Fifteen years after they have weight-loss surgery, almost a third of patients who had Type 2 diabetes at the time they were operated on remain free of the metabolic disorder, a new study says. And six years following such surgery, patients had shaved their probability of suffering a heart attack over the next 10 years by 40%, their stroke risk by 42%, and their likelihood of dying over the next five years by 18%, additional research has concluded.
The two studies, both presented Wednesday at the annual meeting of the American Society for Metabolic and Bariatric Surgery in Atlanta, offer the first indications of weight-loss surgery's longer-term health benefits for patients. While researchers have demonstrated dramatic improvements in many bariatric patients' metabolic function in the short term, the durability of those improvements has been unclear.
Research suggests that over several years, many bariatric patients regain some of the weight they lose in the first two years -- a fact that has raised doubts about the cost-effectiveness of the surgery, which can cost $20,000 to $25,000 for the initial procedure, plus a wide range of costs to treat complications after surgery.
The new studies' findings that patients' health prospects remain better for several more years may make weight-loss surgery a more appealing treatment for insurers to cover, and for obese patients with health concerns to seek out.
The study that followed 604 bariatric patients in Sweden for 15 years found that in the first two years after surgery, 72% achieved diabetes remission: They were able to cease taking medication for the metabolic condition. After 15 years, a little more than half of those had diabetes again. But 31% had remained in remission.
By contrast, only 16% of the comparison group -- similarly obese patients with diabetes who did not get surgery -- had seen their diabetes remit in the first two years. At 15 years out, diabetes remission was six times likelier in those who had surgery than in the those who did not.
In another study, researchers at the Cleveland Clinic in Ohio followed bariatric patients for an average of six years after surgery. They tallied those patients' likelihoods of developing a wide range of health outcomes at the time of surgery and six years later, and compared them. To do so, they used the Framingham risk calculator to estimate the before-and-after 10-year risks of heart disease, stroke, death, kidney disease and complications such as diabetic retinopathy and poor circulation.
(The Framingham risk calculator is derived from probabilities gleaned from following more than 10,000 subjects in Framingham, Mass., in the Framingham Heart Study, which started in 1948.)
In this study, the bariatric patients lost 60% of their excess weight and 61% saw their diabetes remit after surgery. Overall, their risk of having coronary heart disease, stroke or peripheral heart disease dropped by 27%.
Bariatric surgeon Dr. John Morton, a professor of medicine at Stanford University who was not involved in either study, suggested that the results of more modern bariatric surgical procedures may be superior. He added that reducing the stress of obesity on the body, even if some weight returns, may improve a patient's long-term health prospects.
"Carrying extra weight can carry forth year to year," said Morton, who is president-elect of the American Society for Metabolic and Bariatric Surgery. He likened long-term obesity to smoking cigarettes for years, suggesting that the number of years a person remains obese (or smokes) may interact with their degree of obesity (or how much they smoke) to influence his or her likelihood of developing health problems.
"So you're a blogger, are you going to write about this?"
"If I told you..."
I might have already put it on Facebook because I have compulsive posting issues.
I had my Very First Fitness Profile At A Gym yesterday.
Just Because Someone Has Bariatric Surgery - It Does Not Make Them A Magical Athlete Who Runs Marathons, Lifts Weights Or Even Gives A Flying Fuck About Doing These Things.
"But all the people on the Facebooks -- they post photos of the try-athelete-a-thons -- and the Things They Can Do Just Six Weeks After Surgery, and all their new muscles and how they can make it rain, and Why Can't I?"
No. It is not *typical.
Here comes Beth -- pissing on your surgiversary parade again. Boo-hoo. This is my opinion only. If you do not like it, fine.
However individuals that have bariatric surgery -- they are tore up. One does not go from super morbid obesity to Athlete! *with added sparkles and instant motivation* overnight. It just does not happen that way.
Sometimes it takes a very long time to get some any motivation, inspiration to get your butt off the couch and do something anything! In my experience over the past ten years post weight loss surgery: motivation comes cyclically and there's always an underlying trigger and goal.
For a select few post WLS patients, just losing weight is enough of a motivation to get going. You see this in the "honeymoon stage" of weight loss repeatedly - people get all sorts of excited during the rapid stages of weight loss and sign up for their gym - get into a class - buy a piece of equipment for home use - sign up for their first walk, run, "I did my first 5K!" These kind of things are all common.
For me, this happened ever-so-briefly. I got out and walked miles and miles and miles to the Black Eyed Peas - it was 2005. I reached to my "goal" weight. We joined the YMCA. Things were going swimmingly in All Things Weight Loss!
But you know what - life happens sometimes.
"WHAT IS THIS THING YOU CALL LIFE?!?! HOW DARE IT INTERFERE WITH MY SIZE 6 PANTS?!"
Shit happens. You deal.
I threw away my size six pants, bought maternity pants, and she's now seven. (And cute. We'll keep her.) However that wasn't the only Life That I Got. My life imploded at about the same time - and I haven't had a normal living/working situation since.
Again, I'll say this:
Shit happens. You deal. (OR. You don't. And it's pretty obvious when you aren't.)
It looks like a bad ride on the rollercoaster until about one year ago.
And you know some health-coach-wannabe posted that on my weight chart a few years ago - and I nearly tore her head off. It was truth.
My weight chart reflects that I was not dealing very well with my shit.
That kind of honesty hurts sometimes - and I am sorry if it bothers you. But we - as former current-always-cycling-obese folks (...I will always be a big girl) wear our issues. When I stop weighing myself, checking in with my jeans-that-should-fit, eating as I know I should, I need to check MYSELF.
Weight is very personal. Let me repeat this. When I stop weighing MYSELF - it means something is out of balance. It means FOR ME - that I have made a choice to stop doing something right elsewhere: usually my eating choices. To be perfectly honest, it takes very little change in calories or types of food to increase my body weight at this stage so I notice upswings immediately.
(This is when the trainer reading this realizes he got way more than he bargained for. Why did I ask for this URL!?)
A little more than a year ago - I was in a regain pattern. I saw a number on the scale that frightened me. (Personally. We ALL have a number. Your number may be different than my number may be different than her number. I am five foot three, and my personal number was the qualifying number for WLS again.)
I knew that something had to change and I knew that I had to do something different because I was stuck in a rut of this pattern up cycling up so many pounds and back down so many pounds.
I have been a weight loss patient for many years - I know how to lose weight - goodness knows I can regain it - but - maintaining is different. I had to think about it: what haven't I done before?
No shit, right? Nope. My exercise motivation over the last ten years has been apathetic. I have more excuses than most of you, honest. I still do, and it's hardly worth throwing them out there because there are people out there with much bigger challenges than you or I - that are busting their butts - and we aren't.
"What do you mean, EXCUSES, Beth?"
I can't drive a car, when I was diagnosed with intractible epilepsy I had to lose my drivers' license, I can't get to the gym on my own, I am not supposed to exercise near the road, I can't walk on my own, I have four kids, begging them to go is a pain... yadda yadda yadda...
And, the worst of all?
I. am. *lazy. I have always been lazy. I may always BE lazy. I may never really enjoy Exercising On Purpose. It may always feel like work to me.
"Just put in a DVD."
That's where lazy comes in. See? That has happened maybe five times in my life -- and each of those times I ended up blogging about the video instead of working out. TV + Me = No.
So, there's that - I started moving my ass just a little bit.
It worked. It did not take much. I don't try very hard. *See above, lazy. I lost every pound of the regain, plus some, and I have maintained the loss for six months.
As for exercise - if you have been following me on Facebook - I try to get to the gym at least three days a week or more - it is increasingly difficult with my husband's work schedule and six of us in this house but we do what we can. When I do get there - I aim for a full sixty minutes of cardio on a cross-trainer or elliptical machine, and sometimes another fifteen to thirty on another machine or treadmill at a lower intensity.
I was not able to do that much exercise right away. It was overwhelming to me -- which was why I started to write this post to begin with. I started with FIVE MINUTES on the machine, many months ago and pushed through to where I am now. Because you know what -- six months ago -- had you told me "Go do an hour on that machine --" I'd have laughed at you.
That is why I am sharing - because - it's NOT too late to start. I was nine years into my journey when I started "again."
#2 - Food journaling, eating of Le Crap.
*GASP! What do you MEAN the Bad Girl Does Not Actually Eat Cupcakes?*
I cannot validate the caloric-cost. Sorry. I never really have. To be honest: I don't know why that was really ever equated with ME - because - I HATE CAKE. If you knew me at all, you'll know that if we go to the local cupcakery (1-2 times a year) they sell frosting shots, I buy ONE. I put it in the freezer. It's about 2 ounces of pure butter and sugar. It's enough carbohydrates and fat to put a horse in a coma. I am a SUGAR-CRACK-HEAD. I dump on sugar. Therefore, I can't, I don't. But I would if I could. I know myself. I do not purchase nor eat much in the way of junk.
Let me rephrase that: I eat a fair share of what I consider crap, I purchase none of it and I try hard not to allow a lot of stuff in my house. I have a harder time avoiding it if it's in my face, I try to make choices based on what's left in my alloted calories for the day. I do okay.
I aim for 1200-1400 calories, I land around 1400-1600 most days, some around 2000 calories.
I journal about 60-75% of the time lately, days where I am distracted by stuff get forgotten (yesterday was totally lost...) and holidays tend to be screwed the heck up, but overall I have done okay with assessing my intake and my weight has stayed the same.
Where am I now? Where do I "start?"
I passed everything except flexibility - which may have sucked because I just had a brain angiogram and I have a plug in my groin. LOL. (I didn't tell the trainer that.) However, that sit-reach thing brought back awful memories of elementary school and the Presidential Physical Fitness Test. Blech. I couldn't ...
I find this quite amusing -- the suggestions were to lose "two pounds of body fat" to be in the "fit" range, which I did by taking off my clothes and going potty this morning.
I'm fit. "I fit."
And, to add resistance training - because my personal goal is to gain muscle mass and retain health. This is my start.
It's not too late. Have you done a fitness profile?
Major finding: The incidence rate of heart failure during a median 15 years of prospective follow-up after bariatric surgery was 3.1 cases per 1,000 person-years, compared with 5.2/1,000 person-years in obese controls.
Data source: The Swedish Obese Subjects study included 2,010 obese subjects who underwent bariatric surgery in 1987-2001 and 2,037 closely matched obese controls. It is a nonrandomized, prospective, observational study.
Your brain after obesity surgery responds to food differently than before surgery and differently than it does after a behavioral weight program. Likewise, brain function improves in children with excess weight and low fitness after treatment with an aerobic exercise program. These observations come from two new studies in Obesity that provide a glimpse of the growing understanding about how obesity and its treatment affect brain function.
Amanda Bruce and colleagues compared functional MRI scans of a sample of patients before and after gastric banding surgery to scans from a matched sample of patients losing similar amounts of weight in a behavioral treatment program.
The demographics of the two samples were also matched. The found changes in brain responses to food for both groups after weight loss. But the nature of the changes were different.
The response to food cues by the banding patients suggested that the cues were less relevant and rewarding to them. Food cues seemed to command more attention from participants in behavioral weight programs than they did from band patients.
- See more at: http://conscienhealth.org/2013/10/your-brain-after-obesity-surgery/#sthash.hBbCJfvF.dpuf
“What we found was that the cardiac structure and function in these extremely obese adolescents scheduled for bariatric surgery was much more impaired than one might have thought,” said John Bauer, PhD with Nationwide Children’s Hospital.
The hearts and function of super-morbidly obese adolescents before undergoing bariatric surgery -- were that of middle-aged persons.
After bariatric surgery -- the teens' hearts underwent change -- reverting to a healthier state.