Long-term followup of type of bariatric surgery finds regain of weight, decrease in diabetes remission

While undergoing laparoscopic sleeve gastrectomy induced weight loss and improvements in obesity-related disorders, long-term followup shows significant weight regain and a decrease in remission rates of diabetes and, to a lesser extent, other obesity-related disorders over time, according to a study published online by JAMA Surgery.

Obesity was recognized as a global epidemic by the World Health Organization 15 years ago and rates of obesity have since been increasing. Obesity is currently considered a severe health hazard and a risk factor fordiabetes mellitus, hypertension, abnormal lipid levels, heart failure, and other related disorders. Bariatric procedures are reportedly the most effective strategy to induce weight loss compared with nonsurgical interventions. Laparoscopic sleeve gastrectomy (LSG) is a common and efficient bariatric procedure with increasing popularity in the Western world during the last few years, but data on its long-term effect on obesity-related disorders are scarce, according to background information in the article.

Andrei Keidar, M.D., of Beilinson Hospital, Petah Tikva, Israel, and colleagues collected data on all patients undergoing LSGs performed by the same team at a university hospital between April 2006 and February 2013, including demographic details, weight followup, blood test results, and information on medications and comorbidities.

A total of 443 LSGs were performed. Complete data were available for 54 percent of patients at the 1-year follow-up, for 49 percent of patients at the 3-year follow-up, and for 70 percent of patients at the 5-year follow-up. The percentage of excess weight loss was 77 percent, 70 percent, and 56 percent, at years 1, 3 and 5, respectively; complete remission of diabetes was maintained in 51 percent, 38 percent, and 20 percent, respectively, and remission of hypertension was maintained in 46 percent, 48 percent, and 46 percent, respectively.

The decrease of low-density lipoprotein cholesterol level was significant only at years 1 and 3. The changes in total cholesterol level (preoperatively and at 1, 3, and 5 years) did not reach statistical significance.

"The longer follow-up data revealed weight regain and a decrease in remission rates for type 2 diabetes mellitusand other obesity-related comorbidities. These data should be taken into consideration in the decision-making process for the most appropriate operation for a given obese patient," the authors write.

More information: JAMA Surgery. Published online August 5, 2015. DOI: 10.1001/jamasurg.2015.2202 

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Hello maintenance or the no-stress apathetic no-diet plan for long term WLS patients.

I suppose this is maintenance.

I'll take it.  I apparently maintain at this caloric intake at this activity level.

• Source - http://www.caloriecontrol.org/calculator/weight-maintenance-calculator-women

It's magic. 

I have also been extraordinarily "lazy"  (in Beth terms) in the last 30 days -- with very little gym time. Calorie Control.org doesn't have a setting for extraordinarily lazy - but if they did - or a setting for extraordinarily lazy post bariatric patient who eats 1200-1400 calories per day, that would be me.

PS.  I'm not really that lazy, but, I am not about to own running half-marathons up in this bitch, because, no.

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:

I will see a bounce up because "YAY! MUSCLE!"  Or my trend down will start again - although as it has been - very slowly.  I still have body-fat to lose while I grow/gain muscle which I desperately need.   Either option is fine with me.  I have no goal, other than health with no stress in doing so.

Welcome to the apathetic non-diet plan for WLS'ers.  

It works.  

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.

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!

Beth 

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:

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.  

•  Help the BBGC Help.  

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Do you obsess about your BODY or APPEARANCE? Your brain might be different.

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.

Some post weight loss patients suffer terrible with body dysmorphia -- some to a much lesser degree.

But, could brains actually be different in those who have BDD?

1200 calories burned.

I am not known for being ... "active."

When I post this image, it's a big deal for me.  This indicates that Beth Has Been On The Treadmill For An Hour Almost Every Day 9/10 Days.  I also don't typically chart my activity unless I do something on purpose so - this is "doing something on purpose."

I am trying to make a habit -- to create a new habit -- to learn to enjoy exercise before I develop complete loathing for it.  Because it isn't that I hate exercise, I don't.  I just don't enjoy many of same things that others LIKE to do and I am not cut out for a lot of the things that many of you might enjoy.

For example - I will never be a long distance outdoor runner.   It just won't happen.  I can't run outdoors, unsupervised.  Why? I am an uncontolled epileptic and likely to dash into traffic.  I can't swim alone for the same reason, nor can my kids.  I can't kayak.  I can't use a bike.  Nor can I take my kids on bike rides.   Yeah, yeah.  It sucks.  Whine whine.  LOL.

I CAN walk briskly on a treadmill with a safety clip on - with people around me.   (10 times, 10 hours. 3/5-4 miles each. I haven't fallen.)

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.

I CAN walk with the family away from the road, in the woods, trails, etc.    I can hula hoop.  I can roller skate!   (I just did.)  I can take classes at the gym when I can GET there.   I've been lying to myself about all the "can'ts."  

It is really more about won'ts, isn't it?

So.

I don't really have an excuse.  I CAN.

Dysfunction!

Which will really help when I have to take my neurocognitive testing next week.  My cognition was already a mess, now that I have added Topamax back, there may be zero brains left for an actual many hour test.

Restaurant Discounts For Gastric Bypass Patients May Send Mixed Messages

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.

Even "all-you-can-eat" buffet restaurant Golden Corral provides a discounted buffet price upon seeing a proof-of-surgery card in some locations.

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.

 

Gastric Bypass Benefits Persist at 6 Years' Follow-Up : Surgery News

Gastric Bypass Benefits Persist at 6 Years' Follow-Up : Surgery News.

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.

 

Oh. Yes. She. Did.

Hold the Press Releases, Suz!  

How do you go from not paying your taxes, failure to ship orders since 2011, closing your store, foreclosure, shutting down all communication to... THIS?

20/20 Interview Confessions

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.

How Stress Affects Your Digestion and Weight - Running from a lion!

As I sit here, 11 months into the gut death, I wonder!  This is highly interesting for PRE and POST weight loss surgery patients.

Clear as crystal.

I just read an article titled, " Weight Regain, How Can This Be, I Had The Surgery!"

[PDF]

• Weight Regain? How could this be?! I had the surgery!

Oh, honey, it CAN.

And?  It USUALLY DOES! *Disclaimer for the sparkly bunch -- I'm not here to piss on your rose garden, it just happens.  I wish someone TOLD ME!  I had NO idea so many people regained, struggled, and fought these demons SO hard!

I laughed a little, and then thought back to my own early post op days when I swore that it would "never happen to me," that "I would be THE ONE THAT WOULD BEAT THE ODDS!"

I would reach 100% excess weight loss, because the surgery would give me the power to do it!  I would be in ONEDERLAND in no time at all, and even though the surgeon suggested that a loss of 70% was normal, and that I would land in a somewhat pudgy place in several years, I WOULD DO MORE.

MY POUNDS, would be GONE FOREVER.  Snort.

I would be the Super Loss Girl!  100%!   I will show him!

Yeah.  Sure.  Uh-huh.

(My approximate weights since the birth of baby #4. 210 while with fetus - to 150 - to an ungodly regain again to - 150 again - to 170 at present.)

What I did not realize is that the gastric bypass was A FREE PASS for a year of absolutely NO WORK on my part.  (*Disclaimer:  No, it's NOT EASY, it's physically awful, however, the weight loss happens automatically if you even loosely follow guidelines.)

My weight loss came to a SCREEEEECHING halt early on.  I lost nearly all of my excess weight within a year and then ...

BOOM.

Life happened.  A baby?  Yes.  A baby.  Short version:  miscarriage + pregnant + side effects of pregnancy + issues from gastric bypass = weight gain.  I went from my lowest weight of 149 lbs. to a high weight of 210 lbs. at 38 weeks gestation.  Good times!

Sure, after baby, I dropped the weight, and it was about 1,000,000% harder than the initial loss with the gastric bypass.

But.

BOOM.

Life happened again.  My brain broke. Short version:  Neurological symptoms that started during the pregnancy amplified + turned into epilepsy = weight gain.

I lost some of that weight with the addition of a brain-numbing-psycho-bitch inducing-drug, Topamax.  At a certain point, I had HAD IT with the side effects of the drug and stopped taking it, which caused instant regain.  *thumbsup*

Since my seizures were not well-controlled with a single medication, I was prescribed two.  Again with the Topamax.  The side effects are back, which include:  psycho-bitch, numbness, tingling, brain numbness, loss of words, stupidity, and general malaise and nap time for MM.  (However, the balance of NOT seizing?  It's a toss up.)  At this point, I am simply maintaining, and trending downward with adding exercise in slowly.

I guess my point is  -- regain is real.

It happens.  There can be a trigger.  There can be a cause.  Physical or otherwise, it's not always simply a stack of Ritz Crackers, although... if crackers are your crack?

You can lose it again.  And?  It's not a big deal.  You are NOT a failure by any stretch of the imagination.

10 -  20 - 30 - 40 - 50 pounds?  Really?  Did you not gain 100-200 excess pounds before?  Did you not expect that it might creep back into your life?  History repeats itself.  Chronic dieters, yo-yo dieters, we do this!

I am simply disgusted by the suggestion that those of us who "regain" are "failures" and clearly have no self-control.

Or -- that we are bitter, angry, miserable bitches.  (Well, we can discuss that last part, but I am telling you, this medicine is really making me, "special.")

I'm not bitter or angry, my WLS "worked."  I lost the weight, and that was what it was intended to do.  I struggle, just like most of you do, and not as hard as some of my friends out there.  I'm a "lazy" post op.

Even with everything I deal with, a lot of this came easily to me.  I mean that.  I see how hard some of you struggle and it makes me realize just HOW EASY I have it -- even with my broken head.

I do, however, get angry/motivated when "you" point a finger.

When you suggest that we are "failures," or worse, singling someone else out there who is busting their ASS just trying to get through another day, when you've CLEARLY had an issue maintaining your own <bullshit> 135 pounds. </bullshit>

This is where I'm supposed to insert a little WLS Kum Ba Yah and suggest that we all support each other.  Well,  YOU TOO, start doing it.

PS.  If I ever land myself in a book about WLS -- my fat ass will not be on the cover -- unless it's one of those moving pictures you see on a bookmark.  (Which of course, I can only find in kittens and vampires.)

ASMBS: Gastric Banding Gets Low Marks

ASMBS:  Gastric Banding Gets Low Marks

LAS VEGAS -- Adjustable gastric banding achieves only modest weight loss, and even that benefit deteriorates over time in most patients, a Dutch surgeon said here.

Five years after surgery, about two thirds of patients maintained 25% excess weight loss. At 10 years the success rate dropped to less than a third (31%).