Weight Loss Surgery: Lifestyle Changes a Reality (cont.)

During the immediate aftermath of the surgery, people can only tolerate small amounts of food, she explains, but after a while they can eat more because the pouch opening gets stretched out. "Food cravings start coming back and medical problems can follow suit," she says.

"Surgery is not a cure for obesity, it's only a tool," she says. "One has to have the mindset or resolve that lifestyle changes are inevitable. A lot of people have been disappointed in surgery long term because they really thought it would cure obesity and it hasn't." Odom runs a monthly support group for patients considering the surgery as well as those who have undergone it.

Nothing Tastes as Good as Thin Feels

"The significant weight loss that occurs within the first year is a very big motivator, but food urges start coming back and people get scared and have to learn to cope with food urges without acting on them," Odom warns.

Kochman believes she has this part covered. "When it came to dieting all my life, I always felt like a failure, but now my capacity is different and that's the tool that I have been given," she says. "Between that tool and the changes in my own head, I feel like a success."

In other words, "it's more important to feel good about myself than to have a cookie," she says.

Another issue that some former weight loss surgery patients face is that they think surgery will improve everything in their lives, and it doesn't. "A difficult marriage before surgery will be a difficult marriage after surgery," she says.

For Kochman, the only major change in her marriage is that "now I am a cheap date," she quips.

When she and her husband dined out the other night, "I ate a hamburger without the roll, got half way through it and was so full," she says.

Decrease in Medication Aids Motivation

Other motivators are the reduced dependence on medications and freedom from the lifestyle restrictions of obesity.

"The data are pretty strong that patients who have the surgery have a lower mortality risk than those who did not have surgery, and clearly there are dramatic improvements in comorbidites of obesity such as diabetes, hypertension, and obstructive sleep apnea," says Sugerman.

In a recent review of 136 studies published in The Journal of the American Medical Association, weight loss surgery reversed diabetes in 77% of obese patients, eliminated or improved high blood pressure in 78%, and improved cholesterol in at least 70%. In addition, obstructive sleep apnea resolved in 86% of patients.

The New You

When a person loses a large amount of weight in a short period of time, particularly after weight loss surgery, they may have large amounts of extra skin that requires some significant nipping and tucking.

"Different people present with different degrees of deformity," says Al Aly, MD, a plastic surgeon in private practice in Iowa City, Iowa, and a spokesman for the American Society for Aesthetic Plastic Surgery (ASAPS).

Most weight loss surgery patients who undergo body contouring will have a minimum of two and as many as three to four surgeries following weight loss, he says. And as the trend toward weight loss surgery increases, plastic surgeons are learning how to best sequence these surgeries.

"The most common thing is the lower trunk [which comprises] the belly, hips, waist, sides, and buttocks," he says. "Essentially the tummy is the area that bothers people the most, so it is often one of the first things addressed," he says. "The upper arms and thighs are two other areas that are quite problematic for massive weight loss patients as are the area from the neck down to just below breasts," he says.

The excess skin and the amount of follow-up surgeries can come as a surprise to massive weight loss patients, he says.

"People are not told what is going to happen when they lose weight," he says. "In the average person when they lose weight, especially massive weight, their skin is not going to contract down," he says. "If your skin is a balloon that's blown up pretty extensively for an extreme period of time, when you take the air out, it doesn't go back to same shape."

Most Would Do It Again, Despite Obstacles

As Al Roker said in November 2004, about two and a half years after his surgery: "For anybody who thinks that this is a magic bullet, you do this and it's done, you're making a mistake. It's not."

Sugerman agrees. "Some people go into it thinking it's a free ride, and we try to make it clear it's a procedure designed to help them help themselves," he says.

And despite the fact that this is a major surgery involving a whole host of often-difficult lifestyle changes and the potential for even more follow-up surgeries, Kochman would do it again -- in a "New York minute."

That holds for the vast majority of weight loss surgery patients, says Sugerman. "I have had patients 18 years out who control weight and are extremely grateful."

Published Feb. 25, 2005.

SOURCES: Jacqueline Odom, PhD, psychological director, Beaumont Weight Control Center, Royal Oak, Mich. Al Aly, MD, plastic surgeon; spokesman, American Society for Aesthetic Plastic Surgery. Harvey Sugerman, MD emeritus professor of surgery, Virginia Commonwealth University, Richmond, Va.; president, American Society for Bariatric Surgery.

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