VBG revised to GBS=slow weight loss?

Question
HI Dr, I had a revision to an RNY in December of 2010 from a VBG in 1998.  I am having very little and slow weight loss.  Honestly I keep my calories around 800 but I don't exercise a lot.  My surgery weight (for both surgeries) was 280 lbs and I stopped losing weight at about 240lbs with the VBG.  Right now I am 245 lbs.  Why is the weight loss for revisions so slow  and low.  I have read a lot of research on sites like Pubmed where they say weight loss is equal to a primary surgery however, on a lot of surgeon's sites it says that weight loss is modest after a revision.  This is contricictory and confusing.  What is your opinion?  From the surgical report I have a 75 cm bypass and a 10 cc pouch.  Am I doomed to be morbidly obese forever?

Answer
Sandi,
I understand your concern, since you are going through so much to try to achieve a healthier weight.

I have seen the recent literature reports that describe weight loss after revision surgery that is similar to the primary operation but that has not been my experience.  My understanding is that the first operation (whatever type) achieves brisk initial weight loss because the body is not efficient in using calories and it continues to burn calories briskly for the first few months even when calorie intake is low.  As time passes the body becomes more efficient and this increased efficiency at a reduced level of calorie intake is part of how weight stabilizes.

It appears to me that the body remains efficient for most patients who enter into a revision operation, so that there is more modest weight loss even in the setting of low calorie intake.

Given that your current calorie intake is only about 800 calories per day, I would say that your gastric bypass is working fine.  The thing to do is to increase your calorie expenditure and that means exercise.  I'm not sure why you are not exercising, but most people are able to to some type of strengthening exercise.  Strengthening is important because muscle is more active metabolically, which is a fancy way of saying that muscle burns more calories.

I hope this is helpful, and I wish you luck,
Dr JP

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