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Saturday, June 08, 2013

So I've been talking a bit about hormonal obstacles to maintenance and it can be discouraging. But the main thing I've gotten out of this is that a lowered level of leptin is not necessarily bad. Leptin could be responsible for many of the negative health effects of obesity. As for ghrelin, the maintenance research would suggest that over 2 and 5 years people get better and better at maintenance. Do their hormone profiles ever recover, or do they just better succeed in dealing with it?

In the correspondence section (to the right on yesterday's link) the authors rebut critics that while dietary maintenance is possible it is unlikely to persist through adverse life events. I don't think people are getting through 2 and 5 years without any adversity. I believe maintenance behaviors can be an energy resource and not a perpetual drain.

But let's say they're right and we need to consider meds and surgery. Someone was asking me about the maintenance picture for gastric bypass and lap band because some of the hormones are not as impacted (there are 4 major classes of procedure, but there is not as much data on the newer ones.) This is a hot topic between people trying to persuade people that one procedure is safer and easier while another is more effective.

So looking at the 10 year follow up, gastric bypass patients average a 25% reduction in weight and lap band patients average a 13% reduction in weight. It doesn't sound bad, I lost 1/4 of my bodyweight to get where I am. Keep in mind that these patients start at a BMI of 40 or so. (It can be as low as 35 if you have a serious obesity related disease like apnea).

What does that come out to? For a 5'4" woman who is 240, it's -60 lbs for gastric bypass and -31 lbs for the lap band. For a 5'10 man who is 280, it's -70 pounds for gastric bypass and -34 lbs for lap band. (those are average heights for the respective genders starting at a BMI of 40). So even with the more effective surgery, they still land up with a BMI of 30 after 10 years. Proponents of gastric bypass point out that lap band patients are more likely to undergo repeat procedures.

Going from morbidly obese to borderline obese will still benefit your health. But the long term picture on weight loss surgery is more about getting off some meds and reversing some disease processes more than getting back to that weight we fantasized about as teenagers. And it still requires dietary restraint, probably moreso than maintenance of "diet induced weight loss."

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