Lindsay

Source: Life Science/Yahoo

Surgery for obesity began with a simple premise: if you make the stomach smaller, people will eat less, so they will lose weight.

But in recent years the results of obesity surgery have been so outstanding, researchers went back to the drawing boards to figure out what was going on.

Their findings are beginning to present a far more complicated picture of weight — and of how much diet and exercise can really do to change it. Turns out, a slew of hormones from the gut, and their communication with the brain, play a role in the way the body maintains and loses weight.

Chasing down the answer to exactly how obesity surgery works is providing new insights into human weight loss and appetite regulation, researchers say.

"As a result of weight loss surgery, we finally are beginning to understand the physiology of weight loss better than we've ever understood it before," said Dr. Sunil Bhoyrul, a weight-loss surgeon at Olde Del Mar Surgical in La Jolla, Calif.

Their investigations may reveal how to replicate the results of the surgery without requiring patients to go under the knife.

Ghrelin from the gut

There are several different types of weight-loss surgery (also called bariatric surgery), including gastric bypass and gastric banding, but all involve making the stomach smaller. [infographic: Types of Weight Loss Surgery].

Patients can lose up to 60 to 80 percent of their excess weight in one to four years after surgery, and many have an easier time keeping it off than they did through dieting, Bhoyrul said. However, up to a third can end up back at their pre-surgical weight seven to 10 years later, he noted.

But researchers are realizing that weight loss after surgery is fundamentally different from weight loss achieved by dieting.

A key player in this difference is the hormone ghrelin, which stimulates appetite. When we diet, our ghrelin levels rise, making us hungry. We may lose weight, but our ghrelin levels stay high, and we continue to feel hungry even after eating. Ghrelin levels come down only if we regain the weight, said Dr. Robin Blackstone, a bariatric surgeon at Scottsdale Bariatric Center in Arizona.

"People who are trying to lose weight are being fought tooth and nail by the body to keep that weight on," said Dr. Miguel Burch, associate director of general surgery and minimally invasive surgery at Cedars-Sinai Medical Center in Los Angeles.

But after gastric bypass surgery, ghrelin levels go down significantly, Burch said.

"They're losing more weight than they ever had before and not only are not hungry, they have to force themselves to eat," Burch said. This may be why surgery patients can keep their weight off, he said.

And ghrelin is likely just the tip of the iceberg in terms of hormonal changes that occur. There are likely many more hormones we don't know about that aid in weight loss after surgery, Burch said.

Mind over stomach

Results from the surgery have also highlighted the role of the brain in weight loss and weight gain. Your mind, not just your stomach, manages your waistline.

"We never realized that the brain was so important," Bhoyrul said. "We thought it was just as simple as getting people to eat less. That turns out to be the least of the issues," he said.

The brain is the body's energy thermostat, Bhoyrul said, controlling how quickly you use energy, and when to store and expend it. There is an ongoing conversation between the gut and the brain that takes place via hormones, he said.

Deciphering this conversation could help researchers understand how to best instigate weight loss, Bhoyrul said.

A recent finding underscores how much there is to learn about the stomach-brain connection. Unlike the drop in ghrelin seen after gastric bypass, those who undergo gastric banding experience a drop in their hunger, but not in ghrelin, said Dr. Emma Patterson, a bariatric surgeon in Portland, Ore. This may be because ghrelin communicates with the brain differently after this surgery, Patterson said.

Surgery without the surgery

It might be possible to replicate the results of the surgery using drugs.

"If we can understand how these surgeries work…we can put whatever that thing is in a pill," Patterson said.

One possible target may be an enzyme involved in the production of ghrelin, Burch said.

Indeed, one approach taken by researchers seeking to develop an obesity vaccine has been to block the hormone's production.

However, some have argued that, because many hormones are involved in weight loss, targeting one is unlikely to help people lose weight.

"Most of us are skeptical that 'turning off the ghrelin switch' is the universal answer to all obesity," Bhoyrul said.

Pass it on: The success of obesity surgery is yielding a better understanding of how gut hormones and the brain regulate weight and controls appetite.

This story was provided by MyHealthNewsDaily, a sister site to LiveScience. Follow MyHealthNewsDaily staff writer Rachael Rettner on Twitter @RachaelRettner.

thanks Lori. It makes sense. But for me - I really don't want to lose part of my stomach unless I have no other choice. I am willing to take that chance. I know that for some folks, if the stomach swells alot during the plication surgery, there is a chance that you will have to come back to get it tightened...I can live with that...and it makes sense.

Lori - do you have the plication or band??

DonnaC

I believe the gut would swell AFTER surgery. Not during.

It's an after effect.

And it's not to the degree you're imagining.

You will have 'swelling' from the gas they use to expand the stomach cavity during surgery. But that has nothing to with the folding of the stomach, which is what plication is. If they're reducing your stomach size by 70%, the odds that you'll have to go back for tightening would be extremely slim, to none.

Like with any of these procedures, diet and exercise is the key to your success. Not the actual procedure. Please keep this in mind.

This board seems dead because posts get deleted all the time. The OCC doesn't like patients to post anything negative.

This is very true.

Thanks for the input ladies. After reading lots more material I'm very confident in making the "band" decsion. Looking forward to the next step in my life. Thanks to all of you for the support.

Steph

If I have one word of advice: make sure you track down a fill centre/facility/doctor/nurse PRIOR to the lapband surgery. This has been a HUGE issue for many banders, and it's an extra expense they didn't plan for. AND, most doctors won't touch a 'foreign' lapband. This also applies for follow up health care.

Unless you plan on traveling back to Tijuana to the OCC for each fill, you'll be paying out of pocket for each fill -- which can be from 3-10 fills, varying in cost from $300+-$150. So pleeeeease do your research and tracking down of a source PRIOR, and save yourself the pain of realizing you have NO support/follow up local to where you live.

I love my band, knowing I can adjust the restriction ...

If i need more calories, I can ... i'm not stuck at one spot.

like everyone else that's posted, I don't know where i'd be without my band.

it literally saved me from a lifetime of health issues.

and completely changed my life.

Thanks Erica. It doesn't feel like head hunger. It is in my stomach. Plus I am really really REALLY irritable and I have a hard time thinking at all. I went to Jamba Juice and got a high protein smoothie in plain frozen yogurt with 2 oz of soy milk. I get filled up pretty quickly, but like I said, within an hour I have hunger pains again. This is really very miserable. I wish there was an answer.

I would stay away from Jamba Juice, to start.

They're 'high protein' drink has over 480 calories in it, unfortunately not even HALF of that is protein!

They use high fructose corn syrup in all of there drinks, which is basically shit in a cup.

Stick with real food sources.

Protein & fats will be your best friend while you get over this hump ...

I would reco making your own smoothies with a high quality caseine (if you can digest lactose' note: Jamba Juice includes lactose in all of there drinks) or whey protein, mixed with unsweetened almond milk, and fresh/frozen berries. Add a tbsp of flax oil if you're still feeling starved. This will really help.

I've never seen any photos of Dr Quiroz's work. I wish someone in the forum would post.

*hint hint*

wow even with the band and eating right for it for almost 6 years - once the fill was out I went back slowly to bad habits. I am one of those who just has to have the tool..

Congrats on all your hard work!

Rowan

Is it a tool, or a crutch? ..........

I work with 2 differnt plastic surgeons in canada, and i agree its not just the cost but how comfortable they make you feel and the quality in their work

Where in Canada are you?

I'm in Toronto!

When I had my Lower body lift, my plastic surgeon moved my port one layer deeper, it's now against my ab muscles.

The OCC just started offering Plastic Surgery this year. I really don't know what procedures they are doing or the prices.

So this might be why the personal at the clinic might be making the big sales push. I do know that there are several OCC patients that have had some major work done, if you could find out who they are and talk to them, this could be some help in making your decision concerning who to go with.

Also,, if someone at the OCC seems too pushy or rude,, call Lori and tell her what happened or email Dr. Ortiz,, he does read his email.

Doolittle, not that they were rude or pushy, I just didn't like the style of sales. Price and discount is NOT going to make my decision easier!

If anything, it's made me take them off my list all together.

LoL I thought I was the only one who had problems with the port placement - the more weight I lost the bigger the port appeared and started rubbing against everything I leaned up against.

As for the OC plastics surgery - I think it's a new service and as typical they are trying to promote the service as well as give the patients a good deal. That's not uncommon but I agree - it's more about the doctors - and you can only determine that by chatting with them. AND seeing the work they have done.

I don't think I want to do too much comparision shopping to get the best deal on plastic surgery..it is more about the doctor's skill to me.

One thing is for sure - you can trust OC to offer you safe, professional services...

DonnaC in Seattle

Hey Donna,

While I agree, the OCC is a wonderful clinic, I don't think the plastic surgery they offer can be compared to the lapband (and other bariatric options) they offer.

The doctors are very unknown, and we have yet to see ANY of the work they've done.

I'm an OCC patient myself, so I agree with you regarding the professionalism of the clinic.

I've been in touch with the OCC regarding the re-placement of my port, as it's really bothering me ... I need to get it placed much deeper, as it's rubbing against my ribs terribly.

I found they (OCC) really pushed the 'in-house' plastic surgery, as I mentioned a tummy tuck may be in my future ....

I had a feeling there was something up, as I'd never heard of ANYONE in this forum, going with the OCC for cosmetic surgery.

They also offered me a discount, if I brought a friend for surgery too.

Total turn off.

This is surgery. Not Payless Shoes!

I felt this really cheapened the product & service, and really left a bad taste in my mouth.

This isn't something I'm rushing into, as this is a very big deal for me; not so much from a financial standpoint, but of course, I don't want just anyone touching & cutting into my body.

Thank you everyone, as if you'd like to keep this conversation off of forum, please feel free to PM me directly!

I know this is a relatively new service offered at the OCC - looking for those who have had it done there.

Any/all info/feedback would be appreciated!

You can definitely have greens during the induction. Just NO carbs.

(ie no fruit, or sugar veggies)

just GREENS.

If you're only losing 5lbs for surgery, chances are if you cut carbs for even 2 days, you'll see a shift in the scale.

That's water weight, really!

I wouldn't get too into the pre-op diet -- don't make it more complicated than it needs to be.

As long as you're doing a low carb, high protein/high fat diet, you'll drop weight.

Limiting your fat intake will not decrease the size of your liver.

Your body will need fats for energy if you're going very low carb. Proteins alone will not provide you with enough fuel.

I had the banding done March 2010, I am afraid to get another fill as sometimes food gets stuck and I end up PBing, but I am not losing weight. Any suggestions? I may not be eating properly all the time, but am trying. Any ideas on meal plans or comments about whether or not I should get another fill?

No fill.

It will just tighten things up even more ...........

What are you eating (specifically) & what are you doing for exercise? (specifics)

Diet is at least 80% of weight loss results.

Yes, that's GREAT information. I'd much rather invest in something like that than keep getting fills. I wonder if it's continuous and what happens if you stop using it once you've acheived the results you want. I'm guessing you have to keep using it at least to some degree. Thanks again for that. I'm gonna buy some.

From what I've read, you have to continue with it; the growth isn't unlimited, as your eyelashes fall out a lot more than we'd like to believe

So there's always continuous growth.

Hey Lindsay,

The prescription is about $120-150, depending on where you get it filled. I use this product I ordered online called Revitalash. Holy smokes does it ever work! Being blonde, my eyelashes are so pale and were very very tiny.......I've been using this stuff for a couple of years. In the beginning I used it every night right before bed. Now I put it on about 2-3 times a week, and that's enough to maintain. I have very long lashes, but they didn't go really dark as these type of products do for some. It didn't leave any 'stain' on my lash line. I just applied it right along the top lash line and then along the bottom lash line. Beware, it does take time for the product to work. I also use it on my disappearing eyebrows too. It has helped there too, I'm not as consist with the eyebrows as I was with the lashes. If I remember right I got 2 tubes of Revitalash for about $120 and one tube lasts me about 3-4 months. So a bit cheaper than the prescription. Let ,me know if you give this a try, curious to see it you get the same results.

PS. I've have had those lash extensions too, very expensive as they put on eye single lash, cost was about $150 plus fills every couple of weeks. I gave up as it was getting so expensive, that's how I ended up finding Revitalash. One of the gals who worked in the shop where I had the extension put on told me about it. I think they were at that time selling the stuff in the shop for double what I got it for online. But that was 3 years ago, so things could have changed

price wise.

Such good info!

Thank you so much for sharing!!!

I had the lap band and plication surgery done on February 14, 2011. My doctor suggested and thought that I would benefit more with having it done this way. I have lost 37 lbs so far with NO fills. I haven't had any complications at all and I feel better than I have ever felt. I am right on target losing 1-2 lbs a week and that's without them filling my band. Good Luck!!

Who is your doctor?

If you feel restriction, I wouldn't think getting another fill wouldn't be a suitable option ...

it's time to work on everything else - the band is doing what it's supposed to be doing.

start food tracking.

and start exercising.

I started weight training about a week after surgery.

You're good to go, just pay attention to your body.

Do you all get/request receipts?

I went in December and paid less than half of what a fill costs. Which encouraged me to come back every few months and get checked to avoid any problems. So this month I thought I'd go back then I got the price and I was surprised, I asked her why and she said it was because they do it with a barium swallow and x-rays.. I told her , I knew! I've gotten my band checked before and I didn't pay that, she just said, "well the price went up" That was annoying. I probably might wait a few more months and go later but It's still not going to stop me from getting my band checked. $100 bucks is nothing compared to what I'd pay out here in Cali, besides I wouldn't trust anyone with my band other than the OCC.

I've never had my band 'checked'.

I personally wouldn't pay that every few months!

Imagine how much that will cost you in a couple of years!

You should have received a card, to carry with you at all times, that has your band serial # on it, and the size of it.

I would contact the clinic directly to get this info.

We can't see inside of you, so it would be guessing!