The real data for those who say - WLSers gain their wt back.

In my own life, and here on OH, I have come across comments from people, even health professionals, who say just lose the weight because all people who have surgery just gain it back. (There may have been times when we said this to ourselves.)

POPPY****!!

Here is a study that covers over 161,000 WLS patients - maybe you?? (I had surgery in 2015, after the study dates, so I am not included in the 161,000 people). Once again, my thanks to those who have gone before.

On average, WLS patients have 12-17% lower BMIs 5 years after surgery.

For non-surgical interventions - no change in BMI.

http://jamanetwork.com/journals/jamasurgery/fullarticle/1790 378 This is link for full study. Here are my notes.

Bariatric surgery: an updated systematic review and meta-analysis, 2003-2012

Su-Hsin Chang, PhD,1 Carolyn R.T. Stoll, MPH, MSW,1 Jihyun Song, PhD,2 J. Esteban Varela, MD, MPH, FACS,3Christopher J. Eagon, MD,3 and Graham A. Colditz, MD, DrPH1

March 2015

Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine

SUMMARY

In conclusion, our study suggests that bariatric surgery has substantial and sustained effects on weight and significantly ameliorates obesity-attributable comorbidities in the majority of bariatric surgery patients. However, complication rates associated with bariatric surgery range from 10% to 17% and reoperation rates approximately 7%; nonetheless, mortality associated with surgery is generally low (0.08?0.35%). Among different surgical procedures, GB is more effective in weight change outcomes, but generates more adverse events. AGB is considered safer61,62 in terms of lower mortality and complication rates. However, the reoperation rate of AGB is higher than that of GB and SG, and the weight loss outcomes of AGB are less substantial than GB and SG.

My notes: This included a review of 7 studies for RNY but only 1 for VS. (Covered 5 year patient data published data from 2003 to 2012. Only 1 VSG study that presented 5 year data was published by 2012.)

Data from 161,000 were reviewed!!

Key for Table is below:

GB= RNY

AGB=Adjustable Gastric Band

SG=VSG

Control=Non surgical interventions

The weight gain seems to happen at the five year studies. In controlled studies 50-80% of bariatric patients regain significant weight. There are too many to ignore.

This paper isn't a study it's a compilation of data. Some of the sources (to many IMO) come from clinical studies that seek volunteers. People with good outcomes are far more likely to participate in such studies.

The good news is that with comprehensive pre op education, especially treatment of underlying causes like addiction and compulsion, an increasing number of us are not regaining when compared to statistics from 10 years ago.

That being said, in the end,w we are only responsible for ourselves and our own weight.

I think the tables show regain and are consistent with what you mention. My best understanding: and what the medical professionals that work with the MO, whether in a WLS or non-WLS setting should know, is this

5 years post WLS:

25% people gain it all back,

50% keep of at least 50 pounds- this a medically significant wt loss and considered a medical success, but I agree that most WLS (including me) would be devastated to lose 100-200 pounds and only keep 50 off at the 5 yr mark.

25% take most of their excess wt off and stay at a near normal BMI

I think this is consistent with what you state as 50-80% experience sig regain. And I hope those numbers continue to improve with the Apps, better support groups, etc. We, at least I am now a part of the data-base, and doing what I can to stay at normal BMI.

At this time, WLS is not a perfect science, but it beats the conventional wt loss path where 95-97% gain it all back at the 5 year mark. This is what health professionals should know when they interact with WLSers. Not the nonsense I have heard and has been reported here. People can share this study (or one that you know of that is better) to educate and ward off the evil spirits.

Thank you for posting this. It almost sounds to me like there are two distinct populations described here -- those *****gain significantly and those who don't. Unfortunately, there's no way to read these studies' tea leaves (there aren't any) to learn what the causal factors are.

Still, the outcomes are useful to me -- especially the finding that for sleevers the regain challenge begins in earnest after Year Three.

If I am reading correctly, at 5 years a person had a BMI 11% - 17% lower than before surgery.

So a 40 BMI would be reduced to BMI of 35.6 at 11% reduction. Reduced to BMI of 33.2 at 17% reduction.

A BMI of 50 would be reduced to BMI of 44.5 at 11% reduction. Reduced to BMI of 41.5 at 17% reduction.

The sleeve showed a 22% reduction at 3 years. For a 40 BMI that would be a 31.2 BMI.

None seemed to show a normal BMI.

I also think that an important variable is whether or not the wls procedure selected was the best choice for the patient. There is a lot of grey area around the reasons behind obesity. The general public and some opinionated doctors will judge it as a character flaw above all else...that the problem is fork-to-mouth disease. With that bias, they never dig down to the real contributors of obesity, such as thyroid, metabolism, actual nutrition, etc. With this shortcoming, it's either left to the patient or a wls surgeon to pick the procedure.

I'll use myself as an example: I've been told by many doctors to just go on a 900 calorie diet of low fat, then I'm scrutinized because that diet did nothing for me. The most I ever lost was 21 lbs, and it took a year to get there. I was an athlete despite my obesity, and obese despite my sports. My father once commented on how amazed I was so obese with as little as I ate. You'd think a physician would pay attention....but no...it had to be my own fault. I never had a thyroid check or metabolism testing or anything.

The surgeon doesn't know the patient's history or struggles. It's not their job to diagnose the reason for obesity (although they should at least inquire), they get paid to cut. Some may give it a best guess, others will defer to the patient to make the decision of procedure, relieving them responsibility. Some just take the latest trend or one they wish to get a good study group on for a new procedure, like SADI, or one that they can do quickly and make more money in a day's work stacking patients together. If we leave it up to the surgeon results might very well be a crap shoot.

What I did and I suggest everyone do the same, is take a good hard look at your weight history and diet efforts. Did you lose, just to regain it all back? Did you struggle like me with every single pound? Do you eat crap and just can't help yourself? Are you never satisfied no matter how much you eat? Answer honestly in your heart of hearts.

Next, learn about all of the wls procedures. Each works differently and attacks obesity in different ways, so it's important to have a full understanding, so you can compare that to your own body to find the best solution. Some are done to control your volume (VSG, LapBand) of eating, while others make changes to your metabolism and absorption (RNY, DS) along with volume control. Some people need the metabolic change while others don't. Choose volume only when you should have changed metabolism, and you may find yourself disappointed or constantly struggling. Choose metabolic procedure when you only needed volume, then you may fight being underweight or malnourished, despite your best effort.

So, before I step off of my soapbox, those of you who are exploring options, put some serious effort in this. Do not select a procedure for convenience or because your neighbor's cousin's coworker's sister-in-law had success. Select a procedure that will compliment your own physiology to give you the best experience.

And that's all I gotta say about that....