There are very few objective measurements of a person that can more accurately predict your ability to lose weight than your age. Weight loss for those in their sixties requires a much higher level of commitment than it does for those in their twenties. As we age, our set point becomes more tightly fixated, allowing young people to respond to nutrition and exercise alone while older people often require surgery in order to succeed.
Also, the length of time that you must maintain your weight loss varies significantly with your age. Very few people regain a significant amount of weight after seventy, so those in their twenties must maintain their post-surgical weight loss for forty to fifty years after surgery, while those in their sixties only need to do so for ten or fewer years. When I meet with younger patients, I typically try to dissuade them from pursuing a surgical route. The question that I pose to the younger patient who is convinced that surgery is their only option is “when should we do this?” Perhaps it would be better to wait until after you’ve had children or you are more settled in your career? The answer to this question is difficult and cannot be determined by anyone else – it requires you to be honest with yourself and recognize that these surgeries do not offer guarantees, only opportunities.
We must recognize that the surgery offers a once in a lifetime opportunity to lower your set point. This is precious and must be treasured and nurtured. It requires you to eat and live differently than most of your family and peers. If at any time, you drop your guard and join the rest of the world in their regular consumption of processed foods, you put yourself at significant risk for weight regain and set point elevation.
Most young people have a lifetime full of new experiences waiting for them including marriage, children and new professional or social opportunities. Each of these new experiences, while often exciting and joyful, will modify your relationship with food. Finding your life partner and getting married is wonderful and emotionally fulfilling, but now there is another person involved in your daily decisions about what and where to eat. Parenthood can be amazing and wondrous, but often results in an increased consumption of chicken nuggets. Your new job may offer a great salary and professional satisfaction, but it may require more travel and dinner meetings. Patients who are secure with their spousal relationships, have had their children and are stable financially and professionally do not have the same uncertainty ahead of them and are much more likely to be able to commit to a lifetime of good nutrition.
Age of onset of obesity
Those of you who remember being on your first diet in grade school are much less likely to respond to nutritional and exercise modifications than those who gained their weight later in life. If you’ve spent your entire life battling your weight, there is likely something about your genetics or your early childhood development (including your environment in your mother’s uterus) that has made you very susceptible to our modern environments set point raising effects. All of us, even those who are thin acknowledge that the rules of weight gain and weight loss are not fair. Some people can eat all the sweets and processed food they like without gaining any weight, while others gain a few pounds whenever they walk by a bakery. If you are a member of the large, unfortunate group of people who gain weight very easily and have a very difficult time losing weight, and you have been for as long as you can remember, than it is likely that Bariatric Surgery may represent your only, realistic chance at sustained, permanent weight loss.
This rule is very appropriate for those of us over 40 since we were not exposed to the highly processed diet that today’s young people are. If you are under 40 and were raised on macaroni and cheese and Coke products, then you may still be able to respond to nutritional change. Today’s young people were exposed to a very different nutritional childhood than any generation in history. The long term impact of this upbringing is largely unknown and very likely to result in a lifetime of weight problems. However, the physiology of young people is much more malleable than the rest of us and it may not be too late for those raised on junk foods to obtain the lifelong benefits of an unprocessed diet rich in fruit, vegetables, nuts, seeds and beans.