Bariatric surgery.

I read about bariatric surgery today. The first surgeries for weight control in this country began in the early 1950's, with jejuno-colic bypass at the beginning, to jejuno-ileal (JI) bypass from 1954 through the 1970's. The initial surgeries worked through malabsorption. Many had to be redone due to the nutritional deficiences caused by the surgery. Along came refinements, and the Roux-en-Y gastric bypass (RYGB) was born. It and its variants are very successful, safe, and have fewer post-op complications. These surgeries are now done by laparoscopic surgery, vastly reducing recuperation, pain, complications, cost, scarring, etc. People return to their normal activities much sooner.

"Overall, studies generally report weight losses of roughly 40% of excess weight within six months of surgery with the maximum weight loss (roughly 50-60%) generally achieved by two years after surgery. In striking contrast to all other obesity treatments and weight loss methods, the weight loss produced by bariatric surgery is both substantial and highly durable over time."

Follow-ups at five and ten years post-op show around 50% are successfully maintained. That's incredibly impressive when compared to non-surgical weight loss methods. Patients have significant improvement or total resolution of co-morbidities such as diabetes, high blood lipids, hypertension, etc. The most interesting thing for insurance companies to get through their heads is that bariatric surgery for obese people saves huge amounts of money. There are "very substantial decreases" in long term health care costs of severely obese persons. There are also significant decreases in health care resource use, and morbidity, in those who have the surgery.

A megastudy which included 22,094 patients showed a complete resolution of diabetes in 76.8% of patients; hypertension completely resolved in 61.7%, and obstructive sleep apnea in 85.7%. It's interesting, however, that the improvement depended on the type of surgery in some obesity-related medical problems. "In particular, complete resolution of diabetes was observed as follows: 98.9% (for biliopancreatic diversion or duodenal switch), 83.7% (for gastric bypass), 71.6% (for gastroplasty, and 47.9% (for gastric banding)."

The RYGB had more weight loss and greater medical improvements than any other bariatric surgery. The "method is currently generally regarded as the 'gold standard' given its impressive clinical outcomes (weight loss plus broad improvements in co-morbidities) coupled with good safety record."

I didn't realize how different the results were among the various types of surgery, particularly percentage of weight lost. The band is the other one I have some idea about, since I've been reading a woman's website that's very well done. She didn't have all that much to lose, however, so it was a very good choice. You can eat a wider range of foods post-op with it than you can with RYGB, and the potential problems seem to be less severe, or more easily repaired, if you have them with either surgery. There's the whole filling thing to adjust the band to each user; I like that. But I also don't like that. In this woman's case, the port became displaced and is highly visible under her skin. As a matter of fact, they can erode the skin or stomach because they stay in. I doubt that happens much, though. Still, it's something to keep in mind.

This got me to thinking about under what circumstances I would choose bariatric surgery. At 200 lbs.? I don't think so. That's a low enough weight that I'd give dieting, therapy (cognitive, probably), exercise, etc., a good try or three. But 300? Now we're getting into serious weight. An RYGB is forever. I look at someone like Allan's success taking off nearly 200 lbs. and ask myself--do I have what it takes? Because all he's doing is following the bariatric surgery diet he'd have to follow anyway if he had the surgery. He's doing it without the surgery. It's such a marvelous decision (would I have thought of it?). . . However, it's truly not for everyone, nor even 10% of people. Will it have the same success rate as surgery, and for as long a time? It should about equal it, I think. Anyone can eat his/her way back up to 400 lbs. after surgery. Anyone. (Another thing I didn't know before I started reading about all this.) Surgery is (the cliche)--a TOOL. The patient did and does the work, just as if s/he was on a weight-loss diet, which s/he actually is.

My lovely friend here, who had RYGB done, was kind enough to explain her surgery and decision to have it in her blog. Now, having read her reasons, plus as much as I could about the surgeries, I think she made an excellent choice. I'm so happy the modern surgeries are available. I still think that researchers must get on board with finding a very safe drug to effect the same results. It's imperative, now that weight has become such an issue for so many people. Oddly, there are dozens and dozens of medications to help someone gain weight, some of them quite rapidly, such as the steroids and some of the older antidepressants (Elavil, in particular). Ain't that a kick in the head? Just what we need, eh? Not.

It won't help if you tell me it's a good thing that I gained weight. Really, it'll hurt--a lot. But I weighed 95.1 last Sunday, and 95.9 today, for a pound gained. All I can do is cut back this week and quit indulging myself. I should have known when I wasn't hungry all week that I was gaining. Too late now. I can only aim for next week.

Last night I asked DH what kind of bread he wanted me to make today, and he said he had a real craving for focaccia. That was about the last thing I wanted to make, but I did it, anyway. I had a piece and it was great. He'll take in the rest to work tomorrow.

I'm off to read now and decide what my menu is going to be this week. I have to lose this pound. It will be on my mind all week. Take care, people.