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A Bariatric Surgeon Schools Me On Food Addiction and Weight Loss Surgery

Nov 17, 2025

Dr. Mark Vierra, a seasoned bariatric surgeon, dives into the complexities of food addiction and the biology of obesity. He explains how weight-loss surgery alters hormones affecting appetite and improves metabolic health. Vierra shares insights on why many referrals don't lead to surgery and emphasizes understanding individual patient challenges. The conversation also addresses the increased risk of alcohol use disorder post-surgery and the importance of screening motives for drinking. A respectful approach to each patient's biology and story is at the heart of his practice.

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INSIGHT

Obesity Is Often Biological Not Moral

Not all obesity is behavioral; genetics and biology often drive weight more than willpower.
Dr. Mark Vierra emphasizes treating obesity as a medical condition, not moral failing.

ANECDOTE

Reversing Harm Changed His Perspective

Vierra reversed a severe malabsorptive operation for a patient who had gone from 400 to 150 pounds and later returned to 400.
That case shifted his view and pushed him to learn more about bariatric care.

ADVICE

Use Multidisciplinary Screening Before Surgery

Screen patients with dietitians and mental health professionals before considering surgery.
Dr. Vierra and Dr. Steve Chang reject many referrals and often decline surgery after careful multidisciplinary evaluation.

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Food isn’t just fuel and obesity isn’t just willpower. We sat down with bariatric surgeon Dr. Mark Vierra to unpack what weight-loss surgery really changes, why genetics and hormones can overpower the best intentions, and how a careful program decides who needs a scalpel and who needs a different plan. From GLP‑1 surges and ghrelin drops to PYY’s “brake,” we walk through how surgery reshapes appetite signals and why even modest weight loss can dramatically improve diabetes and cardiovascular risk.

The conversation goes beyond the operating room. Dr. Vierra explains why five of six referrals don’t get surgery, how he and his partner analyze food diaries, depression, and daily constraints, and when medications like bupropion or GLP‑1s make more sense. We explore binge patterns, the messy reality of predicting who will do well after weight loss surgery, and the tough calls around patients who’ve been told their BMI is destiny when their labs and function say otherwise. The story shifts sharply when we talk alcohol: after gastric bypass, blood alcohol rises faster and stays higher, which raises the risk of alcohol use disorder over time. We share practical ways to screen motives for drinking, plan safeguards with families, and use craving meds thoughtfully.

What ties it all together is respect for biology and the person in front of us. Genetics like MC4R variants and syndromes such as Prader–Willi can drive lifelong hyperphagia; ultra‑processed foods and liquid calories amplify the problem; stigma keeps people from care. We push for a different bias—against soda and engineered foods, not against people—and for care that follows patients long after the incisions heal. If you want a grounded, humane guide to obesity treatment, this conversation delivers clarity without blame.

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To contact Dr. Grover: ammadeeasy@fastmail.com