Follow-up: the Foundation of Weight Loss Success?

Nearly half of the people who participate in weight loss programs drop-out before completion, according to a new study published in the Canadian Journal of Surgery. In one particular weight-loss program, 43 percent of the participants dropped out, some of which were weight loss surgery patients. For the study, researchers assessed 1,205 participants in the program, 318 of whom had received bariatric surgery. The program lasted one year, and was extended to two years for surgery patients. The drop-out rate among non-surgery participants was 56 percent, while only 12 percent of surgery patients dropped out before shedding the desired amount of weight.  The results are similar to those found in other weight-loss programs.

The researchers said that the large difference in drop-out rates between surgery and non-surgery patients may be because those who opt for surgery are more committed to weight loss. They may also be motivated by the initial weight loss induced by the procedure. Or perhaps participants are less likely to drop out after having surgery because in going through the process of choosing surgery, they feel more deeply connected to the medical significance of their weight loss efforts.

Weight loss experts agree that the success of a program is largely dependent upon people feeling that they are benefiting from it. Dr. David Provost, expert weight loss surgeon in Texas, said “weight loss success with the lap band is entirely dependent upon proper adjustment and follow-up.  The need for frequent follow-up was first suggested by the NYU group – including Drs. Ren, Fielding, and Kurian – in 2004 [Obesity Surgery, 14, 514-519] and has been widely adopted by successful band programs in the U.S., as well as implemented in surgeon training courses for new band surgeons.  In our practice, we see patients every 4 weeks the first year, approximately every 6 weeks the second, and usually at least 3-4 times per year thereafter.” Dr. Provost added that many European surgeons have been reluctant to increase follow-up, arguing that it is not necessary, however their results suggest otherwise.  “Fewer visits may lead to overtightening which leads to pouch dilation and band removal and/or poor weight loss,” he added.

Dr. Terry Simpson, expert bariatric surgeon in Arizona also spoke with us about lap-band follow-up. He said: “Follow up with the band is more than an adjustment; it is a chance to help people on the path to better nutrition and lifestyle. The more interactions the patient gets with the provider, the better chance we have to maximize their tool (the band).” Dr. Provost agreed saying, “There is more of an art to band adjustment than science. Weight loss with the band is entirely dependent upon the aftercare, and so we see variability in reported outcomes. Surgeons providing appropriate aftercare have good results and continue to advocate the band as an important option in bariatric surgery. If a program’s aftercare is poor, their results will be poor.”

Related Reading: Study Shows Bypass and Band Have Excellent Weight Loss at Six Years

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