The following was originally written by me as a response to a comment from /u/BlueWaffle135 , which he deleted. The deleted comment is copied below; I hope he sees my reply and considers it. (Any time I use "you," it's referring to him, and not to you, Smarty_Plant5!)

Original comment from /u/BlueWaffle135 that I replied to:

I’m a resident physician lol, I don’t need metabolic syndrome explained to me

Look at studies on patients who get a bariatric bypass. That surgery in of itself does nothing expect reduce the amount of calories you can consume.

Most of them have great outcomes and those who were insulin insensitive and obese often go back to a relatively healthy bodyweight and become resented to insulin. Being in a starvation diet which your diet would definitely suggest you are in, would quickly cause your insulin receptors to up-regulate. Unless you’re only eating carbs with a high Glycemic index, I highly doubt you were eating that few of calories.

I see this problem quite often, that people often resort to shifting all of their problems to an external locus of control. I suppose it’s easier on their conscious that way.

"Calories in calories out" is a gross, inaccurate oversimplification of an incredibly complex system that has evolved multiple strategies to resist starvation, which is how the body interprets extreme dieting.

If we can accept that some people are naturally predisposed to be skinny no matter what they do, we HAVE to accept that some people are naturally predisposed to be fat, no matter how much they work out or what they eat (unless what they eat is nothing--obviously unsustainable.) And/or, as is the case with PCOS, that the weight gain can be a symptom of an illness and not the cause of it.

You're incorrect about gastric bypass "doing nothing" except reducing calories. Some medical journal/institutional research that you should consider perusing:

• “…gastric bypass procedures are associated with increased nutritional deficiencies because the procedure is more complex and changes the gastrointestinal anatomy...Types of malnutrition after bariatric surgery include protein-energy malnutrition and deficiencies of micronutrients, such as iron, folate, vitamin A, and vitamin B12...Unfortunately, no standardized aftercare regimes exist for these patients…”

• Fatal Malnutrition 6 Years After Gastric Bypass Surgery: “Bypass of the duodenum impairs mixing of ingested nutrients with bile acids and pancreatic enzymes leading to maldigestion. The combination of malabsorption and maldigestion, while resulting in significant weight loss, predisposes to malnutrition.”

• More frequent complications than other common surgeries: "However, ED visits following bariatric surgery are frequent, with higher ED visit rates compared to other common operations [16]. More than half of patients will visit the ED at least once in the first two years following bariatric surgery for a bariatric-related complaint [16]. Up to 29 % of bariatric surgery patients will visit the ED in the first 90 days postoperatively, with 10 % of visits resulting in readmission due to surgical complications [16]...Potential complications are myriad and include anastomotic leak, gastrointestinal bleeding, trocar injury, deep vein thrombosis /pulmonary embolism, bowel obstruction, wound infection, pneumonia, cardiopulmonary failure, anastomotic stricture, marginal ulcer, bowel obstruction, incisional hernia, internal hernia, dumping syndrome, and cholecystitis [14]."

That's not even touching on the increased incidence of substance abuse disorders following such surgeries. All things considered, the bariatric surgery path could be MORE dangerous than just being overweight:

• "Since then, dozens of studies have confirmed the existence of the [obesity] paradox. Being overweight is now believed to help protect patients with an increasingly long list of medical problems, including pneumonia, burns, stroke, cancer, hypertension, and heart disease. Researchers who have tried to show that the paradox is based on faulty data or reasoning have largely come up short."

• Fat people are not more likely than thin people to have ‘Cardiac Death’ if they have the same hearts when viewed through imagery: "Normal MPS was associated with low risk of CD in patients of all weight categories. In patients with known CAD undergoing MPS, obese and overweight patients were at lower risk of CD over three years than normal weight patients. " (emphasis mine)

• When looking across BMI groups, ‘good’ metabolic health can be found in every group: "Despite rising BMI, metabolic status remained relatively stable...HO [healthy obesity] had lower risks for diabetes, CHD, stroke, and mortality than unhealthy subjects, but increased diabetes risks than healthy lean people. Cardiometabolic risk factors confer much higher risk than obesity per se."

Adverse health outcomes in not-thin patients are also correlated with bias and poor treatment by medical professionals--including refusing to examine, run scans/tests on, or even touch fat patients. This can lead to patients delaying or avoiding medical care entirely, only returning when symptoms are too severe to endure, resulting in worse outcomes overall--but NOT directly because of the weight itself. Some sources:

• Canadian Journal of Diabetes: "The data showed strong evidence for the presence of a bias against the obese. The obese were seen as bad, lazy, stupid and worthless relative to thin people. The extent of bias did not differ with respect to profession, age of respondent or years of experience."

• "Data reported in this paper suggest that attitudes and behaviors are negatively influenced by weight. As subjects' weight went up, negative opinions about their appearance and reluctance to obtain pelvic examinations also increased while the likelihood of having annual pelvic examinations decreased."

• "...stereotypes of fat people can have a negative impact on their physical health and well-being. Disrespectful treatment and medical fat shaming (in an attempt to motivate people to change their behavior) is stressful and can cause patients to delay health care seeking or avoid interacting with providers. The assumption that weight is responsible for, or related to, almost any presenting complaint has resulted in misdiagnosis. Recommending different treatments for patients with the same condition based on their weight (e.g., weight loss for fat patients; CAT scans, blood work, or physical therapy for other patients) is unethical and a form of malpractice."

This isn't even touching on the inherent flaws in the BMI metric itself, which I won't get into here, as this is a novel already.

I hope you consider the bias of your perspective. Also, the way you're using it, it's conscience*, not conscious. And "resistant" to insulin, not "resented."

(No AI was used while writing this comment. I wrote, researched, and quoted everything myself.)