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Every year about to , operations are now performed nationwide and that has just skyrocketed in the last 10 years. Diet pills are not the answer. The researchers contrasted these women with a group who worked on the the week weight loss portion of the program first and then moved into maintenance skills for the final eight weeks. Her time of enjoyment lead to 70 pounds of weight gain. By the way, what kind of surgery are we talking about here?

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Instead they spent that time working on mastering the skills of weight maintenance. The researchers contrasted these women with a group who worked on the the week weight loss portion of the program first and then moved into maintenance skills for the final eight weeks. The women were then released for the remainder of the year to navigate their lives with the skills they learned. When all the women returned at the end of the year, those in the maintenance-first group had regained the least amount of weight.

The maintenance-first group only regained three pounds on average where the immediate dieters regained an average of seven pounds.

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In basic plan, foods are preselected for you. The operation is part; you're part of a team when you have the operation. He comes to see his doctor, I'm sure you're seeing a nutritionist and social worker as they do in our program and you're part of a team that's affecting massive behavioral change.

But the question is could you have done it without the operation? First of all, of everybody that comes to your office for this surgery and gets interviewed and has a psychological profile, perhaps does 6 months of intensive dieting What percent go to surgery, what percent do you say no you're not an appropriate candidate?

We haven't figured it out yet. I would say that most of your patients, most of my patients who come end up going on to surgery. She had the surgery and she lost pounds in a period of 16 months all right?

I think I know the answer to this, but just reiterate this for me. Is that it, is she done? She doesn't have to do anything else? You know it takes much longer to lose the same amount of weight with an Adjustable Banding Procedure as it does with the Bypass so I was surprised that she lost so much weight in so little amount of time, but certainly it can happen in a motivated patient.

With a Bypass that makes it take 3 years to get there, is she there forever? She's at risk of regaining that weight if she doesn't continue to see her doctor and get those adjustments of the band and actively participate in these behavioral changes. It's unusual for somebody who's had a Band Procedure to track equally with somebody who's had a Bypass Procedure.

What are the side effects of the surgery that most patients complain about? The first is that that's a major operation. Just getting you out of the hospital is the first step and if patients make it out of the hospital we know that their first 90 days can be rough. People estimate that 1, between 1 out of down to 1 out of 50 people die within 30 days of the operation.

That includes people who are at high risk like Medicare patients who are disabled and patients who are at very low risk; patients who are like Sophie who are at extremely low risk.

And I was specifically talking about the Bypass operation there, not the Banding. I think most large series don't show even the 0.

They're complaining, you asked before about what do they complain about. I'm not going to step on Brian's toes, but what people tell us about are Let's stop for a second shall we and sum up where we are before we go even forward because I can tell you that at this point Sophie's really happy with her surgery. Bariatric Surgery requires changes in your lifestyle and that will include eating habits; you've got to comply with an exercise program, there's a lot going on here, just, not simply just surgery.

So I want to go back to Sophie. Sophie is experiencing now some difficulties after her initial rush of enthusiasm. She ends a relationship because she's embarrassed about her body. She was not prepared for what, Brian you alluded to, which was excess skin. What's that all about? We know this is a side effect of the operation and yet the health care system really hasn't kicked in to address it. It's still considered cosmetic.

Medicare for example doesn't; really cover that intervention nor would Medicaid. Did you have excess skin? I haven't had my annual checkup yet, the 1 year checkup to go through the plastic surgery process. She had to re-learn how to eat; she didn't like that. She complains about, and here's a quote from her; the stress is causing me to eat more and she's gaining weight.

I mean she said right from the beginning she didn't see herself as overweight. Somebody else told her she needed to have the surgery and she was on the fence the whole time. I know, you know, a handful of people who have had the procedure; 3 of them have gained significant amounts of weight to the point now where they are obese again. Those are the stories that you don't hear in the media. But it's one that you very rarely hear. My patients very often if they go to Bill will say, I'm kind of surprised how he was just very, you know, very nonchalant about what the risks were and this is not, he didn't sell it.

I think that's an important point is to really lie out in an unemotional way what the real risks are. It doesn't sound like she ever really was on board. One part of that is that there will be major changes in eating and that there are certain patients or habits that can lead to re-gain. She had an Adjustable Band placed and unlike the Gastric Bypass, which is really an irreversible operation, but with the band, that is a removable device and it is completely reversible. It requires an operation to reverse it.

We talk like this is some kind of magical thing. This is a technical procedure. Yes we can do a Bypass on her, but the same issues about control of what she's taking in and what she wants in terms of behavioral modifications will come to bear and if those things have not changed because it's coming from her, then this too will be a failure. What can she expect now? This is a lady who originally was told to lose weight because somebody else told her to and she didn't see herself as fat.

I'm hoping at some point somebody has sat down with her and said why do you want the surgery? Does she have to eat differently, supplement differently, vitamins, anything else? If they weren't taking enough vitamins in before, they'll need to supplement that. I, I was not worried about the operation at all. I did a lot of research, my mom sent me a lot of emails and cut a lot of articles out so you know I did a ton of research on it and I was pretty comfortable.

Bariatric Surgery is an effective weight loss procedure but there are consequences, there are risks you need to be aware.

You need to have good communication with your doctor so that you're not surprised with any of the results and you've got to get on with the program. Let me tell you a little bit about Sophie now because she's had her surgery. She's down to pounds.

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