Long-term followup of type of bariatric surgery finds regain of weight, decrease in diabetes remission
I suspect that as soon as I get back into a routine at the gym (… school is out and it’s hot and we are whiny) that one or two things will happen:
Recently when I saw a fresh weight loss and posted it, I was confronted with a commenter who asked me why I posted my body-weight. It is a fair question and I do not challenge her asking it, because it's been asked of me many times when I have posted my actual weight-as-a-number.
I will say that number-sharing is the norm (…or was?) in the weight loss surgery/bariatric community as a whole for as long as I have been a part of it — and that is at least 10-12 years that I have actively read and participated in emails, groups and chats. I posted the question as a poll this morning on Facebook as well. Go answer! Come back.
Back in the hey-day of message boards we would add a line of text to our signatures (..siggies!) to signify our –
- HW (Highest Weight)
- SW (Start Weight or Surgery Weight)
- CW (Current Weight)
- GW (Goal Weight)
They would look alot like this!
HW – 320 SW – 298 CW – 151 – GW – 150
Don't judge the comic-sans.
I would go back to *my old posts circa 2003/2004 and show you, except I was banned from my message board back then, and my posts via BethLButterfly disappeared. She posted in Comic Sans at times. Her demise is why MM exists.
Number or weight sharing is. Was. Always will be? I would say that in general — most individuals that have bariatric surgery are often proud of every single pound lost, and want to wear their "pounds lost" as a badge of honor. Some post ops are extraordinarily proud and not only wear the pounds lost, current weight, but will add things like "LBS GONE FOREVER!"
Losing weight is no easy feat, and after bariatric surgery — it feels like victory. Why wouldn't someone want to own it — even just for a while? I suppose when you've been 500, 400, 300, 250 lbs — wearing a newly slimmed down self is quite a change and being able to put that number out there to the universe — even just for a while is worth it.
Bariatric surgery and the life afterwards is ALL ABOUT NUMBERS. Losing pounds, inches, and sometimes counting calories, measuring food, and exercise. If you're a pre-op that doesn't want to 'hear that' – I am sorry – but it really, truly, is.
I absolutely understand that some people take these numbers to an extreme – and extremes are unhealthy at any level — and that is how we get into situations like: needing bariatric surgery. Extreme caloric intake is unhealthy, an extreme sedentary lifestyle is unhealthy. We require balance.
It takes a very long time for some people to learn this: example —-> ME.
While I have always "weighed-in," I am also The Queen Of Avoidance, and as soon as I see the scale move up – I remove the scale. (That's magic, if I can't see my regain, no one else can. That is, until I SEE THE PHOTO EVIDENCE MYSELF AND SCREAM. *See below.)
So what has changed? I removed myself from the effects of negative influences — changed my views on some things and … GASP …
I added ACCOUNTABILITY to my daily life. I now weigh myself near-daily, or at LEAST weekly. I check-in my food nearly every single day on a journal.
Is that obsessive? No. Why? Because before — not paying attention led to weight regain. Surrounding myself by people with negative and apathetic views on life – brought me down.
Apathy causes failure.
Yes, I am fully aware I am a Bariatric Bad Girl – but maybe now you understand – BAD DOES NOT EQUATE "BAD," or breaking rules, or doing things WRONG.
It's BAD-ASS. (Help us help, BTW.)
*June 2012 – April 2013
But, recently I started paying attention – and seeing results:
My brain likes to see results, black and white, literal, on paper, in lines, to show me that if I DO X – Y WILL HAPPEN.
Because it works. (Shut up Weight Watchers.) And my little brain likes proof.
If I can see tangible results I will keep going – I will keep doing a thing if I can see a result. I do not like to work for "free – " you see. Does that make sense? Here's an example, a very simple one. I started going to the gym and doing basic exercise (…long walks on the treadmill and seated elliptical) about a month ago (…I'll check back in my Facebook check ins) and I noticed a tangible result the night before last. My leg muscles are coming back. This is enough to create a positive reaction to keep me motivated.
It's not about obsessing about a number. I don't have a goal.
It's not uncommon for those of us who have lost massive amounts of weight with bariatric surgery to have major issues with body dysmorphic disorder or problems seeing ourselves the way we really look.
Nobody needs to know I am a high-fall risk. (Even though I am.) I take two medications that cause "dizziness" and "sleepiness" among other things.
Please do not give me a reason to patronize restaurants with low-quality food options. MM needs no reason ON THIS EARTH to step foot in a Golden Corral, Olive Garden, Red Lobster, etc… EVER.
Nor do MMs kids. EVER. I do not need a trough of pasta, fried seafood or oily iceberg lettuce based salad.
MM Does Not Endorse The Use Of WLS Discount Cards For Food. We have to learn to eat like normal people. Having an excuse to pay less for crappy food does not teach us anything.
NPR - n.pr/UEF2qA
All of these reduced appetites might seem like bad news for the restaurant business, but surgeon-distributed food discount cards aim to make dining out cheaper and more practical for gastric bypass patients.
But is this kind of encouragement really a good idea?
To accommodate the patients' reduced stomach volumes, the cards, called WLS (Weight Loss Surgery) cards, ask restaurants to allow patients to order a smaller portion of food for a discounted price.
These cards aren't a new phenomenon — they've been around in the U.S. at least since the 1990s, and a similar discount programwas proposed to city council members in Campinas, Brazil, earlier this year.
And like the surgery itself, the WLS cards have grown in popularity, says Ann Rogers, director at the Penn State Surgical Weight Loss Program. "Now there's so much word of mouth about it, that if we forget to give them out [after surgery], the patient says, 'What about those discount cards?' " Rogers says.
Some popular U.S. restaurants accept the cards. For example, Cracker Barrel restaurants allow patients to order from the inexpensive children's menu or order a lunch-sized portion for dinner. In a statement issued to the Salt, Olive Garden and Red Lobster restaurants say they are happy to do the same.
Though gastric bypass surgery leaves the patient with a stomach pouch only about the size of an egg, restaurants, especially buffets, still spell trouble for many patients. Unlimited portions and heavily processed, quickly digestible foods that keep patients from feeling full make it difficult to keep the weight off, says Rogers.
Golden Corral could not provide a spokesperson to respond to our inquiries, but it and other companies have made efforts in recent years to add healthier choices to their buffet offerings.
Even if the patient makes better choices, however, friends and family who come along may not do the same. "I definitely discourage patients from going to buffet-style restaurants — it's a danger for everybody," Rogers says.
In fact, Rogers says she discourages her patients from eating at any restaurant. So why distribute a discount card that seems to encourage dining out?
Rogers says it's OK for patients to use the WLS card and splurge at the buffet every once in a while, and the card also encourages them to order smaller meals at other restaurants. If patients make healthy choices about 75 percent of the time, they'll keep the weight off, she says.
But just as the buffet can have negative family health consequences, patients who are diligent about eating well a majority of the time can encourage healthy habits among friends and family. Rogers says patients who attend regular follow-up appointments, some featuring weigh-ins and healthy cooking classes, retain their lost weight about 70 percent of the time.
"For most of our patients, when the patients change their habits, it changes the eating habits of the whole household. It's pretty educational," she says.
Changing habits is critical, she says. It's a myth that the stomach surgery is a permanent weight loss cure. After surgery, "the [hunger] hormones go down and stay down for a year or two. But, slowly, the hunger starts to come back," Rogers says.
Both weight loss and its associated improvements in cardiovascular and metabolic risk factors persisted for 6 years in most of the 418 severely obese adults who underwent Roux-en-Y gastric bypass surgery in a prospective study published in the Sept. 19 JAMA.
- Results from JAMA - Six years after surgery, patients who received RYGB surgery (with 92.6% follow-up) lost 27.7% (95% CI, 26.6%-28.9%) of their initial body weight compared with 0.2% (95% CI, −1.1% to 1.4%) gain in control group 1 and 0% (95% CI, −1.2% to 1.2%) in control group 2.
- Weight loss maintenance was superior in patients who received RYGB surgery, with 94% (95% CI, 92%-96%) and 76% (95% CI, 72%-81%) of patients receiving RYGB surgery maintaining at least 20% weight loss 2 and 6 years after surgery, respectively. Diabetes remission rates 6 years after surgery were 62% (95% CI, 49%-75%) in the RYGB surgery group, 8% (95% CI, 0%-16%) in control group 1, and 6% (95% CI, 0%-13%) in control group 2, with remission odds ratios (ORs) of 16.5 (95% CI, 4.7-57.6; P < .001) vs control group 1 and 21.5 (95% CI, 5.4-85.6; P < .001) vs control group 2. The incidence of diabetes throughout the course of the study was reduced after RYGB surgery (2%; 95% CI, 0%-4%; vs 17%; 95% CI, 10%-24%; OR, 0.11; 95% CI, 0.04-0.34 compared with control group 1 and 15%; 95% CI, 9%-21%; OR, 0.21; 95% CI, 0.06-0.67 compared with control group 2; both P < .001). The numbers of participants with bariatric surgery–related hospitalizations were 33 (7.9%), 13 (3.9%), and 6 (2.0%) for the RYGB surgery group and 2 control groups, respectively.
I am aware that I did not share the details of the interview with 20/20 this week in my previous post about the show. I wasn't purposely keeping anything from you, in fact I wished I had documented the process as it happened, but I only had a phone and it happened so. very. fast.