The Definition of Success
While there are a number of ways to measure success after weight loss surgery, the bariatric surgery community defines the concept of a “successful” outcome in terms of percentage of excess weight loss (%EWL) following surgery. Longer-term studies of bariatric surgery outcomes extend the definition of success from excess weight loss to excess weight lost and maintained over a longer period of time. A sustained weight loss of greater than 50 percent EWL is used as an indicator of longer-term success.
Although weight loss itself is the primary objective of surgery, a successful outcome is not only losing weight and maintaining the loss, but the patient is able to make changes in their life. The significant weight loss that results from surgery is often the first step in a much longer process toward achieving important life goals.
There are occasions where these two definitions of success collide. Specifically when patients lose a significant amount of weight following surgery but continue to struggle with behavioral and emotional issues that lead them to relapse and resume former habits, often resulting in weight regain. It has become clear that bariatric surgery is not a cure-all and that patients face behavioral, emotional and interpersonal issues before and after surgery.
Patients who are non-adherent to dietary recommendations and engage in specific eating behaviors circumvent the effects of the surgeries are at greater risk for weight regain. Common reasons why some patients struggle to lose weight following surgery or struggle to keep it off are patient adherence, maladaptive eating patterns and emotional eating.
Emotional eating is eating in response or as an automated reaction to emotional distress. Pleasure is derived from eating. People use food and eating as an emotional cure-all. Common examples are grandmothers offering cookies to distract an injured child or baskets of food given to console those who are grieving. Weight loss surgery does not teach patients alternative methods of coping to substitute for eating. Patients need to be aware that it is possible to learn strategies to combat emotional eating.
Maladaptive eating includes grazing, sweet eating, binge eating, and consuming an excess of liquid calories. “Grazing” refers to consuming large quantities of calories over an extended period of time. “Bingeing” refers to consuming a large amount of calories over a short period of time. However the restrictive effect of surgery can inhibit the urge and ability to binge, but this is generally more true shortly after surgery. Unfortunately, some patients recognize that they can no longer binge on foods such as meat and pasta so they resort to grazing on foods more easily consumed such as ice cream, chocolate, and potato chips.
It is highly unlikely that patients do not fail to lose weight due to inadequate knowledge. Patients know what they need to be doing and with encouragement and support they may be willing to do so. Routine follow up visits provide support and encouragement so the patient can identify obstacles to adherence. Treatment of maladaptive eating behaviors also include cognitive behavior therapy (CBT) interventions. The focus of treatment is to focus on breaking these unhealthy patterns while promoting healthier patterns of eating.
Some patients believe that if they have bariatric surgery they will not have to think about their eating anymore. Actually, long-term success requires the opposite: patients need to become very mindful about their eating in order to use their surgery optimally to develop and maintain a healthy lifestyle. The definition of success may be measured by the EWL achieved but truly happens as a result of making changes in one’s life. Hence, the two definitions collide to produce the ultimate success: physically and emotionally within the patient!
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