[Honeykiss1974]

Posted on Thu, Feb. 26, 2004
BY TARA PARKER-POPE
Wall Street Journal


Celebrities such as Al Roker and singer Carnie Wilson have fueled an unprecedented boom in weight-loss surgery. But for many patients, the procedure doesn't live up to the hype.

A small but significant number of patients who have weight-loss surgery regain much or all of their weight back after a few years. Despite anatomical changes that make it impossible to binge or eat large quantities of food, some patients learn to "outeat" the surgery, grazing on small portions of high-calorie foods throughout the day. Other patients lose only a fraction of the weight expected and remain significantly overweight after the surgery.

No one knows for sure how common the problem is, but estimates of these "failures," as they are known among surgeons, range from 5 percent to 20 percent of patients. Some experts worry that the problem may be growing as new weight-loss centers attempt to cash in on the surgical boom without offering patients long-term psychological and nutrition counseling.

"We know there is a portion of the patient population that will not be successful," said Alan Wittgrove, president of the American Society for Bariatric Surgery. "Sometimes the operation fails them, but sometimes they fail the operation."

Because of growing concerns about quality control and long-term patient success rates, the society is pushing a new plan to be launched in about six weeks that will designate "centers of excellence" for weight-loss surgery, similar to those that already exist for cardiac care and organ transplants, said bariatric surgeon Walter Pories. To qualify as a center of excellence, a surgeon or weight-loss center must document long-term patient results, physician expertise in surgical procedures and a program that offers patients long-term access to nutrition and psychological counseling and follow-up care.

While bariatric surgery helps control the quantity of food consumed, most patients are still plagued by the same eating demons that caused them to gain weight in the first place. In one study, 80 percent of patients reported that they regularly felt a loss of control over eating just six months after surgery. Several studies show that beginning two years after surgery, many patients begin to regain at least some of their weight.

In a small percentage of patients, the weight regain will be excessive. Some patients regain the weight by drinking sweetened soft drinks, juices or milkshakes, or by grazing on crackers and dollops of peanut butter.