Wednesday, January 14, 2009

Surgical vs. Non-Surgical Weight-Loss Maintenance

Yes, we all know someone, who has lost a significant amount of weight and is keeping it off – all without drugs or surgery.

While these people definitely exist, they are rare indeed and always interesting people to study. This is exactly what the National Weight Control Registry (NWCR) has been doing for years – anyone, who has maintained at least a 30 pound weight loss for one year or longer can join the study. Currently over 5000 individuals are being followed, many of whom have lost considerable amounts of weight and are continuing to keep it off.

Although this registry is good evidence that long-term weight loss maintenance is indeed possible with lifestyle change alone, in reality, the vast majority of patients attempting lifestyle change will rarely keep the weight off. This is why, an increasing number of patients with severe obesity turn to surgery for help. Despite its risks and limitations, the likelihood for the average patient to substantially reduce their weight and keep it off with surgery is substantially higher than the success rate of lifestyle interventions alone.

So how are patients who manage to lose weight and keep it off different from those who need surgery to do the same?

This question was now studied by Bond and colleagues from Brown University, Providence, RI, USA, in a study just published in the International Journal of Obesity.

This study compared the amount of weight regain, behaviors and psychological characteristics in NWCR participants who were equally successful in losing and maintaining large amounts of weight through either bariatric surgery or non-surgical methods.

A total of 105 surgical participants were matched with two non-surgical participants (n=210) for gender, entry weight, maximum weight loss and weight-maintenance duration, and compared prospectively over 1 year.

Both the surgical participants and the matched non-surgical participants reported having initially lost around 56 kg and hving keept off at least 13.5 Kg over the last 5.5 years.

Over the year of the study, both groups (re-)gained a similar amount of weight (1.8 vs. 1.7 Kg). However, surgical participants reported less physical activity, more fast food and fat consumption, less dietary restraint, and higher depression and stress at entry and 1 year than the non-surgical group. In both groups, higher weight regain was observed in individuals with higher levels of disinhibition.

These findings suggest that weight-loss maintenance comparable with that after bariatric surgery can be accomplished through non-surgical methods with more intensive behavioral efforts.

In other words, obesity surgery appears to be more “forgiving” than lifestyle management alone, when it comes to weight maintenance. Thus, although the surgical participants exercised less, ate more fat and fast food, showed less dietary restraint and were more depressed and stressed, they were still able to maintain the same degree of weight loss as the succesful non-surgical NWCR group. I have little doubt that these same surgical patients would likely have done a lot worse had they relied on lifestyle change alone. This does not deny the fact that success with surgery also requires substantial and consistent changes in lifestyle.

My conclusion from this study is: Yes, some people can indeed lose significant amounts of weight and keep it off, but they need to exercise more, avoid fast food, display high dietary restraint and better not be depressed or stressed out (even then, there is some weight regain). For others, surgery may very well be a more realistic option.

AMS
Edmonton, Alberta

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4 Responses to “Surgical vs. Non-Surgical Weight-Loss Maintenance”

  1. Nana says:

    Arya,
    Thanks for bringing this article to my attention. I commend the authors for their work and their findings explain what we are seeing in bariatric patients long term post surgery. Those patients who continue to maintain their weight loss at 5yr out have adopted a much healthy lifestyle compared to their pre-surgery one. It may not be as regimented as the NWCR subjects, but that may not be realistic for many given the obesogenic environment in which we live. Our group hopes to learn whether post obese patients can make the required changes lifestyle over the long term and how to improve their prospects of doing this.
    Nana

  2. Peter Janiszewski says:

    Hi Arya,

    As always, great post on an interesting study. So the lifestyle group gained back the same amount of weight as the surgery group with much more effort. What if we looked beyond just the weight status of the individuals in either group? Given that the surgery group was less active and had a much poorer diet than the lifestyle group – I am willing to bet they’re less metabolically healthy – despite the similar weight status. I checked, and unfortunately the study did not report on metabolic status, so I can’t corroborate my hypothesis with data – but given the beneficial effects of physical activity and healthy diet on cardiometabolic risk independent of weight, I am fairly confident with my prediction.

    Peter

  3. sean wharton says:

    Great post Arya
    I commend the NWCR. I am with peter on this, i belief that post-surgery patients are probably less metabolically fit. I certainly see it in my practice,many patients psot surgery do very little in term of activity and don’t keep good food diaries or eat healthy food, they simply eat less, due to the effective smaller post surgical stomach. Many of their habits do not change, as evidenced by the previous VGB surgeries that failed with ruptured staples and patients regained all of their weight and often more.

    We are conducting a similar study to the NWCR, but just looking at our clinic’s population of patients and looking a questionnaire of how patients kept weight off, those with more than 10% weight loss, sustained for greater than 6 months. Many patients are over 40% weight loss, with no surgery, and many with surgery, or post protein sparing diets. We anxiously await the results to see what the trends are in a Canadian clinic.

    Sean Wharton

  4. Sensa continued: Anecdotal evidence | Fat Chic says:

    [...] Sugical vs. Non-Surgical Weight-Loss Maintenance (drsharma.ca) [...]

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