'Outeating' Weight-Loss Surgery:
Gee, I bet every person here could have told them this....
High-Calorie Grazing Negates Results
By Tara Parker-Pope
Wall Street Journal
Celebrities like Al Roker and singer Carnie Wilson have fueled an
unprecedented boom in weight-loss surgery. But for many patients, the
procedure doesn't live up to the hype.
A small but significant number of patients who have weight-loss
surgery regain much or all of their weight back after a few years.
Despite anatomical changes that make it impossible to binge or eat
large quantities of food, some patients learn to "outeat" the
surgery, grazing on small portions of high-calorie foods throughout
the day. Other patients lose only a fraction of the weight expected
and remain significantly overweight following the surgery.
No one knows for sure how common the problem is, but estimates of
these "failures," as they are known among surgeons, range from 5% to
20% of patients. Some experts worry that the problem may be growing
as new weight-loss centers attempt to cash in on the surgical boom
without offering patients long-term psychological and nutrition
counseling.
"It's a problem we really can't put our hands around right now," says
San Diego surgeon Alan C. Wittgrove, president of the American
Society for Bariatric Surgery. "We know there is a portion of the
patient population that will not be successful....Sometimes the
operation fails them, but sometimes they fail the operation."
Because of growing concerns about quality control and long-term
patient success rates, the society is pushing a new plan to be
launched in about six weeks that will designate "centers of
excellence" for weight-loss surgery, similar to those that already
exist for cardiac care and organ transplants, says Walter J. Pories,
a long-time bariatric surgeon and past-president of the ASBS.
To qualify as a center of excellence, a surgeon or weight-loss center
must document long-term patient results, physician expertise in
surgical procedures and a multidisciplinary approach that offers
patients long-term access to nutrition and psychological counseling
and follow-up care.
Bariatric surgery, typically performed in obese patients who are at
least 100 pounds overweight, is still the only proven long-term
method for significant weight loss. The most common form of gastric
bypass surgery, which both shrinks the stomach and routes food past
much of the digestive system, helps most patients lose 50% to 70% of
their excess body weight and keep it off for years. In the vast
majority of patients the surgery also helps eliminate diabetes,
hypertension and a number of other health problems associated with
obesity.
But while surgery helps control the quantity of food consumed, most
patients are still plagued by the same eating demons that caused them
to gain weight in the first place. In one study, 80% of patients
reported that they regularly felt a loss of control over eating just
six months after surgery. Several studies show that beginning two
years after surgery, many patients begin to regain at least some of
their weight.
In a small percentage of patients, the weight regain will be
excessive. Some patients regain the weight by drinking sweetened soft
drinks, juices or milkshakes, or by grazing on crackers and dollops
of peanut butter.
But the problem may be widely under-reported because many patients
are simply too ashamed to tell their doctors they are again
struggling with their weight. That's what happened to 29-year-old
Beverly Popolo of Clairton, Pa., who had stomach-stapling surgery
about 10 years ago. After losing 80 pounds, she returned to
overeating, and regained the lost weight and ended up 70 pounds
heavier than she was before the surgery. "I felt like I was a
failure," says Ms. Popolo. "I screwed up my only chance."
But doctors in Pittsburgh agreed to do a gastric bypass after Ms.
Popolo proved she was committed to making the needed lifestyle
changes. Unlike with the first surgery, she met with nutritionists
and underwent a psychological evaluation. Two years later, after
intense counseling and the help of a support group, she has dropped
190 pounds and feels more confident about maintaining her weight.
Last year, doctors performed about 100,000 procedures, up from an
estimated 40,000 in 2001. While top weight-loss doctors report long-
term results in major medical journals, nobody is tracking the
results of the vast majority of patients who undergo surgery. But
doctors are reporting anecdotal evidence of patients who come to them
complaining that their first doctor didn't provide any care other
than the initial surgery.
"It's not automatic -- people have to be taught," says Madelyn H.
Fernstrom, director of the University of Pittsburgh's weight-
management center.
Some doctors think a new gastric banding procedure approved by the
FDA in 2001 may be compounding the problem. The procedure, which uses
an adjustable and removal silicone band to shrink the stomach, is
cheaper, less risky and easier to perform.
But in the U.S., the band procedure also has resulted in less-
impressive weight loss than gastric-bypass surgery. Critics say the
problems are due in part to the nature of the procedure, which
doesn't include bypassing intestines where food is absorbed. But they
also blame a lack of follow-up and counseling. In U.S. studies,
patients who were given the banding procedure lost less than 40% of
their excess weight three years after surgery.
Inamed, the Santa Barbara, Calif.-based maker of the gastric band,
says the band has produced better results in other countries,
possibly because of a stronger emphasis on lifestyle changes. More
recently, results in the U.S. have improved, with patients losing
about 50% of their extra pounds, says an Inamed spokesman.
Dan Lester, Boise, ID honu@... www.gailndan.com/lapband
Dr. Ortiz, Tijuana, 4/28/03
323/216/199 Age 61