NEW YORK (Reuters Health) - Obese people who have lost substantial amounts of weight without surgery can do just as well at maintaining the healthier weight as their peers who lost weight via gastric surgery. That's the finding of the first study to compare the two strategies.

However, people who go the non-surgical route may have to work harder to keep the weight off, Dr. Dale S. Bond of Brown University in Providence, Rhode Island and colleagues found.

Bariatric surgery is agreed to be the most reliable way for very obese people, meaning those more than 100 pounds overweight or with a body mass index of 40 or greater, to lose weight long-term, Bond and colleagues write in the International Journal of Obesity. While recent research has shown intensive behavioral interventions can also help, their long-term effectiveness is unknown.

To investigate, the researchers compared 105 people who had undergone bariatric surgery to 210 individuals who had lost weight non-surgically. All had dropped roughly 56 kilograms (123 pounds), and had kept at least 13.5 kg (about 30 pounds) off for an average of 5.5 years. About two-thirds of the non-surgical weight loss patients had formal help with their efforts, while the rest said they had no professional assistance.

In the one to two years after starting the study, both groups gained an average of roughly 4 pounds a year. Most people in both groups maintained their original weight loss within about 11 pounds.

Those who had undergone surgery ate more fat and more fast food and were less active than those who had lost weight without surgery, the investigators found.

The only factor that predicted whether or not a person would keep the weight off was their level of disinhibition, or loss of ability to control their impulses, at the study's outset, as well as any increases in disinhibition over the following year.

The researchers conclude: "Designing methods to increase resistance to cues that trigger overeating among individuals who have achieved large weight losses through bariatric or non-surgical methods may assist in preventing weight gain."

SOURCE: International Journal of Obesity, online December 2, 2008.

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