Who has had obesity surgery, and how did it work out

In My Humble Opinion
21

Losing weight on a liquid diet isn’t the problem, the problem is weight maintenance. That is a big appeal of surgery, that a person can lose weight and keep it off for 5+ years.

Yo-yo dieting also causes health problems, which I want to avoid. It is cool if you managed to keep weight off solely via lifestyle changes, but I don’t know how realistic that is for me or most people.

However I think over the next decade or so (I hope) somebody will find ways to maintain a weight loss w/o surgery. If they do, I want a reversible bariatric surgery. One method involves using supplemental leptin to bring leptin levels back to what they were before the weight loss. However right now leptin can only be given via injection, they don’t have a form that gets through the digestive system (no idea if they will make a nasal spray or what).

Even if they do make a leptin style drug, it’ll be many years before it is on the market and I’m sure it’ll cost $300+ a month until the patent runs out. Surgery would probably be cheaper over the long run.

22

This is the important issue though. Obesity surgery will only help you to a point. The smaller stomach pouch will stretch over time and then you will be maintaining solely via lifestyle changes. Carnie Wilson is having (or already had?) her second WLS because she hasn’t gotten the hang of lifestyle changes. There’s no avoiding it.

23

I can answer that one. In my other thread, I quote a pubmed study that says that the overall long term success rate of just diet & excercise, for people already obese, is 20 %. So your odds are one in five.

24

The odds of long term weight loss through bariatric surgery are much better then that 20 percent. For the MGB, the results are closer to 90 %. The MGB also reduces (hormonal) hunger and that isan important factor in keeping the weight off long term.

Important factors that increase your odds are:

  1. Go in informed. In my other thread I mentioned a book; the site www.clos.net has a whole handbook the patient has to study and sign.

  2. An experienced surgeon. If he has done more then 75 surgeries of the desired type, the learning curve becomes in your favour.

  3. Not going in with an untreated serious eating disorder. I am not talking about eating too much; I am talking about classic bulimia. a bulemic binge, where the patient ignores the building pain in her stomach can literally cause her stomach to burst.

  4. Most important, like mentioned by Sleeps With Butterflies, a good aftercare regimen of at least a year in which you get medical check ups, blood tests, talks with fellow-patients, (on-line is okay too) and, if indicated, therapy for eating disorders, therapy for untreated mental problems, and help with getting exercise.

5: The type of surgery. Roux&Y, sleeve surgery, or the MGB have the best results and the least complications (below 10 %). The lap band has a long term complication rate of over 50 % (!) laparoscopic has fewer surgery complications and a shorter healing time then open surgery.

25

Just as another counterpoint, in 2009-2010, I lost 130 lbs on a fairly high calorie (1500-1900 in different phases) diet. I actually ate more, not less, as it went on as I exercised more. I spent 2011 pregnant, so I have gained some of that back (currently 30 lbs about my minimum), but I am chipping away at it pretty steadily. I had done low calorie a million times, and it never worked, and I thought I couldn’t diet–too weak willed. Turns out that I have a pretty fast metabolism and I was just starving to death. A very, very *consistent *higher calorie diet works much better for me: no cheat days, but you don’t need them.

26

A near relative just died from complications of the surgery, which was five or six years ago, though her problem is unlikely to be an issue for you. Long story short, the surgery changed her body’s ability to deal with alcohol in the system, and she was able to short out her liver much faster than she would have been without the surgery. Personally, I suspect that the liver had already been stressed by carrying the extra weight, but if you do enjoy a drink now and again be aware that you’ll have to cut back dramatically even moderate drinking. At any rate, talk to your doctor about it.

27

I saw that in your earlier thread but didn’t see the pubmed link, just a reference to the study. I have some questions about that study though.

  1. What is the definition of ‘success’ in weight loss (what % of bodyweight do you need to lose to be successful by those terms)? If you have a BMI of 43 and get down to a BMI of 40, that is an improvement but not a huge one. Were they considering a 5% weight loss a success or a 25%+ weight loss?

  2. How do they define long term? To me long term implies 5 years minimum. I have heard some groups claim ‘long term success’ after 1 or 2 years, but that is far too short to qualify as long term to me.

Since you enjoy studies on obesity, here is one on supplemental leptin injections to reverse the brain changes brought on by weight loss.

In the future I’m hoping they’ll have treatments that separate the weight loss and maintenance phase and treat obesity surgery free. Maybe an intragastric balloon combined with a nasograstric tube or liquid diet for the weight loss, then leptin supplemental medication for weight maintenance. But that is years away.

What I don’t get is what happened to C75? About 10 years ago there were a variety of news stories about a compound called C75, which inhibits fatty acid synthase (which you need to build bodyfat). I guess the drug never got through stage II trials or something. But there are news stories relatively common about a new diet drug that helps with weight control, only to never hear from it again.

28

I just had the Gastric Sleeve done on 3/15. I am already down 44 lbs though the losing is slowing down now. I looked at all the surgeries and picked this as it made the most sense to me. It’s on the newer side, as far as a stand alone procedure but the lomng term results look promising.

I am 6 weeks out from surgery and usually eating between 700-900 cal/day. Eventually I’ll get up to 1200-1300. But all my cravings are GONE and I rarely have any hunger. I’m still in the healing process so having occasional nausea and such, but that is getting better.

Do your research and see which procedure seems to call to you. Check out some of the bariatric message boards out there and read. And Good luck!

29

I’ve had a lap-band since 2003. I lost over 50% of my excess weight (note that’s excess weight, not total weight :slight_smile: ) with it and I’ve maintained my weight loss (actually in the process of losing some more recently since I just had it slightly tightened a little more for the first time in a number of years). I have not had any significant complications. I’m happy I did it.

I do think that it’s essential to find a surgeon who is very experienced in using the lap-band and believes in it (rather than an RNY surgeon who does lap-bands on the side). The surgeon’s surgical technique in placing the band does make a difference in your risk of having complications, and it has been shown that more experienced surgeons have lower complications. However, the good news is that when complications occur with the lap band, they typically are not life-threatening - more along the lines of “you have a leak in your port tubing, so you’ll need to get that replaced” or “Your band slipped/eroded, so you’ll have to get it unfilled or possibly removed” rather than an emergency that is going to kill you overnight. That’s not to say that life threatening complications never happen - they can happen, and it’s true that a few people have died from lap-band surgery - but it’s not as common as severe complications with bypass procedures.

My reasoning for picking the band was that I was fairly young and healthy, so I saw no reason to take the risk of dying from a roux-en-y or duodenal switch procedure.
I also had concerns about the long, long term effects of chronic malabsorption of fats/vitamins, since I was pretty young and I plan to live for a good number of decades to come.

If I were going to be a malabsorption procedure, accepting the risks involved with that, I’d probably choose the duodenal switch because then you can still eat “normally” without the restrictions of the RNY because the DS procedure preserves the pyloric valve. The DS is NOT something to take lightly - it has the risk of causing severe nutritional deficiencies if you don’t take vitamins and monitor your blood work after the procedure, because it causes so much malabsorption - but my personal opinion is that the quality of life after it would be better than the RNY since you can still eat normally.

However, if I ever need to get the lap-band removed, I’d probably try to get the gastric sleeve instead of a full DS. It’s basically the stomach aspect of the duodenal switch without doing anything to the intestines.

30

I suspect that what happened to Carnie was a “stretched stoma”. You are correct that some stretching of the pouch over the long term is normal, but it’s not intended to ever stretch to the point of no restriction at all. Unfortunately, in some cases, RNY patients experience stretching of the opening between their stomach and intestines to the degree that the food doesn’t stay in their pouch long enough to allow them to feel satisfied. The reason I suspect that’s what happened to Carnie is that I know it can be treated by placing a lap-band, which is the additional procedure that Carnie had recently. If the RNY procedure works as it should, there would be no reason to put a lap-band in since even long-term post-op RNY patients should still have significantly smaller pouches than a normal stomach.
Nobody should be expected to maintain weight loss when they never really feel satisfied.

31

Of course the pouches are designed to not stretch to the point of no restriction (did anyone say differently?), but that doesn’t mean that it isn’t possible for the weight to come back. In many, many cases all of the weight.

It absolutely is possible for WLS patients to regain the weight back even though the tool (whether it is the lap band, the sleeve, the RNY) is still in place and working. It is ultimately up to each and every patient to adopt new habits. Lifestyle changes are an absolute must to maintain weight loss. Too many people go into WLS thinking this is a cure It is not. It’s a tool. A very powerful tool, but a tool is all it is.

There are lots of ways to take in too many calories even with a small pouch. If the patient doesn’t watch what they’re eating and drinking and not exercising it is almost a guarantee they will gain weight. The amount of weight depends on the degree of non compliance.

The patient and the surgeon need to discuss the options available and decide which tool would best fit the lifestyle, commitment, amount of weight to lose, and overall health of the patient. The surgeon’s part is the easy part. The patient is the one who has to commit to change for life.

I have no idea why Carnie’s 2nd surgery needed to be done. I know I did see her on that Vh1 Celebrity Fit Club show and she ate crap and lots of it. She had every excuse in the book why wouldn’t follow the diet plan. Perhaps your speculation is correct about why she needed a second surgery, but I know what I saw as far as her eating habits and zero commitment to exercise.

32

I’m not considering surgery, but I am obese (5’9, about 260). So I’m going to ask what’s probably a really touchy subject, but I’m asking from a place of honesty: what kind of weight do you need to be carrying to consider bariatric surgery? Should I be thinking about it? My doc tells me I need to eat better and exercise and I do try the exercise thing from time to time.

Sorry if this hijacks or derails the thread.

33

I have the same question CapnPitt - I am just shy of 6’ (by a half inch!) and weigh 285 clothed. I have tried dieting and exercise alone, but my willpower sucks and I’m often so damned tired as it is that I never have the energy to keep it up.

34

As i said in my other thread, BMI detremines. WHO guideline says indicated for BMI 40 and higher.

35

FYI, I contributed all my meager knowledge about the Vertical Sleeve Gastrectomy to MannyL’s earlier thread on the subject.

Bottom line: I’ve lost 110 pounds in six months on the sleeve, never felt better, very happy with my future… but man, this stuff soooooooo isn’t for everyone, and there’s NOTHING easy about it.

Do your research, talk to docs, talk to other patients, and remember that any surgery, reversible or not, is only a tool, not a panacea.

36

Depends on the surgery. General guidelines are a BMI of 40 or higher, or a BMI of 35 or higher with one or more obesity comorbid health issues (poor blood lipids, hypertension, osteoarthritis, sleep apnea, breathing problems related to obesity, type II diabetes, fatty liver not caused by alcoholism, GERD, etc).

However some surgeries like lap band I have seen the requirements as low as 27 or 30 BMI with comorbid health problems tied to obesity.

But generally the rules are BMI of 40 or higher, unless you have obesity related health issues (which I have), then it is 30 or 35 or higher.

37

As a real humble suggestion–have you ever tried a high calorie diet? At that height and weight, and as a man, you’d probably lose weight at 2500 calories a day, and you might lose weight at 3000. Diets are designed for people who want to lose 20 lbs. They assume a really different basal metabolism than that of someone who needs to lose 100 lbs or more. Just carrying that weight around burns a lot of calories. Count calories really carefully and accurately (tons of apps out there for this) but don’t assume that the goal is to go as low as you can: the goal is to eat as much as you can while still losing any weight at all. And remember that you are aiming at an average–you can splurge some days and make it up over the next week (or “save up” before hand).

What I am saying is that you may have plenty of willpower, it’s just that traditional diets for a man of your height and weight are basically like trying to hold your head underwater. The fact that you can’t do it for long doesn’t mean much.

38

Here’s a BMI calculator by sex and age.

The BMI threshold of 35-40 is a World Health Guideline, comparing surgery risks to net helath benefits) and many insurance companies and doctors adhere to it. Other doctors now think that lower BMI’s should also qualify.. If you pay for surgery yourself, it is easy to find a doc who will operate starting from a BMI of 33-35.

Article about the benefits of even losing 10% of your weightby changing you eating habits (as Manda Jo suggests)

39

Thanks everybody.

40

My biggest motivation for looking into this is my cardiovascular health. I don’t have type II diabetes or sleep apnea (yet) but due to my body size/shape and my genetics it is only a matter of time.

However I don’t know if obesity surgery is a very good independent method of improving ones CVD risk factors.

This study looked into it:

http://www.medicinenet.com/script/main/art.asp?articlekey=153264

And the results were not as cut and dried as they can be made out to be, it wasn’t like there was a 30-50% decline in stroke and heart attack risk across the board. Obesity itself was not the biggest risk factor for CVD. Diabetes appeared to be the biggest factor in whether people saw cardiovascular benefits from surgery (ie people who had diabetes, which is a risk factor for CVD, saw their CVD health improve the most since the surgery tends to make controlling diabetes far easier). That is the jist I get from it at least.

When people get the surgery and their CVD health improves, how much of that improvement is a side effect of conditions like sleep apnea and type II diabetes resolving due to the surgery (which they do resolve 70-90% of the time)? Since I don’t have those conditions (yet) I wonder if I would see much benefit.

I don’t even know how much they factored in or out sleep apnea, another independent risk factor for CVD that is greatly improved via surgery. Sleep apnea is not diagnosed in about 90% of cases. For all I know I do have it and it hasn’t been diagnosed (however I am not tired if I sleep through the night, which makes it unlikely. Not impossible, just less likely that I have it). If lots of people who are morbidly obese have apnea, and the surgery resolves it then that will show CVD benefits.

Or how much the improved socio-cognitive function played a role. I have heard mental health improves a lot with obesity surgery (I don’t have the study on hand, but I think it said a cut of around 50% for psychological problems). Which is not surprising, in a fat phobic society I could see depression, social isolation and anxiety easing among the newly non-obese.

But depression and social isolation are also risk factors for CVD health. So how much of the CVD benefits are due to people getting better in those areas? I don’t really subscribe to the cultural attitudes about bodyfat, so I wouldn’t see much benefit in those areas either (I don’t think, at least not as much as most people).

So I really don’t know how much my health would improve. My blood pressure, cholesterol and triglycerides would all improve. But how much do those alone factor in to the CVD benefits?