[DocSanae]

While you are still researching the surgery, or going through "the process" your very first concern will be "will my insurance approve this?"
Once you have been approved, your concern will be, "will I come through the surgery safely?"
When you are less than a year out, your primary concern will be how much and how fast will you be able to lose, or, what if I don't lose.
When more than a year has gone by since your surgery, and you finally start seeing yourself at a better place, you may start getting complacent with your success and see yourself starting to slide into old habits that did you no good pre op, and you may start wondering about the long term success rate of this surgery.

I have noticed some posts that are kind of panicky, stating of having heard that only 10% will keep their weight off post op, and this, I find rather misleading.

The fact is, medically speaking, in a couple of guidelines published by NIH, the statement there is that many/most post ops keep their weight off long term.
To be exact.
The following are word to word quotes from the source listed.

1) Gastrointestinal Surgery for Severe Obesity (from NIH/NIDDK)
"With the Roux-en-Y gastric bypass, many patients maintain weight loss of 60-70% of their excess weight for 10 years or more."

2) The Practical Guide. Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. (from NIH/NHLBI)
"Weight loss surgery provides medically significant sustained weight loss for more than 5 years in most patients."

Granted, these statements include no numbers, but common sense dictates that many/most will be numbers greater than 10%, as a matter of fact, many will usually be take to be over 50%, and most indicates around 80-90%. Besides, if the success rate was only 10%, do you think NIH or any other medical organizations will recommend this surgery that requires life long aftercare? Unless the success rate is at least 50-50, actually much higher than that, no responsible organization is going to recommend a surgery as impacting as this.

So, where does this discrepancy in the numbers come from?
The difference is most likely due to what the medical professional consigned with the health care of the patient consider as success, and what a post op individually views as success.

To state it differently.
For the health professionals, a successful weight loss maintenance is the individual maintaining the weight where the resolved co-morbidities do not reccur. They actually fully expect a regain of 10% or so from the lowest weight, and see that as being normal, so long as health problems do not reccur. They also know that so long as the post ops use their pouch wisely, there is no possibility of regaining their weight to the point that it threatens their health again.

For the patient.
Any gain from their lowest weight is a threat, a reminder of their worst nightmares. Also, for some post ops, hitting the goal weight becomes the primary concern, not the resolution of their health problems (whereas for the health care workers, resolution of health problems is always the primary concern) so a 10% regain will be an indication of their failure, even if they are able to maintain their weight there.

If you have read the posts of the old timers, those more than 5 years out, you'll notice that they admit a regain of around 30 lbs or so, due mostly to slacking. They also lose that regain successfully, once they decide to work with their pouch again. And by no means have their pre op health issues returned, even with their regain, though they may have had other health issues unrelated to weight regain.

What do I want to say?
My suggestion is not to worry about weight regain, but concentrate on setting up healthy habits--making the right choice of food an automatic habit, making exercise a very natural part of your daily program, developing a coping mechanism for stress that does not involve food or alcohol, or anything else that can sabotage your weight control. Work to make all these healthy habits just that--habits that you do automatically without thinking. That is the best bet for your success.

Good luck to all, wishing you the best in your respective journey.

[Kenyar]

DOC:
Thanks for clarifying. I was going to panic myself thinking I just re-routed my entire innerds and for what??? But thank you so much for posting this.

[fr1endly2]

NICE writeings....thanks for your inputs on the topic ....
being were i am i think panicing of regain daily helps me
to keep on track and be aware of things. THIS way i dont loose
control as i had done in the past.
MY current carb detox is to keep myself in line being i saw some
bad habits creeping in. NOW sure enough that im eating right
its getting back in control. AND i had to do this before it got out of hand. I was given a 2nd chance and i know for me keeping on top of it should hopefully keep me in line.
HOW i had begun to eat the last month or two was scareing me, I saw to many of my old me habits but going back to the right eating for the pouch
things are better. We all dont have the same eating issues that brought us to obesite people but for me "THE CARBS" and me have BIG time issues.
anyway i loved ur input on the topic.

[Robbin]

I have been panicking. I am a year out and have only lost 85 pounds and i know why. I have not been keeping up with my walking and excersizing. I had to spend alot of time with my mother but now I have no more excuses.
I needed to read this, thank you doctor sanae., you always come through for me. This makes me think, and plan.

robbin

[DocSanae]

There is something you will need to understand.
That is, the total NUMBER of people having trouble post op will increase, has increased.

The reason behind this is as follows.
10 years ago, the number of weight loss surgery was less than 13,000. Last year, it was up to 177,000.
Now, say, certain post op complications developed in 5% of the post ops 10 years ago. That will put the actual number of people who had the post op complication at 650 persons. Say the ratio of this particular complication was reduced to 1% with the most recent procedures and conscientious follow up and the resulting data has improved. Because the total of surgery is 177,000, 1% of that is 1,770. That's 1,770 people with the said complication from last year, so the number of people with the complication is actually more than twice, closer to three times the number 10 years ago. However, the ratio of complications had come down to 5 times lower than before, which means the results from the surgery are more favorable than 10 years ago.

This can confuse a lot of people when only certain numbers are cited in various data. You will have to look at the number of people included in the entire study, how they were grouped, and what conditions were set in collecting the data. It is very easy to sway the outcome of statistical data when you know how to do it, and how to set up studies so the results will be favorable to a forgone conclusion.
Also, as the absolute number of people with unwanted results from the surgery increases, their voices in experssing opinions will also increase. Those who are satisfied with the results are understandably more silent, for various reasons.

Bad news travels fast, far and wide. Good news don't.

[TGG]

Is it true that people who do not loose weight pre-op may have more trouble reaching their goal weight? I am 300 lbs and I would like to get down to 160 - is this realistic or I am setting up unrealistic goals

[DocSanae]

Originally Posted by TGG

Is it true that people who do not loose weight pre-op may have more trouble reaching their goal weight? I am 300 lbs and I would like to get down to 160 - is this realistic or I am setting up unrealistic goals

Not necessarily. A study is out with data that people who had pre op weight loss did better, but that doesn't mean that those who didn't, did not do well. What it means is, that the number of people who had better results was greater with the group who were instructed to lose a certain amount pre op. Of course, there were people how did just as well without any pre op weight loss, but the number was smaller, and there were people who didn't do well even with pre op weight loss but again, the number was smaller than with the non-lost group.
The point is, it's a way of you making a jump start on the changes in eating habits that you need to make, and also make the surgery easier for the surgeon to perform, than at your top weight. Even if you get a jump start at the beginning, if you don't do what you must do post op, the surgery isn't going to work. If you do what you must do post op, whether you had pre op weight loss or not, won't make a difference.

Your goal is realistic, fr1endly2/Lisa was 310 pre op, she's 167 now.