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Dr. Kenneth Mitchell

The Ball is in Your Court

Dr. Ken Mitchell, Bariatric Surgeon and Medical Director of Roper St. Francis Bariatric and Metabolic Services, discusses short and long-term weight loss success after bariatric surgery. He states that in the immediate period after surgery, regardless of your compliance, you will lose weight. However, the key to long-term success is compliance with diet and exercise.  

Congratulations on your bariatric surgery. I am sure you’ve spent a great deal of time researching surgeons and programs prior to your operation and that you have been educated, evaluated and supported throughout the process. The great news is that in the immediate period after surgery, regardless of your level of compliance, you will 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. For example, after a gastric bypass the new stomach is small. Initially this new pouch functions as a cup, but as your surgical anatomy matures two things happen. Studies show that the pouch, on average, will double in size in approximately 6 months. As the new pouch matures, patients are able to eat more food at each meal and more often. This is made possible by the pouch learning to empty while you eat. So the question becomes, “How does a post-operative 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. These patients feel that diet and exercise will not be that important, that bariatric surgery is the magic bullet and that all they need to lose weight is a small stomach that will not let them eat so much. I’ve had pre-operative patients who never miss an appointment, who complete their pre-operative 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 you, the patient.  Adherence to an appropriate diet, participation in a regular exercise program and commitment to consuming daily bariatric vitamins and supplements are the keys to long-term success. I use this example for my patients: if you purchase a car, and never change the oil, never rotate the tires, never have it serviced, and overall, do not care for it appropriately, over time the car will not operate normally and 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, doctor follow up and vitamin supplementation. A great operation can only be as successful as you, the patient, allows it to be.

The ball is in your court.

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