Metabolic Surgery Isn’t Extreme — The Myths Are
Metabolic Surgery Isn’t Extreme — The Myths Are
For decades, people living with obesity have been told the same story: eat less, move more, try harder. When that inevitably fails, the blame quietly shifts back onto the individual. According to bariatric surgeon Dr Alex Craven, this narrative is not just outdated — it is dangerous.
In a recent episode of The Bari Chronicles, Dr Craven lays out a reality that many patients already know but rarely hear reflected back by the healthcare system: obesity is not a simple behavioural problem. It is a complex, biological disease influenced by genetics, early development, hormones, medical conditions, medications, mental health, and the environment we live in. Lifestyle plays a role — but it is only one small piece of a much larger puzzle. dr-alex-craven_copy-of-rec00132…
Why “Eat Less, Move More” Fails
One of the most persistent myths around obesity is that behaviour directly controls body weight. Dr Craven is clear: there is nowhere else in medicine where behaviour alone dictates physiology. If humans truly had full voluntary control over their metabolism, we would not survive.
Exercise is undeniably good for health. Eating nutritious food matters. But neither reliably treats obesity. People can follow healthy diets, exercise regularly, and still live in larger bodies with worsening metabolic disease. When we treat lifestyle as the cure rather than a supportive tool, we set people up to feel like failures for outcomes they cannot fully control. dr-alex-craven_copy-of-rec00132…
Obesity Treatment Is Not About Punishment
A recurring theme in the conversation is the harm caused by shame-based approaches to care. Many popular programs — including extreme dieting challenges and rigid food rules — actively damage mental health and increase the risk of disordered eating.
Dr Craven argues that good obesity treatment must do the opposite. It should preserve mental health, protect a person’s relationship with food, and support long-term sustainability. Effective treatment does not require constant restriction, fear, or guilt. In fact, metabolic surgery often provides freedom from dieting in a way nothing else can. dr-alex-craven_copy-of-rec00132…
What Metabolic Surgery Actually Does
One of the most misunderstood aspects of metabolic surgery is how it works. It is not simply about reducing stomach size or forcing people to eat less. These operations work primarily through hormonal and neurological changes that reset the body’s energy regulation systems.
This is why people often see improvements in type 2 diabetes, joint pain, inflammation, and liver disease before significant weight loss even occurs. These benefits are not caused by willpower or restriction — they are the result of profound biological changes. dr-alex-craven_copy-of-rec00132…
Calling this “extreme” while accepting progressive diabetes, kidney failure, and metabolic liver disease as normal is a contradiction that Dr Craven finds deeply troubling.
The Cost Myth and the Healthcare Blind Spot
Another myth Dr Craven dismantles is the idea that metabolic surgery is too expensive. In reality, it is one of the most cost-effective treatments available for people with severe obesity and related diseases. Preventing years of complications, hospital admissions, dialysis, and disability saves both lives and public healthcare dollars.
Yet, despite the evidence, access remains limited. Unlike other life-threatening conditions, obesity treatment is rarely presented as a standard option. Patients are often left cycling through ineffective interventions, internalising blame, and eventually disengaging from healthcare altogether. dr-alex-craven_copy-of-rec00132…
Lived Experience Must Be Part of the Solution
A powerful moment in the episode comes when Dr Craven reflects on how much of his understanding has come from listening to patients. Not textbooks. Not guidelines. Real people sharing what it is actually like to live with this disease.
He draws parallels with other stigmatised conditions, such as HIV and hepatitis C, where progress only occurred once judgement was set aside and evidence was allowed to lead. Obesity, he argues, deserves the same objectivity, respect, and urgency.
The Takeaway
Metabolic surgery is not a shortcut. It is not an easy way out. And it is not extreme.
What is extreme is continuing to deny people access to effective, evidence-based care because of outdated beliefs about personal responsibility. What is dangerous is leaving obesity untreated while pretending that shame and willpower are medicine.
This conversation is a call to rethink how we talk about obesity, how we treat the people living with it, and how we decide what care is “deserved.” Because good medicine is not about judgement. It is about outcomes, dignity, and saving lives. dr-alex-craven_copy-of-rec00132…
