Welcome to Weight Loss Diet - Information on Weight Loss Surgery Support

PHOENIX ARIZ. -- After surgery for morbid obesity, patients require adjunctive support to have continued successful weight loss, Dr. Lee M. Kaplan said at the annual meeting of the American College of Gastroenterology.

Dr. Kaplan, director of the weight center at Massachusetts General Hospital in Boston, reported the outcomes of 28 patients who underwent a Roux-en-Y gas-trojejunostomy and 2 patients who had vertical banded gastroplasty at the center. The patient program is a continuum: an 8-week pretreatment phase, the surgical procedure, and long-term follow-up counseling and care.

"By doing these things, we expect to see the outcomes that are seen by other groups: 80% of patients experiencing significant weight loss of 50-150 pounds or more, with maximum weight loss 18-24 months after surgery," said Dr. Kaplan.

In stark contrast to other weight loss programs, in which 95% of patients, on average, regain all lost weight in 5 years, 50%-80% of gastric bypass patients keep the pounds off if they receive adjunctive support.

Gastroplasty results are "not quite as good" but still hover at about a 50%-60% rate of significant permanent weight loss recorded at 5 years.

Dr. Kaplan described the program by running through the history of one of his patients, a 39-year-old paralegal with a body mass index of 44. At presentation, she was receiving 144 U of insulin per day and suffered from sleep apnea and back pain. She had a long history of failed attempts at weight loss using medication and behavioral approaches.

She underwent several months of fitness training, nutritional counseling, and individual and group support offered in person and via a closed Internet Web site. At the site, patients enter basic information about their weight, activity level as recorded on a portable monitor, and food choices; they receive daily feedback on the information from physicians, nutritionists, counselors, and other patients.

After the 8-week pretreatment program, the patient was ready for surgery. She spent 4 days in the hospital, the cost reimbursed 100% by her insurance carrier, and then continued to make slow and gradual progress in the multidisciplinary program.

Within 6 weeks after surgery, she had lost 31 pounds, her back pain had resolved, and her total insulin dosage was down to 48 U/day. She continues to lose weight at a measured pace.

Dr. Kaplan said weight loss through surgery depends upon several physiologic mechanisms, including restriction of food intake and malabsorption. The most important aspect, however, is the activation of satiety pathways, which explains why gastric bypass surgery works over the long term while wiring shut a patient's jaw works only temporarily.

"I have every confidence that [the surgery] works by making the patient less hungry. Most of our patients don't want to eat. We have to encourage them to ear more after these procedures so they don't lose weight too fast," he said.

Feared complications--the breakdown of staples or dumping of hyperosmolar chyme into the upper small intestine--were not significant problems.

Staples "almost never" break down. Gastric "dumping," when it occurs, resolves within 3 months and can be treated with octreotide, he said.

"Although I tout obesity procedures today, hopefully we won't be doing many of them in the next 20 or 25 years as more effective medical therapies for obesity become available."

According to Dr. Kaplan, more than 120 weight loss medications are in development.