Saturday, September 13, 2008

I am a dieting success. No, really.

Did you hear about the study where at two years, 95% of the people had regained the weight they lost. This was just from the group that actually lost weight. About 42% of the people in the study dropped out because they couldn't lose the weight.

So if you define success the same way they did: as "losing all your weight and not regaining it all in two years", I've done that. That makes me a dieting success, right?

There is another study that says that 98% of the participants had regained their weight at five years. So 2% did not. I went on a diet once and did not regained all my lost weight by five years. (It took me about six or seven to do that.) So I guess I'm a success according to that measure too.

Another measure said that 20% of people were able to lose 10% of their excess weight and keep it off for a year. Heck, by that measure, I've been a dieting success at least four times!

Wait: how can you be a success if you regain all your lost weight and then some more than once in your life?

Common sense says you can't. These measures of dieting "success" are ridiculous, both because they define success in too short a time period and because they set the bar so low.

The bariatric surgery industry's definition of success is slightly more reasonable. They define it as keeping 50% of your excess weight off for at least five years. By that definition somewhere between 70 and 90% of bariatric patients are a success.

One study of excess weight loss of Roux-en-Y Gastric Bypass (RNY) vs. Adjustable Gastric Banding (commonly referred to as Lap Band) had each of them trending towards 50% at about fourteen years out. I think for people who have to lose more than 100 pounds, being able to keep at least half of it off more than a decade later, is a success. It may not be what they hoped and dreamed for, but it's an astonishing accomplishment given the alternatives. It also provides a reasonable amount of good health.

There are no 14 year studies weight loss with a vertical sleeve gastrectomy, but early results are promising and this surgery (and the related Duodenal Switch) address of a lot of the issues that cause 50% long-term EWL with these other two surgeries. There are longer term studies for the Duodenal Switch and excess weight loss is better than with Roux-en-Y in both the short and long-term. The jury is out on whether the sleeve can do as well long-term without the malabsorption component, but, at least for a certain percentage of the population, it seems reasonable to think it can.

But let's say all I can hope for long term is 50% excess weight loss. I know I'll be less than happy if I only get down to 150-160 pounds -- about 50% of my excess weight -- in the beginning. But if I get down to 110-120 pounds and then gradually, over a period of 10-20 years, creep up to 144-155, I'm not so sure I'd be wildly unhappy, to be honest. After all, I've been in that range before and my blood pressure was fine, I could still shop in a normal clothing store, and I was reasonably active. Plus, hey, 20 more years of life gets me into my 70s. Something I wasn't too sure I'd see a few years ago when I was at my heaviest and everything started to slow way down and the health problems started to pile up.

But it's less than ideal and so that's not really my definition of success. My definition of success is to be like all my "tiny old lady" relatives and friends. The ones who are lucky to weight 100 pounds soaking wet and live to be at least in their 80s and die with their boots on. That's my idea of how to live and that's what I'm shooting for. Maybe not the less than 100 pounds part. But 110 or 120 pounds would definitely put me in their ballpark and I think I can do that. I've already got the "short" part down pat.
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