When Bariatric Surgery's Benefits Wane, This Procedure Can Help

Jan 19, 2015
Originally published on January 19, 2015 5:37 am

For most of her life Fran Friedman struggled with compulsive eating. At 59 years old she was 5 foot 2 and weighed 360 pounds. That's when she opted for bariatric surgery.

The surgery worked. Friedman, who is now 70 and lives in Los Angeles, lost 175 pounds. "It was a miracle," Friedman says, not to feel hungry. "It was the first time in my life that I've ever lost a lot of weight and was able to maintain it."

Friedman kept the weight off for almost 10 years. But then to her dismay she started to gain it back. "I thought I was cured," she says. "I thought I could eat like regular people."

She's not alone, says Dr. Rabindra Watson, Assistant Clinical Professor at the University of California, Los Angeles, Division of Digestive Diseases.

About one in three patients regain significant amounts of weight a few years after surgery to reduce the size of the stomach pouch. Bariatric surgery shrinks the stomach to about the size of an egg, so people feel full from eating very little food. The problem is that over the years the stomach stretches, and when that happens, Watson says, "Patients are able to eat more at one sitting and they feel hungrier more often."

At the same time, hormonal changes that reduce the appetite and take effect immediately after the surgery begin to decline. Watson says we don't know for sure, but it's possible the body begins to adapt to those changes, which is why the weight loss is reversed over time.

For Fran Friedman, it meant a 20-pound weight gain and a bout of depression. "The reality hits," she says. "Do I want to go back to where I was or do I want to maintain this level of quality of life?"

So Friedman opted for a less invasive procedure to make her stomach smaller again. It's called Transoral Outlet Reduction – or TORe for short. It's one of several procedures designed to help people maintain the benefits of bariatric surgery. This procedure involves inserting an endoscope through the mouth into the stomach while the patient is under anesthesia. It costs $8,000 to $13,000 and insurance coverage varies.

If the stomach pouch has stretched, new sutures are put in place to once again reduce the size of the stomach. After the surgery, Watson says, patients report feeling fuller and less hungry and they ultimately gain greater control over what they are eating. And research conducted over the past decade suggests it works. There are no significant side effects to the surgery, and patients can return to work the day after they have the procedure.

For Friedman, it did the trick. She has lost 30 pounds since her second surgery. And now, she says, with the help of a support group she is recommitted to watching what she eats and how much she exercises. She wants to lose another 20 pounds. And more importantly, she wants to keep the weight off.


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STEVE INSKEEP, HOST:

Let's look next at weight loss. For extremely overweight people, bariatric surgery is highly effective. It reduces appetite by reducing the size of the stomach, but it is not always a lifelong cure. As NPR's Patti Neighmond reports, a new procedure could help patients maintain their weight loss.

PATTI NEIGHMOND, BYLINE: For most of her life, Fran Friedman struggled with compulsive eating. By the time she arrived at UCLA, she was 360 pounds at just 5 foot 2.

FRAN FRIEDMAN: So I opted to have the bariatric surgery.

NEIGHMOND: And lost 175 pounds.

FRIEDMAN: And maintained that for almost 10 years - the first time in my life that I've ever lost a lot of weight and was able to maintain.

NEIGHMOND: It was a miracle, says Friedman, not to feel hungry. The surgery reduces the stomach to about the size of an egg and people feel full from very little food.

FRIEDMAN: I thought that I was cured. I thought that I could eat like regular people.

NEIGHMOND: But 10 years after the surgery, Friedman started gaining weight again. She felt confused and depressed. UCLA gastroenterologist Rabindra Watson says she's not alone. About 1 in 3 patients regain significant amounts of weight a few years after surgery to reduce the size of the stomach pouch.

RABINDRA WATSON: And then over time what we found is that the pouch can dilate and stretch, and when that pouch stretches patients are able to eat more at one sitting and they feel hungrier more often.

NEIGHMOND: At the same time, hormonal changes that reduce appetite and take affect pretty much immediately after surgery begin to decline.

WATSON: The body again adapts to that change in physiology, and we think that possibly those changes are being reversed over time, that we don't have enough evidence to prove it.

NEIGHMOND: These hormonal changes and a stretched out stomach pouch mean people feel more hungry and are inclined to eat more. For Fran Friedman it meant a 20-pound weight gain.

FRIEDMAN: And then reality hits. Do I want to go back to where I was or do I want to maintain this level of quality of life?

NEIGHMOND: And this may be the hardest part of life after bariatric surgery - understanding that the surgery doesn't mean patients no longer have to pay attention to what they eat or whether they exercise. Gastroenterologist Watson says that's still a lifelong commitment. And for some patients, like Fran Friedman, a new, less invasive procedure can make the stomach smaller again and that can make a major difference.

WATSON: By reducing the size of the pouch what we found is that patients report improvement in their satiety and decrease in their hunger and, ultimately, greater control over how they're eating.

NEIGHMOND: And for Friedman that did the trick. She's lost 30 pounds since that second surgery. And now, with the help of a support group, she's committed to watching what she eats and how much she exercises. Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.