What to Expect Following Surgery
 Currently,
there are no set standards to judge the success
of bariatric surgery. However, the accepted goal
is 25 percent reduction of the starting body weight.
At this level, most of the obesity-related health
risks are reduced or avoided. Randomized trials
have shown that gastric bypass induces significantly
greater loss of excess weight than controlled,
supervised low calorie diets. Although it is considered
that weight loss after gastric bypass is maintained
in the long term, it should be appreciated that
while the literature is full of reports of successful
loss of weight at two years, reports of truly
long-term follow-up are few. A recent study demonstrated
that long-term excess weight loss with gastric
bypass surgery from five to 14 years is 49 to
62 percent.
 The
extent of the unhappiness of morbidly obese patients
is also measured by their renewed enthusiasm for
life after weight loss. They are happy about their
loss of weight and their ability to buy smaller-sized
clothing, to bend down to tie their shoelaces,
to visit the local swimming pool without ridicule
and to participate in recreational activities.
The assessment of patient satisfaction after
the surgical treatment of morbid obesity is very
difficult; most patients feel guilty about their
previous weight and bodily habits, and are grateful
to the surgeon willing to carry out the operation.
Clearly, they have more than the average patient's
vested interest in justifying to themselves that
the perioperative risks and discomfort were worthwhile.
The risk/benefit ratio for surgical treatment
of morbid obesity does not simply depend on weight
loss and patient satisfaction versus postoperative
complications. It must include the outcome of
no treatment or ineffective non-surgical therapy
and the potential savings that result from reduced
blood pressure, improved cardiac status, and amelioration
of diabetes and respiratory insufficiency, together
with un-quantifiable savings to the state in terms
of money saved from prevented premature death.
While the morbidly obese represent only a tiny
proportion of overweight people, they stand to
benefit most from weight correction. Careful follow-up
over many years is required to assess whether
surgical intervention results in increased longevity
as well as the observed improvement of associated
medical problems. At present, gastric restrictive
and gastric bypass procedures appear to be relatively
safe and effective, and represent the best hope
for significant, sustained weight loss.
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