Bariatric Surgery: A "Tool" in the Treatment of the Disease of Obesity

ALWAYS WORTH A REPEAT TO REMEMBER!!!!!


Bariatric Surgery: A "Tool" in the Treatment of the Disease of Obesity
How much weight do you estimate that you lost in your life from diets or anti-obesity drugs? More importantly, how much weight do you estimate you have regained following weight loss programs? Did the weight stay off for less than a year? For two years? Is there anyone who suffered from morbid obesity who was able to maintain their weight loss for more than five years?
Long-term studies have found that approximately 2/3 of people who lose weight on a diet program will regain all of their weight within 2 years. Approximately 99% of individuals will regain all of their weight by 5 years post-diet.
With diet drugs, weight loss is generally around 5% to 10%, which represents a weight loss of only 10 to 20 pounds for someone who is 100 pounds overweight. Weight regain is unusually rapid when the drug is discontinued. And, long-term studies have shown that, even if the anti-obesity medication is continued, weight gain occurs over time.
Weight loss success for the morbidly obese is even more difficult. Most individuals who are morbidly obese not only regain all of their weight loss following conventional therapies (diet, exercise, behavioral modification, or anti-obesity drugs) but, generally, gain even more.
Why are conventional therapies not successful in treating obesity long-term? Conventional therapies fail because obesity is a disease - a progressive and life-threatening disease -not unlike cancer.
Once an individual has the disease of obesity, it progresses rapidly, affecting all body functions, often with fatal consequences. And, similar to cancer, obesity stubbornly responds to treatment. Even when the disease appears to be arrested, the reprise is generally temporary; the disease often returning with vengeance, causing even greater fat tissue proliferation and weight gain.
Studies have found that most individuals who are morbidly obese are not eating thousands upon thousands of calories each day. In fact, several studies have found that the individual with morbid obesity eats fewer calories more than someone who is normal weight but, even so, continues to gain substantial amounts of weight. Why?
The morbidly obese are essentially trapped in a series of fat-promoting biological cycles that cause a greater proportion of calories consumed to be stored as fat. What are some of these fat-promoting cycles responsible for the progression of the disease of obesity?
For one, obesity causes hormone changes, such as an increase in insulin, defects in sex hormone production, low growth hormone, and elevated cortisol. These hormone changes increase fat storage and/or prevent the breakdown of fat, thereby, causing even more weight gain and obesity.
The disease of obesity also alters activities of various enzymes that control fat metabolism, causing less fat to be burned for energy and more to be taken up into fat cells and stored, increasing fat cell size and total body weight. Furthermore, serious obesity (as well as childhood obesity) may not only increase fat cell size but also increase fat cell number. An increase in fat cell number, according to several reports, significantly reduces an individual's chance for successful and sustained weight loss.
Weight gain further enhances the spread of fat tissue by altering the production or actions of several important regulators of eating behavior. By altering these regulators, the disease of obesity may cause an increase in appetite, food cravings, or reduced satiety (feelings of fullness). These defects, in turn, are likely to promote further weight gain and progression of the disease.
To make matters worse, obesity causes numerous health problems that may reduce an individual's desire for physical activity, lowering the numbers of calories the body burns for fuel and increasing those stored as fat. And, ironically, obesity-associated health problems, including diabetes, hypertension, depression, and arthritis are often treated with medications that cause further weight gain.
Bariatric surgery helps to 'break' many of these obesity-promoting cycles, improving the need for medication, normalizing hormones and some of the weight-promoting eating behavior regulators, increasing physical activity and calories burned, improving metabolism, and resolving disease and the need for medications that can cause weight gain. The interruption of these vicious weight gain cycles with bariatric surgery, coupled with the restriction that the surgery imposes on nutrient intake, induces massive weight reduction.
With gastric bypass, as well as the biliopancreatic diversion and duodenal switch, weight loss is rapid and substantial. Excess weight loss one year after surgery is generally 70% or more. Studies have found that 5 years after gastric bypass surgery most individuals will have maintained 48 to 74% of their excess weight loss. One study found that even 14 years after surgery, average excess weight loss for over 600 gastric bypass patients exceeded 50%.
Bariatric surgery, therefore, is effective in inducing massive weight loss in individuals suffering from the disease of morbid obesity and in helping to maintain much of the weight loss for years and years. Still, the surgery is not a 'cure' for the disease of obesity.
Although it is extremely rare for an individual to ever regain all of their weight loss following surgery, some weight regain generally occurs. As discussed above, an individual may lose 70% or more of their excess weight loss with gastric bypass surgery and maintain a 50% or more weight reduction long-term. Although such a high degree of weight maintenance is considered exceedingly successful for the disease of morbid obesity, some weight regain does occur, evidence that the disease is not arrested.
Longitudinal studies of large groups of gastric bypass patients have shown that around the second post-surgical year there is generally a weight regain of approximately 5% to 10%. This increase in body weight tends to happen about the same time that many individuals complain of a 'reawakening' of some of the symptoms of the disease, such as an increase in appetite, food cravings, and a loss of satiety.
How, then, can an individual maintain all their weight loss after surgery? For continued maximal weight loss success, the bariatric patient must realize that their surgery is not a 'cure' for obesity but rather a 'tool' that can assist in keeping the disease 'suppressed'. The surgical 'tool' is effective in inducing and helping to maintain weight loss by substantially reducing total calorie intake. And, as mentioned earlier, the surgical 'tool' breaks those obesity-promoting biological cycles that contribute to the progression of the disease and prevent the afflicted individual from gaining control over their body weight.
The pioneers of obesity surgery recognized years ago that the surgery was not a 'cure' for obesity but rather a highly effective 'tool' that assists in halting the progression of the disease. These individuals worked diligently to see that the morbidly obese patient would have every opportunity for life-long weight loss success. Through their efforts, the National Institute of Health, the National Heart, Lung and Blood Institute, the American College of Surgeons, as well as the national and international societies representing bariatric surgery, all recommend that patients who have bariatric surgery be followed by a multidisciplinary team of obesity healthcare professionals.
The multidisciplinary team of professionals aids the bariatric surgical patient in making lifestyle changes that, with the assistance of the surgical 'tool', helps to keep their disease under control. The multidisciplinary team generally includes (in addition to the surgeon and clinical staff) a nutritionist or dietitian with knowledge of the specific nutrient needs of the bariatric patient, a mental healthcare professional who understands obesity and the psychosocial consequences of the disease, and an exercise physiologist or trainer who can prescribe physical activities that help to promote maximal weight loss success and long-term weight loss maintenance.
There are now several studies reporting the effectiveness of the multidisciplinary approach to the surgical treatment of obesity. The early findings of these studies clearly show that individuals who participate in such programs have greater weight loss success and long-term weight loss maintenance than do those who do not take advantage of the multidisciplinary program.
What can you as the bariatric patient do to keep you disease under control? First, recognize obesity for what it is - a progressive and malignant disease. Second, know that your surgery is a 'tool', rather than a 'cure' for your disease that can enable you to lose massive amounts of body weight. Third, recognize that the surgical 'tool' can help you to keep your disease suppressed and enjoy long-term weight loss maintenance, provided you are willing to make lifestyle changes necessary for long-term weight loss success including: 1) regular physical activity, 2) good nutrition and appropriate vitamin/mineral supplementation, 3) assistance in improving emotional status, and 4) continued involvement in a bariatric support group and in your clinical program.
Cynthia Buffington, Ph.D.
Cynthia Buffington, Ph.D., is the Director of Research for The Obesity Wellness Center
http://www.beyondchange-obesity.com/obesityResearch/bariatricSurgATool.html

Hi Jamie,

Thanks for the information. A reminder is always helpful. I hope you're well. I haven't been on this board lately, but all is well with me. Enjoying summer!

Take Care,
Christina