Tuesday, May 10, 2011

The Weight Loss Window of Opportunity

The fabled weight loss "window of opportunity" puts a lot of pressure on its believers, who worry constantly that if they don't begin losing weight immediately after their surgery and keep up the pace of weight loss week after week, their ability to lose more weight will disappear sometime between 12 and 18 months post-op.
I’m going to share with you my opinion on this issue. If I sound emphatic about it, it’s because I feel strongly, not because I’m a medical professional who can quote 200 studies that prove my point. But give it a listen anyway…maybe it’s time to open your mental window.
As far as I can tell, the weight loss window may exist for people who’ve had RNY (gastric bypass) surgery for 3 reasons. It’s possible for their stoma to stretch out over time, not because of overeating but because that’s what can happen under the circumstances of ordinary use. The malabsorption feature of their intestinal re-routing may diminish as the intestinal villi (little finger-like projections from the intestinal wall) re-grow and thereby increase the surface area available for absorption of nutrients. Their physical hunger may return or grow stronger as their body adjusts the metabolism to the patient’s reduced caloric intake. So at some point, the RNY patient may have to exert more effort in the form of portion control, food choices, exercise, and the like in order to continue losing weight or avoid weight regain.
The adjustable gastric band patient, on the other hand, has a tool that can be fine-tuned with fills and unfills to achieve optimal weight loss at any time after their surgery, be it at 2, 12, 18, 36, or 360 months post-op. Each fill can re-set the patient’s hunger, appetite and satiety controls so that weight loss can re-start or continue. If the patient regains weight, the regain can be lost and the weight loss journey started again without the need for further bariatric surgery. I’m not claiming that it works this way for every single band patient because the band doesn’t seem to work for everyone, nor does it seem to work in the same way for every patient, and there are far too many other factors affecting weight. But the potential for weight loss is definitely there.
At a WLS support group meeting I attended last year, Danielle DeKay, R.D., nutritionist for Swedish Weight Loss Services in Seattle, Wa, commented that band patients and RNY patients all have to make the same behavioral changes in order to succeed. Band patients must start that work before or at the time of their surgery, while RNY patients can lose weight without a lot of effort for 12 to 18 months…but sooner or later, everybody’s got to do the work. I was personally very gratified to hear her say this because it confirmed my own suspicion (and like most people, I do like to be right every now and then).
There are at least two more factors that can open or close the window of weight loss opportunity. Again, this is my own personal observation, not the result of years of scientific research in properly-controlled clinical studies. One factor is this: it’s extremely difficult for anyone, no matter what bariatric surgery they’ve had, to sustain a weight loss effort beyond 12 to 18 months. Over and over again, I’ve seen bariatric patients run out of gas somewhere on the road to their weight goal. They’ve already lost a great deal of weight, they feel better, they get comfortable, they get busy with other perfectly worthwhile things (like childbirth, career advancement, college, you name it), and their attention is no longer 100% on weight loss. I don’t see that as an unhealthy thing, and I don’t think any shame should be attached to re-thinking your weight goal after you’ve moved from the obese to the overweight category and your health has greatly improved. Nor is it a shame to decide after a lengthy weight loss plateau (I’m talking 6 to 12 months, not 6 to 12 days!) that further medical intervention is needed – like weight loss medication or revisional surgery. I also believe that anyone can achieve any weight goal if they dedicate enough time, energy, and resources to it.
The other factor is this. As I wrote in Bandwagon, no bariatric surgery of any description is going to banish the eating demons that live in your head. They must be dealt with sooner or later, like it or not.

1 comment:

Frank said...

There seems to be a lot data to support the fact that obesity is not a single sided issue and the reasons behind relapse in recovery are directly linked to the reasons we became obese.
The nature of pain and addiction and the use of food to deal with pain have real mental basis and so it does not strike me as surprising that when we “fall off the bandwagon” our co-disorders and complications also return.