Years 3-6

There is discussion of the lack of long-term data with VSG.  Arguably, there's not a lot, but some that does exist is not all that encouraging.  A study published in 2010 done in Europe found that of 43 patients followed for 6 years, 13 required revisions (DS primarily) and the 30 remaining patients regained roughly 1/3 of what they had lost going from average EWL of 77% to 53%.  Two of the findings were that increased incidences of GERD and poor eating habits closely correlate with the number of patients gaining weight.  Patient satisfaction remains high in the study probably because 53% EWL is still considered a 'success' and BMI's on average were around 30 at 6 years. Obese, yes, but well within 'average' for our society. 

A couple of things I noted were that while the researchers suggest over-eating led to both GERD and regain, don't people 'self-medicate' for GERD by overeating?  Which is the chicken and which the egg?

The average age for women when being sleeved was 44.  Being 6 years post-op would put most right at the average age for menopause and the drop in estrogen that accompanies it. 

For those 3+ years out, what are your strategies for beating re-gain and bucking the statistics. Do you have GERD?

What was the average starting BMI? Is this much different than RNY folks?

Average starting BMI isn't listed.  I think regain stats are similar or superior to RNY. I'll have to dig up the stats.  There wasn't a direct comparison made.  Those revised to DS had 70% EWL at 6 years, however, compared to 53% with the standalones. 

In another study, of 20 patients with starting BMI's around 46 were sleeved with a 32F bougie, 11 of 13 standalone VSG had EWL over 50% at 8-9 years follow up, 4 additional were revised presumably to DS, and 3 lost to the study.  Even if one were to presume the 3 'lost' were successful, the suggestion is that at 8-9 years post-op only 75% maintain EWL over 50% at 8-9 years. That study did show those successful at 8-9 years seemed to have higher EWL at 1 year. 

I'm not trying to rain on anyone's parade. I'm just a firm believer that  knowledge is power, and if we understand what the key factors are for success or failure long term we can position ourselves better to be in the 'success' category. Neither of these studies was published when I had surgery.  As the data becomes available, I'm going to work to incorporate it into my understanding and personal program. 

At my pre-op appointment, my surgeon said that at the end of 5 years, 70% of people maintain at least 50% EWL, and 30 % regain moreof the lost weight. I think that is mostly from studies with RNY folks. I would feel like a failure, if I regained 50% of my EWL. I'm just wondering, if the research pool was with higher BMI's, since some required revision to the DS.


Another reason to remain mindful and noncomplacent.


Gail

 "Even if one were to presume the 3 'lost' were successful, the suggestion is that at 8-9 years post-op only 75% maintain EWL over 50% at 8-9 years. "

Only 75%? That's a pretty good result, much better than you see in long-term studies of RnY and about what you see with studies of the DS.

I think perhaps you have unrealistic expectations of what WLS can do because the stats you are quoting are right in the ball park for what to expect with WLS. If you compare them to perfection, I guess they can be seen as disappointing, but they are much, much, much better than the stats for diet/exercise.

GERD does not even begin to describe it!  GERD was what I had pre-op.  I don't know what to call it now.  During the day, Nexium and two tums in the morning and two in the evening keep it at bay.  At night, even though I sleep with my head VERY elevated, about once a month I hurl in my sleep.  One of these days, I'm going to expire from it ... or at the very least develop pneumonia from breathing in all that puke.  (Sorry, y'all, but that's the long and short of it.)  I don't eat late at night, and Lord knows I can't eat much anyway, so I don't know what else to do about it.  *sigh*  

And after a 30-pound regain, I'm back to lean protein and veggies with perhaps one not-so-wise choice a day, usually peanut butter crackers.  It is working so far and is waaaaay worth it!

--Dorothy 

I am glad to know this stuff, so thanx for posting the data on regain. It will only steel me further to do battle with the obesity monster and NOT, NO, NOT EVER regain the weight back. I am at 100% EWL and that is a title I do not want to ever lose. I bet they did not have OH back 5 years ago, maybe this blog, and all of us helping each other, will change the horrible statistics.

A while back there was a thread in this group discussing this study. Some comments were that those sleeves were not standardized and may have varried greatly in size and technique. also the amound of follow up/support was unclear.

So while regain can occur after any wls, we have as good a chance as anyone to avoid regain by maintaining our good habits.

Dr. C has data from 10 years of vsg patients and while he has yet to write up this study, he says that less than 10% of patients have regain that exceeds 10% of ewl.  again, nothing written yet but sounds more encouraging.

I had gerd before hiatal hernia repair but don't have it any more and feel so blessed to be rid of it and the prilosec.   diane

Whew so much conflicting data out there huh?

And now, it seems many of the new sleevers have bigger tummies.  The tummy size seems to be all across the board in size, no standardization.  No wonder we can't get solid data.

The data is all over the place, and it makes sense that it would be as the surgery is not standardized, the eating plan after surgery is not standardized, follow up and after-care is not standardized, nothing is standardized.  Therefore, any study done only applies to the patients of that particular doctor, everything else is all over the place.

I know what I need to do to not regain, and in truth, I no longer live in fear of gaining the weight back.  I simply follow my maintenance rules and have a goal of being at goal every third Wednesday on my support group day.  If I am up even a little bit, I bring it back down before that Wednesday.  I don't drink my calories, or graze or eat unhealthy foods most of the time.  I treat myself when the scale gives me the green light and I want a treat, and refrain from treats if the scale is even a tiny bit up.  That's it, maintenance in a nut shell.  I eat mindfully and weigh myself everyday, I will never gain my weight back.  I know this sounds ****y, but I really believe it now.  At almost three years out and five pounds below Dr. Cirangle's goal weight, I think I can do ****y every now and then and be forgiven.   :)