By C. Kenneth Mitchell, Jr., MD FACS

 

So you have had bariatric surgery, I am sure that you spent a great deal of time researching surgeons and programs prior to your operation. You have been educated, evaluated, and supported throughout the process and you are to be congratulated on your success. But did you know that in the immediate period after surgery, regardless of your level of compliance, you will most probably lose weight. You will enjoy the benefits of improvement or even resolution of your obesity related co-morbidities. The comments will flow from friends and family, congratulating you on your decision. People will treat you differently, relationships will change, and you will enjoy renewed self-confidence.
 
But somewhere along the way, your body, the most incredible machine ever made, will learn how to overcome and compensate for almost any restriction placed upon it. After a gastric bypass operation, the new stomach is small. Initially this new ‘pouch’ functions as a cup, but as your surgical anatomy matures, two things happen. Studies discuss that (1) the pouch, in some cases could double in size overtime. And (2) as the new pouch matures, the ability to eat more food at each meal is realized. This is made possible by the pouch learning to empty while you eat. These changes allow patients to eat more food, eat more often, and consume more calories. But the question remains, “How does a postoperative patient maintain weight loss success while the body adapts to these surgically imposed changes?” The answer is very simple: COMPLIANCE.
 
Some patients feel that the surgery is all they need to be successful. Support groups are viewed as unnecessary. Follow up visits and bariatric supplements are expensive. Patients feel that diet and exercise will not be that important, and that bariatric surgery is the “magic bullet”, and “all I need to lose weight is that small stomach that will not let me eat so much.” We all have had preoperative patients who never miss an appointment, who complete their preoperative clearance consultations promptly, attend education sessions with sincere interest, and ask all the right questions, only to have them disappear after the one-month post-op visit. They then return 15 months later, weighing 30 lbs more than they did before surgery, complaining that the surgery stopped working and asking for a revision operation to “fix the problem”.
 
Short-term success is directly related to surgical changes, but long-term success relies on long-term compliance by the patient. The key to long-term success is adherence to an appropriate diet, participation in a regular exercise program, and commitment to consuming daily vitamins and supplements. I use this analogy to illustrate this concept to my patients: if you purchase a car, and never changed the oil, never rotated the tires, never had it serviced, and overall, did not care for it appropriately, over time the car would fail to operate normally. Thus the product would ultimately fail you. Your bariatric operation is no different.
 
We have all heard the statement that bariatric surgery is the best treatment for morbid obesity. This statement is false. The best treatment for morbid obesity is the combination of a well performed bariatric operation with a patient who is committed to changes in diet, exercise, physician follow up, and vitamin supplementation. A great operation can only be as successful as a patient allows it to be. The ball is in your court.