The miracle weight loss that isn’t

When the fat makes its way back
Some bariatric-surgery patients may rationalize any suffering they experience as the cost of losing weight. But even so, they may not keep the pounds off — and the svelte ideal they’re aiming for may be a pipe dream in the first place.

Lisa Tannehill of Grants Pass, Oregon, had high expectations when she had a duodenal switch at age 38. “I’m a big believer in the surgery,” she avers — and remains so despite having to fight through a post-op nightmare of a hernia and a reaction to pain meds. In the first 18 months, she dropped 100 pounds from her 325-pound frame. From there, however, Tannehill’s weight plateaued — and then, to her horror, the pounds began creeping back on. “I didn’t do anything differently!” she says. “I still ate tiny meals!” Nevertheless, six years post-op, Tannehill has leveled off at 240 pounds, a net loss of 85 pounds.

The greatest period of weight loss is the 12 to 18 months after bariatric surgery, after which you start to see weight regain, according to Meena Shah, Ph.D., an obesity researcher at the University of Texas Southwestern Medical Center at Dallas. Her 2006 review of the controlled studies done on the issue revealed that the disease-fighting properties of both bypass and banding surgery go down as patients’ weight goes back up.

Why isn’t weight loss more lasting? More evidence is needed, but one possible explanation is physical: If you keep overfilling the stomach, it can stretch from its tiny postsurgical size to perhaps double its size. In the case of gastric bypass, hormones may also play a role: Researchers have found that the surgery alters the balance of hormones such as ghrelin that regulate hunger and fullness. “For the first four or six months, we actually have to remind patients to eat,” says Sandra Arioli, a registered nurse who runs a gastric-bypass support group at the Renfrew Center eating disorders clinic in Coconut Creek, Florida. Six months later, hormonal balance shifts again and the appetite returns, sometimes with a vengeance, Arioli says. “That’s when they have to start listening to their body because it becomes harder to change their eating behaviors.” Patients need to get into the exercise habit — a task easier said than done — and come to terms with life after food. “Post-op, these people grieve for the loss of food,” Arioli says. “Food is their comfort. And if you don’t figure out how to find comfort in other ways, you’re going to go with what you know. These are some serious eaters.”

But a new theory might provide some answers about post-op weight gain, and prove that willpower has little to do with it. Researchers are now theorizing that the reason patients lose a certain amount of weight in the first place is because gastric bypass, in part by toying with hormones, somehow lowers the body’s natural set point, the weight your system is most comfortable maintaining. A patient’s hunger returns, because the body has achieved that lower set point. “The surgery changes our physiology, the way the body responds to food. It makes heavy people more like people who are naturally thin,” enthuses Dr. Kaplan, who is conducting cutting-edge research on the topic. “Understanding this as a set-point issue allows us to stop blaming the patient who doesn’t do as well, because they were just built that way. What they lose is what they lose, and they can’t expect to lose any more.”

Figuring out the mysteries of bariatric surgery has become an urgent new frontier. Once experts understand how it works, they hope to be able to re-create its positive results in nonsurgical ways — so the surgery can be phased out altogether. “Surgery is the best thing we have right now, but it isn’t the optimal cure,” Dr. Higa says. “We need to figure out why it works, so we can eliminate it. If we do this right, we won’t be doing surgery for obesity in 50 years.”

Giving up on a miracle
Months of surgeries and nutrition therapy failed to pull Eileen Wells out of her downward spiral. “I was a skeleton, just wasting away,” she remembers. “My doctor told me that if I didn’t gain weight, I might die.” Which is why in June 2007, Wells found herself being wheeled into surgery yet again — crying this time — en route to having her gastric bypass reversed.

Some experts argue that, unfortunately, bariatric procedures are not truly reversible. “If you have a two-story addition put on your house, and then you tell the guy take it down — well, he might take it down, but your house might never be like it was,” says Louis Flancbaum, M.D., a retired bariatric surgeon in Teaneck, New Jersey. Removing a gastric band is easier than reversing a bypass. But in all, bariatric reversals — or take downs, as patients call them — are imperfect procedures with one near-guaranteed result: Patients will regain much of the weight they’ve lost. Moreover, people who have their bands removed may find future weight loss surgery more risky, according to the ASMBS.

Nevertheless, it seems inevitable that as the number of bariatric-surgery patients continues to rise, so, too, will the number of complications and reversals. And although experts assert reversal surgery is exceedingly rare — less than 1 percent of cases — a number of women interviewed for this article have undergone it.

Ellen Marraffino got her bypass reversed this past December after being unable to keep down solid food for five years. And in April 2004, after Tammy Cormier developed chronic diarrhea lasting four months — draining her to 95 pounds — a team of doctors concluded she had no choice and agreed to perform the reversal. And so after writing her will, saying her good-byes and selecting her coffin, Cormier went under the knife. Today, she says her stomach is partially paralyzed from all the severed nerves, she’s missing a foot of intestine and she’s back up to 180 pounds. “But I’m alive,” Cormier says wistfully.

For women who wanted so desperately to lose weight, going back to square one feels like the ultimate defeat. “Do I regret having gastric-bypass surgery? Yes, I regret it,” Wells admits. She maintains that for some people who are severely overweight, the procedure can be a lifesaver, even though her bypass put her out of work for nine months — and her reversal hasn’t totally corrected her neurological symptoms. “I thought I was doing something to change my life for the better. But it made me feel a hundred times worse.”

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