Not so great bariatric results
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I'm just copying my response to another, similar thread that is relevant here:
"I had a VSG in 2012. I lost the weight quickly & maintained for 2 years. Then, I regained quite a bit--thankfully not everything. I had a horrible year & just stopped taking care of myself & started binging. That whole year was just a continuous binge for me. I am really thankful for the sleeve because I was restricted in the amount that I could physically put in my stomach. Instead of sitting down & eating a whole package of cookies, I could only eat some of them.
I am now 12 lbs from my maintenance weight & will be back at maintenance within the next 2 months.
I started by going back to my doctor so I would have some accountability in my eating & monitoring of my nutrition & blood work. I see her monthly again. It was embarrassing & hard to admit that I'd gone all haywire. When you lose weight without surgery & regain, everyone is much more understanding. When you have WLS & regain, there are a lot of people waiting to tell you what a big mistake you've made--you've wasted all that money, you haven't learned anything because you took the "easy way out", etc. You don't want to be one of those failure stories everyone trots out when WLS comes up. Pretty early on in my binging, I stopped going to any of my doctors.
I still have my sleeve & can still make use of it. I went back to eating like I did right after my surgery: no liquids 30 minutes before or after a meal, no sodas, no straws, protein first during a meal & get in at least 80g per day, no more than 3/4 cup of food per meal (volume-wise), I cut my calories down to my "losing" amount, I started taking all my vitamins again, I weigh & log everything religiously, I pre-plan everything I eat. I make sure I include sweets because I know that it's not a sustainable plan for me if I don't. These are all the things that I did right after surgery--your specifics may be different. Just go back to the basics. If you don't have your packet anymore, ask your doctor for another one."
I'm now 7.5 lbs from my maintenance weight. You HAVE to track your food. I rarely exercise, although I'm going to start weightlifting as soon as I can get the room cleared out & the equipment set up. It's all about the # calories you eat for weight loss & you have the advantage of having a smaller stomach, so you can actually eat that smaller amount without being really hungry all the time. For me, the hardest part is maintenance--it lasts the rest of your life & every meal is a choice.
My thinking on regain is that it can happen to anyone & probably will. People always bring up that they know so & so who had the surgery & then just regained all the weight they lost. Just about everyone I know who lost weight WITHOUT the surgery has ALSO regained the weight. Seriously, if weight loss was a do it once & then you're done type thing, there wouldn't be a MFP. All you have to do is start reading the posts in the forums & you'll find over & over where people are here to re-lose weight that they lost previously. And not everyone is just rebounding from fad or very low calorie diets. Regain can happen to anyone because maintenance is hard & if you're like me & let anything slip, you'll start to put weight back on. Everyone can talk all they want about how they've made a "lifestyle change" so it's going to last this time, but the reality is that life changes all the time & it's a very slippery slope. This last episode was definitely more than letting things slip for me, but those things happen in real life as well for lots of different people. I hope it never happens again, but if it does, I'm glad to have my sleeve as a tool.
OP, you can absolutely lose the weight. Being here to track your calories is definitely the right choice. You can add me but I'm a horrible friend
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A 50% reduction in excess body weight - So if a 300 lb woman with an ideal weight of 150 hit this average she would still weigh 225 lbs and be obese. Hmm.
I wonder what the median achievement is.....0 -
fatfudgery wrote: »callsitlikeiseeit wrote: »not to mention hundreds out of presumably thousands isn't any better a statistic
True enough. So instead of spewing out meaningless "I know 12 people!" anecdotal evidence, let's look at actual scientific research on the subject:
>>links snipped; see original comment<<
So about a 50% reduction in excess body weight, give or take, when you look at thousands and thousands of bariatric surgery patients 5+ years after surgery. Notice that these are all meta-analyses, too, not one-off studies.
So tell me again how bariatric surgery doesn't work long-term...
Systematic Reviews and metanalysis, huzzah! You are the very first person in 2 years of using MFP that has provided anything approaching real evidence (not small pop, low quality studies) to make a point about weight loss and fitness! I bow down. What a breath of fresh air!0 -
Meta analysis is to analysis what meta physics is to physics ?
Systematic cherry picking is also an issue.0 -
fatfudgery wrote: »billieljaime wrote: »BARIATRIC has a great failure rate for this reason. People dont change their habits and follow through completey. You need to make a life style change to get the results you want.
Bariatric surgery does not have a "great failure rate." Longitudinal studies have shown an average long-term weight loss of roughly 50% of excess body weight [1, 2, 3] - far, far, FAR more successful than any other weight loss method out there for the population in question (i.e., morbidly obese people.)
...clip...
Good luck, OP!
[1] http://www.ncbi.nlm.nih.gov/pubmed/23235396
[2] http://jama.jamanetwork.com/article.aspx?articleid=199587
[3] http://jama.jamanetwork.com/article.aspx?articleid=1900516
If you look at those sources, they exclude all people who weren't losing weight already prior to the surgery. So, if you would eliminate all individuals who didn't lose weight on a controlled diet, prior to tracking for the purposes of the study, I'm positive success rates would be about on par.
National Weight Control Registry shows results are similar to bariatric surgery for long term weight loss success when compared to non-bariatric surgery individuals (https://www.ncbi.nlm.nih.gov/pubmed/10849578?dopt=Abstract).
Personally, and anecdotes aren't studies mind you, of the 4 people I know who have had bariatric surgery to lose weight, 3 of them have put all of the weight back on. The last person lost weight in the first year, then hasn't lost anymore, and is still obese.
Of the myriad individuals I know who merely tracked their intake, and added exercise to their day, all of them have kept it off for 3+ years, and most are now a healthy weight.
Also, a point to bear in mind in that surgery is inherently dangerous, especially so for an invasive procedure such as bariatric surgery. Bariatric surgery is an elective procedure, so only the best candidates are selected for it. So, if we would take the best possible candidates for non-surgical weight loss, and compare to the individuals who have had some form of bariatric surgery, I am positive the results would be far better for non-surgical, and the morbidity would be magnitudes lower for non-surgical intervention.
Of course, this study probably wont happen, because JAMA benefits from the selection bias in their studies.0 -
Meta analysis is to analysis what meta physics is to physics ?
Systematic cherry picking is also an issue.
It would indeed be a flaw in a meta-analysis if the authors "cherry-picked" their studies. It is the job of the peer reviewers to identify any systematic bias, and this should play a role as to whether the paper gets published.
I assume you will be providing us a review where you can demonstrate the "systematic cherry picking" in the studies shared. I look forward to hearing from you which studies were inappropriately excluded from the analyses.0 -
Meta analysis is to analysis what meta physics is to physics ?
Systematic cherry picking is also an issue.
It would indeed be a flaw in a meta-analysis if the authors "cherry-picked" their studies. It is the job of the peer reviewers to identify any systematic bias, and this should play a role as to whether the paper gets published.
I assume you will be providing us a review where you can demonstrate the "systematic cherry picking" in the studies shared. I look forward to hearing from you which studies were inappropriately excluded from the analyses.
There's a systemic bias in the selection of candidates for bariatric surgery, where only the best possible candidates get surgery are being compared to everyone who has attempted non-surgical methods.
ie, bariatric surgery candidates must demonstrate the ability to follow a controlled diet, prior to surgery even being performed.0 -
Someone close to me successfully went through surgery 10 years ago. (She remains at goal today; though that, in and of itself, proves nothing. Having gone through it at the time, I don't really agree that she had do demonstrate much more than a reasonable attempt at these things.
But even if what you say is true, that doesn't argue that the surgery cannot be helpful for the people to whom you refer as the "best candidates."
This is not to say that surgery is the answer for everybody; it wasn't for me. But I am not going to do anything but support people who make that choice.0 -
Unfortunately, we all tend to stereotype based on our own experiences. So my experience with WLS comes only through my friendship with a woman who developed a life threatening heart condition. She had to lose weight immediately to be an acceptable candidate for the heart surgery. She even went from Canada to the US for bariatric surgery and spent a fortune on it. Came back, lost lots of weight, had heart surgery, and now she is as overweight as she was before. Sad. Didnt learn bumpkiss.0
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Someone close to me successfully went through surgery 10 years ago. (She remains at goal today; though that, in and of itself, proves nothing. Having gone through it at the time, I don't really agree that she had do demonstrate much more than a reasonable attempt at these things.
But even if what you say is true, that doesn't argue that the surgery cannot be helpful for the people to whom you refer as the "best candidates."
This is not to say that surgery is the answer for everybody; it wasn't for me. But I am not going to do anything but support people who make that choice.
I'm not so sure it's helpful. When you weigh the risks against whatever minimal benefits come from it, seeing as the best of the best are the only ones who get it, and lose weight, often don't ever get to a healthy weight anyways, and compare it to those with non-surgical intervention who typically not just lose weight, but lose to a point of being in a healthy weight range.0 -
People don't address HABITUAL BEHAVIOR first. That's why it's not uncommon for someone who's had bariatric surgery to divert their behavior to something else. Can't eat anymore? Then there's always alcohol, gambling, or some other compulsive habit to take up.
Hospitals that perform this should deal first with the mental aspect before surgery. Not just a couple months of dieting as confirmation that they can stick to it.
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I considered the barbaric route. I went to the seminar to learn about it and I found that for some people it was necessary to begin the journey. People who were sick, highly medicated, or in peril. In the end, I could not justify the risk of surgery when truly I hold all the power to lose the weight is the end anyway. Been on a losing trend since Jan 2nd. 38 lbs down. Dreaming of another 87 to go. The thing that has surprised me most is that I cannot see or feel a difference yet even though people tell me a,lean of the time ever they see it. I a, waiting for the day when I can say I feel good about my size again.0
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coreyreichle wrote: »Someone close to me successfully went through surgery 10 years ago. (She remains at goal today; though that, in and of itself, proves nothing. Having gone through it at the time, I don't really agree that she had do demonstrate much more than a reasonable attempt at these things.
But even if what you say is true, that doesn't argue that the surgery cannot be helpful for the people to whom you refer as the "best candidates."
This is not to say that surgery is the answer for everybody; it wasn't for me. But I am not going to do anything but support people who make that choice.
I'm not so sure it's helpful. When you weigh the risks against whatever minimal benefits come from it, seeing as the best of the best are the only ones who get it, and lose weight, often don't ever get to a healthy weight anyways, and compare it to those with non-surgical intervention who typically not just lose weight, but lose to a point of being in a healthy weight range.
The OP has already had the surgery. I am not sure spending much time talking about its efficacy will do much for her at this point .
That being said, most of the data I have read suggests that most people who lose weight through any method gain much of it back. So the argument that people who use non-surgical interventions TYPICALLY not just lose weight, but lose to a point of being in a healthy weight range" does not stand up to empirical scrutiny.0 -
coreyreichle wrote: »Meta analysis is to analysis what meta physics is to physics ?
Systematic cherry picking is also an issue.
It would indeed be a flaw in a meta-analysis if the authors "cherry-picked" their studies. It is the job of the peer reviewers to identify any systematic bias, and this should play a role as to whether the paper gets published.
I assume you will be providing us a review where you can demonstrate the "systematic cherry picking" in the studies shared. I look forward to hearing from you which studies were inappropriately excluded from the analyses.
There's a systemic bias in the selection of candidates for bariatric surgery, where only the best possible candidates get surgery are being compared to everyone who has attempted non-surgical methods.
ie, bariatric surgery candidates must demonstrate the ability to follow a controlled diet, prior to surgery even being performed.
What is your evidence for this? Yes most bariatric patients have to lose some weight before the surgery, for different reasons, but this tends to be a short term VLCD doctor supervised diet at the end of which if they are successful they expect the surgery. Most people can be successful under these conditions, it's long term adherence and long term maintenance that are the problems.
Given that they only give weight loss surgery to those that are above a certain level of obesity OR have conflating health problems, I'd argue the typical obese person getting surgery is probably less healthy than the typical obese person not getting surgery. Therefore they are likely to have more limitations. So I disagree with your statement that just because most go through a VLCD prior to the surgery that they are somehow likely to be more successful.0 -
I thought this was the "General Diet and Weight Loss HELP" board. Not a debate board. The OP didn't ask any of you if you felt their decision to have surgery was a good one or not.
Summer...go back to basics, weigh and measure everything. Take control of your kitchen and pantry, get rid of all the "bad" food. Make sure all your "trigger foods" are dumped. Go back to a liquid diet for a few days if need be, to remember to pay attention to what the restriction feels like.
There is a lot of good info from a few posters in this thread, focus on them. Ignore the rest. Only you could decide what you needed to do. If you want it badly enough you'll get there. Focus.
Best of luck to you.0 -
summerbreez1132 wrote: »Is there anyone out there who had a successful bariatric surgery but didn't get the results anticipated because you didn't eat out exercise as directed? Im that person also and would like to hear from others who have. Let's encourage each other top get back on track and finish out quest with amazing results. My name is summer
Welcome, summer. I had the bypass almost two years ago and it has been a success for me. The program here in Canada includes extensive classes and assessment prior to surgery, and a year's worth of follow-up afterwards. The program has a pretty darned good success rate.
There's a program offered by Stanford that I found very helpful, and it's available in every State. It teaches participants how to troubleshoot a problem, come up with some solutions, implement through a SMART goal, and then assess the results. It takes all the defeatism and guilt out of the process.
http://patienteducation.stanford.edu/programs/cdsmp.html0 -
PaulaWallaDingDong wrote: »gurlygirlrcr80 wrote: »People who haven't had surgery, always have the most to say about how it's a failure. SMH
But back to the OP, I've lost almost all my goal weight, I'm currently working on what I want to do with my body now. I'm working out and lifting. Trying to figure out what I want to be when I grow up.
It's not the surgery that fails. It's the patient. Seeing loved one after loved one fail at using the surgery to their advantage definitely gives an observer cause to speak about it.
Agreed... My mother (chronic yo-yo dieter) is about to leave for Mexico for her surgery. I'm terrified for her safety first of all, but also of the stress on her body and mind as she realizes this is no miracle. I wish all surgery havers the best, but these sorts of stories are why I don't think surgery should be an option save for those who are absolutely morbidly obese.0 -
blues4miles wrote: »coreyreichle wrote: »Meta analysis is to analysis what meta physics is to physics ?
Systematic cherry picking is also an issue.
It would indeed be a flaw in a meta-analysis if the authors "cherry-picked" their studies. It is the job of the peer reviewers to identify any systematic bias, and this should play a role as to whether the paper gets published.
I assume you will be providing us a review where you can demonstrate the "systematic cherry picking" in the studies shared. I look forward to hearing from you which studies were inappropriately excluded from the analyses.
There's a systemic bias in the selection of candidates for bariatric surgery, where only the best possible candidates get surgery are being compared to everyone who has attempted non-surgical methods.
ie, bariatric surgery candidates must demonstrate the ability to follow a controlled diet, prior to surgery even being performed.
What is your evidence for this?
...
You just provided it:
"Yes most bariatric patients have to lose some weight before the surgery, for different reasons, but this tends to be a short term VLCD doctor supervised diet at the end of which if they are successful they expect the surgery. Most people can be successful under these conditions, it's long term adherence and long term maintenance that are the problems."
If you gave anyone a weight loss goal, and intense follow up after they met their goal, they would likely succeed. Notice there's no surgery even being explored for any other compulsive disorder?
Like the NWCR's research has found: For long term weight loss, there is very little difference in effect for surgical vs. non-surgical interventions. Those who have maintained long-term weight loss could do it with or without the surgery.0 -
summerbreez1132 wrote: »Is there anyone out there who had a successful bariatric surgery but didn't get the results anticipated because you didn't eat out exercise as directed? Im that person also and would like to hear from others who have. Let's encourage each other top get back on track and finish out quest with amazing results. My name is summer
Welcome, summer. I had the bypass almost two years ago and it has been a success for me. The program here in Canada includes extensive classes and assessment prior to surgery, and a year's worth of follow-up afterwards. The program has a pretty darned good success rate.
There's a program offered by Stanford that I found very helpful, and it's available in every State. It teaches participants how to troubleshoot a problem, come up with some solutions, implement through a SMART goal, and then assess the results. It takes all the defeatism and guilt out of the process.
http://patienteducation.stanford.edu/programs/cdsmp.html
I think offering extensive classes and assessments, coupled with a year's worth of follow-up would be successful with or without the surgery. Research from the NWCR has found the same conclusions as well.0 -
coreyreichle wrote: »Someone close to me successfully went through surgery 10 years ago. (She remains at goal today; though that, in and of itself, proves nothing. Having gone through it at the time, I don't really agree that she had do demonstrate much more than a reasonable attempt at these things.
But even if what you say is true, that doesn't argue that the surgery cannot be helpful for the people to whom you refer as the "best candidates."
This is not to say that surgery is the answer for everybody; it wasn't for me. But I am not going to do anything but support people who make that choice.
I'm not so sure it's helpful. When you weigh the risks against whatever minimal benefits come from it, seeing as the best of the best are the only ones who get it, and lose weight, often don't ever get to a healthy weight anyways, and compare it to those with non-surgical intervention who typically not just lose weight, but lose to a point of being in a healthy weight range.
The OP has already had the surgery. I am not sure spending much time talking about its efficacy will do much for her at this point .
That being said, most of the data I have read suggests that most people who lose weight through any method gain much of it back. So the argument that people who use non-surgical interventions TYPICALLY not just lose weight, but lose to a point of being in a healthy weight range" does not stand up to empirical scrutiny.
Most of the data you've read is wrong, then. See: http://www.nwcr.ws/Research/published research.htm , specifically: https://www.ncbi.nlm.nih.gov/pubmed/10849578?dopt=Abstract
Basically, to be eligible for bariatric surgery at most any institution in the US, you would also be able to meet the requirements to be a part of the NWCR: Lose 30 lbs or more, and keep it off for 6 months.
NWCR findings point to a mindset being key, not necessarily the type of intervention. And, given surgery is highly risky, why engage in the risk taking, when a 0 risk method would accomplish the same?0
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