Left - Fitbloggin' 2012 Right - This Week - Lost the regain - Also, 3 pounds to my lowest weight.
Several years ago, a woman messaged on a weight loss surgery forum and told me that my weight chart resembled a roller-coaster and that she wanted to "help me get control." After a quick Google search -- I noted she was seeking a new client for her weight loss surgery coaching business and dumped her "friendship."
Friends do not pay friends to help them lose weight, maintain weight loss or to help them lose regained weight after weight loss surgery. If you are paying someone for your friendship, it might be time to redefine that friendship -- just saying. I suppose this changes if your friend happens to be a weight loss professional? But how often does that happen -- and how many weight loss professionals would potentially destroy a friendship with aligning with your weight loss journey?
Um. No. A professional would NOT.
Weight loss is personal.
It is something you choose for yourself when you are ready.
Weight loss is not something you can be talked into - nor shamed into.
Regain after weight loss surgery is also a very touchy subject. Countless bariatric patients go through it -- and less want to talk about it. But it seems like everyone wants to sell "us" something to fix it.
Let me repeat -
Weight loss is personal.
It is something you choose for yourself when you are ready.
Weight loss is not something you can be talked into - nor shamed into.
Yet it seems like the larger community wants "us" (the regainers) to feel shamed for regaining and wants to sell us another quick-fix.
Let us discuss: Regain is common. How much? Some is very typical. Sometimes even a lot of regain is normal. You do not have to be sold into another diet, quick-fix, or scam. You need to remind yourself why you had weight loss surgery to begin with --
GET. YOUR. COLONOSCOPIES. IT COULD SAVE YOUR LIFE. Don't be scared. It's no big thing. Really. The preparation is harder than the procedure. (My spouse is at this very moment, searching for a GI to make that appointment he canceled more than five years ago. He's a high-risk patient with family history.)
With that, I tell you - BOTTOMS UP!
(Reuters Health) - Obesity is already linked to a higher risk of colon or rectal cancer, but a new study suggests this risk is even greater for obese people who have undergone weight-loss surgery.
Based on a study of more than 77,000 obese patients, Swedish and English researchers found the risk for colorectal cancer among those who have had obesity surgery is double that of the general population.
Though colorectal cancer risk among obese patients who didn't have the surgery was just 26 percent higher than in the general population, researchers said the results should not discourage people from going under the knife.
"These findings should not be used to guide decisions made by patients or doctors at all until the results are confirmed by other studies," said Dr. Jesper Lagergren, the new study's senior author and a professor at both the Karolinska Institute in Stockholm and King's College London.
Each year more than 100,000 people in the U.S. have surgery to treat obesity.
Lagergren and his colleagues point out in their report, published in the Annals of Surgery, that obesity is tied to elevated risks for a number of cancers, including colorectal, breast and prostate (see Reuters Health story of November 3, 2011 here: reut.rs/t9sYxO).
Whether surgery to lose weight can affect those risks is uncertain.
Two earlier studies, one from the U.S. and the other from Sweden, found that the chances of obesity-related cancers decline after women have weight-loss surgery.
But an earlier study from Lagergren's group found the risks for breast and prostate cancers were unaffected by obesity surgery, and colorectal cancer risk increased.
To investigate that finding further, Lagergren's team collected 29 years' worth of medical records on more than 77,000 people in Sweden who were diagnosed as obese between 1980 and 2009. About 15,000 of them underwent weight loss surgery.
In the surgery group, 70 people developed colorectal cancer - a rate that was 60 percent greater than what would be expected for the larger Swedish population.
When the researchers looked only at people who had surgery more than 10 years before the end of the study period, the number of cancer cases was 200 percent greater than the expected risk for the general population.
In contrast, 373 people in the no-surgery group developed colorectal cancer, which was 26 percent more than would be expected in the population and that number remained stable over time.
A two-fold increased risk for colorectal cancer is not a "negligible risk increase, but it should not be of any major concern for the individual patient since the absolute risk is still low," Lagergren told Reuters Health in an email.
In the U.S., for instance, 40 out of every 100,000 women and roughly 53 out of every 100,000 men develop colorectal cancer each year.
Doubling that risk would make the annual figures 80 out of every 100,000 women and 106 out of every 100,000 men.
Lagergren said that more studies are needed to confirm his results before they should be included in clinical decision-making about whether patients should undergo weight-loss surgery.
The study results cannot prove that the surgery is the cause of the elevated cancer risk.
And, Lagergren says it's also not clear why the surgery might be tied to an elevated risk of colorectal cancer.
One possibility is that dietary changes after surgery, and increasing protein in particular, could raise cancer risk, he speculated.
Because the gut plays a significant role in the immune system, he added, "Another potential factor is that the bacteria that naturally reside in the intestines may change after surgery and alter future cancer risk."
Lagergren noted that he also couldn't rule out the possibility that residual excess weight and weight gain after surgery might be involved.
SOURCE: bit.ly/10TcCGy Annals of Surgery, online March 6, 2013
Objective: The purpose was to determine whether obesity surgery is associated with a
long-term increased risk of colorectal cancer.
Background: Long-term cancer risk after obesity surgery is not well characterized.
Preliminary epidemiological observations and human tissue biomarker studies recently
suggested an increased risk of colorectal cancer after obesity surgery.
Methods: A nationwide retrospective register-based cohort study in Sweden was
conducted in 1980-2009. The long-term risk of colorectal cancer in patients who
underwent obesity surgery, and in an obese no surgery cohort, was compared with that of
the age-, sex- and calendar year-matched general background population between 1980
and 2009. Obese individuals were stratified into an obesity surgery cohort and an obese
no surgery cohort. The standardized incidence ratio (SIR), with 95% confidence interval
(CI), was calculated.
Results: Of 77,111 obese patients, 15,095 constituted the obesity surgery cohort and 62,016
constituted the obese no surgery cohort. In the obesity surgery cohort, we observed 70
patients with colorectal cancer, rendering an overall SIR of 1.60 (95% CI 1.25-2.02). The
SIR for colorectal cancer increased with length of time after surgery, with a SIR of 2.00
(95% CI 1.48-2.64) after 10 years or more. In contrast, the overall SIR in the obese no
surgery cohort (containing 373 colorectal cancers) was 1.26 (95% CI 1.14-1.40) and
remained stable with increasing follow-up time.
Conclusions: Obesity surgery seems to be associated with an increased risk of colorectal
cancer over time. These findings would prompt evaluation of colonoscopy surveillance for the increasingly large population who undergo obesity surgery.
Did your nutritionist give YOU guidance in regards to carbohydrate intake after your roux en y gastric bypass surgery?
Background: Exact carbohydrate levels needed for the bariatric patient population have not yet been defined. The aim of this study was to correlate carbohydrate intake to percent excess weight loss for the bariatric patient population based on a cross-sectional study. The author also aimed to review the related literature.
Materials and Methods: A cross-sectional study was conducted, along with a review of the literature, about patients who underwent Roux-en-Y gastric bypass at least 1 year previously. Patients had their percentage of excess weight loss calculated and energy intake was examined based on data collected with a four-day food recall. Patients were divided into two groups: 1) patients who consumed 130g/day or more of carbohydrates and 2) patients who consumed less than 130g/day of carbohydrates.
Limitations: The literature review was limited to papers published since 1993.
Results: Patients who consumed 130g/day or more of carbohydrates presented a lower percent excess weight loss than the other group (p= 0.038). In the review of the literature, the author found that six months after surgery patients can ingest about 850kcal/day of carbohydrates, 30 percent being ingested as lipids. A protein diet with at least 60g/day is needed. On this basis, patients should consume about 90g/day of carbohydrates. After the first postoperative year, energy intake is about 1,300kcal/day and protein consumption should be increased. We can, therefore, establish nearly 130g/day of carbohydrates (40% of their energy intake)
Conclusions: Based on these studies, the author recommends that 90g/day is adequate for patients who are six months post Roux-en-Y gastric bypass and less than 130g/day is adequate for patients who are one year or more post surgery.
The author concludes that maintaining carbohydrate consumption to moderate quantities and adequate protein intake seems to be fundamental to ensure the benefits from bariatric surgery.
I am approximately five pounds above my very lowest post op weight, which I saw one year post op before I got pregnant and right before I bounced up to 175 lbs. I will say this, my lower weight looks different the second time around. That first low-weight crash post surgery looks like death-warmed over. I look healthier now, and I think it's honestly because I eat food now and haven't had a massive weight loss like in 2004.
People have asked me "What are you doing differently now?"
Food journaling and keeping myself aware of the calories I take in. I don't journal everyday, but I DO journal.
I stopped using soy milk, and swapped to unsweetened almond milk in my coffee and for whatever other "milk" uses I have. I don't use dairy milk at all.
I quit my Starbucks habit pretty much altogether. I get an iced coffee or cappuccino if someone else takes ME out for coffee, but it's rare, and definitely less than once a week. Dunkin Donuts iced coffee, once a week.
No crackers. If I must, one serving, with protein.
No potato chips, etc.
No candy, only super dark 70%+ chocolate if I must have something. One serving.
No protein bars, except to review them, unless I am REPLACING A MEAL with one.
No protein shakes, except to review them, unless I am REPLACING A MEAL with one.
This isn't "new" - but zero alcohol in my house. It's just a rule. If it's not here, I can't have it. It's just the rule.
If there's one thing I have learned this year - it's that I can't graze without noting. I can't just nibble all day long and expect that I won't see gains, because I do. I gain very fast on relatively low calories.
I have also learned that giving up things I can't control - stressors - outside influences - people, even - helps. I started losing the weight as soon as I made this connection.
Look at my weight loss timeline. Look at the dates.
Now look at my regain photos from the last year - same timing.
Seems easy enough, right?
Let. it. go.
âYou will find that it is necessary to let things go; simply for the reason that they are heavy. So let them go, let go of them. I tie no weights to my ankles.â â C. JoyBell C.
People CAN be TOXIC to your HEALTH. Let. them. go.
(*Not the ones in this photo. LOL. But, I am also 25 lbs lighter SINCE these photos and the timeline. It's a visual.)
PS. I THINK every single thing I voted for, won too! ;) We're a great community sometimes.
xo
The WLS Awards are *nominated by* and *voted on* by members of the WLS Community. Any person, business, or charitable organization that is part of the weight loss surgery and bariatric community is eligible, EXCEPT Diva Taunia and last year's winners.
I'm not a shopper. Since I work from home, I rarely get new clothes.
The other day I noticed that New York + Co had a 50% off everything sale and went in. The saleswoman said to me, "You look like you'd rather be anywhere but here."
I told her that I am not fan of clothes shopping, and she called me "Cute," and "Small."
Small. Snort.
I laughed, and realized soon why I have so much dismay for clothes shopping. THE FITTING ROOM. THE LIGHTS.
THE VARICOSE VEINS. I have the legs of an 80 year old woman.
It's not about SIZES or the number on my scale, because I am nearly to my lowest weight. I reached my lowest weight just after one year post op, I hit 149 pounds for one day and regained immediately.
I am 156 pounds today.
I still don't like the melted candle puddle of skin that I have -- nine years later. Full honesty, I am FINE with it once I am wearing appropriate undergarments and everything is in it's place, but even in a size 8P (I also bought a pair of 6P) - sometimes you feel like a puddle of flesh.
ObesityHelp is excited to announce the 10th Annual ObesityHelp National Conference at the Crowne Plaza in Anaheim, California on October 4th and 5th, 2013. The ObesityHelp National Conference is a celebration of health and wellness for those navigating their weight loss surgery journey. Youâll walk away inspired, motivated and with a larger support system than you started with. You will be part of change, gain knowledge from experienced professionals, and witness (or have your own) non-scale victories right at the conference.
The Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient has been updated for the first time since 2008. There are changes and updates and suggestions for your clinicians - the entire text is available online below -
Abstract: The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol.
Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery forpatients with mild obesity, copper deficiency, informed consent, and behavioral issues.
A lifetime history of substance abuse disorder is more likely in bariatric surgery candidates compared with the general population (211 [EL 3, SS]). In contrast, current alcohol and substance abuse in bariatric surgery candidates is low compared with the general population (211 [EL 3, SS]). The LABS study demonstrated that certain groups including those with regular preoperative alcohol consumption, alcohol use disorder, recreational drug use, smokers, and those undergoing RYGB had a higher risk of postoperative alcohol use disorder (212 [EL 2, PCS]). A web-based questionnaire study indicated that 83% of respondents continued to consume alcohol after RYGB, with 28.4% indicating a problem controlling alcohol (213 [EL 3, SS]). In a prospective study with 13- to 15-year follow-up after RYGB, there was an increase in alcohol abuse (2.6% presurgery to 5.1% postsurgery) but a decrease in alcohol dependence (10.3% presurgery versus 2.6% postsurgery) (214 [EL 2, PCS]). In a survey 6-10 years after RYGB, 7.1% of patients had alcohol abuse or dependence before surgery, which was unchanged postoperatively, whereas 2.9% admitted to alcohol dependence after surgery but not before surgery (215 [EL 3, SS]). Finally, in a retrospective review of a large electronic database, 2%-6% of bariatric surgery admissions were positive for a substance abuse history (216 [EL 3, SS]). Interestingly, 2 studies have demonstrated better weight loss outcomes among patients with a past substance abuse history compared with those without past alcohol abuse.
Bariatric surgery remains a safe and
effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
Obesity continues to be a major public health problem in the United States, with more than one third of adults considered obese in 2009- 2010, as defined by a body mass index (BMI) 30 kg/m2 (1 [EL 3, SS]). Obesity has been associated with an increased hazard ratio for all-cause mortality (2 [EL 3, SS]), as well as significant medical and psychological co-morbidity. Indeed, obesity is not only a chronic medical condition but should be regarded as a bona fide disease state (3 [EL 4, NE]). Nonsurgical management can effectively induce 5%-10% weight loss and improve health in severely obese individuals (4 [EL 1, RCT]) resulting in cardiometabolic benefit. Bariatric surgery procedures are indicated for patients with clinically severe obesity. Currently, these procedures are the most successful and durable treatment for obesity. Furthermore, although overall obesity rates and bariatric surgery procedures have plateaued in the United States, rates of severe obesity are still increasing and now there are approximately 15 million people in the United States with a BMI 40 kg/m2 (1 [EL 3, SS]; 5 [EL 3, SS]). Only 1% of the clinically eligible population receives surgical treatment for obesity (6 [EL 3, SS]). Given the potentially increased need for bariatric surgery as a treatment for obesity, it is apparent that clinical practice guidelines (CPG) on the subject keep pace and are kept current.
Since the 2008 TOS/ASMBS/AACE CPG for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient (7 [EL 4; CPG]), significant data have emerged regarding a broader range of available surgeries for the treatment of obesity. A PubMed computerized literature search (performed on December 15, 2012) using the search term ââbariatric surgeryââ reveals a total of 14,287 publications with approximately 6800 citations from 2008 to 2012. Updated CPG are therefore needed to guide clinicians in the care of the bariatric surgery patient.
What are the salient advances in bariatric surgery since 2008?
The sleeve gastrectomy (SG; laparoscopic SG [LSG]) has demonstrated benefits comparable to other bariatric procedures and is no longer considered investigational (8 [EL 4, NE]).
A national risk-adjusted database positions SG between the laparoscopic adjustable gastric band (LAGB) and laparoscopic Roux-en-Y gastric bypass (RYGB) in terms of weight loss, co-morbidity resolution, and complications (9 [EL 2, PCS]).
The number of SG procedures has increased with greater third-party pay or coverage (9 [EL 2, PCS]).
Other unique procedures are gaining attention, such as gastric plication, electrical neuromodulation, and endoscopic sleeves, but these procedures lack sufficient outcome evidence and therefore remain investigational and outside the scope of this CPG update.
There is also emerging data on bariatric surgery in specific patient populations, including those with mild to moderate obesity, type 2 diabetes (T2D) with class I obesity (BMI 30-34.9 kg/m2), and patients at the extremes of age. Clinical studies have demonstrated short-term efficacy of LAGB in mild to moderate obesity (10 [EL 1, RCT]; 11 [EL 2, PCS]; 12 [EL 2, PCSA]; 13 [EL 3, SS]), leading the Food and Drug Administration (FDA) to approve the use of LAGB for patients with a BMI of 30 to 35 kg/m2 with T2D or other obesity-related co-morbidities (14 [EL 4, NE]). Although controversial, this position was incorporated by the International Diabetes Federation, which proposed eligibility for bariatric procedures in a subset of patients with T2D and a BMI of 30 kg/m2 with suboptimal glycemic control despite optimal medical management (15 [EL 4, NE]). Thus, the term metabolic surgery has emerged to describe procedures intended to treat T2D as well as reduce cardiometabolic risk factors. In 1 study, metabolic surgery was shown to induce T2D remission in up to 72% of subjects at 2 years; however, this number was reduced to 36% at 10 years (16 [EL 2, PCS]). In a more recent study, patients who underwent RYGB sustained diabetes remission rates of 62% at 6 years (17 [EL 2, PCS]). The overall long-term effect of bariatric surgery on T2D remission rates is currently not well studied. Additionally, for patients who have T2D recurrence several years after surgery, the legacy effects of a remission period on their long-term cardiovascular risk is not known. The mechanism of T2D remission has not been completely elucidated but appears to include an incretin effect (SG and RYGB procedures) in addition to caloric restriction and weight loss. These findings potentially expand the eligible population for bariatric and metabolic surgery.
Jeffrey I. Mechanick, Adrienne Youdim, Daniel B. Jones, W. Timothy Garvey, Daniel L. Hurley, M. Molly McMahon, Leslie J. Heinberg, Robert Kushner, Ted D. Adams, Scott Shikora, John B. Dixon and Stacy Brethauer
Article first published online: 26 MAR 2013 | DOI: 10.1002/oby.20461
Gastric bypass surgery is something of a medical marvel. In Roux-en-Y surgery, a small pouch is made from part of your stomach, building a new, smaller one. The pouch is then connected to the middle portion of the small intestine (the jejunum), bypassing the upper part (the duodenum). Because your new stomach is about 90% smaller than your old one, you feel full with much smaller amounts of food and take in many fewer calories. Another popular smaller-stomach operation is adjustable gastric band surgery, in which an inflatable silicone device is placed around the top of the stomach.
In all, the American Society for Metabolic and Bariatric Surgery estimates that approximately 200,000 people have bariatric surgery every year. The Roux-en-Y operation generally costs between $15,000 and $30,000; the band is cheaper by about $10,000. Many private insurance policies offer no coverage for what they consider an elective procedure.
There have been previous reports of bariatric surgery patients having serious trouble with alcohol use after their surgeries. A 2012 Archives of Surgery study by the New York Obesity Nutrition Research Center looked at 100 people who had Roux-en-Y and 55 who had the adjustable band. The post-op patients were significantly more likely than the general population to use addictive substances, especially two years after the procedures. The Roux-en-Y cohort seemed particularly susceptible to alcohol use.
If food has always been your drug, and surgery abruptly denies you your fix, you turn to other drugs.
A much larger 2012 study in the Journal of the American Medical Association came to a similar conclusion. University of Pittsburgh researchers followed almost 2,000 people who had Roux-en-Y, adjustable band or another weight-loss surgery. Before their operations, 7.6% of the group abused alcohol; after the knife, 9.6% did so. And, the patients who had the Roux-en-Y surgery were twice as likely to abuse alcohol as those who had the gastric band.
Health experts have long known that obesity and depression often go hand-in-hand. Depression can lead to becoming obese, and the opposite is also true. Many obese people are depressed before they have surgery and are therefore at high risk of depression afterward. For one thing, recovery is a slow process, and health complications of the surgery are very common; 40% of patients suffer from infection and post-operative bleeding. Perhaps more important, bariatric surgery is no magic bullet, and some patients become disillusioned as they realize that in order to "solve" their serious weight problems, they have to maintain good eating and exercise habitsâlifestyle changes that likely proved elusive in the past.
Addiction experts see the problem as one of switching addictions. People become obese because they use eating as a drug. Excessive eating is a form of self-medication for painful feelings associated with depression, anxiety and deeper personality disorders. Like most drugs, food, especially carbs and sugars, trigger the brain's reward pathways, causing a feeling of pleasure. But sustained excessive eating causes the brain to lose its capacity to produce these feel-good chemicals. That's whenaddiction starts.
Weight-loss surgery fixes the outside of a person, but not the inside. While it can reduce the harm of obesity, it leaves the needs driving your addiction untouched. So if food has always been your drug, and stomach-minimizing surgery abruptly denies you your fix, you turn to other drugs. Alcohol, being legal, is the most available, but patients can take their pick among the panoply of addictive substances.
Hogwash, says John Morton, MD, a bariatric surgeon at the Stanford School of Medicine and member of the executive council of the American Society for Metabolic and Bariatric Surgery. Like many other surgeons who specialize in this procedure, he favors a physical rather than a psychological or switching-addiction explanation for the high risk of alcohol abuse. "[There is a] heightened sensitivity to alcohol [and it is] purely physiologic," Morton says. Along with the liver, the stomach produces alcohol dehydrogenase, an enzyme that breaks down alcohol into other, less toxic molecules. Because gastric bypass patients have much less stomach, and therefore less of that enzyme, more alcohol enters their bloodstream.
"As a result," Morton says, "you get drunker faster and stay drunker longer." The same phenomenon occurs with people who have their stomachs removed because of cancer. If alcohol abuse in bariatric patients were due to psychological issues, you wouldn't expect cancer patients to have greater alcohol sensitivity, Morton argues.
Mitch Roslin, MD, a specialist in bariatric medicine at New York's Lenox Hill Hospital, agrees. He calls the switching-addictions theory "BS.â Drinking alcohol in your post-Roux-en-Y life is "the epitome of drinking on an empty stomach"âafter all, your stomach is almost nonexistent. "Essentially," Roslin says, "drinking alcohol after Roux-en-Y is like having an alcohol IV."
"Essentially, drinking alcohol after Roux-en-Y is like having an alcohol IV," Roslin says.
But why does alcohol sensitivity show up more in the second year after the surgery? Roslin suggests that the second year is when you realize that your surgery will not, by itself, keep you healthy, that you do indeed have to "fix the inside." At that point, you might feel depressed, use alcohol to escape and comply less with your post-op instructions.
Mortonâs and Roslinâs explanations may account for why people who have had gastric bypasses can get a buzz by drinking a small amount of alcohol, but they don't quite explain why some people who never abused booze before end up becoming post-op alcoholics. Nor do they account for another, even more serious, health risk for people who have had gastric bypasses: suicide.
Two recent studiesâin Pennsylvania and Utahâreinforce the link between obesity and emotional distress by focusing on suicide rates. A study of 17,000 weight-loss surgeries performed in Pennsylvania from 1995 to 2004 showed a surprisingly high incidence of suicide. Of the 440 deaths that occurred, 16 resulted from suicide or drug overdose; by comparison, the rate for the general population is only three. And this August, a study published in The New England Journal of Medicineshowed that a group of almost 10,000 bariatric patients had a 58% higher than average risk of dying in an accident or suicide. When the bariatric patients' suicide rate was compared to that of obese people who had not had surgery, it was close to double, 11.1 per 10,000 compared to 6.4 per 10,000.
When the high risk of suicide is coupled with the high risk of alcohol abuse, a psychological, if not a switching-addiction, explanation is almost inescapable. Patients may be aware of these risks, but the need for the surgery overrides such concerns. While prospective patients often undergo psychological evaluations before the procedure, doctors often do not follow up with the patients and patients often do not participate in post-surgery counseling. The addiction to food is typically viewed as more or less having been "treated" by the gastric bypass. The danger of developing a new addiction remains low on the list of health priorities.
There is no denying the benefits of bariatric surgery. Without it, many people struggling with obesity would be doomed to lives burdened with diabetes, heart disease, mobility problems and high risk of stroke and early death. At the same time, it's clear that the surgery's benefits would be increased by improved screening of patients for mental health problemsâand addictionâbefore surgery as well as deeper, longer counseling afterward. This may mean fewer people will be eligible for the surgeryâa prospect that neither doctors nor patients would embrace. At the very least, reframing how patients understand the surgery is in order: It is not a magic bullet but one in a serious of interventions that are, like it or not, lifelong.
Weight loss surgery does not lower health costs over the long run for people who are obese, according to a new study. Shocking? Meh. No.
Pre-op patients don't want to know this sticky business, so maybe you should close your eyes or click away. NOW. I don't want to pop your bubbles. I am not in the biz of selling weight loss surgery up in heah.
I don't think it would come as a surprise to many long-term post bariatric patients. I know you understand. We live it.
But that is just me, consider my stance as a nine year gastric bypass post op, married to a nine year gastric bypass post op, with a mother in law and sister in law who are both gastric bypass post ops. Collectively we have about 30 years of missed "obesity" costs, but we have increased our health-care costs in other areas. (*Looks at my current tally at the hospital.*)
The four of US (yes, this is totally biased because it is my immediate circle and what I know...this is understood, I am not arguing, I do not care to sell WLS nor unsell it!) are currently all maintaining a normal or slightly overweight body weight 6-9 years post bariatric surgery, however between us, we have created some seriously HUGE bills and other health conditions since having weight loss surgery. (I have not shared much of it because I'm already TMI and HIPPA cries.)
Imagine now if any of us have a full and complete regain - which is a totally and absolutely typical pattern. What then of our health? What if we have the comorbids of obesity come back? (Some of which don't always go away.... have you met my legs?) Just saying. I know we have made it this far, but it has NOT been cheap.
Some researchers had suggested that the initial costs of surgery may pay off down the road, when people who've dropped the extra weight need fewer medications and less care in general.
The new report joins other recent studies challenging that theory (see Reuters Health story of Jul 16, 2012 here: reut.rs/NrQKPU).
But, he added, "We need to view this as the serious, expensive surgery that it is, that for some people can almost save their lives, but for others is a more complex decision."
According to the American Society for Metabolic and Bariatric Surgery, about 200,000 people have weight loss surgery every year.
Surgery is typically recommended for people with a body mass index (BMI) - a measure of weight in relation to height - of at least 40, or at least 35 if they also have co-occurring health problems such as diabetes or severe sleep apnea.
A five-foot, eight-inch person weighing 263 pounds has a BMI of 40, for example.
For their study, Weiner and his colleagues tracked health insurance claims for almost 30,000 people who underwent weight loss surgery between 2002 and 2008. They compared those with claims from an equal number of obese people who had a similar set of health problems but didn't get surgery.
As expected, the surgery group had a higher up-front cost of care, with the average procedure running about $29,500.
In each of the six years after that, health care costs were either the same among people who had or hadn't had surgery or slightly higher in the bariatric surgery group, according to findings published Wednesday in JAMA Surgery.
Average annual claims ranged between $8,700 and $9,900 per patient.
Weiner's team did see a drop in medication costs for surgery patients in the years following their procedures. But those people also received more inpatient care during that span - cancelling out any financial benefits tied to weight loss surgery.
One limitation of the study was that only a small proportion of the patients - less than seven percent - were tracked for a full six years. Others had their procedures more recently.
The study was partially funded by surgical product manufacturers and pharmaceutical companies, including Johnson & Johnson and Pfizer. Claims data came from BlueCross BlueShield.
It's clear that surgery can help people lose weight and sometimes even cures diabetes, Weiner told Reuters Health. But it might not be worthwhile, or cost-effective, for everyone who is obese.
That means policymakers and companies will have to decide who should get insurance coverage for the procedure and who shouldn't.
"It's showing that bariatric surgery is not reducing overall health care costs, in at least a three- to six-year time frame," said Matthew Maciejewski, who has studied that topic at the Center for Health Services Research in Primary Care at the Durham VA Medical Center in North Carolina, but wasn't involved in the new study.
"What is unknown is whether there's some subgroup of patients who seem to have cost reductions," he told Reuters Health.
In the meantime, whether or not to have weight loss surgery is still a personal decision for people who are very obese, Weiner said.
"Every patient needs to talk it through with their doctor," he said. "It obviously shouldn't be taken lightly, but shouldn't be avoided either."
SOURCE: bit.ly/K8qAyI JAMA Surgery, online February 20, 2013.
Importance Bariatric surgery is a well-documented treatment for obesity, but there are uncertainties about the degree to which such surgery is associated with health care cost reductions that are sustained over time.
Objective To provide a comprehensive, multiyear analysis of health care costs by type of procedure within a large cohort of privately insured persons who underwent bariatric surgery compared with a matched nonsurgical cohort.
Design Longitudinal analysis of 2002-2008 claims data comparing a bariatric surgery cohort with a matched nonsurgical cohort.
Setting Seven BlueCross BlueShield health insurance plans with a total enrollment of more than 18 million persons.
Participants A total of 29 820 plan members who underwent bariatric surgery between January 1, 2002, and December 31, 2008, and a 1:1 matched comparison group of persons not undergoing surgery but with diagnoses closely associated with obesity.
Main Outcome Measures Standardized costs (overall and by type of care) and adjusted ratios of the surgical group's costs relative to those of the comparison group.
Results Total costs were greater in the bariatric surgery group during the second and third years following surgery but were similar in the later years. However, the bariatric group's prescription and office visit costs were lower and their inpatient costs were higher. Those undergoing laparoscopic surgery had lower costs in the first few years after surgery, but these differences did not persist.
Conclusions and Relevance Bariatric surgery does not reduce overall health care costs in the long term. Also, there is no evidence that any one type of surgery is more likely to reduce long-term health care costs. To assess the value of bariatric surgery, future studies should focus on the potential benefit of improved health and well-being of persons undergoing the procedure rather than on cost savings.
A clinical trial at Beth Israel Medical Center in Boston, MA is under way where a group of people who have had gastric banding surgery undergo non-invasive brain stimulation. Video is at the link.
If there was ever a motivation to get active, here it is -
Just one hour of moderate-intensity physical activity a week â or eight minutes a day â was associated with 92 percent lower odds of treatment for depression or anxiety among adults with severe obesity.
That's TWO songs-worth of dances.
Let's go.
Here is 6:20 worth, dance! Walk, bounce, march, whatever you can!
Adults undergoing bariatric surgery who are more physically active are less likely to be depressed, according to a new study, which found that being active for as little as eight minutes a day made a difference.
âTypically, clinical professionals manage their patientsâ depression and anxiety with counseling and/or antidepressant or anti-anxiety medication,â she said. âRecent research has focused on physical activity as an alternative or adjunct treatment.â
Just one hour of moderate-intensity physical activity a week â or eight minutes a day â was associated with 92 percent lower odds of treatment for depression or anxiety among adults with severe obesity.
Similarly, just 4,750 steps a day â less than half the 10,000 steps recommended for a healthy adult â reduced the odds of depression or anxiety treatment by 81 percent.
âIt could be that, in this population, important mental health benefits can be gained by simply not being sedentary,â said King, who also was the lead author of the study.
The researcher notes it is important to treat depression and anxiety prior to bariatric surgery. Preoperative depression and anxiety increase the risk of these conditions occurring after surgery â and have been shown to have a negative impact on long-term surgically induced weight loss.
As part of the Longitudinal Assessment of Bariatric Surgery-2, an observational study designed to assess the risks and benefits of bariatric surgery, King and her colleagues assessed participantsâ physical activity for a week prior to undergoing bariatric surgery using a small electronic device worn above the ankle. Participants also completed surveys to assess mental health, symptoms of depression, and treatment for psychiatric and emotional problems, including depression and anxiety.
The study included 850 adults who were seeking bariatric surgery between 2006 and 2009 from one of 10 different hospitals throughout the United States.
Approximately one-third of the participants reported symptoms of depression, while two in five reported taking medication or receiving counseling for depression or anxiety.
The researchers noted that the link between physical activity and less depression was strongest when only moderate intensity physical activity was considered. However, the number of steps a person walked each day, no matter the pace, also was related.
âAnother goal of this study was to determine physical activity thresholds that best differentiated mental health status,â said King. âWe were surprised that the thresholds were really low.â
Because this was an observational, cross-sectional study â meaning patientsâ regular physical activity and symptoms of depression were measured at the same time â the study could not prove that a patientâs physical activity influenced mental health.
âResults of the study are provocative, but we would need further research to verify that physical activity was responsible for lower levels of depressive symptoms in this patient population,â said study co-author Melissa A. Kalarchian, Ph.D., associate professor at Western Psychiatric Institute and Clinic, part of University of Pittsburgh Medical Center (UPMC). âNonetheless, physical activity is a key component of behavioral weight management, and it is encouraging to consider that it may have a favorable impact on mental health as well.â
Bariatric surgery led to sustained improvements in left ventricular mass and diastolic function in morbidly obese teenagers, a researcher reported here.
But, she noted, "even though the measures are significantly better, they're still not normal," indicating that interventions might have to occur sooner.
"These data support a more aggressive preventive approach to adolescent weight issues," Ippisch said.
The prevalence of childhood obesity has risen from about 5% in the 1970s to about 17% today, according to Stephen Daniels, MD, PhD, MPH, of Children's Hospital in Denver, who moderated a press conference at which the results were presented.
The severity of obesity has increased as well, he said, making bariatric surgery a treatment consideration for some of these kids.
Consensus criteria generally reserve bariatric surgery for children with a body mass index over over 50 kg/m2 or for those with a BMI over 40 kg/m2 and serious comorbidities such as obstructive sleep apnea and type 2 diabetes.
Ippisch said leaner children might qualify for bariatric surgery depending on the burden of comorbidities.
I received my issue, issues (two, because we have two memberships!) of Your Weight Matters Magazine from the Obesity Action Coalition today. I got a little bit excited because the recap of the National YWM Convention was in there, and yes, that's me up there, OAC Advocate of the Year. This is my digital-clipping of said event!
It's all online - get into it - to view a full PDF version of this issue, pleaseclick here.
"I am the âafterâ side of surgery, having lost more than 250 pounds. No one gets this, at least not without an explanation, because I still weigh over 200 pounds, and the weight loss fable is supposed to end when youâre thin, not when youâre merely âan average fat American.â
Yes, some of us do "get it."
This is a powerful article a friend of mine who happens to be a special kind of "after" (which is not the kind of " air quotes" that indicate failure, but that she has SHIT TO DEAL WITH and y'all need to stop judging a person at first glance, you know?) posted in my BBGC support group. Thank you, Sarah. I GET IT. Some of us DO. Rawr.
Please read it. Please open your mind to all "afters," and stop the WLS shaming.
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 (â¥10 years) and finding the same weight loss of 47% excess weight loss for the much larger group."
"There's a group of us out there who have had weight loss surgery who are athletes now. I never felt comfortable saying that," said Smith.
But her coach at SBR Coaching in Verona has called her that for a long time."I've never worked with anybody quite like Aimee. She started her journey by losing the weight and not knowing quite what to do only that she thought she was going to die and she needed to do something," said the coach.
(This would have been a super time to try out my brand-new Nikon, so as not to take a iPad shot of a mobile phone photo?)
My good friend Wendy heard that Al Roker had a live book signing near her hometown last night, so like a good Bariatric Bad Girl, she went!
I didn't see her Facebook message to ME until the moment she was Sitting In the Bookstore With My Name On A Sticky-Note For Mr. Roker To Sign when I realized what was going on. (This is partly because I am without cell-plan, and only see messages when I am near the computer now. So, sorry?!) When I saw this I was like like, "Why is Wendy at a party with resin lawn chairs in January -- with a book -- wai -- wha??"
And then I remembered the proximity of her stalkery locale to New York City (no comment from the peanut gallery) and this happened.
Wendy had a brief opportunity to talk to chat with Mr. Roker about the BBGC Bariatric Bad Girls Club and discussed fundraising we've done with the Obesity Action Coalition. Thank you, Wendy -- and thank you Al!
