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Bariatric surgery may improve pregnancy outcomes - mostly

Many women opt for bariatric surgery in order to increase chances of maintaining a healthy pregnancy.  A recent study suggests that weight loss surgery can help a woman do just that, but there are risks.

Personally, my full term post bariatric surgery pregnancy was different than my pre-WLS pregnancies.  I was at a more normal bodyweight at the time of my daughter's gestation, and I did not seem to suffer the ill effects of obesity on pregnancy like I had with my prior children.  I had no high blood pressure, no high blood sugar, nor did I land on bedrest - which I had with previous babies.    My post RNY pregnancy offered me anemia and rampant hypoglycemia.  I was not well. 

She was born healthy, but small, in comparison to my earlier babies.  I noted a lack of body fat at birth.  This is several weeks old.

Baby
My post bariatric surgery baby - my smallest birthweight baby.

 

New York Times

While the study found some risks for women who had surgery, including more babies born too small and a greater likelihood of stillbirths, experts said that overall the results were better.

The findings have implications for an increasing number of women and children, especially in the United States, where nearly a third of women who become pregnant are obese. Obese women have more problems in pregnancy, including gestational diabetes, pre-eclampsia, and stillbirth. Their babies are more likely to be premature, overweight or underweight at birth, have certain birth defects, and develop childhood obesity.

The study, published Wednesday in The New England Journal of Medicine, sought to find out if surgery could safely mitigate some of those effects. Swedish researchers, led by Kari Johansson, a nutritionist at the Karolinska Institute, evaluated records of 2,832 obese women who gave birth between 2006 and 2011, comparing women who had bariatric surgery before becoming pregnant with women who did not.

They found that women who had had surgery were about 30 percent as likely to develop gestational diabetes, which can lead to pre-eclampsia, low blood sugar, birth defects and miscarriage. They were about 40 percent as likely to have overly large babies, whose challenges can include lung and blood problems.

The outcomes were worse in some categories. Women who had surgery were twice as likely to have babies who were small for their gestational age, suggesting the need for better nutrition for pregnant women with surgically-reduced stomachs. And more of their babies were stillborn or died within a month after birth, although the number of such deaths in each group was very small and might have been due to chance, experts and the authors said. There was no significant difference in rates of premature births or babies with birth defects.

The study via NEJM -

BACKGROUND

Maternal obesity is associated with increased risks of gestational diabetes, large-for-gestational-age infants, preterm birth, congenital malformations, and stillbirth. The risks of these outcomes among women who have undergone bariatric surgery are unclear.

METHODS

We identified 627,693 singleton pregnancies in the Swedish Medical Birth Register from 2006 through 2011, of which 670 occurred in women who had previously undergone bariatric surgery and for whom presurgery weight was documented. For each pregnancy after bariatric surgery, up to five control pregnancies were matched for the mother’s presurgery body-mass index (BMI; we used early-pregnancy BMI in the controls), age, parity, smoking history, educational level, and delivery year. We assessed the risks of gestational diabetes, large-for-gestational-age and small-for-gestational-age infants, preterm birth, stillbirth, neonatal death, and major congenital malformations.

RESULTS

Pregnancies after bariatric surgery, as compared with matched control pregnancies, were associated with lower risks of gestational diabetes (1.9% vs. 6.8%; odds ratio, 0.25; 95% confidence interval [CI], 0.13 to 0.47; P<0.001) and large-for-gestational-age infants (8.6% vs. 22.4%; odds ratio, 0.33; 95% CI, 0.24 to 0.44; P<0.001). In contrast, they were associated with a higher risk of small-for-gestational-age infants (15.6% vs. 7.6%; odds ratio, 2.20; 95% CI, 1.64 to 2.95; P<0.001) and shorter gestation (273.0 vs. 277.5 days; mean difference −4.5 days; 95% CI, −2.9 to −6.0; P<0.001), although the risk of preterm birth was not significantly different (10.0% vs. 7.5%; odds ratio, 1.28; 95% CI, 0.92 to 1.78; P=0.15). The risk of stillbirth or neonatal death was 1.7% versus 0.7% (odds ratio, 2.39; 95% CI, 0.98 to 5.85; P=0.06). There was no significant between-group difference in the frequency of congenital malformations.

CONCLUSIONS

Bariatric surgery was associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, an increased risk of small-for-gestational-age infants, and possibly increased mortality. (Funded by the Swedish Research Council and others.)

PS.  Post RNY baby is eight years and four months old now.  She's fine.

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Exercise improves insulin sensitivity after gastric bypass

Clinical trial demonstrates additive effect of exercise following gastric bypass.   

So. do. it.  I know, I know, easier said than done. 

Over 75 million adults in the US are obese. These individuals are predisposed to health complications, including diabetes, heart disease, and cancer. Gastric bypass surgery results in dramatic weight loss and can improve diabetes symptoms in obese patients. A new study in the Journal of Clinical Investigation reveals that exercise following bypass surgery provides additional benefit for obese patients. Bret Goodpaster and colleagues at the University of Pittsburgh conducted a study on individuals that had recently undergone gastric bypass surgery. One group followed a moderate exercise protocol for 6 months, while the control group underwent a health education program. Individuals in both groups exhibited dramatic weight loss and reduced fat mass. However, individuals in the exercise group had improved insulin sensitivity and cardiovascular fitness. The results of this study support the inclusion of an exercise program following gastric bypass surgery.

Read the article released earlier this week in JCI: http://buff.ly/1wlKroB


#itfits

It, fits?  OH COME ON.  

The NEW AND IMPROVED LAPBAND!  

You can do better!

New

Apollo Endosurgery, Inc., the leader in minimally invasive endoscopic surgical products for bariatric and gastrointestinal procedures, today announced the launch of the “It Fits” campaign, aimed at rejuvenating the LAP-BAND® System and educating a broad range of patients about the benefits of the minimally-invasive weight loss procedure.

“It Fits” supports the company’s decision to place greater emphasis on the unique advantage of the LAP-BAND® System – the only FDA approved device for weight reduction for people with at least one weight-related health problem, and having a BMI of 30 or greater.

Read more: http://www.digitaljournal.com/pr/1989812#ixzz34taKYjn9

The new ad spot - from Apollo - tugs right there at your heart, don't it?  I might be tearing up over all of the completely stereotypical situations right here in this here commercial!  OMG I CAN FIT IN THE AEROPLANE SEATBELT WITHOUT AN EXTENDER COULD YOU PLEASE PUT ME IN A COMMERCIAL ALTHOUGH I WAS NEVER SUPER MORBIDLY OBESE I AM JUST AN ACTOR!

Until this and my tears dry up!

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Because of course we will ignore the patient histories of thousands -- to have a procedure to lose how much weight?  

Just as a frame of reference, that makes me qualify in a few BMI points.  Confession:  when I reached my high weight about the same time the new BMI-qualifications for the Allergan-owned lap-band came around, I decided THAT WAS IT.  I could not possibly do it again, my butt was not revising band-over-bypass for that much weight, not after watching this weight loss community for 12 years.  Nope.

Jawdrop


Ethicon Bariatric Surgery Comparison Tool Online - What can you lose?

I am easily distracted online by quizzes, gadgets, tools, and "Who Will You Be When You Grow Up?"  (Which said TEACHER, BTW, ME, The Kid Who Failed Half Her High School Classes...) quizzes, which is when I saw this - Online Tool Designed to Help Patients Evaluate Potential Bariatric Surgery Outcomes - thingamajig - I did it myself even though I am already ten years and two months post gastric bypass.

How cool is this?

Are you considering weight loss surgery?  Check this out.

LA Times -

A new tool nveiled at the annual meeting of the American Society for Metabolic and Bariatric Surgery may help patients with a body mass index over 30 -- the threshold at which obesity is diagnosed -- to navigate those complexities. Based on the accumulated experiences of 75,000 bariatric surgery patients, the Bariatric Surgery Comparison Tool details the expected outcomes of gastric banding surgery, gastric bypass surgery and sleeve gastrectomy, the three most common bariatric procedures.

I did it myself, based on my start weight - height - though I have lost an inch of height.  (Shut up.)

Start weight - 320, start height 5 ft 4.  I am close to 5 ft 3 now.

Are you considering weight loss surgery?  Check this out.

image from http://s3.amazonaws.com/hires.aviary.com/k/mr6i2hifk4wxt1dp/14060712/190a84c8-6aca-452b-953c-cec251332856.png

 

And now -

Screen Shot 2014-06-07 at 8.24.16 AM
 

And the tool gave me these results based on the potentials of experiences of 75,000 patients (... surveyed out of the most common WLS) 

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The stats for the gastric bypass are damn close to what my surgeon "quoted" me for my landing place after my procedure.  

I bottomed out lower than this, my very lowest was 147 lbs, but wouldn't you know I bounced exactly to 175 lbs and maintained around there for a good portion of the years after my RNY?  The gastric bypass got me there, everything after that was a lot more work.  (See the blog.  I was pregnant immediately after.  And, so on.  This was 2005, guys.)  

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The 24 month data is EXACTLY right!  I am ten years post op and 149 - 158 lbs!

I guess what I am saying is -- that the data for this "tool" --  (and you know I loathe that word) is there, it is right on the money.

Some goobledegook from Ethicon - 

  • The tool (officially named the Ethicon Bariatric Surgery Comparison Tool) pools data from more than 75,000 U.S. people who have had bariatric surgery, and based on personally provided, anonymous information, shows what people of similar demographics have experienced after undergoing bariatric surgery. The tool shows data for gastric bypass, sleeve, and adjustable gastric band surgeries.

o   Ethicon understands that no two patients are identical.  For example, when considering bariatric surgery, obesity related conditions like diabetes, hypertension and cholesterol need to be taken into consideration – this tool helps do just that.

o   Based on patients who have had similar conditions to theirs, prospective patients using the tool are able to see what surgical outcome looked like for patients just like them and can use this as a discussion point with their doctor about  which treatment option might be most appropriate for them (i.e., gastric bypass, gastric sleeve or gastric band).

 Now is a promising time for people in need of support for obesity and illnesses associated with it (such as type 2 diabetes).  There are safe, effective ways for physicians to help patients better manage their conditions.  There’s a growing body of clinical evidence that shows that bariatric surgery not only helps with weight loss, but that it also can help with issues like type 2 diabetes.

Some things you should know about bariatric surgery and the tool

Bariatric surgery is used in severely obese adult patients for significant long-term weight loss. It may not be right for individuals with certain digestive tract conditions. All surgery presents risks. Weight, age, and medical history determine your specific risks. Individuals should ask their doctor if bariatric surgery is right for them.

The tool is provided for educational purposes only and is not intended to be a medical evaluation, examination, consultation, diagnosis or treatment. The tool provides potential results by procedure type including pounds lost and medication reduction over time based on personal information provided by the user of the tool. Patients should consult a physician or other health care provider to determine whether or not bariatric surgery is right for them and for guidance on expected outcomes benefits and risks.

The weight loss, medication, and diagnosis information provided by the tool is derived from statistical analysis of historical claims and clinical databases as well as research published in peer-reviewed journals. While predictive modeling techniques were used, the results cannot predict the specific outcomes for any individual. The information presented does not represent any statement, promise or guarantee by Ethicon Inc. concerning a patient’s eligibility, experience, or potential outcomes. Individual patient results may vary.

 I had gastric bypass in 4/2004 in Boston, MA with Dr. Michael Tarnoff

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The Effectiveness and Risks of Bariatric Surgery - March 2014

Study - 

The Effectiveness and Risks of Bariatric Surgery

Importance  The prevalence of obesity and outcomes of bariatric surgery are well established. However, analyses of the surgery impact have not been updated and comprehensively investigated since 2003.

Objective  To examine the effectiveness and risks of bariatric surgery using up-to-date, comprehensive data and appropriate meta-analytic techniques.

Results  A total of 164 studies were included (37 randomized clinical trials and 127 observational studies). Analyses included 161 756 patients with a mean age of 44.56 years and body mass index of 45.62. We conducted random-effects and fixed-effect meta-analyses and meta-regression.

In randomized clinical trials, the mortality rate within 30 days was 0.08% (95% CI, 0.01%-0.24%); the mortality rate after 30 days was 0.31% (95% CI, 0.01%-0.75%). Body mass index loss at 5 years postsurgery was 12 to 17. T

he complication rate was 17% (95% CI, 11%-23%), and the reoperation rate was 7% (95% CI, 3%-12%).

Gastric bypass was more effective in weight loss but associated with more complications.

Adjustable gastric banding had lower mortality and complication rates; yet, the reoperation rate was higher and weight loss was less substantial than gastric bypass.

Sleeve gastrectomy appeared to be more effective in weight loss than adjustable gastric banding and comparable with gastric bypass.

Conclusions and Relevance  Bariatric surgery provides substantial and sustained effects on weight loss and ameliorates obesity-attributable comorbidities in the majority of bariatric patients, although risks of complication, reoperation, and death exist. Death rates were lower than those reported in previous meta-analyses.

The Effectiveness and Risks of Bariatric Surgery


Weight loss surgery: 'not everyone lives happily ever after' - Medical News Today

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Weight loss surgery: 'not everyone lives happily ever after' - Medical News Today.

http://www.medicalnewstoday.com/articles/272432.php

I realize this is a very small sample study, but I can't say I don't disagree with most of it after living this WLS-life for ten years and observing hundreds of people in it.

http://www.medicalnewstoday.com/articles/272432.php

All women had undergone gastric bypass surgery - one of the most common bariatric surgery procedures. It involves rerouting a part of the small intestine past the stomach in order to reduce food intake, promote satiety and suppress hunger.

The majority of the women were interviewed twice. The first time was 1 year after surgery, while the second interview took place 2.5-4 years following surgery.

Groven says although most previous research suggests that weight loss surgery leads to an increase in quality of life for the majority of patients, her findings suggest that not everyone lives happily ever after following bariatric procedures.

Positive outcomes after surgery 'can feel like grief'

There is no doubt that weight loss surgery puts the body through a series of radical changes.

Groven says that although the procedure leads to a slimmer body - which others perceive as a "sign of success" - the surgery can cause many smaller problems that other people are unable to see.

Groven explains:

"Becoming slimmer and lighter is mostly perceived of as positive. At the same time it is ambivalent, since people start to behave differently towards the women after they've had surgery.

People are friendlier than before, and this may feel extremely provoking. And people often ask very invasive questions concerning the woman's radical weight loss."

The interviews revealed that some of the women experienced a boost in self-esteem after surgery, were more outspoken, and found other people were more likely to listen to what they were saying - particularly in the workplace.

Groven notes that although these factors are clearly positive outcomes, this could also be seen as a "grief" because the women realize they had to undergo weight loss surgery before seeing these outcomes.

Many of the women also felt embarrassment after the surgery, particularly when it came to speaking about their weight loss. Some women told others they had been on a diet to lose the weight because they were ashamed to say they had undergone bariatric surgery.

Excess skin promotes a negative self-image

Groven found that many of the women had mixed feelings about their naked body after surgery, and many of these feelings come from the occurrence of loose skin - a common consequence of rapid weight loss.

"It is given little focus before the operation. Patients are often told that this is something that can be fixed afterwards. But it is not so easily fixed, and the women are not prepared for the challenge of having to live with the loose skin," explains Groven.

Although women can undergo surgery to remove excess skin, Groven notes that many women are not prepared to take the risks associated with this procedure, which include hematoma or seroma formation, infection and risks associated with future pregnancies.

Groven found that some of the women interviewed even spoke about their excess skin in third person, which she believes is a way of distancing themselves from it.

Health problems and bad food relationships after weight loss surgery

According to Groven, five of the women interviewed reported a lower quality of life after they underwent weight loss surgery, compared with their quality of life before.

She notes that this was down to the development of chronic stomach and intestine problems, and one woman became so ill that she had to endure another operation because of problems with her scar tissue after the gastric bypass procedure.

The five women also said they felt as if they had complete lack of energy following weight loss surgery.

Furthermore, Groven found that many of the women reported having a negative relationship with food after the procedure.

Some women were worried about eating too much or too little, or eating the wrong food at the wrong time. Because of these concerns, some women experienced tiredness, nausea, dizziness and even intense shaking.

Some of the women who had problems with overeating before weight loss surgery continued to overeat after surgery, even though this made them ill. Groven says some women commented that "the eating disorder is not gone."

Groven says that while previous research suggests that patients can avoid testing their eating limits after surgery by following dietary advice, the reality is much more complicated.

She adds:

"It is reasonable to ask, I think, whether the eating disorders that some of the women develop after surgery are diseases, or if they may be understood as normal changes as a result of the operation."

No regrets

Although many women reported negative thoughts and health issues after weight loss surgery, none of them said they regret undergoing the procedure.

"They say they would have done the same today and that they had no choice considering their life before surgery. Some said that the pains were a small price to pay," says Groven.

She adds that this suggests women are influenced by society's perception of the ideal female body, and that being obese is not within this scope.

"They are living with a body which is not accepted by society, and they are constantly judged from their size," she says.

"The message from the media and medical science is that they are likely to get cancer or diabetes unless they lose weight and the surrounding world regards their obesity as self-inflicted. Some have children and are afraid to die and leave them alone."

Groven concludes that although it is true that obesity can lead to health complications, such as diabetes and heart attack, little is known about the long-term effects of weight loss surgery and what complications may arise from this procedure.

With this in mind, Groven plans to conduct further research that will look at the effects of bariatric surgery 3-10 years after patients have undergone the procedure.

http://www.medicalnewstoday.com/articles/272432.php

 


That time I shamefully admit I was lazy.

excess arm skin
December 2013
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February 2014
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Current

This is that moment where I put my tail between my legs and come to you and say it -- because this is what I Need To See - Proof That A Thing Works?

I have a very literal type brain.  (More on that later this year.  I promise you. My next appointment is Valentine's Day.)

Left-vs-right-brain-mix11
Figure out where Beth's seizure focus is?

I must have proof of a thing in order to believe it.  I do not blindly follow anything without seeing results, documents, charts that show me "IF YOU DO X, Y will be yours."  This is why I am a hard "sell" and you rarely see reviews here anymore.  (More on that, coming, too.)

In 2012 I was in a regain pattern and found myself hitting a high weight that I could not imagine after RNY.

image from http://aviary.blob.core.windows.net/k-mr6i2hifk4wxt1dp-14020918/4d86845e-4c9c-41d5-a316-a2246a703da4.png
Regain, 2012

I refused to allow it although I know realistically it is possible.  I've been there before.  And knowing that I need to eat food  -- I realised I needed to do something different because obviously eating as much food as I want/need to and not moving my ass was no longer working.

I added a little bit of exercise -- and I saw a little bit of endurance increase.  And I struggled to keep going, and keep at it and now I finally see body results.  

The scale is in solid maintenance mode.  I see range of up 5 lbs down 5 lbs up 5 lbs down lbs every single month.  But I guarantee my muscle mass is increasing.  I will get a new assessment done at some point to ensure this -- and see because I am interested in knowing the percentage of change.

This is where those people who used to scream at me to MOVE MY ASS get to say, "WE TOLD YOU SO."  I did not listen.  I was (...somewhat, but not really) lazy.  I thought I could get away with just "eating okay" and being relatively active.  

Nope.  I am proof it (...sitting on your ass) doesn't work.  


Factors Distinguishing Weight Loss Success and Failure at Five or More Years Post Bariatric Surgery

What makes someone a Weight Loss Success long term after bariatric surgery?  

According to a study by Colleen Cook of BSCI - it's following the rules of your WLS.

I've heard her say it a hundred times at bariatric events - fall back to the RULES of your surgery - because it DOES WORK -

(Nodding in agreement - I am proof.)

Here's the study details from ASMBS/TOS 2013 -

Dietary support after bariatric surgery, along with pre-operative teaching and post-operative management, may mean the difference between weight-loss success and failure for patients with obesity, according to results of an on-line survey presented at the 31st Annual Scientific Meeting of The Obesity Society (OBESITY 2013).

“This study confirms the need to put into place the resources to support people after bariatric surgery, including the dieticians and behavioural therapists who are actively involved with their patients, and can be critical to their success or failure,” stated American Society for Metabolic and Bariatric Surgery past president, Scott Shikora, MD, Center for Metabolic Health, Brigham and Women’s Hospital, Boston, Massachusetts.

People who have had bariatric surgery and are complying with the very basic principles of personal accountability, portion control, food intake, vitamins and supplements, proper nutrition and exercise are the ones who have been doing well long-term,” noted lead author Colleen M. Cook, Bariatric Support Centers International, Jordan, Utah, speaking here on November 14.

Cook and colleagues conducted a survey to assess adherence to specific, research-based, behavioural recommendations based on earlier research. Of their 535 total initial respondents, 255 were 5 or more years post-surgery. From this group, they took a final sample of 158 respondents comprised of 117 (74.05%) who reported achieving at least 80% of their excess body weight loss (the Highly Successful group) and 41 (25.9%) who reported achieving less than 40% of their excess body weight loss (the Not Highly Successful group).

The groups were compared on self-reported behaviours, including dietary intake, physical exercise, attendance at surgical follow-up visits, and participation in bariatric support groups.

The Highly Successful group reported significantly higher rates of compliance with dietary recommendations (P< .001); fewer total calories per day (1511.9 kCals versus 2190.0 kCals, P< .001 ); consuming a higher percentage of calories from protein (49% vs 36%; P< .001); higher frequency of eating protein first (P =.007); and lower percentage of calories from carbohydrates (31% vs 40%; P = .001).

The Highly Successful group was much more likely to regularly weigh themselves (P< .001); attend support groups (P = .002); and take supplemental multivitamins (P = .029), including calcium (P = .004), iron (P = .011), and B12 (P = .001).

The Highly Successful group was significantly less likely to eat mindlessly (P< .001); to “graze” (P< .001); to eat in front of the TV (= .002); to eat fast food (P< .001); and to eat food high in sugar (P< .001).

The groups also differed significantly on carbonated beverage (P = .02) and caffeine (P = .005) drinking patterns. The Highly Successful group reported significantly more physical activity at least several times per week than the Not Highly Successful group (P< .001).

The researchers found no significant differences, however, for ingestion of percentage calories from fat or the frequency of eating at sit-down restaurants, drinking calorie-laden liquids, or attending surgical clinic follow-ups.

Participants in this study averaged 51.7 years of age and 8.8 years post-surgery; 96% were female, 59% were married, and 89% were white. Both groups had similar demographics.

Funding for this study was provided by Bariatric Support Centers International.

[Presentation title: Factors Distinguishing Weight Loss Success and Failure at Five or More Years Post Bariatric Surgery. Abstract A-366-P]


Bariatric surgery leads to lasting improvement in health, studies say - TOS/ASMBS

From studies presented at this year's Obesity Society - ASMBS meeting in Atlanta, new data on weight loss surgeries long-term efficacy.

Not too shabby.  

LA Times

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.