Question:
Long Term Weightloss Maintainance -- any opinions?
I've been approved for WLS and am in the pre-op testing stage but am still having doubts, more of them the closer I get to surgery. I'm still not decided on whether it will be Lap Band or RNY, though I'm leaning toward banding. After reading answers to questions regarding weight re-gain & anectdotal stories about people who've had WLS, I wonder if WLS is any different in the end from a good diet. It seems as if most obese people regain all their weight within a year or so of dieting, unless they have a helluva lot of self discipline to keep it from coming back. WLS sounds no different. So does WLS REALLY work any better LONG-TERM??? Are there many WLS patients who have had the surgery years & years ago and still maintained their losses? I see a lot of personal pages kept up by WLS patients in the first 1-2 years, but very few that jounal or post pics in the followup years. This makes me VERY concerned about risking major surgery for something that has no better long-term chance of success than say a lowcarb diet. I understand that it really is different for DS'ers, but would the people who've had RNY or Lap Bands 3 yrs. or longer and maintained their weight loss, expalin why this worked for them when diets didn't? If both methods require diligence, discipline and permanant change in habits, why were you successful after WLS and not after diets? If my post sounds negative, it's not meant to. I'm just really, really worried about the long-term results. It seems to me that it would be heart-breaking to look & feel great again, just to have it all come back, worse than if you'd never lost it at all. Sort of like Charlie in "Flowers for Algernon"... Does anyone REALLY know what percentage of patients have maintained good weight loss 3, 5 or more years down the road? Reliable statistics would be great, but even rough estimates from your observations on this message boards would be a help in my decision. Thanks for any & all replies! Barb — Barbara M. (posted on July 24, 2003)
July 23, 2003
See barb thompsons great book it talks of this and has long term loss
numbers. URL is on the very bottom of my profile. Most keep off over 50%
or more of their original loss at least over 5 years. Thats way better
than dieting. We MUST add exercise to keep it off and retain good eating
habits. I know lots of long termers, the successful ones exercise, the ones
gaining are couch potatoes. WLS isnt a get thin free card, it requires
work. I gained a bit back but bottomed way too low according to my PCP and
surgeon. I know a nurse over 20 years out RNY. She snt skinny but looks
good. She saids the candy machine calls to her so she takes no money to
work. She looks after the surgical waiting area at presby. As to the lack
of long term post ops here. Our lives get so busy WLS is no longer the
center of them. We move on living our lives. At 2 years I feel the call to
move on too. Theres just so much to do and so little time. The psych doc
who approves us all says this is normal and a sign of a well adjusted post
op.
— bob-haller
July 23, 2003
Barb, I am so glad you posted this question. I hope you get a lot of
responses! I was wondering the same thing myself. This is my BIGGEST fear
and also the question that I get asked the most from other people. I'm
never really sure how to answer them. All I can say is, I am 6 months out
and have completely changed my eating habits. I have not touched sugar,
potato, pasta or bread since my surgery. I have never been able to do that
for this long on a diet. I don't even miss them that much. Only now and
then. One thing I have going for me is the fear of humiliation! Failing
on a diet is one thing, but the fact that everyone knows I had this
surgery, makes me all the more determined to be a long term success. For
me, also, I have never felt so good as I do now, and had never felt so bad
as I did right before the surgery. I don't think I will ever forget how
horrible I felt. I totally realize that this is not a "get thin
free" card, as Bob calls it, and I think that's part of the first step
to being successful. I am learning to refocus my life on other things and
steer away from food oriented activites. It's not as hard as I thought it
would be. Anyway, that's my 2 cents! I'll be anxious to see what others
have to say.
— Kathy S.
July 23, 2003
Great question, and one I think about a lot as a pre-op. Despite many,
many dieting attempts over a long-term period, I never reached a goal
weight for my height, or even my own (slightly higher) goal weight. Heck I
haven't been under 200 lbs over 20 years. So if WLS provides that for me,
it will be the most tremendous boost I can ever imagine! My plan is to get
the most weight off that I can, and then maintain. I don't really feel it
will be all that hard - I know that regular exercise is vital, but
something I can't do right now because of heel spurs and knee and back
pain, which I'm hoping will be helped by WLS. Up until the last couple of
years, I always had a pretty active lifestyle, and I know how to eat right.
What I want is to be able to eat like a "normal" person - eating
healthy most of the time, but if you have occasional desserts or treats,
that's OK, too - that's normal. I actually feel like I've gotten my
emotional eating under control, so I don't look for that to be a problem
post-op. I've been under a great amount of stress lately (my father's
stroke April 5, my son's WLS surgery May 5, son getting married this
weekend, my own health problems, and the prospect of moving to another job
within my company 1 month before my surgery). Despite all of this I've
only gained 5 pounds since my surgical consult in February, so I consider
stress eating a non-issue for me now! I'm being offered a wonderful
opportunity here, and I plan to take full advantage of it. Maybe I will
fail long-term, but I have to give myself this LAST chance to be a healthy
and active person, the person that's been trying to get out of this
"fat prison" for too long! I'm ready. Good luck to you in your
journey and thanks for a great thought-provoking question.
— Carlita
July 23, 2003
Barbara, I can only speak for myself here but here's my take on things.
First off, I'll be six years post op in September. Started off with a VBG
in 97, revised to an RNY in 2000 after a mechanical failure of my VBG (lost
my ring!). Sure, there are people with amazing willpower who can diet and
keep it off. But they are few and far between. WLS is a wonderful tool. It
keeps you from being ravenous and eating huge portions while you learn to
eat better. Also, should you start to regain, it helps you get things back
under control by satisfying you with less food. Still, it's up to you to
choose the proper foods. WLS is not a magic bullet, it won't do the work
for you but it IS a strong weapon if you use it properly. Believe me, I am
no poster child for healthy eating as I don't always make the best choices.
But when I find my pants starting to tighten up I can easily get things
back on track again thanks to my tool. Without my surgery, I was 320lbs
with diabetes, high blood pressure, asthma, constant back, knee, feet and
ankle pains. With my tool, I weigh 170lbs with none of the above mentioned
problems. Give me my WLS over dieting alone any day of the week! Hope
this helps!
— Kellye C.
July 24, 2003
Barb where are you having your surgery? I had it 11 weeks ago at Alexian
Bros. Hospital in Illinois and they have you attend classes before you have
your surgery and there are people there who were 10yrs out and look
wonderful so I think it works the way they do it now. My sister had her
tommy stapled 20 yrs ago and it didnt work but now they reroute your
intestines.
— Maree S.
July 24, 2003
Hi Barb. I have read where the failure rate for diets are 95% over time.
I know all WLS are just a tool that you use, but it is you that have to do
a lot of the work. You have to change your relationship with food, and
have to exercise more. WLS is not a cure-all. <p>
When I was making my decision as to which surgery was the best for me, I
went with the lapband mainly because of long-term aspect. I can get a fill
years later and I would be restricted. For me, I felt that this was a tool
that I could use for the rest of my life, or at least until they find a
better way to keep the weight off.<p>
I do beleive that the reason that we don't see a lot people that have been
successful long-term is because those people have gotten off the support
groups and are leading successful, healthy lives. There are a few that
hang around to help us newbies, but most are through with the support
thing. Good luck with your decision! Sheryl
— Sheryl W.
July 24, 2003
RNY has a much higher success rate than just dieting. Plus is is
clondisered the gold standard of bariatric procedures. You're right that
it is not a cure all, but it greatly enhances your chance of success. I
had open RNY in 3/02 and have lost 156 lbs. I have never been happier. I
feel great, yes I have to watch what I eat. Not because it makes me sick,
but just to eat things that make sense--healthy foods. Could I sabotage my
succes, absolutely. It still takes some self control and discipline, but
it much, much easier than before.
— jan M.
July 24, 2003
This was my biggest concern as as pre-op (right down to the "Flowers
for Algernon" analogy). I still worry about it even though I've been
at (or past) goal for five months. I wish it was five years, so I could
answer you better. But for what it's worth, my thinking, as a pre-op, was
this:<P>Without the surgery, I was going to keep on gaining more and
more, and though I'd made several valiant efforts at dieting "the hard
way" in my life (losing 50 pounds here, 80 pounds there, living at the
gym, etc.), I felt I didn't have any more tries left in me because I just
couldn't maintain that lifestyle, and I couldn't go through yet another big
regain. Plus, the obesity was finally taking a measurable toll on my
health. Walking hurt, and it wasn't getting any better with any
orthopaedic intervention. I knew I was at a point where my weight gain
would get exponentially worse without doing something. It's important to
realize that, for many people, the choice is *not* WLS or the status quo;
it's WLS, or steadily declining health and quality of life.
Ouch.<P>As a pre-op, I read a study done by NIH in 1991 that tracked
WLS patients for three years. Over those three years, people did indeed
regain, but at the three-year point, they'd still kept off 70 percent of
what they'd lost. I was really struck by that. With conventional dieting,
something like 95 percent of dieters regain everything they lose (and in my
case, more). I thought, I don't want to have surgery just to regain, but
realistically, I have *never* kept off 70 percent of any weight loss in my
life. I hated the idea of regain, but I knew the quality of my life would
be vastly improved even if I turned out to be a "regainer" after
surgery.<P>Of course, like all of us, when I chose WLS, I was
determined to lose absolutely 100 percent of my excess weight and to keep
it all off. I had this mentality despite knowing that such
"All-or-Nothing" thinking was a big part of my screwed up
relationship with food and the resulting morbid obesity. Nevertheless,
setting that goal -- no regain -- helps me keep myself in line, at least,
so far. I'm always looking for hints from long-term post-ops on how they
do it (not regain). I see them on protein shakes, I see them going
high-protein (and low carb), I see them exercising ... and I watch for any
hints of success. Plenty of folks do things I don't want to do, but I pick
and chose and try to build a little a-la-carte menu (there's the food
*again*) that might work for me.<P>I hope I can maintain my vigilant
attitude, but I've read enough postings to realize lots of people who work
as hard or harder than I did struggle to get to goal, or struggle with
regain. It could happen to me despite my best efforts. That's okay. I'll
still be better off than I would've been doing nothing.<P>Good luck
with your decision. As long as you know you need to "bring something
to the table" besides your surgeon, I really think you can succeed
with the RNY, or any other WL surgery you determine to be the right one for
you.
— Suzy C.
July 24, 2003
I had my RNY surgery on 9/11/00 and have kept the weight off, I guess I
need to update my profile, I'm 5'7" 142 lbs. I have no regrets about
surgery, I'm at a healthy weight for my height. The funny part is that
everyone is so used to the "new" me that they don't remember me
ever being as big as I was. WLS is a part of my life, I'm in such a habit
of eating to live versus eating for pleasure that I don't miss the old me
at all. Good luck with your decision.
— Mary A.
July 24, 2003
— vitalady
July 24, 2003
All of the others are right. I've seen the statitistic that 25% of WLS
patients (I don't know if this includes only RNY, or all surgeries) will
not maintain a weight loss of at least 50% of their excess weight for a
period of five or more years. But, that means that 75% of us will! The
NIH study showed that 96% of obese people fail long-term with diets. So,
we are way more likely to be successful with the help of WLS (4% will
succeed with diets; 75% will succeed with WLS).
Note I said "with the help of". You absolutely must participate
in your weight loss and maintenance. The surgery makes it easier, but you
must participate by making good food choices and taking your vitamins and
supplements, and exercising regularly. Having this surgery takes a
personal life-long commitment on the patient's part, and that is why it is
so important for people to understand going in what it will take to be
successful. If you honestly can't make those changes, then surgery is
probably not a good choice, at least until you know you can do those
things. However, also know that having had the surgery does make it easier
to do the right things. You certainly can't eat as much, and you have many
of the early months to retrain yourself and change your relationship with
food. You're not on a life-long diet, but you must be vigilant all your
life. I also wouldn't be too worried that you don't see posts from
long-term post-ops on the boards and profiles. I don't think people stop
posting because they have regained, but because the other aspects of their
lives now overshadow WLS, and it's just not so important or necessary to
them to be so engaged and caught up in the support and information that a
site like this provides. They've moved on, but I think most have not
regained substantial weight. It's good for you to be thinking about this
so that you know what you're signing up for! When I first thought about
WLS years ago, I knew that I wasn't ready to do all the things that I
needed to, so I didn't have the surgery then. I waited until I was sure
that it was the right option for me, and that I could make a life-long
commitment to change some pretty tough things. I have no regrets. I wish
the same for you.
— Vespa R.
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