How Could ALL the Weight Come Back?

Hello All,

I'm currently considering one of the by pass procedures.  From what I understand, the stomach is replaced by a much smaller pouch.  I cannot understand how a person can regain ALL of his/her weight back if the stomach is a fraction of the size it previously was.  Seems like it would be physically impossible.  If the stomach cannot physically hold the larger volume of food, one should not be able to gain all the weight back......right???

 

Howdy!!!  While I am not a failed WLS person - I can tell you that at 3+ years out - I CAN regain weight if I WANT to and LET it happen......

Is your stomach reduced in size YES!  BUT - that pouch does stretch SOME after surgery and after time...... now - at first, I would get full off less than a 1/4 cup of food - but NOW - I can eat a whole sandwich (sometimes - and with nothing else).  So - IF I made bad food choices, i.e. ice cream, candy, high carb foods all the time - I could regain weight and without exercising and continuing those bad choices over an extended time - I COULD gain the weight back.

Surgery is a TOOL to allow you to adjust your HABITS - not an unbreakable cure-all.  It's a lifetime of monitoring and mainenence, my friend.......

Thanks for the info #1.  I think the surgery is the right choice for me, especially because of my comorbids (diabetes, HBP, cholesterol, sleep apnea).  I know, it's bad.  I know it will be great for me to lose the weight but the mere possibility of regaining makes everything sound bitter sweet.  Maybe it's just me being negative and putting too much thought into it.

I had co-morbids too......

this surgery doesn't 'cure' anything - it's a tool to allow YOUR lifestyle CHANGES to work and be productive......

Regaining will come just like your original gain did - through BAD habits, LACK of exercise and POOR food choices......

stick to the maintenence plan and you will be JUST fine!

Several things. You need to look at the DS while doing your research on WLS, as it has the best statistics on percentage of weight lost, maintenance of loss, and resolution of co-morbidity's including cholesterol and diabetes.
There is also some encouraging info about the DS regarding people of color which I'm re posting from one of Diana Cox posts.

http://health.groups.yahoo.com/group/African_American_Duoden al_Switch_Support/?yguid=196013215

1: Obes Surg. 2008 Jan;18(1):39-42. Epub 2007 Dec 15. Links

The impact of race on weight loss after Roux-en-Y gastric bypass surgery.

Harvin G, DeLegge M, Garrow DA.

Department of Medicine, Division of Gastroenterology and Hepatology, Digestive Disease Center, Medical University of South Carolina (MUSC), 96 Jonathon Lucas Street, CSB #210, P.O. Box 250 327, Charleston, SC, USA.

BACKGROUND: Gastric bypass surgery for morbid obesity has dramatically increased in volume over the past decade. Caucasian patients have been noted previously to lose more weight after bariatric surgery than African-Americans patients. Data regarding predictors of maintaining weight loss after surgery are minimal. We sought to determine predictors of long-term weight loss after bariatric surgery. METHODS: Retrospective analysis using a multivariate logistic regression model of all patients undergoing Roux-en-Y gastric bypass surgery at the Medical University of South Carolina from May 1993 to December 2004 for whom 2 years of follow-up data was available. Our dependent variable was the percentage of weight lost from baseline, dichotomized at +/-35%. Our primary independent variable was race, defined as Caucasian, African-American, or other. Relevant covariates were added to the model to control for their potential effects on outcome. RESULTS: One hundred eleven patients (17 male/94 female; 85% Caucasian, mean age 44 years (range 18-68 years). In our model, Caucasian subjects (adjusted odds ratio [OR] = 7.60, 95% confidence intervals [95%CI] = 1.83-31.5) and late post surgical complications (adjusted OR = 2.67, 95%CI = 1.05-6.80) significantly predicted weight loss at 2 years, after controlling for relevant confounders. Other covariates did not significantly impact the model. CONCLUSION: Race and late post surgical complications significantly impacted the percentage of weight loss at 2 years for patients undergoing Roux-en-Y gastric bypass surgery at our institution. Future research should be directed at determining potential genetic and/or social reasons for these differences.

1: Obes Surg. 2007 Apr;17(4):460-4. Links

Are African-Americans as successful as Caucasians after laparoscopic gastric bypass?

Madan AK, Whitfield JD, Fain JN, Beech BM, Ternovits CA, Menachery S, Tichansky DS.

Section of Minimally Invasive Surgery, Department of Surgery, University of Tennessee Health Science Center, 956 Court Ave., Room G210, Memphis, TN 38163, USA. amadan@...

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been demonstrated to provide weight loss comparable to open gastric bypass. It has been suggested that African-Americans (AA) are not as successful as Caucasians (CA) after bariatric surgery. Our hypothesis was that AAs are just as successful as CA after LRYGBP in terms of weight loss and comorbidity improvement. METHODS: A retrospective chart review was performed on all AA and CA patients who underwent LRYGBP for a 6-month period. Success after LRYGBP [defined as (1) 25% loss of preoperative weight, (2) 50% excess weight loss (EWL), or (3) weight loss to within 50% ideal weight] was compared by ethnicity. RESULTS: 102 patients were included in this study. 97 patients (30 AA patients and 67 CA patients) had at least 1-year follow-up data available. Preoperative data did not differ between both groups. There was a statistically significant difference in %EWL between AA and CA (66% vs 74%; P<0.05). However, there was no ethnic difference in the percentage of patients with successful weight loss (as defined by any of the above 3 criteria). Furthermore, there was no statistical difference between the percentages of AA and CA patients who had improved or resolved diabetes and hypertension. CONCLUSIONS: LRYGBP offers good weight loss in all patients. While there may be greater %EWL in CA patients, no ethnic difference in successful weight loss exists. More importantly, co-morbidities improve or resolve equally between AA and CA patients. LRYGBP should be considered successful in AA patients.

1: Obesity (Silver Spring). 2007 Jun;15(6):1455-63. Links

Weight loss and health outcomes in African Americans and whites after gastric bypass surgery.

Anderson WA, Greene GW, Forse RA, Apovian CM, Istfan NW.

Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, MA 02118, USA.

OBJECTIVE: The objective was to describe differences in weight loss, dietary intake, and cardiovascular risk factors between white and African-American patients after gastric bypass (GBP). RESEARCH METHODS AND PROCEDURES: This was a retrospective database review of a sample of 84 adult patients (24 African-American and 60 white women and men) between the ages of 33 and 53 years. All subjects had GBP surgery in 2001 at the Bariatric Surgery Program at Boston Medical Center in Boston, MA, and were followed for one year postoperatively. Patients were excluded if weight data were missing at baseline, 3 months, or 1 year after GBP. A total of 9 African Americans and 41 whites provided data at all 3 time-points and were included in the study. Differences in weight loss, diet, and cardiovascular risk factors were analyzed. RESULTS: There were no differences in baseline characteristics between African Americans and whites. Mean weight loss for the entire sample was 36 +/- 9%, with a range of 8% to 54% relative to initial body weight. Whites lost more weight (39 +/- 8%) than African Americans (26 +/- 10%) (p < 0.05). Dietary parameters, as well as improvements in blood pressure and lipid profiles, were similar in the two racial groups. DISCUSSION: Differences in weight loss between severely obese African Americans and whites undergoing open GBP are unlikely to be related to postoperative dietary practices. Our data are consistent with previous reports implicating metabolic differences between the two racial groups.

1: Obes Surg. 2006 Feb;16(2):159-65. Links

Ethnic differences in obesity and surgical weight loss between African-American and Caucasian females.

Buffington CK, Marema RT.

U. S. Bariatric, Fort Lauderdale and Orlando, FL 33308, USA. drbuff@...

BACKGROUND: In the general population, African-American females are more obese and resistant to weight loss than Caucasian women. In the present study, we examined the severity of obesity among morbidly obese African-American and Caucasian females, studied the effectiveness of Roux-en-Y gastric bypass (RYGBP), and sought to identify factors contributing to obesity and weight loss. METHODS: The study population included 153 morbidly obese females randomly selected from our general bariatric patient population. Anthropometric measurements consisted of body weight, body mass index (BMI), excess weight, and waist, hip, thigh, and neck circumferences. Factors that may contribute to obesity included age, age of obesity onset, number of childbirths, calorie intake, diet composition, and degree of psychological distress. The effects of RYBGP were studied in weight-matched groups of African-American and Caucasian females (n=37 per group) at weight loss nadir, i.e. 12 to 18 months after surgery. RESULTS: We found that morbid obesity is more severe among African-American than Caucasian females. The greater degree of obesity of African-American, as compared to Caucasian, females is not due to ethnic differences in calorie intake, diet composition, age or age of obesity onset, number of childbirths, and psychological distress. RYGBP is less effective in reducing body fat and, consequently, excess body weight of the African-American than the Caucasian females, suggesting possible ethnic differences in fat metabolism. CONCLUSION: African-American females with morbid obesity have greater adiposity than do Caucasian women and lose significantly less body fat after RYGBP.

1: J Assoc Acad Minor Phys. 2001 Jul;12(3):129-36. Links

Bariatric surgery for severe obesity.

Sugerman HJ.

Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia 23298-0519, USA. hsugerma@...

Severe obesity is associated with multiple comorbidities and is refractory to dietary management with or without behavioral or drug therapies. There are a number of surgical procedures for the treatment of morbid obesity, including purely gastric restrictive, a combination of malabsorption and gastric restriction or primary malabsorption. The purely gastric restrictive procedures, including vertical banded gastroplasty and laparoscopic adjustable silicone gastric banding, do not provide adequate weight loss. African-American patients do especially poorly after the banding procedure with the loss of only 11% of excess weight in one study. Gastric bypass (GBP) is associated with the loss of 66% of excess weight at 1 to 2 years after surgery, 60% at 5 years and 50% at 10 years. For unknown reasons, African-American patients lose significantly less weight than Caucasians after GBP. There is a risk of micronutrient deficiencies after GBP, including iron deficiency anemia in menstruating women, vitamin B12, and calcium deficiencies. Prophylactic supplementation of these nutrients is necessary. Recurrent vomiting after bariatric surgery may be associated with a severe polyneuropathy and must be aggressively treated with endoscopic dilatation before this complication is allowed to develop. The malabsorptive procedures include the partial biliopancreatic bypass (BPD) and BPD with duodenal switch (BPD/DS). The BPD appears to cause severe protein-calorie malnutrition in American patients; the BPD/DS may be associated with less malnutrition. Weight loss failure after GBP does not respond to tightening a dilated gastrojejunal stoma or reducing the size of the gastric pouch. These patients may require conversion to a malabsorptive distal GBP, similar to the BPD. However, because of the risk of severe protein-calorie malnutrition and calcium deficiency BPD should be reserved for patients with severe obesity comorbidity. The risk of death following bariatric surgery is between 1% and 2% in most series but is significantly higher in patients with respiratory insufficiency of obesity. In most patients, surgically induced weight loss will correct hypertension, type II diabetes mellitus, sleep apnea, obesity hypoventilation syndrome, gastroesophageal reflux, venous stasis disease, urinary incontinence, female sexual hormone dysfunction, pseudotumor cerebri, degenerative joint disease pains, as well as improved self-image and employability.

Great info!  Thanks for sharing!

HI there.  It's great that you are researching weight loss surgery (WLS) and asking questions.  OH is a great place to get information and support.  I've been so happy to have found this site.  I am still waiting for my surgery and now that I have decided that I want the surgery, I wish I could fast forward to getting it done.  Weird to say that I WANT TO HAVE SURGERY, that's for sure!

Anyhoo, just wanted to mention that the RNY bypass is not the only restrictive/malabsortion surgery available.  The Duodenal Switch (DS) is also available and one of the nicer things about this surgery is that it has the least amount of regain of any of the other WLS that are currently available.  There is a forum here on OH about the DS http://www.obesityhelp.com/forums/DS/ as well as an independant site www.dsfacts.com

I wish you well on your journey to good health.

Take care.

With your diabetes and concerns about regain, you owe it to yourself to investigate the duodenal switch!  Check out dsfacts.com before you make any decisions.

It's because of the foods we choose.  In the beginning, it's the amount of food you eat.  But after a year or so, it's just the food.  The bad food choices.  If you don't change your relationship with food, your body adapts to the amount, and uses it to the best of it's ability.

I wanted to respond to tell you about the DS...but I see many of my co-posters from the DS board already beat me to it!

Good for you for asking questions.  Do yourself a favor...if you decide on WLS...do it 1 time.  Do it right, and KNOW that unless there is a complication, that you will not ever, ever need a revision because it failed you...or you failed it.

Do this once.

I will now step off my soap box.
 

Hi,

There are a variety of reasons.   I have been a member of OH since 02 and I have seen a consistant pattern among those who gain.  Some of it has to do with medication side affects, others has to do with a food addiction or eating disorder and so on.  That's why it is good  to have whole body support from the mind down.  The battle is in the head for the most part.  Even our hunger triggers come from the brain, THEN to the stomach.  I hoe this helps.