weight loss surgery body contouring

Obesity, Weight Loss Surgery, Body Contouring, and Maintaining the Results

December 13, 2021

Obesity, Weight Loss Surgery, Body Contouring: The Good, The Bad, and The Truth

Obesity

According to the CDC, obesity in the United States rose from 30.5% in 1999 to 42.4% through 2018.  Severe obesity rose from 4.7% to 9.2% during the same time. There has also been a significant jump in childhood obesity, and since 1988 the number has tripled; almost 20% of children between the ages of 2 and 19 in the United States are obese. 

Statistics show that children that are obese, have a much higher chance of being obese adults. A report released by The Trust for American Health (TFAH.org) cited that medical costs for individuals who are obese totaled over $147 billion in 2008, which was almost $1,500 higher than someone who was in a healthy weight.

Obesity contributes to stroke, heart disease, cancer, liver disease, sleep apnea, depression, arthritis, diabetes (in adults and children), which can cause premature death. The travesty in this scenario is that most of this is preventable.

Obesity is measured or described as Body Mass Index (BMI) and is calculated using the persons' height and weight. A healthy BMI is considered to be under 25, and obesity is split into 3 categories: Class 1 obesity is 30 – 35, Class 2 is 35 – 40, and Class 3 is a BMI of 40 or more.  Classes 2 and 3 are considered severe and are often impossible to correct with diet and exercise alone.

Weight Loss Surgery

Surgery performed to help an individual lose weight is known as bariatric surgery. This type of surgery changes the design and the way your digestive system works and can help you lose weight and relieve some health or medical conditions directly related to obesity. 

The American Society of Metabolic and Bariatric Surgery (ASMBS) reported that in 2019 alone over 256,000 individuals in the United States had some form of bariatric surgery to help them lose weight. There are different types of bariatric surgery and a consultation with a board-certified surgeon would be the best way to determine which procedure an individual may be a candidate for. 

Types of Bariatric Surgery

There are various surgical procedures but all bariatric surgeries without exception help individuals lose weight by limiting how much food can be consumed at one time. Some procedures also put limitations on nutrients that can be absorbed. 

Bariatric surgery procedures include Sleeve Gastrectomy, Roux-en-Y gastric bypass, Adjustable Gastric Band, biliopancreatic diversion with Duodenal Switch, Single Anastomosis Duodenum-Ileal Bypass with Sleeve Gastrectomy, and Balloon systems.

What Causes Obesity?

The reasons behind obesity are numerous and complex, and for years there was a debate as to whether it was a disease or a behavior abnormality. In 1998, the National Institute of Health labeled it a disease, later (in 2008) The American Obesity Society followed suit, and then in June of 2013 The American Medical Association (AMA), one of the most well-known and influential groups in the United States, also concurred. Their mission is to influence improvements in research, funding, treatments, health insurance coverage, and to also remove the stigma commonly associated with obesity. 

It is important to note that the AMA decision as well as the publication of the other entities is still the subject of controversy, and the AMA’s own Council on Science and Public Health made a statement in 2012 indicating there was not enough evidence to support classifying obesity as a  disease.

Experts who are studying obesity have named genetics, menopause, stress, metabolism, cancers, psychological, hormonal impairments, and neurological reasons as potential contributors to obesity.

Life After Bariatric Surgery

Bariatric surgery can help people lose weight but they need to understand that surgery is the beginning of a lifelong commitment and will require ongoing lifestyle changes and support. Lifestyle choices would include a healthy diet, daily exercise routine; support could come from friends, family, co-workers, surgeons, and more importantly, a personal selection of experts to provide much-needed ongoing assistance.

A personal trainer would be instrumental in helping with physical fitness, a dietician can provide support regarding healthy meal planning, and a psychologist can help put it all together.

Individuals who are the most successful in losing weight and maintaining it have spent some time looking honestly at what the “root cause” of their obesity is/was and dedicated time to participate in ongoing activities. For instance, if an individual became obese through “emotional eating” there is an underlying factor that caused that person to turn to food to ease the pain they are feeling emotionally. 

These emotions are not going to simply disappear after the bariatric surgery and may inhibit that patient’s ability to lose weight, maintain their initial weight loss, or can manifest through a different type of self-destructive behavior. Utilizing the support of a trained therapist can help a patient persevere and continue the lifestyle changes that are necessary to continue their weight loss journey and contribute to their overall health.

In an article published in Endocrine News, Kasey Goodpaster, Ph.D., psychologist of the Bariatric & Metabolic Institute, Cleveland Clinic (Cleveland, OH) stated: “I always tell my patients that bariatric surgery is a ‘stomach surgery,’ not a ‘brain surgery,’ and much of eating is triggered by thoughts, feelings, and situations which will remain after surgery if not tackled proactively.” And the loss of control when it comes to eating is likely to re-emerge but manifests differently.

Body Contouring After Bariatric Surgery

A study conducted by the Obesity Center Amsterdam that ran from January 2010 until December 2014 showed some interesting results related to patients who received body contouring surgery following weight loss resulting from bariatric surgery; 1,150 patients all underwent Roux-en-Y gastric bypass (RYGB) and of those patients, 126 also received body contouring. 

Patients who received body contouring had to complete their weight loss surgery at least 18 months prior and also maintained a stable weight for at least 12 months with their BMI less than 30.  Patients received one to three contouring procedures including tummy tuck (abdominoplasty), arm lift (brachioplasty), buttocks lift, breast lift (mastopexy), and thigh lift (thighplasty).

Out of the 1,150 patients who underwent the weight loss surgery, those who also chose body contouring were more successful in maintaining their weight.

Liposuction is often used to remove unwanted fat and aid in body contouring, especially in patients who have had weight loss surgery.  Often fat gathers in locations that make it resistant to diet and exercise, even in people who have seemingly low BMI numbers.

What Happens If I Gain Weight After Weight Loss Surgery, Body Contouring, or Liposuction?

After having weight loss surgery, liposuction, or body contouring, gaining weight will negatively impact your results and may adversely affect your health.

Health issues that patients experienced previously due to obesity or related to high BMI may return, new health risks may occur; some can even be life-threatening.  

Body contouring results will be compromised.  If a patient has a tummy tuck and they continue progressively gaining weight, their skin will become stretched out again, and even losing weight may not be enough to restore the results of the original tummy tuck.   The second procedure to correct this weight gain may be less successful and more difficult. Aging, scar tissue and BMI may even affect their ability to undergo additional surgery.

The danger of fat increasing after liposuction. The fat cells that are removed during liposuction are gone forever; however, new fat cells can grow.  Additionally, the fat cells that were not removed or are located in other parts of the body that did not undergo a liposuction procedure, can grow. 

This means that if you lost 6 pounds of fat during your liposuction procedure and you gain 15 pounds, that 15 pounds of fat has been redistributed throughout your body and may show up in places where historically [for you] it has never been before. 

Also, every person has two types of fat; subserosal fat and visceral fat. 

Subserosal fat is the kind of fat that is located right under the skin, the stuff you can pinch. This is the fat that is liposuctioned out during a body contouring procedure. 

Visceral fat is the “dangerous fat” and is normally found wrapped around vital abdominal organs inside your body. Visceral fat can not always be seen or felt but it is associated with serious medical issues like type 2 diabetes, Alzheimer's, high cholesterol, stroke, and heart disease.

A study published by The Journal of Clinical  Endocrinology and Metabolism reported that liposuctioned fat from the abdominal region did not regrow with subsequent weight gain but that it did result in an increase in visceral fat if not counteracted by physical activity. 

Bottom line: if you have liposuction,  you need to maintain a healthy lifestyle complete with exercise to avoid an increase in visceral fat.

Obesity, Weight Loss Surgery, Body Contouring: The Truth

The take-away from all of this information is that choosing to take control of your weight and your health is a life-long commitment. Today, we are fortunate that we do have surgery, body contouring, and surgeons who can help us, but the responsibility ultimately lies within ourselves. 

We are responsible for making healthy food choices. We are responsible for ensuring we get daily exercise. We are also responsible for our mental health and for reaching out to get a support team. 

Doctors, dieticians, psychologists, and personal trainers are great resources for everyone. There are also many support groups available in-person or as a part of online communities that you can join and participate in.   

The surgeons and their teams take utmost care to ensure your weight loss surgery and/or body contouring results meet or exceed your expectations as well as increase your well-being and self-confidence.  The rest is up to you!

References

Angelina Postoev

ABOUT THE AUTHOR

Dr. Angelina Postoev is the founder of Surgicare Arts & Aesthetics and a co-founder of Ideal Body Institute, and Georgia SurgiCare. She is triple-board certified by the American Board of Surgery and the American Academy of Cosmetic Surgery. Triple-trained and licensed in cosmetic, general surgery, and critical care surgery.