The Fat Doctor Podcast

Riley's Story: The Bariatric Surgery Risks Nobody Talks About

• Dr Asher Larmie • Season 5 • Episode 25

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Riley's doctor recommended bariatric surgery as the solution to their health concerns, but when Riley came to me for advice, I realized they hadn't been told about the real risks. From anastomosis leaks with 15% mortality rates to spontaneous bowel perforations years later, the complications of weight loss surgery extend far beyond what most patients are counseled about. 

In this episode, I walk through the evidence-based risks that every patient deserves to know before making this life-altering decision, because informed consent requires the whole truth. If you or someone you know is considering weight loss surgery, then be sure to send them a link to this episode!

References:

  1. Lim, Robert et al. “Early and late complications of bariatric operation.” Trauma surgery & acute care open vol. 3,1 e000219. 9 Oct. 2018
  2. Silva, Ana Flávia da et al. “Risk factors for the development of surgical site infection in bariatric surgery: an integrative review of literature.” Revista latino-americana de enfermagem vol. 31 (2023)
  3. Complications of bariatric surgery: presentation and emergency management--a review.” Annals of the Royal College of Surgeons of England vol. 91,4 (2009): 280-6.
  4. Benotti, Peter et al. “Risk factors associated with mortality after Roux-en-Y gastric bypass surgery.” Annals of surgery vol. 259,1 (2014): 123-30. 
  5. Coupaye, Muriel et al. “Evaluation of incidence of cholelithiasis after bariatric surgery in subjects treated or not treated with ursodeoxycholic acid.” Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery vol. 13,4 (2017): 681-685 
  6. Husain, Syed et al. “Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management.” Archives of surgery (Chicago, Ill. : 1960) vol. 142,10 (2007): 988-93 
  7. Seeras K, Acho RJ, Lopez PP. Roux-en-Y Gastric Bypass Chronic Complications. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519489/

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Hi everyone and welcome to episode 25 of season 5 of the Fat Doctor podcast.
Today is Riley's story. I settled on Riley. It was either Riley or Jordan. I'm using a unisex name to describe an imaginary patient who is going to be the focus of this podcast because some of you love people's stories. Riley has been told that they need to lose weight, and a really good idea would be to consider bariatric surgery. Riley has come to me and said, "I'm really thinking about going down the bariatric surgery route. Please don't judge me."
First thing I've said to Riley is absolutely not. I do not judge you. I will never judge you, and I will support you, whatever decision you make. So just putting that out there. If you decide to have bariatric surgery, or you've had bariatric surgery, aka weight loss surgery, that's cool. No judgment here, and anyone who does judge you is an asshole.
Riley has been told that they need to consider bariatric surgery, and they've come to me and said "I'm thinking about doing bariatric surgery. I'm thinking about doing a Roux-en-Y gastric bypass, or possibly a gastric sleeve. I haven't decided, but my doctor has suggested a gastric bypass, because that's the traditional way of doing it, and I know what it is, and I'm thinking of doing it. But I just wanted to talk it through with you."
So this is what I say to Riley. I say, "Hey Riley, first of all, tell me, why do you want to do the surgery? Why do you want to do the surgery?" Because there's got to be something in it for you, right? For any surgery. That doesn't just apply to weight loss surgery, any surgery.
Why do you want to have your wisdom teeth removed? Because my wisdom teeth are really hurting me, and I keep getting pain and abscesses and needing to go to the dentist. I hate the dentist. So I just want to get my wisdom teeth out. Very good reason for wisdom tooth surgery.
Why do you want to have your gallbladder removed? Because I've got gallstones, and I keep getting gallstone pain, and it's agonizing, and it makes me sick all the time, and it's ruining my life, and I just want to have it out so I never have to think about it again. And yes, I know that chances are, if I have this operation, I may end up needing to go for a shit at all hours of the day, and I might end up with diarrhea, and that might be the rest of my life that I just never, ever really have a normal bowel movement again. But I've thought about it, and I have decided in the grand scheme of things, getting rid of this pain is what I need. That's a good reason to have surgery.
So tell me Riley, why do you want to have weight loss surgery? What are your reasons?
If the reasons are "because I want to be thinner, so that people will be nice to me," that's a very valid reason. Totally valid. I get that as a reason.
If you say "because I need to have weight loss surgery, otherwise I can't access the care that I really need," I'd be like, well, that's bullshit. You shouldn't be coerced into getting weight loss surgery in order to access healthcare. However, I respect that as an answer. That's a valid answer. It's wrong, but it's not your fault, Riley. It's the medical profession's fault, so we'll lay the blame entirely on them.
But again, a good reason to consider weight loss surgery. So I want to get thinner because I just want to look thinner, or I want to get thinner so that people will treat me better, or I want to get thinner so that my doctors will treat me better. All legitimate reasons. I mean, again, I would argue this is a society problem, not a you problem, but they're all valid reasons.
But if you say to me, "It's because I want to reduce my risk of diabetes down the line," I'm going to have to stop you there. There's no evidence that that's going to work.
I mean, you might be able to find some studies that say people who have weight loss surgery are less likely to develop diabetes. I'd love to see that study, to just check how accurate that is. I would love to critically appraise that study, because more often than not, when you actually look at the study you're like, that's not correct. The study in of itself is problematic. So I would argue that there is no real evidence that weight loss surgery is going to prevent diabetes.
But that's not even likely. There's no real evidence to suggest that's true. If you say "Oh, I really want to have weight loss surgery because it will extend my lifespan," no, it won't. If you say "I really want to lose weight because it will help my blood pressure," no, it won't. No, it won't.
That is not a reason to have surgery. If you want to treat your blood pressure, take blood pressure medications. And if you want to prevent your risk of diabetes, tough shit, because you can't. If you're going to get diabetes, you're going to get diabetes. There's really no evidence to suggest otherwise.
When you have wisdom tooth pain and you remove your wisdom teeth, that will absolutely stop you from having wisdom tooth pain. I'm not saying it will change your life, but if you have pain from your wisdom teeth and you have them removed, that's going to fix the problem. If you have gallstone pain and you remove your gallbladder, then you don't have gallstones, so you're not going to have gallstone pain anymore. There, you've fixed it.
Weight loss surgery doesn't have those kinds of guarantees. The only thing I can promise you will happen is for a time you will lose weight. I don't know how much weight you'll lose. I don't know if it's going to be enough weight. I certainly can't promise you you're going to be thin, but chances are with weight loss surgery, you will lose some weight. That's the only outcome that we can say with a fair degree of certainty. All the other stuff, the health stuff? No, sorry. That evidence is not very reliable.
So my first question will be, why are you doing it? And my second question will be, okay, so what do you think is going to happen? How do you see this playing out? What do you think is going to happen? You're going to go in, you're going to have the surgery. Take me through it. Tell me what you think is going to happen. What have you been told?
I want to make sure that they have a realistic understanding of what's going to happen. You're supposed to be screened for eating disorders. That doesn't seem to be happening. It's supposed to happen, and it doesn't seem to be happening. You're supposed to be fully counseled about the risks. Again, I haven't met a lot of people who have had weight loss surgery, and I said, "Well, obviously they told you about this beforehand," and they look at me blankly and go "What? No, no one mentioned that." So that's a bit worrying.
People seem a bit shocked by the outcomes. For example, "I started gaining weight again." And I'm like, yeah, that was going to happen. That was inevitable. That always happens. Did they not tell you that?
People will say, "Oh, you know, I'm malnourished all the time." I'm like, yes, that's an inevitable outcome of weight loss surgery. They remove part of your stomach that is responsible for absorbing certain nutrients, so you will always need to supplement those. That's just part of the process. Did they not warn you about that? "No, didn't mention that."
So I ask people, I ask the Rileys of this world, I say, "Hey, tell me what you think life is going to look like straight after the surgery, 6 months after surgery, a year, 5 years, 10 years. What do you think life is going to look like for you? Do you think you're going to stay thin? You're going to lose a ton of weight and then stay thin forever?"
Because statistically speaking, that's not true. That won't happen. Statistically speaking, it's about between 4 and 7 years. Not everybody regains all the weight, I will say, but regains enough weight for them to be like "what was the point."
So that will be a conversation to be had. What do you think is going to happen, Riley?
And then I will say, "Riley, tell me about what you've been counseled about, the risks you've been counseled about." And I'm going to read them all out to you folks. I want the Rileys of this world who are being told that they need to have weight loss surgery, I want them to listen now very carefully, and make sure that what I am describing to you is what your weight loss surgeon is describing to you, because these are facts.
I am taking these facts from Robert Lim et al, "Early and late complications of bariatric operation" from Trauma Surgery and Acute Care Open, volume 3, written on the 9th of October 2018. And I will leave that reference in the show notes.
Here we go. You ready?
Risk number one: Anastomosis leak. What is an anastomosis? An anastomosis is when the two parts of the gut are joined together, stitched back together, because they cut a piece out, right? So they stitch some parts together, and obviously that has to hold. And if it doesn't hold, then the contents of your gut can leak into your peritoneum, into your abdomen, and that'll kill you if you're not careful. So the mortality rate if you have an anastomosis leak is 15%, and the morbidity rate is 61%. Morbidity just means poor health outcomes. You'll be sick and you'll end up in hospital. Mortality means death. So if you have an anastomosis leak, there's a 15% chance of you dying. So you don't want an anastomosis leak, right?
The average time for symptoms of a leak to present is approximately 3 days after the operation. Often people have been discharged home by this point in time. The average amount of time could be less, could be more. So oftentimes what happens is you go home, and then all of a sudden there's a leak, and you get really sick. You end up hopefully going back into the emergency room. But if you don't get back soon enough, then that's often when deaths occur.
So you might be thinking, "Oh, I don't want one of those. What are the chances?" Well, it depends on the surgery. If you have a Roux-en-Y gastric bypass surgery, according to this paper, the incidence of leaks ranges - I'm slightly concerned about the range - between 0.6 to 4.4% of patients. I'm hoping it's more on the 0.6% side than the 4.4% side. But let's assume the worst. It's better to assume the worst than to assume the best, right? So we'll assume the worst: 4.4% of patients. So out of a hundred patients, 4 of them are going to have a leak. Remember, 15% of those are fatal.
That's quite high. If you have a gastric sleeve, the risk is much higher, between 1 and 7%.
That's number one: anastomosis leak.
Number 2: Stenosis, twists or kinks. What is stenosis? Well, basically, as I said, you cut it out and you're stitching them back together. And if you stitch too tight, basically you can cause a blockage. The hole that the food is supposed to pass through becomes too tight. People are not able to get either solids, which is bad, but in some cases liquids beyond the anastomosis, the gastrojejunal anastomosis, or the sleeve depending on which surgery you've had.
You need to be able to get liquid obviously from your mouth into your gastrointestinal system. Otherwise you'll die.
The incidence of stenosis after Roux-en-Y gastric bypass is between 8% and 19%. Holy crap. Now, not all of them are full stenosis when you can't get anything down. But the risk is up to 20%. That's 1 in 5 will have a stenosis.
And basically, what they have to do is, if they're going to treat it - and I have met many people who've developed a stenosis after a bypass, have gone to their surgeon who did the bypass, and have said, "I can't get any liquids or food down," and their surgeon, instead of saying "This is a very, very common complication," have gone, "That's because you're eating too much, eat less."
I have met people who literally, by the time they got help, were so sick they were this close to dying because their surgeon just went "because you're eating too much, eat less, and you won't vomit."
The risk is up to 20%. That's 1 in 5 people. What they're supposed to do is supposed to put an endoscope down with a balloon and dilate the stenosis. That's how they're supposed to do it, and it should be done straight away after surgery. The article writes, "This is typical management with endoscopic balloon dilatation safely done by an experienced endoscopist safely done in the first week."
It's far less common if you have a gastric sleeve. I said it's up to 20% if you've had a bypass, but it's only up to 2% if you've had a sleeve. It's a different procedure, so less likely to have a stenosis or a narrowing.
Moving on: Post-operative bleeding. Whenever we talk to patients about the risk of surgery, we have to tell them about the risk. Bleeding is almost always in there. Bleeding is always a risk for any surgery that you do. But now I want to talk about different kinds of post-operative bleeding. You may bleed after surgery, and that is not uncommon. But bleeding that requires intervention - there's a different kind of post-operative bleeding. Now that requires you to either be readmitted into hospital, to be stabilized, to begin treatment, possibly to be re-operated on, all sorts of things.
So we're talking now about post-operative bleeding that requires intervention. Could be a blood transfusion. Can occur in up to 11% of cases of gastric bypass. 85% of them, you'll be pleased to know, can stop without surgical intervention. Fortunately, 15% will require surgical intervention. 11% of people who have had a bypass will have post-operative bleeding that requires intervention.
It's quite high. I would be really upset if someone told me "I'm going to do an operation on you. Cool. There's a chance you might have bleeding that requires intervention. Shit. What are the chances?" "One in 10." I'd be like, "Are you kidding me? One in 10? That's a lot. That's big."
To put it into perspective, a cholecystectomy - I don't know the actual number, so I don't want to put it out there, but it's going to be 1 to 2%, if that, probably less. Any laparoscopic intervention is going to be less than 1%. So it's quite high risk.
All right, so we said leaks - I'm just getting started. These are just the early complications, by the way - stenosis, bleeding, surgical site infection.
Now infection is again, if you're going to talk about what are the risks of surgery, bleeding is one, infection is another, very, very common. And infection of the surgical site - obviously, this is a potentially dirty area. In other words, it's not clean, it's not sterile. There are parts of the body that are sterile - the heart is a sterile organ. But the gut is not. So if you get an infection, you're more likely to get infection when you're messing around with the gut.
Again, rates range between 0.4% and 7.6% of patients who have laparoscopic surgery. It's higher in people if you have open surgery or robotic surgery.
So that's actually from a study called "Risk factors for the development of surgical site infection in bariatric surgery: an integrative review of literature," published in 2023 by Anna Flavia da Silva. That's a cool name. I really like that name.
So there you go, up to 7.6%. Again, I always err on the side of caution. If it says "up to," I'm going with that number.
So we said 1 in 20 people can end up with a leak. 15% of those can be fatal. If you have a bypass surgery, that's what Riley's thinking about doing. Up to 1 in 5 people end up with a stenosis. Post-operative bleeding was 1 in 10 people. And surgical site infection was - we're going to say 1 in 20, because we're being generous. It's actually slightly more than that.
Now, then there's venous thromboembolism. I told you, you always get told after any surgery: bleeding, infection, clot, in that order, or maybe in different order. But a blood clot is unfortunately always a risk of surgery. The more complex the surgery, the longer time you spend in theatre, the longer it takes for you to recuperate, the higher the risk.
So venous thromboembolism can be a DVT, a deep vein thrombosis, which is blood clot in the veins of the leg, the lower leg, and that can spread. A little piece can break off and wind up in the lungs, and that's when it becomes fatal. That is a pulmonary embolism. And 50% of pulmonary embolisms that occur after bariatric surgery are fatal. 50%.
So high mortality. Now you'll be pleased to know it's fairly low risk, not like the others, which was like 1 in 10. The rate of VTE after bariatric operation is low. It's difficult to know exactly, because these, more often than not, will occur at least 3 weeks after the procedure. They don't tend to happen on the day of the procedure, or even the week of the procedure. And so we're not always including them in the mortality data or in morbidity data, because oftentimes we only capture the first 30 days. So if a PE happens after the 30 days, it's not included in the data, so we'll miss a lot of them. So it's harder to say exactly how common they are.
One study - Monkhouse et al, "Complications of bariatric surgery: presentation and emergency management: a review" - states that the risk of PE, pulmonary embolism, is between 1 and 2%. So 1 in 100 to 1 in 50. Remember that 50% were fatal.
Still, I still think that's high.
Now, the mortality rates. It's important to know that with every surgery there is a risk of bleeding, infection, stenosis. There's also a risk of death. That is the case with every surgery, even wisdom teeth. The chance of dying from wisdom tooth surgery is almost unheard of. The chance of dying from a gastric bypass is cited as 0.15%. That is 15 out of every 1,000 patients, or 1.5 people in a hundred, or 15 out of a thousand. This is the 30-day mortality. As I said, it does not include complications later on, just for the first 30 days.
And I got this from Benotti et al, "Risk factors associated with mortality after Roux-en-Y gastric bypass surgery," and this is from a 2014 paper. I'll link them all in the show notes.
So Riley, these are just the early complications. I just want to make sure that your surgeon has counseled you that there is a 1 in 20 chance of developing a leak. 15% of those are fatal. There is up to 1 in 5 chance of developing a stenosis, which means that you won't be able to swallow and eat properly. There is a 1 in 10 chance of post-operative bleeding requiring intervention. There is a 1 in 20 chance or thereabouts, slightly more than that, of developing a surgical site infection. There's a 1 in 100 chance or 1 in 50 chance, depending on the statistics - and I say we're erring on the side of caution, so 2 in 100 chance, 1 in 50 chance of developing a pulmonary embolism. And I could say 1 in 100 chance of you dying from a pulmonary embolism. And there's a slightly higher risk of just dying in general. There's 15 out of a thousand people will die from this surgery within the first 30 days of the surgery.
And that will be the early complications. Let's move on to late complications, shall we? Because this is the stuff that really bothers me. Nobody talks about this stuff that could happen years down the line. And then when it happens, people are shocked. Why are we shocked? We should have been warned about this.
So gallstone disease. I found a study that showed that the incidence about a year after surgery of gallstones was 32.5%. That's basically 1 in 3. A third of people have gallstones a year after having a bypass surgery. This was "Evaluation of incidence of gallstones after bariatric surgery and subjects treated or not treated with ursodeoxycholic acid."
By the way, if you want to massively reduce your risk of developing gallstones after bariatric surgery, you can just take a tablet for 6 months, and it drops it from 1 in 3, a third of patients, to 5.7%. It drops it to 1 in 20. If I was going to do it, Riley, if you decide to do it, make sure you take ursodeoxycholic acid. You should take that, definitely take that.
So gallstones, really, really common, 1 in 3 people.
Marginal ulceration. You've heard of stomach ulcers, ulcers. You can get ulcers around the site where they bypass, this bypass site. So not in the stomach - they bypass your stomach now - but around that site. It can be even further down in the duodenum. And this causes symptoms. When you have an ulcer, it can be really painful - pain, heartburn. And unfortunately, if you're unlucky, the ulcers start bleeding, and about 15% of marginal ulcers end up bleeding. So again, that happens in 1 in 20 people. And this is a late complication. This doesn't happen straight after surgery. This can happen years later. So you can develop gallstones, you can develop ulcers.
Here's one I don't know if anyone ever mentioned this: spontaneous perforation. So you know that bit that they stitch together? They can just pop open anytime, just perforate. It's like spontaneous combustion, except it's a real thing. Happens in 1 to 2% of patients. That's 1 in 50. 1 in 50 spontaneous perforation, just like that.
And as I said, you can get bleeding from marginal ulcers.
Then there's bowel obstruction. And somebody told me - I think it was Lisa Marie Presley died of this, or some celebrity died of this - bowel obstruction. So we are messing with the bowel, and we can cause small bowel obstruction, so obstruction in the small bowel. It can happen on average 313 days after gastric bypass on average, but it can happen up to 1,215 days, even longer. So we're talking years later.
And one study by Sayed Hussein et al, "Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis and management" - this is from a 2007 paper. So I would say that's quite old. Maybe we have more up-to-date studies. But anyway, that study showed an overall incidence of 4.4%. Again, that's 1 in 20, basically. 4 out of 100, 4 and a half out of 100. Round up, 1 in 20.
So you can have bowel obstruction. Bowel obstruction can be fatal if not treated. As I said, people die of bowel obstruction.
You can also develop an internal hernia. And this happens in about 2.5% of people. And this is one of the hardest things to diagnose, and therefore one of the most catastrophic complications, because we miss it. And then it causes a surgical emergency. And then people die.
So basically, you get this hernia, and then you get what we call a small bowel volvulus. And you just need to Google that to see what that actually looks like. I can't describe it. But from a hernia, that can cause very serious, end-stage, catastrophic complications, because it's really difficult to diagnose. It causes very non-specific discomfort, abdominal pain. Nobody knows they've got it until it's too late.
So that happens in 2.5% of people, slightly more than 1 in 50. What is that? That's 1 in 40, isn't it?
So Riley, have you been paying attention? There's another condition I want to talk to you about, which is actually very common, and nobody talks about it, and it's a shame because they should be, and that is dumping syndrome. Anyone heard of dumping syndrome?
So I'm taking this from another study, another paper that was published in 2023, which describes a lot of the same complications. I'm not going to read all of them out again. But I will talk about dumping syndrome, because this describes it in great detail.
Actually, dumping syndrome can be early or late, and it presents very differently if it's early dumping syndrome or late dumping syndrome. The prevalence of dumping syndrome post gastric bypass surgery, with a median follow-up of 4 and a half years - so this is a late complication - is about 13%.
So up to 13% of people, maybe more, develop this condition. It is more common, apparently, in young females. I don't know why, it just is.
So early dumping syndrome occurs in the first hour after having a meal, usually within a few minutes. And basically, what's happening is - because what's supposed to happen is food goes from your mouth into your esophagus into your stomach. It sits in the stomach for a little while, starts digesting. All sorts of things happen, and then it passes into the small bowel, right? That's what's happening. But because you don't have a stomach anymore, what happens is you're rapidly introducing nutrients into the small bowel.
And that causes all fluid basically to move into the bowel, into the wall of the bowel. And it can cause diarrhea. It can cause dizziness, flushing, nausea. It can even cause your blood pressure to drop. So then you have really low blood pressure straight after eating.
And this is really common side effects. And what they say is, "change your diet," that's how to fix it.
"Oh, it's not that big a deal. Just change your diet. Low carb, high protein, small, frequent meals. Blah, blah." That's what you've been told to do anyway, isn't it? To prevent this from happening?
And it's very common straight after surgery, and usually it settles down. But many people will have it 12 to 18 months later, even more than that, and that's very distressing. Every time you eat something you feel like crap. Your blood pressure drops through your boots, you start flushing, you feel dizzy, you feel sick, you have diarrhea. It is not cool. Nobody wants to go through that, so you become very afraid of eating.
And I know a lot of surgeons think that's a good thing. "Well, you'll eat less. That's a good thing, because we want to starve you for as much as we possibly can." But it's not a good thing, A, because eating is a social event as well as a way of giving yourself nutrients, and B, because it's a way of giving yourself nutrients. And if you can't eat, you're not getting enough nutrients into your body, and then you become malnourished. And if you're unlucky, you become so malnourished that it affects your kidney, your heart, your blood pressure, and all sorts of other things. It will cause weakness, it will cause tiredness, it will cause all sorts of issues.
That's early dumping syndrome. And there's late dumping syndrome. This happens hours after a meal, and is basically when you develop hypoglycemia. Your blood sugar, instead of your blood pressure dropping, it's your blood sugar that goes down. And you can get tremors, palpitations. It can even impact your mental status.
It can be really distressing. And yes, again, this is post-surgical. As I said, up to 13% of people get this.
So Riley, now we have to ask an important question. Do the risks of this surgery outweigh the benefits, or do the benefits outweigh the risks? Remember right at the beginning, Riley, I asked you to tell me why you want to have this surgery.
And only you can decide whether the benefits outweigh the risks. That's a personal decision. And if you've heard all of this information and you've gone, "Yeah, do you know, Asher? Yep, that's fine," then my next thing is, "Okay, so how can we manage these risks? What can we do for you? How can we resource you to ensure that we manage these risks, that we reduce the chance of this happening as much as possible?"
By the way, there were plenty of risks I didn't put out there, like malnourishment, for example. That's a given. So what are we going to do to make sure that you're being tested regularly, that you're getting all the supplements that you need? Are you going to be able to afford to pay for these supplements, because they probably will not be something that you can get on your insurance, or that you can get through the NHS? So you'll have to pay for these supplements. Can you afford them? Will you be able to afford them long term?
In terms of reducing your risk of gallstones, can you take the acid thing that I told you about? Could you do that? Risk of a blood clot - how can we reduce that? There's plenty of ways that we can reduce your risk of a blood clot. How can we get you moving as soon as possible? How can we reduce your risk of infection? What can we do to reduce your risk? So we can work through that. Just because the risks exist doesn't mean we shouldn't mitigate them. And I think it's really important that we have these conversations prior to surgery. "Okay, all right, I'm willing to take the risk. However, I want to do this, this, this and this," and we can talk about that.
But if Riley, if you say to me, "Do you know what? Actually, I'm not sure. I'm not sure I want to take the risk of my bowel perforating 2 years from now, just spontaneously, without warning, just boom, perforation. I don't want that because I won't be able to relax. I won't be able to rest and enjoy myself."
That would be very valid, too. And if that's what you're thinking, dude, I totally get it. I think we need to go back to your surgeon and say, "Yeah, thanks, but no thanks."
And if your doctor is saying to you, "Unless you consider weight loss surgery, I'm not going to let you have surgery," then come find me because I have ways around this. I have ways to challenge this.
Doctors cannot by law coerce you into having surgery, especially surgery with these risks, really really significant risks. Why should you be forced to take those risks?
There is such a thing as autonomy, and doctors cannot deny you care unless you consider having weight loss surgery. They cannot. And they're going to tell you some bullshit about anesthetic risk. And one of these days, maybe next time it won't be Riley, it'll be someone else where I'll have a long chat with you all about your anesthetic risk and how they're talking out their assholes.
But until then, Riley, I hope you found this helpful, and anyone else found this helpful. And if you know someone that's considering weight loss surgery, feel free to send them a link to this podcast. If you're being harassed to have surgery, if your family members are suggesting it to you or your friends are suggesting it, or your colleagues are suggesting it, or even your doctors are, just say to people, "Do you know what? Just before you say anything else, do me a favor. Just listen to this podcast. Listen to Riley's story and then come back to me."
Everything that I have said here today, I will back up with evidence in the show notes.
Thanks for listening. Hope you enjoyed Riley's story. I normally have a guest for the last episode of the month. I'm not sure that's going to happen if I'm honest, just because that feels like a lot of hard work to organize right now.
I do want to keep having guests on the podcast, but I'm not sure how I'm going to do that at the moment, so you'll have to bear with me. I will be back actually. Maybe I'll take a break. Maybe this is an opportunity to take a week off.
Can you imagine? 3 weeks on, one week off. That feels quite good. I'm going to do that. I'm going to take a week off. I'll be back in 2 weeks time. Until then, take care of yourselves. Bye.