Doreen A. Samelson - The Weight Loss Surgery Workbook: Deciding on Bariatric Surgery, Preparing for the Procedure, and Changing Habits for Post-Surgery Success

Josies experience of regaining more weight than she lost with each diet is the rule, not the exception. While weight regain is possible after WLS, when compared to conventional dieting and exercise, surgery results in greater weight loss and better maintenance of weight loss, and as well learn in this chapter, sustained weight loss improves health and quality of life. Still, WLS is not without drawbacks, so its important to understand the costs of surgery as well as have a realistic understanding of its benefits. Surgery costs arent limited to insurance co-payments and deductibles. WLS has lifestyle and physical costs as well. The better you understand these costs beforehand, the more successful youll be. Well start by examining the qualification guidelines for surgery and then look at how much weight you can expect to lose with WLS.

Most surgical procedures have qualification guidelines, and WLS is no exception. The majority of surgeons and insurance companies in the United States follow the National Institutes of Health (NIH) guidelines. NIH guidelines use body mass index (BMI) and obesity-related medical conditions (like diabetes) to determine who qualifies for WLS (Norris 2007). BMI is a body-weight measure that considers your weight and height. Calculate your BMI by taking these steps, or if you prefer, use one of the many online BMI calculators by searching for body mass index.

BMI Calculation

My weight in pounds:______

My height in inches:______

Now put your weight in pounds and height in inches into this formula:

[Your weight in pounds (Your height in inches x Your height in inches)] x 703

Heres the formula for someone who is 64 inches tall and weighs 250 pounds:

[250 (64 x 64)] x 703 = 42.9

Based on NIH guidelines, if your BMI is 40 or higher and you have failed multiple times to lose weight with diet and exercise, WLS is probably appropriate for you. If your BMI is 35 to 39, you may still qualify for WLS if you have obesity-related medical conditions like diabetes, hypertension, or sleep apnea that would likely improve with weight loss. In 2010, an FDA panel recommended lowering the minimum BMI guidelines for the LAP-BAND, a popular type of adjustable gastric banding. If the FDA accepts the panels recommendations, this type of WLS could be available to patients with BMIs as low as 30. Check with your doctor if you are considering WLS and your BMI is lower than 35 (Pollack 2010). Its important to remember that these are just guidelines, and sometimes other factors, such as your personal surgery risks or severity of obesity-related medical conditions, might be more important than your BMI in determining whether WLS is right for you.

Unrealistic expectations for surgically assisted weight loss are common. Most people think WLS produces bigger weight losses than it actually does (Heinberg, Keating, and Simonelli 2010). Disappointment with weight loss increases your risk for postsurgical problems like depression and weight regain (Kaly et al. 2008). The first step in developing realistic expectations is to calculate your excess weight. Now that you know your BMI, its time to calculate your excess weight. The amount of excess weight youre carrying is defined as the amount of weight you need to lose to reach the normal BMI range (18.5 to 24.9). Look at the following table to determine how much you need to weigh to have a BMI of 22 (middle of the normal range). The amount of weight you can expect to lose depends, in part, on surgery type, but losing 40 to 70 percent of excess weight is a good WLS outcome (Norris 2007). Its important to remember that we are talking about percent of excess weight, not percent of total weight.

My Realistic Weight-Loss Range

Find your height in inches on this chart. The weight to the right is your weight at a BMI of 22.

My current weight: _____

My weight at a BMI of 22: _____

My current weight minus my weight at a BMI of 22: _____ (my excess weight)

40 percent of my excess weight: _____

70 percent of my excess weight: _____

The fact that we usually dont see a 100 percent loss of excess weight after WLS means, if you were thin in young adulthood, you probably wont return to being a thin person. The limits on weight loss with WLS also mean, if youre like Josie and have never been thin, youll probably never be thin.

Last, while it may sound silly to point out that WLS and weight loss wont make you rich or famous, or resolve normal life issues, its important to make sure you dont expect all your problems to be solved. The good news is that its realistic to expect WLS to benefit you in some important ways, so lets look at these benefits now.

Excess weight is associated with serious medical conditions. Your doctor may have told you that you need to lose weight for health reasons. Marks doctor talks to him at every visit about losing weight, and Mark has tried to lose weight. But like Josie, Mark has never been able to lose enough weight to make a significant difference in his health. So losing enough weight and sustaining that weight loss is a WLS benefit for Mark.

Metabolism

Its not just the amount of weight lost or the ability to keep it off that makes WLS beneficial for someone like Mark. WLS can actually speed up your metabolism, which can help resolve metabolism-related conditions like diabetes (Guth and Livingston 2008). Metabolism is the process your body uses to convert food into energy. Your basal metabolic rate (BMR) dictates how fast your body turns food into energy. If your BMR is high, you convert food into energy or burn calories quickly. The faster you convert food into energy, the more calories you can consume without gaining weight. An extremely low BMR means extra pounds will probably accumulate unless you diligently restrict calories.

How high your BMR is set is determined by factors such as age, gender, amount of body fat, and muscle mass. The bad news is that if youre obese, chronic dieting can actually lower your BMR (Kurian, Thompson, and Davidson 2005). The good news is that in addition to reducing your weight, exercise will increase your BMR. Exercise builds muscle, and the higher your muscle mass, the higher your BMR will likely be. Mark is a good example of how muscle mass can make a difference in BMR. Even though Mark was overweight during his football days, he was muscular. His muscular physique, along with his lower weight and age during his teens and twenties, translated into a higher BMR, and Mark found he could eat a lot without gaining weight. In his thirties, Mark maintained his high-school weight but became less active. His change in activity level decreased his muscle mass, adding to the normal age-related decline in his BMR. This decrease in BMR made it easier for Mark to put on weight as he moved into middle age. After his divorce Mark gained more weight, lowering his BMR even more, and he developed serious health problems.