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 While surgery remains more effective for lasting weight loss than
alternatives such as dieting and exercising, said lead study author
Dr. Andrei Keidar, the study findings suggest that doctors still
have more to learn about which patients will get the most benefit
from operations and what strategies can make the initial results
stick.
“The first year after surgery is usually a honeymoon period that
should be used for coining new habits, and the ones that don’t do
that regain weight,” Keidar, a researcher at Tel Aviv University,
said by email. “Don’t take surgery as a panacea – beware of bad
eating habits.”
Globally, 1.9 billion adults are overweight or obese, according to
the World Health Organization. Obesity increases the risk of heart
disease, diabetes, joint disorders and certain cancers.
Surgical weight loss has gained traction in recent years, but it is
not risk free. And with these particular operations patients can
become malnourished.
In the U.S. alone, roughly 180,000 people get these procedures each
year, according to the American Society for Metabolic and Bariatric
Surgery (ASMBS). The most common operation is what’s known as a
sleeve gastrectomy, which reduces the stomach to the size of a
banana, followed by a surgery known as Roux-en-Y that creates an
even smaller stomach pouch.
Keidar and colleagues followed 443 obese patients who had sleeve
gastrectomy procedures to see how much weight they lost and whether
they experienced improvements in other health problems tied to
obesity such as diabetes, hypertension and high cholesterol.
After one year, the participants still in the study had lost 77
percent of their body weight on average, but they slid back toward
to their original weight as time passed. At three years, they were
still down by 70 percent of their original weight, and just 56
percent at five years.
About half of the patients with diabetes experienced complete
remission after one year, with their previously elevated blood sugar
returning to a healthy range common in people without the disease.
In this, too, patients backslid over time, with just 38 percent in
complete remission after three years and only 20 percent at five
years.
Participants experienced significant reductions in levels of
low-density lipoprotein (LDL), the bad kind of cholesterol, at one
year and three years, but at five years the change was so small it
might have been due to chance.
Roughly 46 percent of people with hypertension returned to a normal
blood pressure at one year and at five years.
One shortcoming of the study is that many patients dropped out at
each stage, leaving results for very few participants at five years,
the researchers note in JAMA Surgery.
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“There are still critical gaps in knowledge about the long-term (5
years and longer) results of bariatric surgery,” Dr. Anita
Courcoulas, author of an editorial accompanying the study and chief
of bariatric surgery at the University of Pittsburgh Medical Center,
said by email.
A separate study in the journal examined the effects of alcohol
consumption after Roux-en-Y operations. Researchers found that after
surgery, patients who drank the same amount they did before the
operation experienced a much faster increase in blood alcohol
levels, which were about twice as high as they would have been
before surgery.
“Because blood alcohol levels are doubled after surgery, people
could engage in risky drinking when drinking only moderate amounts
of alcohol,” lead study author Marta Yanina Pepino of the Washington
University School of Medicine in St. Louis, said by email.
This issue, as well as the potential to regain some weight initially
lost, shouldn’t deter obese patients from considering operations,
said Dr. John Morton, ASMBS president and head of bariatric surgery
at Stanford University School of Medicine in California.
“You get meaningful health changes with just a 5 percent weight
loss, so losing 50 percent after five years is still a heck of a lot
of improvement,” he said. “These are the sickest of the sick who
seek out bariatric surgery, and the vast majority of patients
benefit.”
SOURCE: http://bit.ly/1dDjZYQ JAMA Surgery, online August 5, 2015.
(The story has been refiled to correct Dr. Pepino's affiliation to
Washington University School of Medicine in paragraph 15)
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