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Being Mindful About Weight-Loss Surgery

If you’re a candidate for weight-loss surgery, here’s some good news: By having a bariatric procedure, your odds of living longer than someone who doesn’t are greatly increased.

Researchers in Milan, Italy, found that patients with obesity who had a bariatric procedure reduced their odds of dying by almost half compared to their counterparts who did not have surgery to lose weight. The researchers analyzed data from eight clinical trials involving more than 44,000 obese men and women. About 14,000 of the subjects actually underwent some form of bariatric surgery – either gastric bypass or stomach banding – and the rest served as control subjects for comparison. The trials included an average of 7.5 years of follow-up.

Of the roughly 3,300 deaths among all participants, 2.8 percent had had a bariatric procedure; 9.7 percent did not have surgery. Patients who underwent bariatric surgery had 45 percent lower odds of dying. The team found a similar benefit when it looked specifically at heart-related deaths. Overall, death rates were comparable for the approximately 10,000 banding and 4,000 gastric bypass surgeries, although the protective effects on heart-related deaths differed: Compared to no surgery, banding provided 29 percent lower odds of heart-related death versus a 52 percent risk reduction with gastric bypass.

The Risks of Bariatric Surgery

The message here is not that surgery is the only solution to obesity – which we know leads to all kinds of health problems and many preventable deaths. Invasive, risky and expensive surgery isn’t the only way to shed large amounts of fat. But for people with severe obesity who are unable to manage their diet and exercise, it is an option – one to be carefully considered with the help of a trusted doctor.

The three most common bariatric procedures are a lapband, gastric sleeve and gastric bypass. A lapband is an inflatable device placed around the top portion of the stomach to slow consumption of food – and, in theory, reduce consumption. The gastric sleeve procedure surgically removes a large portion of the stomach, leaving a tube or “sleeve” that holds much less food. Gastric bypass separates the stomach, creating a smaller pouch – which holds less food – that is then attached to a lower part of the intestine; this bypass decreases the amount of food absorbed.

Bariatric surgery isn’t cheap. It costs between $14,000 for lapband surgery or sleeve gastrectomy and $26,000 for gastric bypass. Many insurers cover the procedures, but there are other costs involved. The potential for complications leading to severe health problems and even death can’t be overlooked. These risks include staple or suture ruptures resulting in stomach acid leaks into the body, as well as infections, hemorrhages, ulcers, bowel issues and nutritional deficiencies. The numbers are tough to pin down, but estimates for overall complication rates vary from 7 percent to as much as 20 percent. The estimated rate of death from bariatric surgery ranges from less than 1 percent to as much as 2 percent depending on the study. Again, these procedures should not be taken lightly.

Another important thing to consider is that many people actually have some type of bariatric surgery only to gain the weight back again. The band actually has a high failure rate: Furtado says that 50 percent of people who have adjustable gastric banding surgery fail to lose 30 percent of their excess weight – where losing 30 to 50 percent of excess pounds is considered successful. On average, gastric bypass patients lose 60 to 70 percent of excess body weight, with some weight regain – 5 to 10 percent is normal. The newer bariatric procedure, sleeve gastrectomy, has gained immense popularity over the years, and Medicare and private insurers typically cover the procedure. Many people have enjoyed success with the less-invasive alternative to gastric bypass surgery. With the sleeve, patients lose an average of 40 to 60 percent of their excess weight loss in the five years following the procedure, based on U.S. data. But no matter the type of procedure, bariatric surgery is not a fail-safe weight-loss solution.

‘They Don’t Operate on Your Brain’

“The surgery, no matter how involved, is just a tool and doesn’t change your brain and/or [your] relationship with food. That has to change for long-term success,” says Margaret Furtado, formerly a clinical dietitian specialist at Johns Hopkins Bayview Medical Center, who specialized in bariatric surgery during her 12 years working in obesity medicine centers, including Tufts Medical Center, Massachusetts General Hospital, Johns Hopkins and the University of Maryland Medical Center. (Margaret is currently finishing her second year of medical school, and she aspires to one day combine her 23 years as a registered dietitian with medicine as an obesity medicine specialist.)

“There are certainly ways to sabotage the band, as well as gastric bypass,” Furtado says. “As I would say every day to my patients, both pre- and post-operative bariatric surgery, ‘They don’t operate on your brain.’” Her message: “Even the most sophisticated bariatric surgery procedure will [only] take you so far.” She says weight-loss success still requires a healthy lifestyle, which includes a balanced diet with lots of fresh fruits and vegetables, healthy proteins and heart-healthy fats, a lot of water, regular exercise and something akin to meditation and possibly yoga to help the mind stay balanced in a stressful world. And she recommends seeking support from friends and loved ones.

Over the course of about 12 years that Furtado worked as a dietitian with gastric banding, she says she witnessed only a handful of patients lose all of their excess body weight. “In my experience, corroborated by statistics and conference talks, people who are ‘volume eaters’ versus ‘grazers’ tend to do better with the band as a tool. It’s like a funnel, so snacks, liquid calories … go right down without problems,” she says. Adjustments (also called fills) are made to the lapband to decrease the opening to the stomach so as to allow for just the right amount of food to obtain optimal nutrition without gaining weight. If the opening is too small, the patient may be unable to tolerate meat, chicken and vegetables, which can cause people to eat only junk foods and/or liquid calories.

Research reveals that a purely restrictive bariatric procedure, like gastric banding, doesn’t change genetic or physiological barriers that keep a person within a certain weight range. What’s more, the brain “fights” the weight loss for up to one full year after a person sheds pounds from dieting or even the band, so regular physical activity and a healthy diet with protein at every meal and every snack are vital to help long-term success.

Bariatric surgery procedures like gastric bypass and the newer gastric sleeve are considered “metabolic” surgeries in that they help increase metabolism for about six months or so after surgery. However, it’s imperative that healthy eating, including having protein at least three times a day, and regular exercise be a part of the prescription to help these tools work best. Adequate sleep and stress management are also key to long-term weight-loss success.

It’s of the utmost importance that people change their relationship with food and exercise to keep the weight off after weight-loss surgery of any kind. Furtado recommends a healthy, balanced approach to food that includes viewing food as nourishing the body rather than as just a source of calories or micronutrients.

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