Fast or operate: a bariatric surgeon on the use of intermittent fasting in the treatment of obesity

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Fast or operate: a bariatric surgeon on the use of intermittent fasting in the treatment of obesity
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Just stop eating from 16:00 to 12:00 the next day – a simple recipe for combating excess weight from popular adherents of intermittent fasting. There are a lot of “success stories” on the Internet, but has a fail-safe way to control excess weight really been found?

Why don’t we eat enough?

One of the most important causes of excess weight and obesity is overeating. Why does a person eat a lot? Satiety begins in the stomach. When we eat, it expands and signals are sent through the vagal nerve, which connects the stomach to the brain, that the person is full. The transmission of this signal can be disrupted for physiological or emotional reasons.

  • The most common physiological cause of overeating is a distended stomach: the signal to the brain arrives very late, when a large volume of food is already in the stomach. In this case, a person almost always runs the risk of eating 2-3 times more than normal.
  • Also, saturation may occur later than expected if a person has a lack of sleep. At such moments, improper production of the hormones ghrelin (hunger hormone) and leptin (weight loss hormone) occurs in the body. Their synthesis and secretion vary, adjusting to metabolism and energy balance. When there is a lack of sleep, a disorder occurs – the body begins to produce more ghrelin and less leptin.
  • A common emotional cause of overeating is strict dieting. A long and painful diet restriction leads to energy deficiency and a lack of essential microelements for normal life. At some point, the desire to eat something “forbidden” overpowers, a breakdown occurs, and the person eats 2-3 times more than normal.

How does intermittent fasting affect the body?

Intermittent fasting is an eating pattern that involves periods during which a person abstains from food in order to lose weight. The technique is often used to reduce body weight by people who are overweight, but not obese. Many scientists even advocate that this style of eating is evolutionarily characteristic of humans. It fits perfectly into the cycle of wakefulness (day) and sleep (night), that is, human circadian rhythms. We are talking about evening intermittent fasting according to the 16:8 scheme. (16 hours without food, you can only eat for 8 hours during the day). It is a known fact that eating at night is associated with a higher risk of obesity and diabetes, so giving up food, for example, three hours before bed can be the right decision for almost everyone.
Intermittent fasting for obesity
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But the safety of eating at serious intervals has been confirmed by researchers only for the average healthy person. Circadian rhythms and intermittent fasting have not been studied in the long term, and there are no supporting large population findings.

Risks “in the moment” are known:

  • Long breaks lead to the fact that a person does not feel full for a long time while eating, so he risks eating 2-3 times more than his norm in terms of volume and calorie content. And regular overeating is one of the main causes of obesity.
  • Alternating periods of overeating and subsequent hunger is a pattern of pathological eating behavior. A healthy person replenishes the necessary energy through nutrition. This is signaled by a feeling of hunger, and it occurs on average 2-3 times a day. Therefore, it is more psychologically safe (to avoid eating disorders) to eat small portions several times during the day, following the regime.
  • Irregular eating, which is intermittent fasting, can disrupt the production of hormones such as insulin, ghrelin and leptin, which are responsible for hunger, satiety and metabolism. This can lead to the development of systemic chronic diseases such as diabetes, obesity, metabolic disorders, and increase the risk of developing cardiovascular diseases.
  • Fasting is dangerous for pregnant and breastfeeding women.
  • In our experience, there are risks of dyspeptic disorders in people with gastrointestinal diseases, exacerbations of cholelithiasis, ulcers.
  • Lack of nutrients in the body due to fasting can cause vitamin and mineral deficiencies, which will affect a person’s overall health.

Intermittent fasting VS bariatric

The proportion of Russians who are obese is growing rapidly: already every tenth person is overweight, which means that the number of complications is increasing – diabetes, cardiovascular pathologies, etc. Bariatric surgery is developing and gaining popularity. This is an effective treatment method, the indication for which is not only obesity, but also concomitant diseases and complications. There are several types of bariatric surgery, but most involve reducing the volume of the stomach using some type of surgical technique.

Bariatrics
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In 2020, 3,292 operations were performed, and in 2023 there were already 8,955—172% more. There are even quotas for interventions, for example, for people with diabetes. The Nationwide Bariatric Registry reports that only 30% of obese people do not have additional diagnoses. But they may also be eligible for bariatric surgery if their BMI (body mass index) is above 40.

Often, supporters of intermittent fasting claim that the technique is an alternative to bariatric surgery because it can help reduce the volume of the stomach without surgery. This is partially true: when you are in a calorie deficit, your stomach volume can actually decrease temporarily. However, as with any other diet, after the end of intermittent fasting, the stomach will quickly return to the same size or even risk enlargement.

In the short term, due to the reduction in the number of meals, you can see the first results of weight loss in a few days. However, there is no point in long-term intermittent fasting – then the weight will come off more slowly or stop altogether. Therefore, intermittent fasting cannot be considered as an alternative to bariatrics.

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But we cannot say that the intermittent fasting technique is harmful. According to observations, it works for “short distances” when a person is overweight, but not yet obese. And if a person, after a diet, generally changes his lifestyle and decides to permanently reduce the amount of food he eats, this is good and correct.

Moreover, there are no strict contraindications to intermittent fasting in bariatric patients. This method is chosen by patients to lose a few kilograms before surgery. But due to the danger of exacerbation of chronic diseases, it is extremely important to increase control over the intake of medications at this time; laboratory tests must be regularly carried out to prevent deficiencies of microelements and vitamins, and in general the process should be monitored by a doctor.

Contraindications

In many cases, the decision “to go on a strict diet from tomorrow” comes to those who already have not only a high body mass index, but also chronic diseases associated with excess weight. It is possible that there may be psychological problems that contribute to the development of eating disorders. Therefore, before prescribing a patient for bariatric surgery, doctors conduct a full examination.
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Ruslan Abramov
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The decision to operate is made collectively. Before making a serious decision, it is important to identify all contraindications and consult with doctors – therapist, nutritionist, endocrinologist. This approach should be taken before introducing any weight loss techniques, including intermittent fasting. At a minimum, you should consult a doctor regarding personal contraindications.

For intermittent fasting, the primary list includes:

  • stomach diseases;
  • diseases of the gallbladder (with prolonged practice, stagnation of bile and the development of cholelithiasis are possible) and adrenal glands;
  • diabetes mellitus, hypertension, gout;
  • body mass index less than 18.5;
  • eating disorder;
  • pregnancy and breastfeeding;
  • regular medication intake associated with meals;
  • age up to 18 years.
Both after a diet and after bariatric surgery, it is important to maintain a sleep schedule and eat a regular and balanced diet, drink enough water, and engage in daily aerobic exercise. And most importantly, all this needs to be done under the supervision of doctors, from the standpoint of a complete lifestyle change, and not short-term measures.

There is confirmed quantitative data that if in obesity the process of losing and maintaining weight is not supervised by doctors, including bariatric surgeons , for men the chances of achieving normal body weight are only 1 in 210, and for women – 1 in 124.

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Maxim Burikov
Have you used the intermittent fasting method to lose weight? What effect did you achieve?
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