Can't compare?!? Long!
Jillicats from the Cali board posted this information that she'd received in an email newsletter -- makes perfect sense. It's long, but well worth the read!
Have a WONDERFUL weekend, My Friends!!!!
((((skinny hugs))))
wendyb
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Why Did They Lose More Weight Than Me?" - by Cynthia K. Buffington, Ph.D.
During a recent support group meeting, five patients whose surgical procedures were identical and performed on the same day asked why they were losing weight at different rates. Three months following laparoscopic adjustable gastric banding, the only male patient, Charles, had lost 71 pounds. Sarah, on the other hand, had lost 57 pounds, Sally had lost 40 pounds, Sue was 29 pounds lighter, and Jennifer had lost only 19 pounds.
Why had Charles lost more weight than the female patients? Why had Sue and Jennifer experienced less weight loss than the other patients? Were Jennifer and Sue not adhering to the recommended postoperative dietary protocol? Were they consuming calorie-dense beverages or foods, such as milkshakes, colas, cake, ice cream? Did Charles and Sarah, who lost the greatest amounts of weight, exercise more regularly than Sally, Sue, and Jennifer?
In order to determine why there were such large differences in weight loss between patients, we examined the lab results, nutritional profiles, and clinical reports of their most recent follow-up appointments, which had taken place only 3 and 4 days earlier.
To attempt to understand why some individuals lost more weight than others, we first examined body size measurements before and after surgery. All patients had a somewhat similar body mass index (BMI) prior to surgery, i.e. range 43 to 47, but patients differed as to where on their bodies fat was distributed.
Body fat distribution is determined by measuring the circumference (distance around) the waist and the circumference of the hips and then dividing the waist circumference by that of the hips to derive the waist-to-hip ratio (WHR). A male with a WHR greater than 0.95 stores much of his body fat around the waist (abdominal fat). Premenopausal females store fat in their hips and buttocks and generally have a WHR less than 0.80, but females with a WHR greater than 0.80 tend to store fat in abdominal regions, as well.
Deep abdominal or visceral fat has a much faster rate of turnover than fat that is deposited on the hips and thighs. For this reason, larger amounts of abdominal visceral fat are lost with calorie restriction than are fat deposits on the hips and thighs. A person with abdominal obesity, therefore, is likely to lose weight more rapidly on a diet or after surgery than would someone with fat on the hips and thighs.
Men tend to store much larger amounts of fat in abdominal visceral adipose depots than females and, for this reason, men are generally able to lose weight more rapidly than females. Charles had a pre-surgery WHR of 1.2 and at 3 months had lost most of his weight from around his waist. The greater rate of turnover of Charles' abdominal fat is likely to be one of the primary reasons he was capable of losing more weight than the female patients.
Sarah, Sally and Sue all had similar WHR, i.e. 0.85, 0.84, and 0.83, respectively. Changes in waist and hip circumferences at 3 months after surgery were also similar, with all patients having a proportionately greater loss of inches from the waist than from the hips and thighs.
Jennifer who had lost the least amount of weight of any of the patients (only 19 pounds) had very large hips and thighs and a relatively small waistline and upper torso. Her WHR before surgery was 0.68. Fat on the hips and thighs is broken down at a far slower rate than fat in abdominal regions. Women who have large hips and thighs and small waists generally have the greatest difficulty losing weight following surgery or with any other anti-obesity procedure. Jennifer may, therefore, have lost the least amount of weight post-surgery because most of her fat was stored on her hips and thighs where fat turnover is slow.
Differences in fat distribution could not explain why Sarah, Sally and Sue's weight losses differed, as all three had a similar WHR. (Remember: Sarah had lost 57 pounds, Sally 40 pounds, and Sue only 29 pounds.) The three females also had similar starting weights. Furthermore, exercise habits could not account for differences in these patient's postoperative weight losses, as all three patients were participants of the same postoperative exercise program. Nutritional profiles, however, did provide a clue as to why Sue's weight loss post-surgery differed from Sarah and Sally.
At our clinic, nutritional profiles are obtained from patients' food diaries at each of their follow-up visits. Nutritional information obtained from these profiles include total calorie intake, the percentage of diet that is protein, carbohydrate and fat, the types of protein, carbohydrate and fat consumed, and dietary vitamins and minerals. We found that Sarah and Sally's nutritional profiles were similar with regard to daily calorie intake and dietary composition. Sue's diet, however, significantly differed.
Sue was eating an average of 250 calories more per day than Sarah and Sally. In addition, Sue was consuming fewer calories as protein and more calories high in sugar-containing carbohydrate. Sue's greater intake of sugar-containing carbohydrate, coupled with the slightly greater number of calories she was consuming each day, could have contributed to the lower weight loss she experienced when compared to the weight losses of Sarah and Sally.
Sugar-containing carbohydrate and processed grains increase insulin to levels higher than would occur if fiber-rich carbohydrates were consumed, such as fruits, whole grains, nuts, legumes, vegetables. Insulin, in turn, drives fat into fat storage depots and reduces the breakdown of fat, thereby adversely affecting weight loss success.
Sue's diet was not only higher in simple carbohydrates but was also lower in protein than the diets of Sarah and Sally. Eating sufficient amounts of protein helps prevent the breakdown of muscle and other lean body tissue that may occur post-surgery or with low calorie diets. Muscle has high metabolic activity and oxidizes (burns) fat. A loss of muscle or other lean body tissue, therefore, would reduce metabolic activity and fat metabolism.
Over the 3-month postoperative period, Sue lost proportionately more muscle and other lean body tissue and proportionately less fat than did Sarah or Sally. (Note: body composition was measured by bioelectric impedance). Sue also had a greater reduction in basal metabolic activity (measured by indirect calorimetry) in association with her loss of muscle and lean body tissue. Basal (resting) metabolic activity accounts for up to 70% of all calories burned during the course of the day. Sue's failure to lose weight as effectively as Sarah and Sally, therefore, could have resulted, in part, from her postoperative loss of lean body tissue and decreased basal metabolic rate.
Sue's poor nutritional profile, her greater muscle and lean body tissue loss with surgery and reduced basal metabolic activity could explain why she lost less weight than did Sarah or Sally. However, differences in nutritional profiles, body composition, and basal metabolic activity, as well as fat distribution, initial body size, and levels of physical activity do not explain why Sally lost less weight with surgery (17 pounds less) than did Sarah, since all of these measures were similar.
Why, then, would Sally have lost less weight than Sarah? According to Sally's 3-month postoperative clinical records, she was still taking diabetes medication (a sulfonylurea) to control her blood sugar, albeit at a lesser dosage than before surgery. She was also taking a beta-blocker for hypertension. Sarah, on the other hand, was on no medication.
Ironically, many medications used to treat diseases caused or worsened by obesity increase body weight. Most diabetes medications (except metformin) cause fat accumulation and weight gain, including insulin, sulfonylureas and the thiazolidinediones. Many anti-depression medications or mood stabilizers also cause weight gain, especially lithium and the tricyclic antidepressants. In addition, steroids used to treat osteoarthritis or autoimmume disorders increase body weight and fat accumulation, as do beta-blockers and calcium channel blockers for hypertension.
It is likely that Sally's diabetes and hypertension medications were responsible for her inability to lose as much weight as Sarah. However, there could have been factors other than medication, diet, exercise, metabolic rates, or fat turnover that caused post-operative differences between Sally's or Sarah's weight losses or those of other patients in the group.
One patient may have lost less weight than another because their growth hormone levels were low, sex hormone production was altered, or cortisol levels were high. Defects in hormones, gut factors or neurochemicals that regulate food intake, satiety and energy expenditure may also have caused variability in patient post-surgical weight loss. Altered activities of enzymes regulating fat metabolism or energy utilization may have influenced rates of post-surgical weight loss. Genetics could have contributed to weight changes, as could numerous other conditions that influence energy intake or expenditure.
Why, then, does one patient lose more weight than another with surgery? For numerous reasons, including differences in calorie intake, energy expenditure, body habitus and body composition, basal metabolic activity, hormone profiles, genetics and much more. Because weight loss is regulated by such a myriad of factors, it would be highly unlikely that any two individuals would lose identical amounts of weight post-surgery, even if they were consuming the same amount of calories and performing similar amounts of physical activity.
Therefore, it is important that healthcare professionals realize that identical surgical procedures do not result in identical weight loss patterns and that weight reduction is regulated by far more than calories in and calories out. Furthermore, patients should not despair or feel unsuccessful if they have lost less weight than others, particularly if they have been honest in adhering to their postoperative dietary and exercise regimens.
Cynthia Buffington is the Director of Research, U.S. Bariatric, Fort Lauderdale, Miami, Orlando
Originally Published in Beyond Change - 2004
Thank you for taking the time to post this. I am a slow loser, and have been beating myself up, depressed and wondering why I can't lose like other people. I found lots of information that could explain it, taking diabetic meds, betablockers etc. in this email. I'll just stay the course and accept the results. And mainly stop worrying, it is what is is!
Dianne
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