Weight loss surgery: ‘not everyone lives happily ever after’ – Medical News Today


Weight loss surgery: 'not everyone lives happily ever after' – Medical News Today.


I realize this is a very small sample study, but I can't say I don't disagree with most of it after living this WLS-life for ten years and observing hundreds of people in it.


All women had undergone gastric bypass surgery – one of the most common bariatric surgery procedures. It involves rerouting a part of the small intestine past the stomach in order to reduce food intake, promote satiety and suppress hunger.

The majority of the women were interviewed twice. The first time was 1 year after surgery, while the second interview took place 2.5-4 years following surgery.

Groven says although most previous research suggests that weight loss surgery leads to an increase in quality of life for the majority of patients, her findings suggest that not everyone lives happily ever after following bariatric procedures.

Positive outcomes after surgery 'can feel like grief'

There is no doubt that weight loss surgery puts the body through a series of radical changes.

Groven says that although the procedure leads to a slimmer body – which others perceive as a "sign of success" – the surgery can cause many smaller problems that other people are unable to see.

Groven explains:

"Becoming slimmer and lighter is mostly perceived of as positive. At the same time it is ambivalent, since people start to behave differently towards the women after they've had surgery.

People are friendlier than before, and this may feel extremely provoking. And people often ask very invasive questions concerning the woman's radical weight loss."

The interviews revealed that some of the women experienced a boost in self-esteem after surgery, were more outspoken, and found other people were more likely to listen to what they were saying – particularly in the workplace.

Groven notes that although these factors are clearly positive outcomes, this could also be seen as a "grief" because the women realize they had to undergo weight loss surgery before seeing these outcomes.

Many of the women also felt embarrassment after the surgery, particularly when it came to speaking about their weight loss. Some women told others they had been on a diet to lose the weight because they were ashamed to say they had undergone bariatric surgery.

Excess skin promotes a negative self-image

Groven found that many of the women had mixed feelings about their naked body after surgery, and many of these feelings come from the occurrence of loose skin – a common consequence of rapid weight loss.

"It is given little focus before the operation. Patients are often told that this is something that can be fixed afterwards. But it is not so easily fixed, and the women are not prepared for the challenge of having to live with the loose skin," explains Groven.

Although women can undergo surgery to remove excess skin, Groven notes that many women are not prepared to take the risks associated with this procedure, which include hematoma or seroma formation, infection and risks associated with future pregnancies.

Groven found that some of the women interviewed even spoke about their excess skin in third person, which she believes is a way of distancing themselves from it.

Health problems and bad food relationships after weight loss surgery

According to Groven, five of the women interviewed reported a lower quality of life after they underwent weight loss surgery, compared with their quality of life before.

She notes that this was down to the development of chronic stomach and intestine problems, and one woman became so ill that she had to endure another operation because of problems with her scar tissue after the gastric bypass procedure.

The five women also said they felt as if they had complete lack of energy following weight loss surgery.

Furthermore, Groven found that many of the women reported having a negative relationship with food after the procedure.

Some women were worried about eating too much or too little, or eating the wrong food at the wrong time. Because of these concerns, some women experienced tiredness, nausea, dizziness and even intense shaking.

Some of the women who had problems with overeating before weight loss surgery continued to overeat after surgery, even though this made them ill. Groven says some women commented that "the eating disorder is not gone."

Groven says that while previous research suggests that patients can avoid testing their eating limits after surgery by following dietary advice, the reality is much more complicated.

She adds:

"It is reasonable to ask, I think, whether the eating disorders that some of the women develop after surgery are diseases, or if they may be understood as normal changes as a result of the operation."

No regrets

Although many women reported negative thoughts and health issues after weight loss surgery, none of them said they regret undergoing the procedure.

"They say they would have done the same today and that they had no choice considering their life before surgery. Some said that the pains were a small price to pay," says Groven.

She adds that this suggests women are influenced by society's perception of the ideal female body, and that being obese is not within this scope.

"They are living with a body which is not accepted by society, and they are constantly judged from their size," she says.

"The message from the media and medical science is that they are likely to get cancer or diabetes unless they lose weight and the surrounding world regards their obesity as self-inflicted. Some have children and are afraid to die and leave them alone."

Groven concludes that although it is true that obesity can lead to health complications, such as diabetes and heart attack, little is known about the long-term effects of weight loss surgery and what complications may arise from this procedure.

With this in mind, Groven plans to conduct further research that will look at the effects of bariatric surgery 3-10 years after patients have undergone the procedure.



Screen Shot 2013-05-01 at 10.04.28 AM

Apathy and failure

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.

Screen Shot 2013-05-01 at 10.04.28 AM

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.

Screen Shot 2013-05-03 at 10.01.47 AM

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.

Now, for me.  This commenter wondered if my posting about my actual number was an obsession – let me clear it up here.  No.  I've always weighed myself.  

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:

Screen Shot 2013-05-03 at 7.45.36 AM

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.

Screen Shot 2013-05-03 at 8.20.49 AM

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.  

Study – 47% Weight Stays Off Long Term After Gastric Band Bariatric Surgery – But…

Medpage –  Weight Stays Off Long Term After Bariatric Surgery

O'Brien PE, et al. "Long-term outcomes after bariatric surgery. Fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature" Ann Surg 2013;257:87-94.

Obese patients maintained about 50% excess weight loss for as long as 15 years after laparoscopic adjustable gastric banding, (LAGB), Australian investigators reported.

Experience at a single center showed an average of 47% excess weight loss in 714 patients followed for more than 10 years after LAGB, including 47% among patients followed for 15 years and 62% in a small group followed for 16 years, according to Paul O'Brien, MD, and colleagues, of Monash University in Melbourne, Australia.

A systematic review of published studies revealed a mean excess weight loss of 54% at 10 years and beyond for patients treated with LAGB or Roux-en-Y gastric bypass (RYGB), they reported in the January issue of Annals of Surgery.

The results also showed a marked reduction in late-occurring adverse events after LAGB, the authors added.

"Gastric banding is a safe and effective treatment option for obesity in the long term," they said. "The systematic review shows that all current procedures achieve substantial long-term weight loss. It supports the existing data that LAGB is safer than RYGB and finds that the long-term weight loss outcomes and needs for revisional surgery for these two procedures are not different."

Despite a history dating back more than 50 years, bariatric surgery has a paucity of long-term data to demonstrate durable weight loss. Most published studies have follow-up of less than 3 years. Systematic reviews have added relatively little in terms of long-term follow-up data, according to the authors.

O'Brien and colleagues introduced LAGB at their center in 1994, and have followed all patients by means of a dedicated bariatric surgery database. As of December 2011, O'Brien and co-author Wendy Brown, MBBS, PhD, also of Monash University, had treated 3,227 patients with LAGB.

The authors performed a prospective longitudinal cohort study of the patients. For comparison, they performed a systematic review of published literature on bariatric surgery. The focus was on long-term follow-up, 15 years for the cohort and 10 years for the systematic review.

The cohort had mean age of 47 and a mean presurgical body mass index of 43.8 kg/m2. The authors identified 714 patients followed for at least 10 years, including 54 patients followed for 15 years and 14 followed for 16 years.

  • The 10-year excess weight loss was 47%.
  • The authors reported that 26% of patients required revisions for proximal enlargement,
  • 21% for port and tubing problems, and 3.4% for erosion.
  • Band removal was performed in 5.6% of patients.

During the first 10 years of clinical experience, the revision rate for proximal enlargement was 40%, declining to 6.4% during the last 5 years of the study period. Patients with and without revisions had similar excess weight loss.

The systematic review consisted of 19 published articles, 24 data sets, and approximately 14,000 patients. The data included six sets involving patients with LAGB, nine sets for RYGB, five sets for gastroplasty, three for biliopancreatic diversion or duodenal switch (BPD/DS), and one involving fixed open gastric banding.

According to the authors, every study had deficiencies related to data reporting. None of the studies was a randomized controlled trial. One investigation was a prospective, nonrandomized, matched interventional study, and the rest were observational studies.

With respect to safety, one perioperative death occurred in 6,177 LAGB procedures, compared with 21 in 2,684 RYGB procedures (P<0.001).

Excess weight loss at 10 years averaged 54% with LAGB and RYGB, 53% with gastroplasty, and 73.3% with BPD/DS. The mean revision rate was 26% with LAGB and 22% with RYGB. Revision rates from individual data sets ranged as high as 60% with LAGB and 38% with RYGB.

"The longitudinal cohort study of the LAGB patients shows that they have achieved and maintained a loss of nearly half of their excess weight to 15 years," the authors wrote. "The validity of the 15-year figure of 47% of excess weight loss is reinforced by the pooling of all long-term data (≥10 years) and finding the same weight loss of 47% excess weight loss for the much larger group."

Gastric bypass surgery: Follow up as directed to lose more – double!

Gastric bypass patients who follow through with their post op appointments in the first two years lose nearly twice as much weight as those who do not, suggests a study from the University of Pennsylvania School of Nursing.

Imagine what could happen with even more follow up.

Gastric bypass surgery: Follow up as directed to lose more

August 1999 - Bridezilla

Never did party like it was 1999, though.

Then: August 1999

1. Age: 20

2. Romantic Status: Engaged, Married August 28th.

August 1999 - Bridezilla

3. Occupation: Full time parent to one toddler and one infant.

4. Fun night out:  Any night out.  We didn't get many nights out.  They were usually nights out to grocery shop without two crying babies.

5. My BFFs:  Ha.  Probably Amy at this point, she would walk up to my house and we'd go for walks up to the playground with the kids.

6. I spent way too much time:  Changing diapers, potty-training my oldest daughter.

7. I spent not enough time: Doing much of anything else.

8. I wanted to be when I grew up: I had NO idea then, I have a little more motivation now.

9. Biggest concern:  Living on one small Wal*Mart Manager's income, dealing with a serious asshole neighbor, we eventually moved because of him. I wonder what became of that man.  *twitch*

10. What my biggest concern should have been: Getting some schooling accomplished – we probably qualified for aid then.

11. Where did I live:  A condo that we should have kept and sold for serious $$$ if we waited a little bit longer.

12. Dumbest thing I did that year:  Gave birth?  Got married?  LOL.  I don't know.  It's a bluuuur.

13. If I could go back now and talk to myself I would say:  Stop gaining weight now, stupid!

14. Picture of me then:

Just after baby #2, '99...

Now: August 2009

1. Age: 30

2. Romantic Status: Married 9.11 years.

3. Occupation: Mom or four

4. Fun night out:  Again, ANY NIGHT OUT, there's fewer even NOW!

5. My BFFs: Ha ha, that's funny right?

6. I spend way too much time: Doing household shit and not being productive.

7. I spend not enough time: Being productive.

8. I want to be when I grow up: Many things, mainly retired from whatever it is I DO.

9. Biggest concern: Financial ruin, not being able to provide for six humans.

10. What my biggest concern should be: The same, and getting my ass prepared to work.

11. Where do I live: In the same area – four houses later.

12. Dumbest thing I have done this year:  Just one thing?

13. What I think I would say to myself in 10 years:  "Grandma?"  SCREAM.

14. Picture of me now:



1. What do I miss most from 1999: Not a damn thing, oh, wait, we weren't plugged in to the 'net then!  Technology was not part of my life.

2. What do I miss least from 1999:  Being broker than broke.  Not that we're still not up to our eyes in bills, but we don't have to borrow toilet paper!

3. What have I accomplished in 10 years that I am most proud of:  I made two more healthy humans, I lost 170 pounds (initially, not right now) and made it to 2009!  We are all alive and well.  That's enough.

4. What have I NOT accomplished in 10 years that I wish I had:  A million things, but, I have time.

Stolen from dooce.

A couples survey, I lifted from www.dooce.com 

What are your middle names?
Lynn + Joel.

How long have you been together?
Longer than humanly possible.  We started dating in freshman year of high school – 1993.

(A newspaper photo from Sophomore year.  We were in DECA together.)

How long did you know each other before you started dating?
He was in my Algebra class, I knew him vaguely since September, and he asked me out in April.

Who asked whom out?
Oh.  Just answered that.

How old are each of you?
I am 30, he is going on 32.  He stayed back in elementary school once (he says it was because he had a hearing problem and couldn't hear the teacher, he still has a hearing issue, it's pretty bad) and I started school young, at age 4.

Long ago, there was a little Bob. by you.

Whose siblings do you see the most?
His, they babysit for us, and he's got three sibs.  I only have one, a brother, who would implode if we asked him to sit. 

Which situation is the hardest on you as a couple?
It's always been money.  We've been on our own since age 18, and had babies early, so money has always been elusive, overwhelming and stressful.  It doesn't change even even if you make more.  We're still trying to make it.

Did you go to the same school?

bethbobSRprom by you.

Are you from the same home town?
Nope.  We had a regional high school.

Who is smarter?

We both have had IQ testing.  I won.  However, I ask him for help ALL THE TIME.  I have serious troubles with basic things sometimes.  It's cahhh-razy. 

Who is the most sensitive?
I wouldn't call it sensitive.

Where do you eat out most as a couple?
What is this thing you call eating out?  We don't get out much — if and when we do — it ends up being quick-serve something or other because we don't EAT much.  I always ask for Chinese, Thai, etc…

Where is the furthest you two have traveled together as a couple?
Together?  Orlando.  Mickey Mecca.  He's been to Scotland/England.

Who has the craziest exes?
Um.  We don't really have many exes — since dating so young.  But, I would say I do.

Who has the worst temper?

I would say he does, he would say I do.  He is easily irritated, and I am moody.

Who does the cooking?
Me, mostly.  He will cook when he craves something – aka FUDGE, etc.  because I refuse to make it.

Who is the neat-freak?
Me.  But, when he's on a mission – he will clean things obsessively – like the walls.  We have a toddler who colors on the walls in hiding when she finds a writing implement.  He freaks out.

Who is more stubborn?
He, like an ox.  But I am super-stubborn also.

Who hogs the bed?
Me.  I sleep like a starfish, but we also have a kid in the bed most nights.

Who wakes up earlier?
Meh.  We are equal – since three kids have to be up and to school – and he goes to work.

Where was your first date?
To the movies and out for DONUTS.  LOL.  His aunt drove us, and we went out after for donuts.  I should have seen it coming.

Who is more jealous?
Eh.  No real reason to be.  If he is, he can hide it well.  LOL.

How long did it take to get serious?
We were engaged in December just after high school.

Who eats more?
We're both RNY Gastric Bypass'ed — it's pretty even.  I can eat more in quantity than he can — but he eats more overall.  He can take in more calories.

Who does the laundry?
I do.  He does not separate well – and things get icky.  While I was in the hospital last week he took over — and now my white towels aren't really white.  But he will do it if asked or if I'm unavailable.

Who's better with the computer?
Him, overall, but we have two iMacs and neither really has used them to capacity yet.  I have no clue about most of the programs.

Who drives when you are together?
Him.  I do not drive any more, due to my seizures.  I have six months (again) before I can consider getting behind the wheel.

Feel free to answer some or all of the same questions about your
significant other in the comments, or leave a link to your website if
you prefer answering there.