Let's say you're trying to lose 20 pounds or boost your immunity or increase your ability to fight COVID or even cancer.

Well, the amazing thing is with the right diet, you are well in your way to achieving these vital health goals.

Welcome to the Nutrition Facts Podcast. I'm your host, Dr. Michael Greger.

Today, we have the first and a four-part series on bariatric surgery, the most common of which are stomach stapling and gastric bypass, both of which involve change to a person's digestive anatomy.

So how safe are these procedures and how well they work for weight loss? Let's find out.

The treatment of obesity has long been stained by the snacoel swindling of profiteers, hustlers, and quacks. Even the modern field of bariatric medicine, derived from the Greek word baros, meaning weight, is pervaded by an insidious image of sleeves.

Beguiled by advertising for fairy tale magic bullets of rapid effortless weight loss, people blamed themselves for failing to manifest the miracle or imagine themselves metabolically broken.

On the other end of the spectrum are overly pessimistic practitioners of the opinion that people who are fat are born fat and nothing can be done about it.

The truth lies somewhere in between. The difficulty of curing obesity has been compared to learning out foreign language. It's an achievement virtually anyone can attain with a sufficient investment of energies, but it always takes considerable time and effort.

And of those who do stick with it most will regain much of the weight lost. To me this speaks to the difficulty rather than the futility. It may take smokers an average of 30 quit attempts to finally kick the habit.

Like quitting smoking is just something that has to be done. As the chair of the Association for the Study of Obesity put it, it doesn't take willpower to do essential tasks like getting up at night to feed a baby. It's just something that has to be done.

Our collective response doesn't seem to match the rhetoric or reality. If obesity is such a national crisis reaching alarming proportions dubbed by the post-9-11 search and generalize every bit as devastating as terrorism, why is our reaction been so tepid?

For example, governments meekly suggest the food industry take voluntary initiatives to restrict the marketing of less healthy food options to children.

Have we just given up and seeded control? Our timid response to the obesity epidemic isn't capsulated by a national initiative promulgated by a joint task force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council, the Small Changes Approach.

Since small changes are more feasible, suggestions include using mustard instead of mayonnaise and eating one rather than two doughnuts in the morning. Seems a bit like bringing a butter knife to a gun fight, but with only one croissant.

Proponents of the small changes approach element that unlike other addictions, for example alcohol, cocaine, gambling, or tobacco, we can't cancel our obese patients to give up the addictive element completely as no one can give up eating.

But just because we have to eat doesn't mean we have to eat junk, like just because we have to breathe doesn't mean it has to be through the end of a cigarette.

What about bringing a scalpel to the gun fight instead? The use of bariatric surgery has exploded from about 40,000 procedures noted in the first international survey in 1998 to now hundreds of thousands performed every year in the United States alone.

The first technique developed the intestinal bypass involved carving out about 19 feet of intestines, where 30,000 intestinal bypass operations were performed before catastrophic disastrous outcomes were recognized, including protein deficiency induced liver disease which often progressed to liver failure and death.

This inauspicious start is remembered as one of the dark blots in the history of surgery. Today, death rates after bariatric surgery are considered very low.

According on average, in perhaps one in 300 to one in 500 patients, the most common procedure stomach stapling, also known as sleeve gastrectomy, which most of the stomach is permanently removed, only a narrow tube of stomach is left so as to restrict how much food people can eat at any one time.

It's ironic that many patients choose bariatric surgery convinced that diets don't work for them when in reality that's all the surgery may be an enforced diet.

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