of jaded journalism.

I know I, as well as my colleagues from around the country, could very well say that we have probably made a lot of enemies throughout the years of working in this business. We have fought with insurance companies, primary care physicians, hospital administrators and those who feel the need to degrade the benefits of bariatric surgery in the media. I mentioned this to our support group one evening that being in this business has often created a negative impact on my personality. One patient called those of us who work in the profession of bariatric surgery leaders in the field. All patients agreed that we should continue to fight with those who refuse to be educated and hopefully they might understand the benefits of the surgery one day. Everyone believed we were fighting for those who suffer with the disease of obesity. They were right.

The next morning I received an email from the same patient that was a quote from Colin Powell. His lesson was “Being responsible sometimes means pissing people off.” He continued to say, “Good leadership involves responsibility to the welfare of the group, which means that some people will get angry at your actions and decisions. It’s inevitable, if you’re honorable. Trying to get everyone to like you is a sign of mediocrity: you’ll avoid the tough decisions, you’ll avoid confronting the people who need to be confronted, and you’ll avoid offering differential rewards based on differential performance because some people might get upset.” Our rewards were always based on patient success and our leadership was fueled by their willingness to be successful.

Now that original group, most of us who are still around, can look back and say that we have fought the toughest fight of our careers. We can discuss our professions among new acquaintances and feel that we will not be chastised. We can talk about weight loss surgery and feel that we are educating others and not defending the procedures. We know that even though it is more acceptable we still have a lot of work to do to make it a “cool thing to do.” It is a serious, life changing surgery, it is not a quick fix, not an easy way out and above all it takes the hard work of the patient to make it successful and acceptable with the guidance and care of a quality bariatric team. We always have to remember the necessity of long term follow-up.

Jacquelyn K. Smiertka, RN, Program Director of Beyond Change