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Let's look next at weight loss. For extremely overweight people, bariatric surgery is highly effective. It reduces appetite by reducing the size of the stomach, but it is not always a lifelong cure. As NPR's Patti Neighmond reports, a new procedure could help patients maintain their weight loss.
PATTI NEIGHMOND, BYLINE: For most of her life, Fran Friedman struggled with compulsive eating. By the time she arrived at UCLA, she was 360 pounds at just 5 foot 2.
FRAN FRIEDMAN: So I opted to have the bariatric surgery.
NEIGHMOND: And lost 175 pounds.
FRIEDMAN: And maintained that for almost 10 years - the first time in my life that I've ever lost a lot of weight and was able to maintain.
NEIGHMOND: It was a miracle, says Friedman, not to feel hungry. The surgery reduces the stomach to about the size of an egg and people feel full from very little food.
FRIEDMAN: I thought that I was cured. I thought that I could eat like regular people.
NEIGHMOND: But 10 years after the surgery, Friedman started gaining weight again. She felt confused and depressed. UCLA gastroenterologist Rabindra Watson says she's not alone. About 1 in 3 patients regain significant amounts of weight a few years after surgery to reduce the size of the stomach pouch.
RABINDRA WATSON: And then over time what we found is that the pouch can dilate and stretch, and when that pouch stretches patients are able to eat more at one sitting and they feel hungrier more often.
NEIGHMOND: At the same time, hormonal changes that reduce appetite and take affect pretty much immediately after surgery begin to decline.
WATSON: The body again adapts to that change in physiology, and we think that possibly those changes are being reversed over time, that we don't have enough evidence to prove it.
NEIGHMOND: These hormonal changes and a stretched out stomach pouch mean people feel more hungry and are inclined to eat more. For Fran Friedman it meant a 20-pound weight gain.
FRIEDMAN: And then reality hits. Do I want to go back to where I was or do I want to maintain this level of quality of life?
NEIGHMOND: And this may be the hardest part of life after bariatric surgery - understanding that the surgery doesn't mean patients no longer have to pay attention to what they eat or whether they exercise. Gastroenterologist Watson says that's still a lifelong commitment. And for some patients, like Fran Friedman, a new, less invasive procedure can make the stomach smaller again and that can make a major difference.
WATSON: By reducing the size of the pouch what we found is that patients report improvement in their satiety and decrease in their hunger and, ultimately, greater control over how they're eating.
NEIGHMOND: And for Friedman that did the trick. She's lost 30 pounds since that second surgery. And now, with the help of a support group, she's committed to watching what she eats and how much she exercises. Patti Neighmond, NPR News.