Want to delay surgery until your patient loses weight? Think again.
Tenacity of Obesity Revealed in Study

A study of 75, 000 obese men and 100, 000 obese women in the United Kingdom is discouraging. Researchers found that less than 1% of obese individuals will, in their lifetimes, attain normal weight.
Parker Brown, wrote for MedPage Today that the study found that the chance of attaining normal weight is about 1 in 210 for the men and 1 in 124 for women. For those who are extremely overweight the chances of pulling their BMI (body mass index) down to a more normal range was an astonishingly small 1 in 1, 290 for men and 1 in 677 for women. The study, conducted by Alison Fildes, Ph.D., at King’s College in London and she observed these patients for 9.9 years. None of the subjects had undergone bariatric surgery.
“Our findings indicate that current nonsurgical obesity treatment strategies are failing to achieve sustained weight loss for the majority of obese patients, ” wrote Fildes and her colleagues. “These findings raise questions concerning whether current obesity treatment frameworks, grounded in weight management programs accessed through primary care, may be expected to achieve clinically relevant and sustained reductions in BMI for the vast majority of obese patients and whether they could be expected to do so in the future.”
Brown wrote that, “of those who did achieve 5% weight loss, 53% regained the weight within 2 years and 78% had regained it within 5 years. Probability of achieving the weight loss increased as BMI categories increased. For both men and women, 12% recorded only BMI increases.”
“Fildes noted that, because of the high levels of comorbidity seen in obese people, it’s possible that they consulted more often with a doctor—and had their BMI recorded more often—than did those in the normal weight group. If so, she wrote, it is possible that all of the patients in the study represent a biased, less healthy sample.

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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