Bariatric Surgery: Caution or Fear?
An impressive new study of ten-year outcomes for bariatric surgery makes us wonder whether it’s caution or fear that is holding people back from choosing to have bariatric surgery. Caution makes perfect sense in thinking about this surgery. Fears are not such good guides.
The new study shows that bariatric surgery patients in the VA system lost substantially more weight than matched controls and that they kept most of that weight off, even after ten years. Only 3.4% of 564 surgery patients regained weight to within 5% of their starting weight after all that time.
In an invited commentary on these results, Jon Gould calls them “remarkable.” He notes that they are especially remarkable because follow-up was so high (82%) in this study.
One of the great concerns for someone considering bariatric surgery the fear of regaining weight after the surgery. This study puts that fear into perspective. Likewise, ample data put the fear of complications into perspective. Complication rates for bariatric surgery are no worse (and perhaps better) than complication rates for gall bladder surgery or knee replacement.
Still, as Gould notes, less than one percent of people with severe obesity elect to have bariatric surgery. More than two-thirds won’t even consider it, citing concerns about complications, as well as expressing some denial about having obesity. The benefits – a longer life, better quality of life, and a healthier life – are clearly defined by good long-term data. But those data are no match for the emotions that surround this surgery.
So we are left to ponder the difference between caution and fear. Caution is rational. Fear is not. It seems that fear is winning.
Click here for the study and here for the commentary. Click here for perspective from ASMBS President Raul Rosenthal on Reeger Cortell’s Weight Loss Surgery Podcast.
Diminished Life, photograph © Strep72 / flickr
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September 2, 2016
September 02, 2016 at 8:34 pm, Brian Trainor said:
Excellent article and very timely. I had just returned from the “Your Weight Matters” National Obesity Conference in Washington DC (#OAC) and this topic was one of many discussed by those in attendance.
In 2014 I had a MIni Gastric Bypass in Tijuana and dropped from a high weight of 354 lbs. I now weigh 183 lbs and besides losing 170 lbs, I also lost diabetes, GERD, sleep apnea, and high BP/Chol. I’ve gone from 15 pills a day to none and now run 10K (6.2 miles) daily all at the tender young age of 60 lol.
I have had zero complications, have not experienced malabsorption in the least. Bariatric surgery was the single most important health decision I’ve ever made. I recognize that the surgery is a tool and not a cure. Eating within the guidelines of a proper post surgery diet as well as daily exercise is part of a lifetime commitment. I can eat whatever I want however because my stomach is the size of an egg, I can’t go nuts thank goodness. I look at it as a taste of whatever I crave but that’s the extent of it.
September 03, 2016 at 5:44 am, Ted said:
Brian, thanks for sharing your experience here and YWM2016. It was great meeting you and learning from you.
September 14, 2016 at 8:41 am, Brian Edwards MD said:
ConscienHealth is a great news service, and I hope you can answer this question. Why are surgeons not required to give intention to treat results?
The study did 1787 RYGB surgeries.
What happened to the other 1223 patients that had RYBG surgery?
I understand it is a cohort study and they want to match patients but I would also like to know the “waterfall” results of all 1787 patients that had surgery. LOOK AHEAD gave these results.
I went to a conference on Obesity in Washington DC in October 2015. Dr. Denis Halmi gave a lecture titled Recidivism after Bariatric Surgery.
The most important fact I took away from that lecture on Bariatric surgery was:
“30% of patients regain the lost weight by 10 years”
I bet if we get the data on all 1787 RYBG patients that will be the number of patients who gained all their weight back after 10 years.
I suspect many of these patients not included in the surgery had repeat surgery. The sad fact is that we now have four new diet medications to help these patients prevent regain. Lets hope the drugs will be are going to be implemented.
September 14, 2016 at 2:37 pm, Ted said:
Brian, thanks for your comments and questions. Your speculation is incorrect. Not all 1787 patients in the study had reached 10 years because many of them had their surgery less than 10 years before the analysis. Of the 700 RYGB patients for whom 10 or more years had passed, follow-up data was available for 81.9% of them. That’s remarkably high follow up for such a study as the commentary notes. Only 3.4% of those patients with follow up data regained weight to within 5% of their baseline weight.