Outcomes & How to Gage Success?
First, a brief word about appropriate goals for weight loss surgery – it is reasonable to undergo a bariatric surgical procedure to achieve improved health, or improved ability to be active for health. Patients should not enter into this surgical commitment because of appearance or social factors alone.
Weight loss and the subsequent improvement in medical problems are the core outcomes of bariatric surgery. We find that if a patient loses into a BMI range of 25-30 then they will achieve terrific long-term improvement in health and sense of well-being. Patients who lose down to the so-called “ideal” weight of a BMI in the 22-25 range usually lose strength and energy – having come from their previous (extremely heavy) weight it turns out to be unhealthy to lose down far enough to reach “ideal.”
5′ 6″ FEMALE, weight = 310 pounds, BMI = 50.
We would commonly expect to see a patient at this starting weight lose down to about 170 pounds (BMI = 27). About half of this weight loss occurs over the first 3 months after gastric bypass, and then proceeds more gradually until the patient reaches equilibrium about 12 or 15 months following surgery. All weight loss is a bit slower with Lap-Band®. In the range of 170 pounds, we would expect that our patient would have improvement in most of her major medical problems, as well as a dramatic improvement in her sense of well-being. Although her Ideal Body Weight (IBW) is about 130 pounds, we find that a patient who starts from anywhere over 250 pounds would be weak and ill if she lost to less than about 150 pounds. A different way of gauging weight loss, using a commonly published parameter for “success” is that in our practice about 85% of patients will lose more than half of their excess weight, and maintain their new weight for many years.
The weight loss described here will not turn the average patient into a bikini contestant, but it will significantly reduce the number of trips to the doctor and the amount of medicine they require. The weight loss has a significant positive impact on various medical conditions that are associated with obesity, and the expected effects for specific medical conditions are outlined below:
Very likely to improve or resolve after GBP * Good chance of improvement after GBP Unlikely to change after GBP
Diabetes – 86% resolved
High Blood Pressure (Hypertension) – 60% resolved
Obstructive Sleep Apnea – 40% resolved
GE Reflux Disease (GERD) – 95% resolved
Knee pain – 90% improved
Congestive Heart Failure (CHF)
Menstrual irregularity, infertility
Vascular disease Arthritis Organ damage caused by obesity does not resolve, although the ongoing stress is decreased after weight loss
*The practical reality is that Weight Loss Surgery achieves resolution of major medical problems, and improved health, in the vast majority of patients. There is no medication, diet/exercise plan, or other treatment that even comes close to the actual demonstrated effectiveness of Weight Loss Surgery for people who are morbidly obese.
In our practice, the overall results of Gastric Bypass can also be broken down as follows:
* 80% – usually patients lose a great deal of weight without major complications, achieve significant improvement in medical condition and overall outlook, and maintain this better situation for the long haul.
* 15+% – a fair number of patients have some significant problem following the surgery (need for reoperation, prolonged hospital stay, insufficient weight loss, persistent nausea/vomiting, etc) but we work through it and the patient ends up doing well in the long run.
* 2-3% – a small but real proportion of our patients have major unresolved problems over time, mostly related to difficulty with the diet, poor stomach pouch function, or poor weight loss. A very small percentage of our patients die as a direct result of the surgery. These are all real people who did not plan to have major problems, and we are not able to predict before surgery who will succumb to such difficulties. Once again, think carefully.
The outcomes outlined above are the main reason to do bariatric surgery. Statistically, the group of patients who undergo bariatric surgery do better and live longer than equally heavy people who try to lose weight without surgery. This statement includes the complications and risks outlined above. The tough part is that these numbers are only rough guides for outcomes and there is no way to guarantee that a given patient will fall in the “good” category.