Fat can come back after weight loss surgery, study shows

Undergoing fat reduction surgery is no guarantee of a slim future, according to one of the first in-depth studies on one of the most popular weight reduction surgeries.

Data on 443 laparoscopic sleeve gastrectomies (LSG) gathered by Dr. Andrei Keidar of Beilinson Hospital in Petah Tikva – all the patients who underwent LSGs between April 2006 and February 2013 – showed that five years after surgery, the average patient had gained back nearly half the weight shed as a result of the operation.

Similar results were found for the return of two weight-related maladies – Type II diabetes and hypertension. However, said one medical authority invited to comment on the study, more data was needed in order to draw conclusions on the effectiveness of LSG and bariatric surgery in general.

In LSG, the stomach is shrunk considerably as doctors remove two-thirds to three-quarters of the stomach, creating a “sleeve,” a banana-shaped pouch that functions as the patient’s new stomach. Together with the stomach, large portions of belly fat are also removed.

Unlike liposuction, which is a cosmetic procedure that many people undergo to even out fat patches on the body, LSG is usually reserved for morbidly obese to dangerously obese individuals who often have to lose weight because they are at risk for heart attacks, diabetes, high blood pressure, and other weight-related diseases.

The data set for the study was not complete because of follow-up issues (not all patients showed up for appointments, etc.), although full data were available for 70% of LSG patients at a five-year followup examination.

After one year, patients on average had maintained 77% of their post-operation weight loss – which is in line with doctors’ expectations that patients will gain back some weight as they adjust their eating habits to match their new stomach size.

However, it was at the five year mark that Keidar and his team discovered that LSG may not be a long-term solution; by that point, patients had gained weight to the point where they were only at 56% of their post-operation weight loss.

Similar results were seen for weight-related issues; in patients who had previously suffered from Type II diabetes and had gone into remission as a result of the post-operation weight loss, only 20% were still in complete remission after five years, compared to 51% in the first year after surgery, and 38% in year three.

For hypertension patients, 46% remained free of that disease five years later, the same as in the first year after surgery.

The results of the study were published online this week by the journal JAMA Surgery.

The study did not take into consideration patient exercise and activity habits. According to doctors, exercise is an important part of keeping weight off. The study also did not poll eating habits, which also need to be adjusted for patients who want to keep weight off, experts say.

According to Dr. Anita P. Courcoulas of the University of Pittsburgh Medical Center, who was invited by JAMA to comment on the study, “it is unclear whether current studies will address critical questions about the long-term outcomes of bariatric surgery, including the sustainability of weight loss and comorbidity control and long-term complication rates. These critical gaps in knowledge pose a significant problem for people considering a potential surgical option to treat severe obesity.”

Although Keidar and his team agree that more data is needed, the study indicates the importance of modifying lifestyle – something many people are reluctant to do. “The longer follow-up data revealed weight regain and a decrease in remission rates for type 2 diabetes mellitus and other obesity-related comorbidities,” the study said. “These data should be taken into consideration in the decision-making process for the most appropriate operation for a given obese patient.”