People who follow their doctor's recommendations after bariatric surgery lose about 35 percent more weight in the first year than those who do not and tend to keep more of it off even after five years, according to a new survey conducted by Harris Interactive® released here at the 25th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS).

This nationwide survey of 409 bariatric surgery patients (208 gastric bypass patients and 201 gastric band patients) found that those who said they most closely followed doctor's orders lost more than 123 pounds the first year, while those who were less compliant lost 92 pounds, with this trend continuing up to five years. At the five year mark, the most compliant bariatric surgery patients lost more than 127 pounds compared to less compliant patients who ended up losing about 100 pounds.

Harris Interactive worked with the ASMBS to design the survey questionnaire and provide expert analysis. Ethicon Endo-Surgery sponsored the survey.

Doctor recommendations for post-surgery activities or aftercare include keeping doctor's appointments, maintaining a food diary, receiving nutritional counseling and psychological support, exercising, changing eating habits and going to patient support groups. However, according to the survey, less than half (47%) of the patients participated in five or more of these post-surgical activities, and participation tended to decrease each year resulting in less weight loss and in some cases, the regaining of weight.

"While bariatric and metabolic surgery is the most effective treatment for morbid obesity, weight loss and disease improvement or resolution can vary from patient to patient depending on what a patient does after surgery," said Phil Schauer, MD, Immediate Past President, ASMBS and director of the Cleveland Clinic Bariatric and Metabolic Institute (BMI). "Thirty-five percent more weight loss for those that comply is a significant number that cannot be ignored and should motivate more patients, health professionals and insurers to increase the focus on aftercare to help deliver outcomes that exceed what surgery can accomplish alone."

Aftercare seems to be even more critical for gastric band patients than for gastric bypass patients. Gastric band patients that participated in five or more components of aftercare lost 30 percent more weight and report having a significantly better quality of life than those who participated in four or less. Most said their health (84%) and self-esteem (79%) got much better compared to those who participate in fewer components (46% and 47% respectively).

Gastric bypass patients who were more compliant with aftercare lost more weight and had a better quality of life than those who were less compliant, but their success was not linked to any specific number of aftercare activities. Patients who complied in year three achieved about the same total weight loss as those who didn't, but those that complied in year five lost about 30 percent more overall than those who did not.

Aftercare Drops Off After the First Year and Most Significantly In Year Three

During the first year after surgery, nearly 80 percent of patients exercised at least one to two times per week, but by the third year only about half exercised at recommended levels, 12 percent were not exercising at all and about 30 percent were exercising only a few times a month or less. Also, after the third year, a little more than one-third (36%) of patients were still in contact with their bariatric surgeon.

Most patients believe changing eating habits (61%) and exercising regularly (49%) were two of most important keys to success after surgery, but also the most difficult to do, followed by attending support groups and keeping exercise and food diaries.

"There is a great need to standardize aftercare so we can provide the best possible care, motivation and support for patients at their most vulnerable moments after surgery," said Scott Shikora, MD, ASMBS President-elect and Chief of General Surgery, Bariatric Surgery and Minimally Invasive Surgery at Tufts Medical Center in Boston. "This survey provides additional direction on what we can do to get even greater results from surgery and help patients achieve long-term success."

Additional Survey Highlights

Do You Like Your Surgeon? It Helps!

Gastric band patients who have a positive relationship with their surgeon's office decrease their body mass index (BMI) by over 50 percent more than those with a negative relationship. The relationship with the surgeon's office did not seem to matter as much for bypass patients.

Those Most Prepared for Surgery Have Easier Time with Compliance Afterwards

Being prepared for surgery and having appropriate expectations seemed to significantly help people deal with life adjustments after surgery. Those who felt prepared were twice as likely to say compliance after surgery was easy than those who felt "very or somewhat" unprepared for surgery.

Patients Grade Their Own Compliance

For gastric bypass patients, only 9 percent of patients rated their level of compliance as fair or poor the first year after surgery, but that number rose to 23 percent in year two, to 37 percent in year three and to over 50 percent in year four. Gastric band patients gave themselves better grades in all years following surgery, except the first year where more (14%) graded their compliance as fair to poor. In the second year that number rose to 19 percent, to 22 percent in the third year and to 44 percent in the fourth year. Bypass patients (77%) indicated greater ease in complying with doctor's recommendations than gastric band patients (66%).

Life before Surgery

On average patients tried 24 diet and exercise programs prior to surgery. The most weight they reported ever losing is 50 pounds and the average patient was obese for about 20 years before surgery. Only 58 percent of patients linked their obesity-related illnesses such as type 2 diabetes, high blood pressure and sleep apnea to their obesity. Two-thirds (67%) of patients reported having an average of five obesity-related conditions.

Top Reasons for Surgery

According to the survey, patients considered bariatric surgery for about three years before making their decision to have surgery, and about one-quarter of them were denied insurance coverage three times before getting approval. About 60 percent of patients report that their health worsened during this waiting period.

Improving their health was the primary reason patients opted for bariatric surgery (25%) followed by the desire to lose weight (20%), resolve disease (17%), improve self-esteem (10%), and being around for their families (8%). Only three percent said they wanted bariatric surgery for cosmetic reasons, making it the least important reason among the reasons cited. Among those individuals with an obesity-related condition, type 2 diabetes was the main reason for surgery (25%), followed by obstructive sleep apnea (14%), joint pain (11%), high blood pressure (10%) and depression (8%). Almost three times as many patients thought they were more likely to die from obesity (64%) than from bariatric surgery (24%).

About Bariatric Surgery

In 2007, the ASMBS reported that an estimated 205,000 people in the U.S. had bariatric surgery. According to guidelines issued by the National Institutes of Health (NIH), bariatric surgery is indicated for people with a body mass index (BMI) of 35 or more with an obesity-related condition or a BMI of 40 or more. People who are morbidly obese are generally 100 or more pounds overweight.

The most common methods of bariatric surgery are laparoscopic gastric bypass and laparoscopic adjustable gastric banding (LAGB). In gastric bypass, the stomach is reduced from the size of a football to the size of a golf ball and food bypasses part of the small intestine. In LAGB, a silicone band is wrapped around the upper part of the stomach to restrict the amount of food the stomach can hold. The amount of restriction is adjusted by adding or removing saline from the band.

About the Survey

Online surveys were conducted in April and May, 2008 among 282 surgeons and 409 patients (208 gastric bypass surgery patients and 201 gastric band surgery patients). Patients who had gastric bypass or gastric banding surgery in the previous one to five years were recruited from Harris Interactive's Chronic Illness Panel, general population panel and eRewards Patient data were weighted to be representative of U.S. obese adults ages 18 and older. Propensity score weighting was also used to adjust for respondents' propensity to be online. Because the sample is based on those who agreed to participate in the online survey, no estimates of theoretical sampling error can be calculated. A full methodology is available.

Ethicon Endo-Surgery, is a Johnson & Johnson company, develops and markets advanced medical devices for minimally invasive and open surgical procedures, focusing on procedure-enabling devices for the interventional diagnosis and treatment of conditions in general and bariatric surgery, as well as gastrointestinal health, gynecology and surgical oncology.

About Harris Interactive

Harris Interactive is a global leader in custom market research. With a long and rich history in multimodal research that is powered by our science and technology, we assist clients in achieving business results. Harris Interactive serves clients globally through our North American, European and Asian offices and a network of independent market research firms.

Harris Interactive

About ASMBS

The ASMBS is the largest organization for bariatric surgeons in the world. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of morbid obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for morbidly obese patients.

ASMBS