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The Findings

Patients who gained before surgery lost 62.5% of their excess weight a year after the operation; those who lost before surgery had lost 64.5% of their excess weight a year later.

At 24 months, the weight loss was maintained in both groups, DeMaria found. "What we saw was in the first 12 months, the losers are ahead, but that's gone by 24 months after they entered the program."

"The percent of patients off diabetesmedications 24 months after the operation was 81% of gainers and 83% of losers," he says. "At 24 months, 48% of gainers and 42% of losers were off medications for blood pressure and had normal blood pressure." An equal number -- 87% -- of both groups could discontinue their nighttime airway treatment for sleep apnea.

The gainers did require 15 more minutes of surgery time, he says. But complications (such as blood clots) occurred equally in both groups.

Interpretations

DeMaria worries that requiring patients to lose weight before the surgery may cause some to get discouraged if they can't and to drop out, not having the potentially lifesaving surgery.

"Gaining before the surgery doesn't have an effect on the surgery," he says. But he emphasizes that he is not discounting the value of patients still trying to lose weight and to learn good nutritional habits before having the surgery.

"We always encourage people prior to surgery to continue to hold their weight and to lose if they can," says Philip Schauer, MD, president of the American Society for Bariatric Surgery and director of the Bariatric and Metabolic Institute at the Cleveland Clinic in Cleveland.

But, he adds, it's extremely difficult for many patients. "My average patient has been on 10 diets or more," he says. "When someone has reached 100 pounds overweight, there is no evidence that diets work long-term. Even if they lose a lot, it is unlikely to replace the need for surgery."

To be considered for bariatric surgery, patients must have a body mass index (BMI) of 40 or more or a BMI of 35 or greater with an obesity-related disease such as heart disease. A person 5-feet-10-inches tall who weighs 280 pounds has a BMI of 40.2.

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