Bariatric Surgery vs Conventional Dieting in the Morbidly Obese

Weight loss and psychosocial events have been compared between low calorie conventional diet (n = 11) or following obesity surgery (n = 17). Interviews were ≥ 9 months following initiation of treatment. After surgery significantly less hunger was experienced (surgery 76% [13/17] vs diet 18% [2/11] p < 0.01) and less will-power was required to stop eating (surgery 88% [15/17] vs diet 27% [3/11] p < 0.001). More dieters stopped eating because of ‘figure and health’ (surgery 12% [2/17] vs diet 64% [7/11] p < 0.01) whereas postoperative patients stopped due to vomit avoidance (surgery 53% [9/17] vs diet 0% [0/11] p ≤ 0.05). More of the postoperative group were employed (surgery 76% [13/17] vs diet 18% [2/11] p < 0.005). Following surgery there were subjective appearance improvements (surgery 94% [15/16] vs diet 50% [5/10] p < 0.01) and fewer social limitations (surgery 69% [11/16] vs diet 27% [3/11] p ≤ 0.05). Physical activity improved (surgery 73% [11/15] vs diet 18% [2/11] p < 0.01). Although both groups continue to feel ‘fat’ at times, more dieters think other people view them as obese (surgery 35% [6/17] vs diet 91% [10/11] p ≤ 0.05). Satisfaction with weight control method was greater following surgery (surgery 100% [16/16] vs diet 33% [3/9] p < 0.005). Enforced behavior modification (vomit avoidance) is the mechanism of action of gastric restrictive surgery. Physical activity increases, and satisfaction with weight loss method is greater, after surgery. Employment is greater (probably self selection) in the post-surgical group. We found that comparing ≥9 months following surgery or beginning a conventional diet, the morbidly obese have a more positive response to surgery.