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New Study: Lifestyle Changes As Effective As Surgery For Obesity

By L. K. Regan

For people who are very obese, bariatric surgery (one version of which is gastric bypass) is often seen as the only option for substantial weight loss. Now, a new study suggests that lifestyle and behavioral changes can accomplish the same results, with similar success rates. And, though the researchers acknowledge that lifestyle change requires much more work, they also found secondary benefits suggesting that in the long term, it is an option deserving much more exploration.

The study was conducted by a team of researchers primarily from The Miriam Hospital and Alpert Medical School at Brown University, funded by the NIH, and published online in the International Journal of Obesity. It used the National Weight Control Registry to find 312 participants who had lost very substantial amounts of weight—an average of 124 lbs lost and maintained for an average of 5.5 years. At the beginning of this two-year study these participants were matched up, with each bariatric surgery patient being paired with two non-surgery patients. All the subjects were surveyed at the beginning of the study about a number of objective and subjective categories, including their food intake, exercise, mood, food cravings, stress and depression. There were follow-up surveys at the one and two-year marks.

In many ways, the groups had remarkably similar patterns. Both surgical and non-surgical patients gained back an average of four pounds per year; their daily caloric intake was similar as well. And within both groups, those people who gained back substantial amounts of weight over the period of the study were the patients who had the greatest difficulty resisting cues that stimulate impulsive overeating.

The fact that these measures were so similar was itself surprising. As the study's authors write, "As large weight losses are rarely achieved through any method except bariatric surgery, there have been no studies comparing individuals who initially lost large amounts of weight through bariatric surgery or non-surgical means." That the non-surgical patients were able to maintain similar outcomes to the bariatric surgery patients was an unexpected outcome. And how did they do so? Largely through exercise. Only a third of surgery patients reported exercising, in comparison to 60 percent of the non-surgery patients. Surgery patients also took on board more junk and fast food calories than non-surgical patients. And, most interestingly, the surgical patients reported higher degrees of stress and depression than the non-surgery patients.

The upshot? Massive weight loss is possible without surgery, if people commit to a lifestyle change, rather than merely a diet. The study's authors say that, "Despite marked behavioral differences between the groups, significant differences in weight regain were not observed. The findings suggest that weight-loss maintenance comparable with that after bariatric surgery can be accomplished through non-surgical methods with more intensive behavioral efforts."

This conclusion has long been the advice of San Francisco nutritionist Manuel Villacorta, MS, RD, CSSD, founder of the interactive weight-management web site Nutrition for You, whose RealJock/Nu4You Weight Loss Challenge participants lost a collective 312 pounds over nine weeks this fall. According to Villacorta, the key to weight loss success is not merely eating less, but performing a complete lifestyle make-over, learning to understand the effect of food on the body, and putting in place a support network to provide accountability and encouragement. "We don't just try to tell people to eat less—we try to teach nutrition, and to help people see the choices they make, by keeping records, making sure they eat breakfast, and finding coping mechanisms for emotional eating. It's not just about calorie restriction." Though the study's authors acknowledge that a lifestyle change requires more work than surgery, the improved stress and depression measures suggest that a lifestyle change helps people let go of more than pounds.

Want to make a lifestyle change of your own? Manuel Villacorta and Nutrition For You will be running a second, and longer, RealJock/Nu4You Weight Loss Challenge in January of 2009. Keep your eyes on for details coming soon, and get ready for the journey of a lifetime—to a new you.