One Fourth of Those Who Undergo Stomach Reduction Surgery Become Obese Again

12/08/2014 - 08h49

One fourth of the patients who undergo bariatric surgery gains weight again and may be subject to another operation, which increases the risks of post-surgery problems.

The main problem is fistula, when the staples used to reduce the stomach break. The risk is above 1% after the first surgery and increases to 13% after the second.

Reoperations to reduce weight and their complications were discussed in a bariatric surgery congress which took place in Rio de Janeiro last week.

Brazil is No. 2 in bariatric surgery worldwide, with some 80,000 surgeries a year (10% are performed by the public health system), behind the U.S., which has 140,000.

Specialists say that patients are expected to gain up to 5% of the weight they lost with bariatric surgery. For example: if a patient lost 50 kilos, it is normal that he gains 5 kilos.

The problem occurs when the weight gain is higher, reaching 50% or more. A survey held by the UnB (University of Brasília) with 80 patients who had undergone surgery more than two years earlier showed that 23% gained more weight than expected.

Another study by the Federal University of Alagoas with 64 obese people who had undergone surgery shows that 28% of them were overweight five years after the bariatric surgery.

"The problem is that, aside from the extra weight, those who undergo the surgery present the same risk factors as before, such as high blood pressure and diabetes," says surgeon Almino Ramos, president of the Sociedade Brasileira de Cirurgia Bariátrica e Metabólica (Brazilian Society of Bariatric and Metabolic Surgery).

He says that the main reason that leads to a new weight gain is patients' non-adherence to a new lifestyle, which includes a balanced diet and regular exercise.

"The surgery is not a miracle. Patients must follow a new multidisciplinary program, with the support of nutritionists, psychologists. If they don't, their stomach will dilate and they will gain weight."

Spa Med, in Sorocaba (SP), has at least 150 patients in those conditions: they underwent bariatric surgery and have practically regained nearly all the weight they had lost. Some will undergo a new operation.

"At the beginning they avoid high-calorie foods, but later they start to make allowances and have milkshakes, chocolate, popcorn, alcoholic drinks, and, when they realize it, they are obese again," says Lucas Tadeu Moura, an endocrinologist at the spa.

He says that many of these patients have vitamin deficiency, such as B12. The lack of that vitamin can lead to severe anemia and contribute to cardiac and neurologic problems.

Businessman Antônio, 46, underwent bariatric surgery four years ago, when he weighed 195 kilos. Today he weighs 170 kilos and has diabetes and high blood pressure. "Diets and exercise don't work for me."

Another study presented at the congress in Rio de Janeiro showed that 80% of those waiting to undergo bariatric surgery had psychiatric (mood and anxiety) problems.

"This must be treated before the surgery. You can't put the cart before the horse," says Ramos.

Lucas Moura says patients often switch food for alcohol, and become alcoholics.

"It's complicated. Patients undergo surgery and think they are cured. Then they are out of the doctor's radar."

Translated by THOMAS MUELLO

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	Pedro Amatuzzi/Código19
	Brazil is No. 2 in bariatric surgery worldwide, with some 80,000 surgeries a year (10% are performed by the public health system)