October 23rd, 2013
An article in the October edition of the white journal (Plastic & Reconstructive Surgery - "the" plastic surgery journal) made the news recently. In it, the authors claimed that patients who underwent body contouring after gastric bypass had better long-term weight control than patients who just had weight loss surgery without plastic surgery.
Big News, right?! "Come see me for your plastic surgery - it's worth it! You'll be healthier in the long run!"
Not so fast...
The way this article was portrayed in the Wall Street Journal is somewhat misleading, and illustrates the need to actually go to the original paper and get the details instead of taking what's found in the "news" at face value. I have included the abstract of the original article here:
I agree with the authors' statement that body contouring should be considered reconstructive in the setting of post-bariatric surgical changes. And, I don't think there is any argument that patients who undergo post-bariatric plastic surgery have better long-term weight maintenance than patients who don't. But, is the plastic surgery responsible for their weight loss, or are there other factors that were the cause of the weight maintenance and the plastic surgery was just the bystander? It seems to me to be a chicken vs. egg debate.
The problems with the study are these:
1. People who are willing and able to have plastic surgery after bariatric surgery are usually financially better off than those that don't. That's not a value judgment, but a statement of fact - plastic surgery, especially this kind, is expensive. The authors are automatically selecting a group that is more financially secure and, therefore, able to spend more on their health - gym memberships, health foods, and supplements.
2. People who are willing to undergo the long process of body contouring are motivated and invested in themselves. They MAY be the ones who are more "image conscious" and willing to do whatever it takes to keep the weight off, regardless of whether they had surgery or not.
3. Lastly, plastic surgery itself may be the reason people in the study group kept the weight off. Once the extra skin is gone, it's understandable that your confidence is boosted (you've "made" it), and you're more motivated to exercise, maintain your diet, and keep living your new lifestyle than when you still had the remnants of your "old" life staring back at you in the mirror every morning. You look better, and you want to make sure you keep it that way.
I don't want to throw stones - the authors of this study did an excellent job putting this together and are solid advocates for their patients. They should be congratulated. And, they mentioned all this at the end of their article, as good scientists do. However, I think that a statement that says "tummy tucks after bariatric surgery keep the weight off", which was essentially how this study was cited in the Wall Street Journal, is a bit of a stretch. It's taking good science and twisting it to make headlines... which it did.