Those patients who have a strong family history of obesity often find that surgery is their only realistic means for success. If it seems like most members of your family are overweight or obese, despite eating a reasonable diet, then it is likely that your genes are set to favor fat storage when exposed to our processed American diet.
The rules are not equal when it comes to weight gain. Many people can eat heavily processed diets without gaining a pound, while others with less “lean” genes eat a relatively clean diet, yet gain weight easily. The reason for this difference is largely unknown, but we are starting to make progress. Several genes have now been identified that are tightly linked to obesity and we’re finally putting hard science behind what we’ve always known: certain genes predispose their owners to a lifetime of obesity.
However, it’s important not to become too fatalistic when we consider our genetic tendencies. Weight loss surgery offers you the opportunity to draw another ticket from the genetic lottery. Many people may have genes that favor fat storage that have plagued them their entire life, yet also possess genes that make them exceptionally receptive to the favorable hormonal changes that occur after surgery. Just as there is significant variation in people’s ability to lose and maintain weight before surgery, this same variability exists after surgery. The amount of weight that is lost after surgery is highly variable – some patients lose nearly all of their excess weight and are able to maintain their weight loss easily for decades, while others plateau well before they reach their goal weight and then struggle with weight regain.. As we delve into the reasons behind this variability, we find that success after surgery has as much to do with our genes as it does our ability to stick to our exercise and weight loss program. In my practice, I find that approximately 15% of my postop patients resemble one of those skinny people who find it extremely easy to maintain their post-surgical weight. There is clearly something different about the way their body has responded to surgery, and the answer most likely lies in their genes.
One of the most helpful questions I can ask a patient to help predict success after surgery is “Do you have a first degree relative (parent, child or sibling) that has undergone Bariatric Surgery, and, if so, how did they do?” Just as a tendency to gain weight runs in families, so does success after weight loss surgery. I am always happy to see a new patient who is a close relative of one of my most successful patients. Although most of us are quick to attribute success after surgery to discipline and willpower, the science supports a favorable genetic makeup as an equally important factor. We’ll discuss the balance between lifestyle changes and your genetics in more detail later in the book when we explore the best approach to achieve lifelong success.