Obesity Surgery Outcomes Weighed
Patients Who Gain Before Weight Loss Surgery Have Outcomes Similar to Those Who Don’t
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 diabetes medications 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.
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
"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
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.
Insurance Industry Weighs In
The recommendation to attempt weight loss before undergoing bariatric
surgery is included in the National Institutes of Health guidelines on
obesity surgery, issued in 1991, says Susan Pisano, a spokeswoman for America’s
Health Insurance Plans, a Washington, D.C.-based industry group representing
“An individual might avoid surgery,” she says, by first following diet and
exercise plans for weight loss. “There is also research telling us there is
significant health benefit with relatively modest weight loss.”