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What a Plateau Does Not Mean A plateau does not mean: You are resistant to the medication The dose has stopped working Weight regain is inevitable Reaching a plateau after substantial weight loss is a sign of physiologic adaptation not treatment failure

Therefore impaired glucose tolerance, elevated fasting glucose concentrations and diabetes mellitus are frequent in Cushings disease and acromegaly

Potential advantages Often a strong option for patients with significant reflux May be especially helpful for patients with type 2 diabetes or metabolic disease Can be used as a revision option after Lap-Band or sleeve in selected patients May provide more weight loss for some higher-risk or higher-BMI patients Long track record in bariatric and metabolic surgery Important considerations More complex anatomy than gastric sleeve Higher need for lifelong vitamin and mineral compliance Dumping syndrome can occur, especially with high-sugar foods NSAID and steroid use may be restricted because of ulcer risk Requires careful long-term follow-up Which Procedure Might Be the Best Fit

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Stopping abruptly typically leads to rebound appetite and calorie intake returning to previous levels