Re: Washington Post Article - What do OUR Long-Term People See?

March 13, 2006

As the article says, WLS is not a cure for obesity " It is a tool to help you

help yourself " , there are no gaurantees for anyone. Some people have to work

alot harder thenn others to get the initial weightloss, some people dont have

to work at it years later and some people have trouble keeping their weight

off. It says in our manual that there is an average weight regian of 10% (I

think those are the numbers) but if I lose 250 lbs and I have an average regain

of 25 lbs I will still be the happiest ex fat person you know.

in Fla

407/384/272/160

hi/preop/now/goal

March 13, 2006

Ok .. I am about to give a very unpopular opinion here ... if you

don't do what is " required " postop, i.e. learning to eat more healthy

foods, watching what you (not dieting but eating normally), moving

more, etc. you can in all likelihood regain weight. Could you regain

it all? I believe I could! I am 5 years and 5 months postop .. I

had lost a total of 128 pounds. I have kept off about 88. What do I

attribute my weight regain to ... my own stupidity! I went back into

a " mindless snacking " , eating whatever I wanted whenever I wanted,

not exercising, etc.

So ... moral of the story ... be like " normal " people ... watch what

you eat, eat healthy and get some exercise. If we do that .. we will

be fine I believe.

in GA

> According to this article, the weight lost from WLS surgery only

> lasts about 3 to 5 years! Gosh!

>

> Choosing the Knife

>

> By Sally Squires

> Tuesday, March 7, 2006; HE01

>

> " Today " show weatherman Al Roker and singer Carnie

> are likely to have a lot more company in the

> once-exclusive ranks of those who have had weight-loss

> surgery.

>

> A recent Medicare decision expands coverage for

> gastric bypass and other weight-loss surgery to people

> with a body mass index of 35 or greater -- about 60

> pounds or more overweight -- who also have at least

> one weight-related medical problem, such as diabetes,

> sleep apnea or heart disease.

>

> In 2005, about 170,000 people in the United States had

> weight-loss surgery, according to the American Society

> of Bariatric Surgery (ASBS). Medicare paid for 6,000

> of those procedures. Ninety percent of those

> operations were performed on people younger than 66,

> who are disabled by their weight and other medical

> problems, according to the federal Centers for

> Medicare and Medicaid Services (CMS). Since private

> insurers generally follow Medicare's lead, weight-loss

> surgery is expected to increase significantly

> throughout the country.

>

> But experts caution that surgery is not a cure for

> obesity. " It's a tool designed to help you help

> yourself, not a free ride, " says surgeon Harvey

> Sugerman, past president of ASBS and professor

> emeritus at Virginia Commonwealth University.

>

> Some worry that the expanded coverage sends the wrong

> message, since medical treatment for obesity is

> limited at best. " Insurance companies won't cover the

> medical care of obesity treatment, but they're willing

> to pay for surgical intervention, " notes Arthur ,

> director of the Washington University Weight

> Management Program. " That's outrageous. It drives

> people into surgery . . . and may create the wrong

> incentives. "

>

> Here are some of the caveats to keep in mind about

> gastric bypass and other weight-loss surgery, which

> has a mortality risk of about 0.5 percent to 2

> percent, about the same as a hip or knee replacement.

>

> Surgery only gives a jump start. The procedures

> promote weight loss in two ways: either by diverting

> food from the stomach to a lower part of the digestive

> tract where nutrients can't be absorbed, or by

> reducing stomach size so that less food can be

> consumed at a given time. Overeating after surgery can

> result in vomiting or in " dumping, " a condition that

> lasts about 30 minutes and is characterized by

> lightheadedness, nausea, flushing and sometimes

> diarrhea.

>

> " But you can always beat the system by drinking milk

> shakes or eating ice cream, " says , who notes

> that the same healthy habits prescribed for weight

> loss -- eating less and moving more -- are still

> required after surgery.

>

> That may be particularly challenging since people who

> become morbidly obese usually have difficulty

> controlling what they eat and often don't exercise.

> " Lots of people go into this with unrealistic

> expectations that the surgery will take care of it all

> and this will be it, " says Ronna Saunders, director of

> the Center for Behavioral Change in Richmond, who

> counsels people after weight-loss surgery and screens

> them before it.

>

> Plan on taking vitamin and mineral supplements for

> life. Weight-loss surgery alters the digestive tract

> so that enough key vitamins and minerals can't be

> absorbed from food alone. After surgery, " all

> menstruating women need iron supplements, " Sugerman

> says. " All patients need vitamin B12daily by mouth or

> monthly by injection. " Also required: a daily

> multivitamin and at least 500 milligrams of calcium

> per day.

>

> Expect to regain some of the weight lost initially.

> During the first two years after surgery, an average

> of 60 percent of excess pounds are lost, which can

> improve the patient's health by treating such

> conditions as type 2 diabetes, high blood pressure,

> sleep apnea and ease joint pain. But those who undergo

> weight-loss surgery almost never achieve an ideal body

> weight and still remain slightly obese or at least

> overweight. " If they started off with a body mass

> index of 60, they may get to a body mass index of 35, "

> Sugerman says. " They're not going to get to a BMI of

> 30 or 25. "

>

> The weight also creeps back, as Roker has found. He

> shed more than 100 pounds after surgery in 2002, but

> in January of this year began a diet on the show to

> lose 20 of the pounds he's regained. He's said that a

> back problem and a hectic business travel schedule

> have contributed to his added pounds. " Typically

> you'll get three to five years of benefit in terms of

> weight loss, " notes. " But the weight almost

> invariably comes back. "

>

> Prepare to pay . Even if you have health insurance, it

> may not pick up much of the tab. Weight-loss surgery

> averages $30,000, plus the cost of follow-up care.

> Private insurers take their cue from CMS, which allows

> $10,000 for hospital costs, plus up to $1,700 for the

> surgeon. Medicare picks up 80 percent of the surgeon's

> cost; the patient pays 20 percent. Follow-up medical,

> psychological, diet and exercise treatment are extra

> and can run thousands of dollars more and generally is

> not covered by insurance or Medicare.

>

> Find additional help. The often large and fairly rapid

> weight loss following surgery " requires physical and

> emotional adjustment, " notes clinical psychologist

> Kalarchian, who studies people who have

> undergone weight-loss surgery at the Western

> Psychiatric Institute and Clinic in Pittsburgh.

>

> Spouses may also need some assistance. A recent

> University of Tennessee study examined spouses of 63

> people who underwent weight-loss surgery. They found

> that 75 percent of spouses who were obese gained

> weight in the year after surgery -- perhaps because

> they ate food no longer eaten by their mates -- as did

> 38 percent who were not obese. The team suggests

> counseling to prevent weight gain and that very obese

> spouses be considered candidates for bariatric surgery

> themselves.

>

> Surgical treatments have not proven effective for

> severe obesity. " Nothing about the surgical procedures

> will cure the disease, " notes . " It's the very

> uncommon patient who will sustain the weight loss. But

> if you can get five years of benefit out of it, that's

> pretty good. "

>

March 13, 2006

I read the article Jami posted as well, and was pretty shocked by it.

BUT...we know a few things. We know that the surgery is merely a tool to

" level the playing field " in the future. We know that ultimately, we CAN

gain back weight (a number of forum members have attested to this) if we are

not careful. We know we need to change our eating habits to stay slim and

healthy. We know we need to take the recommended supplements. And so on.

I am almost two years out, so I can't give the 5-year perspective yet. But

I can state with certainty that the honeymoon DOES end. For some, it ends

in less than a year; for others it takes a couple years. But at some point,

your ability to eat will be such that you can gain weight. And this is why

I stress that those who have just had the surgery use the first few months

to change their eating habits forever. Don't go back to eating sugar and

junk food. In the beginning, you have so little appetite that it's easy to

avoid this stuff. If you don't reintroduce it at all, you will be doing

yourself a big favor! I think you should view those first months as a

" detox " period. You are ridding your body of its desire to eat

nutritionally empty foods.

While articles like this are terrifying to read -- and probably exaggerate

the risks of regain for those who have had MGB-- they serve an important

purpose. We simply can not take our slimness for granted. If we do, we

will almost definitely gain back weight.

As always, just my two cents!

Joanie

5/25/04

Drs. Walsh and Rutledge

>From: Neal Haerich <neal_haerich@...>

>Reply-

>

>Subject: Washington Post Article - What do OUR Long-Term

>People See?

>Date: Mon, 13 Mar 2006 05:56:07 -0800 (PST)

>

>I'm only three months and 40 pounds post-op, and reading this column made

>me sick to my stomach (no pun intended).

>

> PLEASE: If there are people out there in MGB land that have kept their

>weight off for 5 years or longer, can you let the rest of us know that we

>didn't do this in vain? What are the " real " long term stories for MGB???

> Thanks

> Neal

>

>JamiGoldWing <jamigoldwing@...> wrote:

> According to this article, the weight lost from WLS surgery only

>lasts about 3 to 5 years! Gosh!

>

>Choosing the Knife

>

>By Sally Squires

>Tuesday, March 7, 2006; HE01

>

> " Today " show weatherman Al Roker and singer Carnie

> are likely to have a lot more company in the

>once-exclusive ranks of those who have had weight-loss

>surgery.

>

>A recent Medicare decision expands coverage for

>gastric bypass and other weight-loss surgery to people

>with a body mass index of 35 or greater -- about 60

>pounds or more overweight -- who also have at least

>one weight-related medical problem, such as diabetes,

>sleep apnea or heart disease.

>

>In 2005, about 170,000 people in the United States had

>weight-loss surgery, according to the American Society

>of Bariatric Surgery (ASBS). Medicare paid for 6,000

>of those procedures. Ninety percent of those

>operations were performed on people younger than 66,

>who are disabled by their weight and other medical

>problems, according to the federal Centers for

>Medicare and Medicaid Services (CMS). Since private

>insurers generally follow Medicare's lead, weight-loss

>surgery is expected to increase significantly

>throughout the country.

>

>But experts caution that surgery is not a cure for

>obesity. " It's a tool designed to help you help

>yourself, not a free ride, " says surgeon Harvey

>Sugerman, past president of ASBS and professor

>emeritus at Virginia Commonwealth University.

>

>Some worry that the expanded coverage sends the wrong

>message, since medical treatment for obesity is

>limited at best. " Insurance companies won't cover the

>medical care of obesity treatment, but they're willing

>to pay for surgical intervention, " notes Arthur ,

>director of the Washington University Weight

>Management Program. " That's outrageous. It drives

>people into surgery . . . and may create the wrong

>incentives. "

>

>Here are some of the caveats to keep in mind about

>gastric bypass and other weight-loss surgery, which

>has a mortality risk of about 0.5 percent to 2

>percent, about the same as a hip or knee replacement.

>

>Surgery only gives a jump start. The procedures

>promote weight loss in two ways: either by diverting

>food from the stomach to a lower part of the digestive

>tract where nutrients can't be absorbed, or by

>reducing stomach size so that less food can be

>consumed at a given time. Overeating after surgery can

>result in vomiting or in " dumping, " a condition that

>lasts about 30 minutes and is characterized by

>lightheadedness, nausea, flushing and sometimes

>diarrhea.

>

> " But you can always beat the system by drinking milk

>shakes or eating ice cream, " says , who notes

>that the same healthy habits prescribed for weight

>loss -- eating less and moving more -- are still

>required after surgery.

>

>That may be particularly challenging since people who

>become morbidly obese usually have difficulty

>controlling what they eat and often don't exercise.

> " Lots of people go into this with unrealistic

>expectations that the surgery will take care of it all

>and this will be it, " says Ronna Saunders, director of

>the Center for Behavioral Change in Richmond, who

>counsels people after weight-loss surgery and screens

>them before it.

>

>Plan on taking vitamin and mineral supplements for

>life. Weight-loss surgery alters the digestive tract

>so that enough key vitamins and minerals can't be

>absorbed from food alone. After surgery, " all

>menstruating women need iron supplements, " Sugerman

>says. " All patients need vitamin B12daily by mouth or

>monthly by injection. " Also required: a daily

>multivitamin and at least 500 milligrams of calcium

>per day.

>

>Expect to regain some of the weight lost initially.

>During the first two years after surgery, an average

>of 60 percent of excess pounds are lost, which can

>improve the patient's health by treating such

>conditions as type 2 diabetes, high blood pressure,

>sleep apnea and ease joint pain. But those who undergo

>weight-loss surgery almost never achieve an ideal body

>weight and still remain slightly obese or at least

>overweight. " If they started off with a body mass

>index of 60, they may get to a body mass index of 35, "

>Sugerman says. " They're not going to get to a BMI of

>30 or 25. "

>

>The weight also creeps back, as Roker has found. He

>shed more than 100 pounds after surgery in 2002, but

>in January of this year began a diet on the show to

>lose 20 of the pounds he's regained. He's said that a

>back problem and a hectic business travel schedule

>have contributed to his added pounds. " Typically

>you'll get three to five years of benefit in terms of

>weight loss, " notes. " But the weight almost

>invariably comes back. "

>

>Prepare to pay . Even if you have health insurance, it

>may not pick up much of the tab. Weight-loss surgery

>averages $30,000, plus the cost of follow-up care.

>Private insurers take their cue from CMS, which allows

>$10,000 for hospital costs, plus up to $1,700 for the

>surgeon. Medicare picks up 80 percent of the surgeon's

>cost; the patient pays 20 percent. Follow-up medical,

>psychological, diet and exercise treatment are extra

>and can run thousands of dollars more and generally is

>not covered by insurance or Medicare.

>

>Find additional help. The often large and fairly rapid

>weight loss following surgery " requires physical and

>emotional adjustment, " notes clinical psychologist

> Kalarchian, who studies people who have

>undergone weight-loss surgery at the Western

>Psychiatric Institute and Clinic in Pittsburgh.

>

>Spouses may also need some assistance. A recent

>University of Tennessee study examined spouses of 63

>people who underwent weight-loss surgery. They found

>that 75 percent of spouses who were obese gained

>weight in the year after surgery -- perhaps because

>they ate food no longer eaten by their mates -- as did

>38 percent who were not obese. The team suggests

>counseling to prevent weight gain and that very obese

>spouses be considered candidates for bariatric surgery

>themselves.

>

>Surgical treatments have not proven effective for

>severe obesity. " Nothing about the surgical procedures

>will cure the disease, " notes . " It's the very

>uncommon patient who will sustain the weight loss. But

>if you can get five years of benefit out of it, that's

>pretty good. "

>

March 13, 2006

Hi -

I am only 4 years and 2 months postop, but lost 186 pounds and still only

play with 10 pounds. I do think it's important to understand this is a

tool. I feel that I have to be aware of my food intake, activity level,

etc., but it really is the first time in my life that I feel I am on the

same fair playing field as other average sized people. Prior to surgery I

carried an excess of 200 pounds and struggled all the time to lose even 20

pounds. 4+ years after surgery I have to be aware of what I eat, but it is

manageable. I can back off and the extra pounds drop off. 10 pounds and

not 200 extra is a whole different story. I will let you know if things

change drastically in the next 10 months. :-)

I don't know about others, but I still feel that the surgery keeps my body

in check. I obviously eat more than initially after surgery. I can eat

more than a saltine cracker, but still never a full serving of anything. I

may pick at it over time and eat something, but I am still restricted by how

much I can eat. Due to the bypass my body keeps me from eating " bad " foods

too often so the 2 components given to me are assisting my weight control.

The foods that make me feel the best are healthy and if I fill my smaller

stomach with these choices most of the time it seems to be working.

I take my vitamins, watch the scale, and try to never forget where I

started. This seems to be the same as my 110 pound daughter-in-law. She

too watches what she eats, exercises, but will never really experience the

control food had in my life. Even average sized people have to " watch " what

they eat, but it seems we're better fat storers prior to surgery than

others. I pray everyday that I never wake up from this dream. I am

thankful for the MGB, Dr. Rutledge, and the tool he provided to me.

Kim Hazen

The Centers for Excellence in Lapraroscopic Obesity Surgery

CLOS Director of Michigan

Phone: 989-450-8081

Fax: 989-671-9813

Email: khazen@...

_____

From: [mailto: ] On

Behalf Of Neal Haerich

Sent: Monday, March 13, 2006 8:56 AM

Subject: Washington Post Article - What do OUR Long-Term People

See?

I'm only three months and 40 pounds post-op, and reading this column made me

sick to my stomach (no pun intended).

PLEASE: If there are people out there in MGB land that have kept their

weight off for 5 years or longer, can you let the rest of us know that we

didn't do this in vain? What are the " real " long term stories for MGB???

Thanks

Neal

JamiGoldWing <jamigoldwing@...> wrote:

According to this article, the weight lost from WLS surgery only

lasts about 3 to 5 years! Gosh!

Choosing the Knife

By Sally Squires

Tuesday, March 7, 2006; HE01

" Today " show weatherman Al Roker and singer Carnie

are likely to have a lot more company in the

once-exclusive ranks of those who have had weight-loss

surgery.

A recent Medicare decision expands coverage for

gastric bypass and other weight-loss surgery to people

with a body mass index of 35 or greater -- about 60

pounds or more overweight -- who also have at least

one weight-related medical problem, such as diabetes,

sleep apnea or heart disease.

In 2005, about 170,000 people in the United States had

weight-loss surgery, according to the American Society

of Bariatric Surgery (ASBS). Medicare paid for 6,000

of those procedures. Ninety percent of those

operations were performed on people younger than 66,

who are disabled by their weight and other medical

problems, according to the federal Centers for

Medicare and Medicaid Services (CMS). Since private

insurers generally follow Medicare's lead, weight-loss

surgery is expected to increase significantly

throughout the country.

But experts caution that surgery is not a cure for

obesity. " It's a tool designed to help you help

yourself, not a free ride, " says surgeon Harvey

Sugerman, past president of ASBS and professor

emeritus at Virginia Commonwealth University.

Some worry that the expanded coverage sends the wrong

message, since medical treatment for obesity is

limited at best. " Insurance companies won't cover the

medical care of obesity treatment, but they're willing

to pay for surgical intervention, " notes Arthur ,

director of the Washington University Weight

Management Program. " That's outrageous. It drives

people into surgery . . . and may create the wrong

incentives. "

Here are some of the caveats to keep in mind about

gastric bypass and other weight-loss surgery, which

has a mortality risk of about 0.5 percent to 2

percent, about the same as a hip or knee replacement.

Surgery only gives a jump start. The procedures

promote weight loss in two ways: either by diverting

food from the stomach to a lower part of the digestive

tract where nutrients can't be absorbed, or by

reducing stomach size so that less food can be

consumed at a given time. Overeating after surgery can

result in vomiting or in " dumping, " a condition that

lasts about 30 minutes and is characterized by

lightheadedness, nausea, flushing and sometimes

diarrhea.

" But you can always beat the system by drinking milk

shakes or eating ice cream, " says , who notes

that the same healthy habits prescribed for weight

loss -- eating less and moving more -- are still

required after surgery.

That may be particularly challenging since people who

become morbidly obese usually have difficulty

controlling what they eat and often don't exercise.

" Lots of people go into this with unrealistic

expectations that the surgery will take care of it all

and this will be it, " says Ronna Saunders, director of

the Center for Behavioral Change in Richmond, who

counsels people after weight-loss surgery and screens

them before it.

Plan on taking vitamin and mineral supplements for

life. Weight-loss surgery alters the digestive tract

so that enough key vitamins and minerals can't be

absorbed from food alone. After surgery, " all

menstruating women need iron supplements, " Sugerman

says. " All patients need vitamin B12daily by mouth or

monthly by injection. " Also required: a daily

multivitamin and at least 500 milligrams of calcium

per day.

Expect to regain some of the weight lost initially.

During the first two years after surgery, an average

of 60 percent of excess pounds are lost, which can

improve the patient's health by treating such

conditions as type 2 diabetes, high blood pressure,

sleep apnea and ease joint pain. But those who undergo

weight-loss surgery almost never achieve an ideal body

weight and still remain slightly obese or at least

overweight. " If they started off with a body mass

index of 60, they may get to a body mass index of 35, "

Sugerman says. " They're not going to get to a BMI of

30 or 25. "

The weight also creeps back, as Roker has found. He

shed more than 100 pounds after surgery in 2002, but

in January of this year began a diet on the show to

lose 20 of the pounds he's regained. He's said that a

back problem and a hectic business travel schedule

have contributed to his added pounds. " Typically

you'll get three to five years of benefit in terms of

weight loss, " notes. " But the weight almost

invariably comes back. "

Prepare to pay . Even if you have health insurance, it

may not pick up much of the tab. Weight-loss surgery

averages $30,000, plus the cost of follow-up care.

Private insurers take their cue from CMS, which allows

$10,000 for hospital costs, plus up to $1,700 for the

surgeon. Medicare picks up 80 percent of the surgeon's

cost; the patient pays 20 percent. Follow-up medical,

psychological, diet and exercise treatment are extra

and can run thousands of dollars more and generally is

not covered by insurance or Medicare.

Find additional help. The often large and fairly rapid

weight loss following surgery " requires physical and

emotional adjustment, " notes clinical psychologist

Kalarchian, who studies people who have

undergone weight-loss surgery at the Western

Psychiatric Institute and Clinic in Pittsburgh.

Spouses may also need some assistance. A recent

University of Tennessee study examined spouses of 63

people who underwent weight-loss surgery. They found

that 75 percent of spouses who were obese gained

weight in the year after surgery -- perhaps because

they ate food no longer eaten by their mates -- as did

38 percent who were not obese. The team suggests

counseling to prevent weight gain and that very obese

spouses be considered candidates for bariatric surgery

themselves.

Surgical treatments have not proven effective for

severe obesity. " Nothing about the surgical procedures

will cure the disease, " notes . " It's the very

uncommon patient who will sustain the weight loss. But

if you can get five years of benefit out of it, that's

pretty good. "

March 13, 2006

Joanie is absolutely right! It's a tool, not a cure. I'm 3 years post op and I

watch my weight very carefully. If I eat ice cream & junk I gain 5 pounds real

quick and if I stop I lose it. Althought I cannot speak personally about 5

years post op, a friend of mine had an RNY 5 years ago and she is still thin.

Looks and feels great! She eats very small portions.

I won't lie to you, that article is terrrifying to me. I cannot stand the

thought of gaining that weight back and I thought this was going to be a free

ride. This is a wakeup call. I'd love to hear from more of you further out of

your post-op.

Thank you,

Holly

318/175

5'10 " Size 8

March 11, 2003

Dr R (MY HERO!)

Washington Post Article - What do OUR Long-Term

>People See?

>Date: Mon, 13 Mar 2006 05:56:07 -0800 (PST)

>

>I'm only three months and 40 pounds post-op, and reading this column made

>me sick to my stomach (no pun intended).

>

> PLEASE: If there are people out there in MGB land that have kept their

>weight off for 5 years or longer, can you let the rest of us know that we

>didn't do this in vain? What are the " real " long term stories for MGB???

> Thanks

> Neal

>

>JamiGoldWing <jamigoldwing@...> wrote:

> According to this article, the weight lost from WLS surgery only

>lasts about 3 to 5 years! Gosh!

>

>Choosing the Knife

>

>By Sally Squires

>Tuesday, March 7, 2006; HE01

>

> " Today " show weatherman Al Roker and singer Carnie

> are likely to have a lot more company in the

>once-exclusive ranks of those who have had weight-loss

>surgery.

>

>A recent Medicare decision expands coverage for

>gastric bypass and other weight-loss surgery to people

>with a body mass index of 35 or greater -- about 60

>pounds or more overweight -- who also have at least

>one weight-related medical problem, such as diabetes,

>sleep apnea or heart disease.

>

>In 2005, about 170,000 people in the United States had

>weight-loss surgery, according to the American Society

>of Bariatric Surgery (ASBS). Medicare paid for 6,000

>of those procedures. Ninety percent of those

>operations were performed on people younger than 66,

>who are disabled by their weight and other medical

>problems, according to the federal Centers for

>Medicare and Medicaid Services (CMS). Since private

>insurers generally follow Medicare's lead, weight-loss

>surgery is expected to increase significantly

>throughout the country.

>

>But experts caution that surgery is not a cure for

>obesity. " It's a tool designed to help you help

>yourself, not a free ride, " says surgeon Harvey

>Sugerman, past president of ASBS and professor

>emeritus at Virginia Commonwealth University.

>

>Some worry that the expanded coverage sends the wrong

>message, since medical treatment for obesity is

>limited at best. " Insurance companies won't cover the

>medical care of obesity treatment, but they're willing

>to pay for surgical intervention, " notes Arthur ,

>director of the Washington University Weight

>Management Program. " That's outrageous. It drives

>people into surgery . . . and may create the wrong

>incentives. "

>

>Here are some of the caveats to keep in mind about

>gastric bypass and other weight-loss surgery, which

>has a mortality risk of about 0.5 percent to 2

>percent, about the same as a hip or knee replacement.

>

>Surgery only gives a jump start. The procedures

>promote weight loss in two ways: either by diverting

>food from the stomach to a lower part of the digestive

>tract where nutrients can't be absorbed, or by

>reducing stomach size so that less food can be

>consumed at a given time. Overeating after surgery can

>result in vomiting or in " dumping, " a condition that

>lasts about 30 minutes and is characterized by

>lightheadedness, nausea, flushing and sometimes

>diarrhea.

>

> " But you can always beat the system by drinking milk

>shakes or eating ice cream, " says , who notes

>that the same healthy habits prescribed for weight

>loss -- eating less and moving more -- are still

>required after surgery.

>

>That may be particularly challenging since people who

>become morbidly obese usually have difficulty

>controlling what they eat and often don't exercise.

> " Lots of people go into this with unrealistic

>expectations that the surgery will take care of it all

>and this will be it, " says Ronna Saunders, director of

>the Center for Behavioral Change in Richmond, who

>counsels people after weight-loss surgery and screens

>them before it.

>

>Plan on taking vitamin and mineral supplements for

>life. Weight-loss surgery alters the digestive tract

>so that enough key vitamins and minerals can't be

>absorbed from food alone. After surgery, " all

>menstruating women need iron supplements, " Sugerman

>says. " All patients need vitamin B12daily by mouth or

>monthly by injection. " Also required: a daily

>multivitamin and at least 500 milligrams of calcium

>per day.

>

>Expect to regain some of the weight lost initially.

>During the first two years after surgery, an average

>of 60 percent of excess pounds are lost, which can

>improve the patient's health by treating such

>conditions as type 2 diabetes, high blood pressure,

>sleep apnea and ease joint pain. But those who undergo

>weight-loss surgery almost never achieve an ideal body

>weight and still remain slightly obese or at least

>overweight. " If they started off with a body mass

>index of 60, they may get to a body mass index of 35, "

>Sugerman says. " They're not going to get to a BMI of

>30 or 25. "

>

>The weight also creeps back, as Roker has found. He

>shed more than 100 pounds after surgery in 2002, but

>in January of this year began a diet on the show to

>lose 20 of the pounds he's regained. He's said that a

>back problem and a hectic business travel schedule

>have contributed to his added pounds. " Typically

>you'll get three to five years of benefit in terms of

>weight loss, " notes. " But the weight almost

>invariably comes back. "

>

>Prepare to pay . Even if you have health insurance, it

>may not pick up much of the tab. Weight-loss surgery

>averages $30,000, plus the cost of follow-up care.

>Private insurers take their cue from CMS, which allows

>$10,000 for hospital costs, plus up to $1,700 for the

>surgeon. Medicare picks up 80 percent of the surgeon's

>cost; the patient pays 20 percent. Follow-up medical,

>psychological, diet and exercise treatment are extra

>and can run thousands of dollars more and generally is

>not covered by insurance or Medicare.

>

>Find additional help. The often large and fairly rapid

>weight loss following surgery " requires physical and

>emotional adjustment, " notes clinical psychologist

> Kalarchian, who studies people who have

>undergone weight-loss surgery at the Western

>Psychiatric Institute and Clinic in Pittsburgh.

>

>Spouses may also need some assistance. A recent

>University of Tennessee study examined spouses of 63

>people who underwent weight-loss surgery. They found

>that 75 percent of spouses who were obese gained

>weight in the year after surgery -- perhaps because

>they ate food no longer eaten by their mates -- as did

>38 percent who were not obese. The team suggests

>counseling to prevent weight gain and that very obese

>spouses be considered candidates for bariatric surgery

>themselves.

>

>Surgical treatments have not proven effective for

>severe obesity. " Nothing about the surgical procedures

>will cure the disease, " notes . " It's the very

>uncommon patient who will sustain the weight loss. But

>if you can get five years of benefit out of it, that's

>pretty good. "

>

March 13, 2006

Hi ,

Thank you for your very honest reply. As you know, I am one of those, whose

window of opportunity closed at about 6 months and have been working

consistently at WW to lose the rest. I remember hearing somewhere that Dr.

Rutledge said that you could gain back some weight, if we continue eating in

the same manner as before, but no more than 30%. If that is the case, 30% of

the 128 lbs lost would be 38.4 for a total loss of 90 lbs, which is right at

your overall loss of 88. Just a thought.

Rhue Green

5/6/04

Dr. Dasher

>From: " juliewmson " <jwmson1@...>

>Reply-

>

>Subject: Re: Washington Post Article - What do OUR Long-Term

>People See?

>Date: Mon, 13 Mar 2006 14:18:05 -0000

>

>Ok .. I am about to give a very unpopular opinion here ... if you

>don't do what is " required " postop, i.e. learning to eat more healthy

>foods, watching what you (not dieting but eating normally), moving

>more, etc. you can in all likelihood regain weight. Could you regain

>it all? I believe I could! I am 5 years and 5 months postop .. I

>had lost a total of 128 pounds. I have kept off about 88. What do I

>attribute my weight regain to ... my own stupidity! I went back into

>a " mindless snacking " , eating whatever I wanted whenever I wanted,

>not exercising, etc.

>

>So ... moral of the story ... be like " normal " people ... watch what

>you eat, eat healthy and get some exercise. If we do that .. we will

>be fine I believe.

>

> in GA

>

> > According to this article, the weight lost from WLS surgery only

> > lasts about 3 to 5 years! Gosh!

> >

> > Choosing the Knife

> >

> > By Sally Squires

> > Tuesday, March 7, 2006; HE01

> >

> > " Today " show weatherman Al Roker and singer Carnie

> > are likely to have a lot more company in the

> > once-exclusive ranks of those who have had weight-loss

> > surgery.

> >

> > A recent Medicare decision expands coverage for

> > gastric bypass and other weight-loss surgery to people

> > with a body mass index of 35 or greater -- about 60

> > pounds or more overweight -- who also have at least

> > one weight-related medical problem, such as diabetes,

> > sleep apnea or heart disease.

> >

> > In 2005, about 170,000 people in the United States had

> > weight-loss surgery, according to the American Society

> > of Bariatric Surgery (ASBS). Medicare paid for 6,000

> > of those procedures. Ninety percent of those

> > operations were performed on people younger than 66,

> > who are disabled by their weight and other medical

> > problems, according to the federal Centers for

> > Medicare and Medicaid Services (CMS). Since private

> > insurers generally follow Medicare's lead, weight-loss

> > surgery is expected to increase significantly

> > throughout the country.

> >

> > But experts caution that surgery is not a cure for

> > obesity. " It's a tool designed to help you help

> > yourself, not a free ride, " says surgeon Harvey

> > Sugerman, past president of ASBS and professor

> > emeritus at Virginia Commonwealth University.

> >

> > Some worry that the expanded coverage sends the wrong

> > message, since medical treatment for obesity is

> > limited at best. " Insurance companies won't cover the

> > medical care of obesity treatment, but they're willing

> > to pay for surgical intervention, " notes Arthur ,

> > director of the Washington University Weight

> > Management Program. " That's outrageous. It drives

> > people into surgery . . . and may create the wrong

> > incentives. "

> >

> > Here are some of the caveats to keep in mind about

> > gastric bypass and other weight-loss surgery, which

> > has a mortality risk of about 0.5 percent to 2

> > percent, about the same as a hip or knee replacement.

> >

> > Surgery only gives a jump start. The procedures

> > promote weight loss in two ways: either by diverting

> > food from the stomach to a lower part of the digestive

> > tract where nutrients can't be absorbed, or by

> > reducing stomach size so that less food can be

> > consumed at a given time. Overeating after surgery can

> > result in vomiting or in " dumping, " a condition that

> > lasts about 30 minutes and is characterized by

> > lightheadedness, nausea, flushing and sometimes

> > diarrhea.

> >

> > " But you can always beat the system by drinking milk

> > shakes or eating ice cream, " says , who notes

> > that the same healthy habits prescribed for weight

> > loss -- eating less and moving more -- are still

> > required after surgery.

> >

> > That may be particularly challenging since people who

> > become morbidly obese usually have difficulty

> > controlling what they eat and often don't exercise.

> > " Lots of people go into this with unrealistic

> > expectations that the surgery will take care of it all

> > and this will be it, " says Ronna Saunders, director of

> > the Center for Behavioral Change in Richmond, who

> > counsels people after weight-loss surgery and screens

> > them before it.

> >

> > Plan on taking vitamin and mineral supplements for

> > life. Weight-loss surgery alters the digestive tract

> > so that enough key vitamins and minerals can't be

> > absorbed from food alone. After surgery, " all

> > menstruating women need iron supplements, " Sugerman

> > says. " All patients need vitamin B12daily by mouth or

> > monthly by injection. " Also required: a daily

> > multivitamin and at least 500 milligrams of calcium

> > per day.

> >

> > Expect to regain some of the weight lost initially.

> > During the first two years after surgery, an average

> > of 60 percent of excess pounds are lost, which can

> > improve the patient's health by treating such

> > conditions as type 2 diabetes, high blood pressure,

> > sleep apnea and ease joint pain. But those who undergo

> > weight-loss surgery almost never achieve an ideal body

> > weight and still remain slightly obese or at least

> > overweight. " If they started off with a body mass

> > index of 60, they may get to a body mass index of 35, "

> > Sugerman says. " They're not going to get to a BMI of

> > 30 or 25. "

> >

> > The weight also creeps back, as Roker has found. He

> > shed more than 100 pounds after surgery in 2002, but

> > in January of this year began a diet on the show to

> > lose 20 of the pounds he's regained. He's said that a

> > back problem and a hectic business travel schedule

> > have contributed to his added pounds. " Typically

> > you'll get three to five years of benefit in terms of

> > weight loss, " notes. " But the weight almost

> > invariably comes back. "

> >

> > Prepare to pay . Even if you have health insurance, it

> > may not pick up much of the tab. Weight-loss surgery

> > averages $30,000, plus the cost of follow-up care.

> > Private insurers take their cue from CMS, which allows

> > $10,000 for hospital costs, plus up to $1,700 for the

> > surgeon. Medicare picks up 80 percent of the surgeon's

> > cost; the patient pays 20 percent. Follow-up medical,

> > psychological, diet and exercise treatment are extra

> > and can run thousands of dollars more and generally is

> > not covered by insurance or Medicare.

> >

> > Find additional help. The often large and fairly rapid

> > weight loss following surgery " requires physical and

> > emotional adjustment, " notes clinical psychologist

> > Kalarchian, who studies people who have

> > undergone weight-loss surgery at the Western

> > Psychiatric Institute and Clinic in Pittsburgh.

> >

> > Spouses may also need some assistance. A recent

> > University of Tennessee study examined spouses of 63

> > people who underwent weight-loss surgery. They found

> > that 75 percent of spouses who were obese gained

> > weight in the year after surgery -- perhaps because

> > they ate food no longer eaten by their mates -- as did

> > 38 percent who were not obese. The team suggests

> > counseling to prevent weight gain and that very obese

> > spouses be considered candidates for bariatric surgery

> > themselves.

> >

> > Surgical treatments have not proven effective for

> > severe obesity. " Nothing about the surgical procedures

> > will cure the disease, " notes . " It's the very

> > uncommon patient who will sustain the weight loss. But

> > if you can get five years of benefit out of it, that's

> > pretty good. "

> >

March 13, 2006

Neal,

The folks who have responded have provided the best persepctive you can

get - this is a powerful TOOL but not a magic bullet 'cure'.

I passed my 5 year anniversay a few months ago. I too have about a 10

pound range that I seem to operate in. I am probably one of the more

unusual cases Dr R had - I started at about 600 lbs and he wouldn;t

touch me as a patient until I was under 400. I did that because I wanted

THIS TOOL for long term success. With it the last 200+ pounds are gone

(for good I hope) - but that is under my control. Life is certainly

different at 185-190 vs 600!!

People have a difficult time believing that I had ever been 600 lbs -

until the see the jumbo sized photos. I hate the excess skin - but as

far as I can tell the cosmetic benefits don't yet outweigh the risk of

the additional surgery. Not afraid of the knife as much as the

anesthesia. Love my brain - hate my brain after anesthesia. But that's

another story . . .

And as far as eating I have learned what I can and can't eat - and if

you didn;t know I had had WLS you would not know that I was intake

restricted. It is very much a matter of what I eat and in what order. I

limit carbs (especially at the start of a meal), fill up (and I mean

fill) on veggies, fruit and protein. I still never drink when I eat -

not even water - so I get 'full' from the food and stay full longer -

and hopefully get the biggest bang from the digestive process as possible.

Small changes in life make a difference - like taking the stairs up 3

flights - exercising - I've just started taking a Yoga class and my

instructor told me that I was 'extraordinarily flexible' for a beginner.

I'm guessing my former size may have added to that, but who knows.

I'm not perfect by any means. I'm not obsessive. I 'cheat' on occasion -

when I want a little ice cream I eat a little ice cream. But the key is

moderation. A spoonful not a pint!

Bottom line - I understand the stress Al Roker is under and why he may

be gaining. Been there - and recognized the potential. This was the

'last chance' as far as I was concerned. This was a tool to help support

a lifestyle change. For that it has worked for me 5+ years out!

Good luck!

JP

March 14, 2006

Wow -- I guess this means you have lost a total of 400 pounds. What an

accomplishment! And to keep up all or most of it is also a huge

accomplishment. Your nutritional strategies sound perfect to me. I am

still trying to knock off about 20 pounds, and I must remember the

basics...protein and veggies and fruit, in that order, to fill the pouch.

Congrats on doing this for yourself. I can only imagine how your life has

changed!!

Joanie

5/25/04

Drs. Walsh and Rutledge

>From: Amysdad <amysdad@...>

>Reply-

>

>Subject: Re: Washington Post Article - What do OUR Long-Term

>People See?

>Date: Mon, 13 Mar 2006 23:09:07 -0600

>

>Neal,

>

>The folks who have responded have provided the best persepctive you can

>get - this is a powerful TOOL but not a magic bullet 'cure'.

>

>I passed my 5 year anniversay a few months ago. I too have about a 10

>pound range that I seem to operate in. I am probably one of the more

>unusual cases Dr R had - I started at about 600 lbs and he wouldn;t

>touch me as a patient until I was under 400. I did that because I wanted

>THIS TOOL for long term success. With it the last 200+ pounds are gone

>(for good I hope) - but that is under my control. Life is certainly

>different at 185-190 vs 600!!

>

>People have a difficult time believing that I had ever been 600 lbs -

>until the see the jumbo sized photos. I hate the excess skin - but as

>far as I can tell the cosmetic benefits don't yet outweigh the risk of

>the additional surgery. Not afraid of the knife as much as the

>anesthesia. Love my brain - hate my brain after anesthesia. But that's

>another story . . .

>

>And as far as eating I have learned what I can and can't eat - and if

>you didn;t know I had had WLS you would not know that I was intake

>restricted. It is very much a matter of what I eat and in what order. I

>limit carbs (especially at the start of a meal), fill up (and I mean

>fill) on veggies, fruit and protein. I still never drink when I eat -

>not even water - so I get 'full' from the food and stay full longer -

>and hopefully get the biggest bang from the digestive process as possible.

>

>Small changes in life make a difference - like taking the stairs up 3

>flights - exercising - I've just started taking a Yoga class and my

>instructor told me that I was 'extraordinarily flexible' for a beginner.

>I'm guessing my former size may have added to that, but who knows.

>

>I'm not perfect by any means. I'm not obsessive. I 'cheat' on occasion -

>when I want a little ice cream I eat a little ice cream. But the key is

>moderation. A spoonful not a pint!

>

>Bottom line - I understand the stress Al Roker is under and why he may

>be gaining. Been there - and recognized the potential. This was the

>'last chance' as far as I was concerned. This was a tool to help support

>a lifestyle change. For that it has worked for me 5+ years out!

>

>Good luck!

>

>JP

>

_________________________________________________________________

On the road to retirement? Check out MSN Life Events for advice on how to

get there! http://lifeevents.msn.com/category.aspx?cid=Retirement

March 14, 2006

Hi, there,

I'm not quite two years out, and am very fortunate in that I am

experiencing a longer-than-usual " honeymoon " period and admittedly

not eating as " cleanly " as I know I should.

However, in my defense, the FIRST thing I do every morning is get on

the scale, and depending on what it tells me (regarding 1-2 lbs. up

or down) I adjust my eating accordingly until the scale is back where

it should be. I also exercise at the level that some might consider

complusive (8-10 hours a week), but only activities that I really

enjoy and consider my " fun " time with my gym-rat buddies (which

currently include choreographed dance aerobics, step, circuit

training and power salsa).

I am confident that by reacting IMMEDIATELY to what the scale tells

me as well as maintaining regular exercise (maybe not as much as I'm

doing right now, but I have exercised at least 3 hours a week since

1980, so this is an ingrained habit for me) that I will be able to

beat the odds on possible regain...like so many have already said,

this has been the best answer to my life-long weight problem, and I

am committed to making it the PERMANENT answer.

I don't think that Al Roker and Carnie are particularly good

examples to hold up for evaluation. Al admittedly had an injury

which prevented him from his exercise routine. Mathematically, as we

all know, if the energy expended is reduced, than the energy injested

must also reduce to prevent weight gain. However, if you're not

exercising, not only are you not expending the calories, but you do

not get the benefit of the reduced appetite for a couple hours after

an exercise session, plus you have more free time to fill with eating.

I'm not sure where Carnie is weight-wise, but she was doing

well with the 10 lb. range until she got pregnant. I think she made

the same mistake that many woman make (how many of us had our weight

problems initiated by pregnancy?) in taking that condition as license

to eat any and everything, and then not getting back on track

immediately after delivery. Poor girl. As public as she was with

her journey, I'm sure she's embarrassed now. I hope she is able to

turn it around as Al seems to be doing.

These days, I like to restrict embarrassment to my 13-year-old niece,

who is appalled that I will dance to the Musak at restaurants while

we're waiting to be seated!

Regards to all my fellow journeyers.

in Atlanta

06/03/04

High Point/Dr. Dasher

290/120

size 6 (I never thought I'd see the day of single digit sizes! And

when I hold them up and look at them, I'm STILL always amazed that

they fit!)

I'm only three months and 40 pounds post-op, and reading this column

made me sick to my stomach (no pun intended).

PLEASE: If there are people out there in MGB land that have kept

their weight off for 5 years or longer, can you let the rest of us

know that we didn't do this in vain? What are the " real " long term

stories for MGB???

Thanks

Neal

March 14, 2006

Sara,

Thanks for posting. I found your story very interesting. As a pre-op,

stories like yours keep me going while I wait on insurance appeals.

Congratulations on your tremendous weight loss and your healthy new life!

in NC

pre-op

Vaughn Schutz <saraschutz@...> wrote:

Hi,

I haven't posted in a very long time, maybe years, but I get the list

in digest form and skim it sometimes, and I happened to see the post

about WLS patients gaining the weight back. That has been a terrible

fear of mine, because I would really probably rather be dead than weigh

as much as I did and feel as badly as I did physically.

Anyway, I am more than 5 years out from having my MGB by Dr. R (Aug. 2,

2000), so I thought some of you might like to know that my weight is

still down. I had surgery at 255 lbs. and 5 " 4 1/2 " tall. I now weigh

127 (my weight today) and am 5 " 5 " ! I never, ever measured at 5'5 "

before the surgery, but that's how tall the doctor says I am now, and I

am 48 years old, so I should be past the growth stage . I guess the

weight was weighing me down all those years. I fluctuate in about an 8

lb. range, from about 123 to 131. But when I go above 126 or so, it

really seems to be water weight. My weight has been stable in this

range for about 3 years. I did drop down to a low of 118 about two

years ago, but that was during a period of extreme stress in my life.

My blood work has always been pretty good except for one time early on

when I had too high levels of Vitamin B. Dr. R said to stop taking

extra B other than my 3 vitamins a day, but I wasn't taking any extra B

then, and it hasn't happened again, so maybe it was a fluke. My liver

enzymes are often up a bit. My doctor has tested me for hepatitis, but

that is negative. So she just has them checked every 6 months or so,

and sometimes they are up higher than other times. She doesn't know

why, but she's not too worried about it anymore. Last time it was

checked, a few weeks ago, things looked fine. Dr. R said I had a very

fatty liver when he looked at it during surgery.

I had a Dexa scan to check for osteoporosis a few weeks ago, just

because I was worried, and it turned out normal. I know that I am

probably not the norm, but I am very thankful that I seem to be able to

eat whatever I want and not really gain my weight back so far. I am

lactose intolerant since the surgery, so I can't drink milk or eat ice

cream, and if I could I probably would do a lot of that, so that

probably helps me keep my weight down. I do feel sick if I eat a lot

of sugar, but I can eat some with no problem, especially if I eat other

stuff first. If I eat very fatty foods I get bad heart burn, so I do

try not to do that. I can eat quite a bit, but not as much as before

the surgery. I can sometimes eat two big pieces of pizza and a piece

of cake after . But sometimes I can't eat that much. No one ever

says anything about me not eating much, because I think I eat pretty

much like a normal sized person would.

I don't exercise . I have never been able to make myself exercise

regularly. I do have a small farm, and do get some natural exercise

from that, but that's all. I don't advocate not exercising! But I

have been very lucky in spite of my shortcomings in that area. I do

take my vitamins, and I do try to eat a lot of protein.

I am thankful every day that I had the MGB. I pray that it's great

effects will continue the rest of my life. I feel so free not having

to worry continually about my weight. It has truly been a miracle for

me.

Sorry this was so long, but I thought some of you might be interested.

Sara Schutz in TN

255/127 MGB by Dr. R-August 2, 2000

http://www.sweet-dream-farm.com

March 15, 2006

Thanks very much for the post. It is nice to hear from all those patients out

five years or so. Hopefully we'll all be here 25 years from now talking about

our experiences in the same way!

Markham Lee