Continuing Lifestyle Intervention, Part 7

Most recently, we mentioned the sad statistics around weight regain after both bariatric surgery and semaglutide therapy. Everyone, it seems, is destined to suffer the rebound effect. Even former contestants who went through all the rigmarole of being on a weight-loss TV contest show, regain most of the pounds they so strenuously shed.

This post and this one illustrate how, with or without surgery or GLP-1 drugs, continuing lifestyle modification is the only road to ultimate victory. This is true enough of the pretty-well-functioning person, and even more so of a person who went into the adventure with a few issues.

For instance, there is the ever-elusive problem of patient compliance, which is never a given. Even after spending a tremendous amount of effort and money to achieve their results, people will backslide. Some will simply be unable to stick with the program because of the side effects.

Outside of the patient’s psyche, a lot of things can go wrong. With the drugs, supplies can be interrupted due to shortage of the product, world events beyond the suppliers’ control, catastrophic massive health emergencies like another pandemic, insurers going broke trying to fulfill their obligations, and uninsured patients being unable to keep up with the cost of the meds.

And, as must always be mentioned, not much information is available on the long-term effects of the meds. Even under the best conditions, neither surgery nor drug therapy is the perfect solution.

A shocker

At one point Dr. Pretlow attended a meeting of the Obesity Society where it was stated that weight loss with the GLP-1 drugs is just as good whether accompanied by lifestyle programs or not, which a member remarked was “jarring” for the majority of attendees to hear. A Cleveland Clinic article, however, affirms the righteousness of continuing lifestyle intervention:

Bariatric surgery requires a large change in lifestyle post-operative… An integral part of your decision to have safe weight loss surgery is the commitment to follow-up.

In other words, surgery is not a fix-it-and-walk-away proposition, and no one should expect embarking on a course of weight-loss meds to be that, either. In the realm of just plain obesity intervention, the American Gastroenterological Association’s weight loss guidelines include the caveat,

With no further treatment (or with infrequent follow-up meetings) patients typically regain one third of lost weight in the first follow-up year, with continuing weight gain thereafter. Patients, on average, return to their baseline weight within 4-5 years.

Your responses and feedback are welcome!

Source: “Life After Bariatric Surgery,’, undated
Source: “Intensive Lifestyle Intervention for Obesity: Principles, Practices, and Results,”, May 2017
Image by Orin Zebest/CC BY 2.0 DEED

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Profiles: Kids Struggling with Weight

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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