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UPDATE page 2: I am going my bi-monthly "bariatric surgery" rumination..........


Joanne
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Please, please, please don't suggest that I move more and eat less. I have done everything "right" for weeks and months several times in the last 5 or so years and can not lose weight according to the calories in/calories out model. Yes, I've had my thyroid checked.

 

As far as the surgery - I qualify. Although I don't "feel" as fat as I have in my head for people who "qualify", I do qualify.

 

My 3 barriers:

 

  1. Reasonable concern about the risk vs reward on elective surgery.
  2. The substance abuse/addiction and WLS correlation - again, a reasonable consideration given my background.
  3. The stupid, old, defeating idea that **I** will have failed to master something "simple" if I have to get WLS.

 

2 things bring this to the forefront of my thinking:

 

A recent plan trip

Speaking with a nurse at my weekend job who had it done last year

 

I would like to discuss this, with the one boundary.

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The surgery is a tool. I know people who have had it done and years later have lost and maintained at a healthier weight. I also know people who had it done and gradually undid it by not sticking to how they were supposed to eat as a couple years went by afterward, and had less success.

 

If a doctor (such a your GP) who doesn't specialize in the surgery found you to be a good candidate AND the specialist agree that you're a good candidate, it's certainly worth considering doing.

 

For me, moderate calorie restriction and limiting my carb/sugar together, along with exercise, help me lose weight, but I have yet to make permanent changes to sustain it so I've gained back. It's the permanent lifestyle changes that are the hardest for most people. Surgery won't actually help with that part.

 

Finally, there's the question of overall health. Do you feel that you need to lose weight not just because you're not at some "ideal weight" a doctor or chart says you should be at, but because as it stands you're not healthy/"in shape" enough to do the things you want/like to do? Being fit for the lifestyle you want is more important than weight/BMI measures in my book. If your weight is affecting your quality of life, it's something to consider very seriously.

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I thought I'd add that for the people I know for whom it was successful, the impact on quality of life was significant. I know one lady who had had her mobility impaired, she had to use a scooter and could barely walk. Now, she still uses a cane, but the weight is no longer complicating things for her and she's able to do much more. (She's in her 70's and the weight wasn't the only issue she had, but it made it all worse).

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I agree with Ravin.  Surgery won't help with "the stick to the diet" part of it.  And are you fit enough to do the things you want to do?  

 

There is a woman at my church that had this done right before Thanksgiving.  She did it to try and balance hormonal issues.  It's 2 months later and she still carries around a water bottle type with a brown looking drink.  It's all the vitamins she's not getting because her meals are so small.  She also did a lot of prep going in.  I don't know if its required or not.  But she modified her diet for a while before surgery and lost 20 pounds that way.  She is finally noticeably different.  But that may be because she wasn't still wearing "old" clothes on Sunday, she had on something that looks like it fits.

 

I'm sure you'll get lots of stories about knowing people for whom it worked and stories for whom it didn't.  I wish you wisdom in the decision.

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I have seen it go both ways. Some people are very successful with it, others just never seem to gain control over their eating no matter what they do.  For the few people I know who have had WLS, it seems like the surgery just seem to amplify whatever will power they all ready had.  If they already had great will power and were eating the right things for years at a time, then the surgery was a success and they met their goals.  For my friends who yo-yo's off and on diets, and often fell off the wagon of the various diets they were on, the surgery made things worse.  They would eat the wrong things, feel horrible and then continue the cycle of 'eat bad/feel worse until the benefits of surgery were essentially undone, and all they had left were the negative consequences. 

 

I have seen some patients with complications like vitamin deficiencies due to absorption issues, painful GI symptoms,and  other medical conditions that were complicated to treat correctly due to absorption of medications.

 

 

I have also seen life changing weight loss that brought people back to a weight that was easier to manage.  They were able to better participate in actives with their children and be more physically active in their every day lives. I am much more likely to invite a friend who had WLS, out to do something like a trip to the mall now, than before because she can walk with less pain and she doesn't get out of breath as easily.  Now, she can walk fine and I don't need to worry that I am pushing her too hard or too far (she would get red and out of breath). 

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Unless you have signifigant health concerns I would be very cautious.  Very.

 

Do you have a lot of addictions in your family?

 

Have you tried eating a spoonful of saturated fat every day, and avoiding vegetable oils, corn syrup, and processed foods?

 

If you're walking an hour 5 days a week, eating 6-10 servings of produce every day (mostly vegetables), not smoking, have good friends and a rich spritual life, and don't have serious health problems related to weight (diabetes, etc), being overweight is not as dangerous as people would have us believe.

 

If you have addictions in your family, you might look into MTHFR genetic issues.  It's fairly common, and all of the fortefied processed foods have made things worse for those with that defect, which, at least for me, made me feel like I was driven to overeat.  When I learned about it after having several miscarriages I switched vitamins and started avoiding fortefied foods, and I've found that when I'm consistent with taking the right vitamins my appetite is FAR less.   People keep telling me I look thinner, but I haven't lost more than a few pounds, I'm just getting less puffy. I'm now to the point that I'm starting to think that weight is driven by biological issues, not character ones. Maybe B-vitamins aren't the issue for you, perhaps fat soluable ones are.  If I were you, I would try really hard to make sure you're getting the nutrients you need before you do anything that's dangerous and life altering.

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If you're walking an hour 5 days a week, eating 6-10 servings of produce every day (mostly vegetables), not smoking, have good friends and a rich spritual life, and don't have serious health problems related to weight (diabetes, etc), being overweight is not as dangerous as people would have us believe.

 

 

 

Definitely.  I think genetics plays as much a role if not more.  My husband's family is all mostly overweight.  Many of his family members lived (or are living) very long lives.  It does not all come down to weight. 

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I would look far down the road. You have spoken with folks who have had good results, and have been identified as a good candidate, as Ravin points out.

 

I understand that, following such a procedure, eating habits must change as a result (please inform me if I misunderstand). I would be asking lots of questions about the actual lifestyle changes that are necessary to comply with what's required for a successful result (or honestly, to avoid complications). I'd be holding this info up against what I really feel I desire to do and will be able to do, long term.

 

I appreciate your thoughtful approach, Joanne.

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I only know one person who has done the surgery, and it was about 12 years ago.  She's like a new person.  She lost the weight, and after a year or two she had further surgery to get rid of the excess skin. People who meet her today have no idea what she was like back then. She eats normal foods, works out a reasonable amount.  The only negative is that she got divorced soon after she lost the weight- but she feels she married him right out of high school because she was overweight and she married the first boy who showed an interest. She has remarried and seems very happy.  At the time a lot of folks 'blamed' the surgery but I had other friends who got divorced at the same time but without the surgery.   And you're not married anyway.g 

 

I know exactly how you feel. Dh has tried everything, and he works out five days a week. He has a trainer who designs his workouts and the trainer just cannot figure out why the weight doesn't budge.  We keep a food log and I am sure he's being truthful.   It's frustrating to have people tell him to 'move more' or try their diet of the week.   The math says he should be losing a lot of weight, and dh is an engineer so it is frustrating when science isn't behaving as it should. 

 

You do have a tough decision, but with everything you have gone through, I'm sure if you decide to do this you'll give it your all and be successful.  

 

 

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Joanne,

 

I had the surgery last April.  I would be happy to speak with you further about it.  I'm so glad I finally just did it.  Wish I hadn't waited. And there is science that suggests it is the only thing that works long-term for certain subsets of people.  Sooooooooo, I'm definitely positive about it in general.  

 

ETA (now that baby is asleep :) ):  

 

So I have real issues with food, eating, etc.  It is something I'm definitely needing to work out now that has been eight months and I can basically eat anything.  Just like you have your past addiction issues to work out now, you'll have them post-surgery.  85% of your stomach being removed doesn't change that.  I think that you have the added benefit of the years of understanding of your addiction and yourself around that issue.  Since it wasn't my issue, I didn't research it, but I would think you would be in a BETTER situation in terms of that than the average person who is just going to replace drinking for the food they are no longer able to stuff in.  

 

Anyway, weight was a big part of it for me, but health was definitely the winning factor.  

 

1) my mobility is SIGNIFICANTLY better.  No more cane, scooter, etc.  I still have some hip pain but it is significantly better.  The back pain is almost gone.  HUGE difference.

 

2) my energy level is much better which is important to me (see signature!).  

 

3) emotionally I've had some ups and downs but I definitely am better off.  

 

4) my sugar is normal !!!!

 

5) my blood pressure is nice and low even when I go to the dentist!  

 

6) I can imagine living the next 30 years (when I was wondering about the next 30 days).  

 

And like I said, weight DID count to me.  My goal was a size 10.  I am a size 10 today (and it is loose).  I'm still a good 30 pounds from my goal weight so I guess I'm going to be under a size 10 :)  I still see that fat person more often than not, but I'm trying to talk myself into seeing the size 10 person. Thankfully, feeling so much better and being so much healthier has meant a lot more to me now that it is here so makes up for still seeing myself as a size 18/20.  

 

One HUGE negative is the attention I'm receiving (and not receiving).  I have had people intentionally not mention it because they know that I had surgery to do it (so "cheated").  But a LOT of people comment on it A LOT, being positive, but I *really* don't like the attention 99% of the time.  

Anyway, so you will still have to choose a way of eating (I'm vegetarian or vegan depending on the week) in the end, but the tool really does help and the benefits to quality of life are HUGE.  

 

Hope this helps a little.  Again, PM if you'd like. Or ask anything here.  :)

 

 

 

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My best friend went through the surgery. It was a bonus stop to her type two diabetes. The rest looked like a nightmare to me. I recall her not working for a while post op and miseries from time to time afterwards. She lost 20 pounds. I know one that has done well and others have regained weight. I don't know which approach they used.  If I understand your list I would pay attention to one and two. Three sounds like that bad tape playing again. Also the calorie drop pre and post surgery is so dramatic. In the clinic near here one has to drop calories and lose weight before the surgery. At some point they start the liquid diet they will be on post op. They try to teach patients and their bodies what it will be like post op. I worry about you missing work and feeling poorly at this point in your life.  :grouphug:

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My dad had the surgery over 30 years ago --he went from just over 300lb to 180lb in just a few months (March-August)--just in time for my sister's wedding!

He has been able to maintain a healthy weight.  Occasionally he feels he still has to diet -- he is almost paranoid about being over 180 pounds.

 

The first year or so after surgery his meal size was very limited- after that he ate/eats healthy portions.

 

The downside was that he has to take vit B injections and other supplements because he cannot absorb them naturally.

 

He also has type 2 diabetes (recent DX)-- even though he is at a healthy weight.  Somethings are purely genetic (almost all of his relatives on BOTH sides were type 2).  Because of his surgery he cannot take Metformin (it interrupts vitamin absorbsion)... so he has to be VERY careful in what he eats.

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I have three extended family members who have done this, and it has been hugely successful for each of them on different levels.  One was about 15 years ago, the other two were about 8 years ago.  All three have seen positive changes in energy level and quality of life, to varying degrees. They each have their own issues which impact the success - 2 have substance abuse issues, one has ongoing chronic health issues - and it's hard to say how their individual issues have impacted their current situations.  I think a lot (of the potential success) might be dependent on genetics and one's constitution (for example, I don't recover from surgeries well, and suspect it would be a tough road for me, though I could be wrong).  The most successful of the three did have some addiction issues following the surgery, and needed a lot of support in terms of treatment for that.  But she had those issues (actively) prior to the surgery.  

 

It's a tough decision.   :grouphug:

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I don't know...I tend to be extremely leary of gastric bypass. It is so extremely far from a "normal/natural" nourishment concept. It doesn't change any physiological or psychological dysfunction.

 

Admitedly, though, this isn't a problem I have had to manage in my own life.

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I'm now to the point that I'm starting to think that weight is driven by biological issues, not character ones. 

 

The bolded bears repeating for anyone who struggles with weight. It's not an excuse for not being able to lose weight, it's a reason. 

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The bolded bears repeating for anyone who struggles with weight. It's not an excuse for not being able to lose weight, it's a reason. 

 

I knew a couple who had surgery together..  the husband died from complications of surgery, and she's been quite ill ever since .  I don't think surgery is something I would do for cosmetic reasons whatsoever.  Basically life-threatening reasons only, and even then I'd try a full-on ketogenic diet first, with lots of greens and one small serving of berries per day.

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I know for some things can be very difficult. 

 

intestinal bacteria can affect weight. (gasseri is one strain.)  as will cortisol levels.

 

calories in and calories out is misleading.  not all calories are equal.

 

I hope you're able to come to a decision that works for you.

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I've had two bariatric surgeries...a Lap-Band right as it was approved and a sleeve gastrectomy. I'm about 6-1/2 years out from the sleeve, 14 years post Lap-Band..., and I've kept off 50 of the 70 pounds I lost with the VSG. I never got "thin". I got to about a BMI of 30-31. It was similar to my adult weight at 19/20....pre kids.

When i had my second one, I considered the duodenal switch. It has the best longterm results. In the 15 or so years I've been on WLS boards, I've seen tons of revision with Lap-Bands, RNYs, and now VSGs. I've seen only a few revisions with DSs...and usually to take down the DS portion.

In general, the longer you've been MO....or the closer you are to a BMI of 45+... the more I'd recommend a DS. Why? Because those are the people who I think really benefit from both restriction and malabsorption. I've also seen some good long-term success with the Mini-GB, but it's not covered by insurance. Check out the DS boards on OH and look at DSFacts.com too. The intestinal portion alone is also done on diabetics.

I would not recommend a RNY on any account. It's too difficult a revision compared to a VSG. VSG gives you a pyloric sphincter, which means limited/little dumping, more normal eating, etc. No stoma to be enlarged or get stuck. Do not believe the line that you don't need to worry about vitamin deficiencies with VSG. B12, Vitamin D, calcium, iron, can all be issues. If Vitamin D gets too low, you can have issues with PTH. Vitalady is a great source for supplementation info even if you do not buy from here. I've watched Bariatric Advantage grow since the beginning, and I think you can do better, although their calcium wafers are popular.


I would not recommend a Lap-Band at all...it's surgically enforced bulimia, and not very effective. Every single person I had surgery with back in 2001 has been revised. Every single one.

 

In general, restriction (and the VSG is also hormonal because of the ghrelin absence for the first year), can help you lose the weight...but most will say that its malabsorption that keeps it off.

 

 RNYers have issues with simple carbs.  The typical post-op diet is sugar free, low fat, low carb.  

 

VSGers don't have issues with any type of food, and are usually told protein first, followed by non-starchy carbs, and then starches/fats.  

 

DSers have the most malabsorption, so in general they eat the most. Also, the sleeve made for their stomach is often larger than a stand-alone sleeve, although it depends on the surgeon.  Some like a tighter sleeve, with a longer common channel (the area of the intestine where food is absorbed.)  Others like a larger sleeve, but shorter common channel.  Personally, i'd go for a longer channel as it leads (in theory) to less issues.  They do not absorb most fat, so often eat very high fat diets.  They also need to take non-fat soluble versions or 'dry" versions of vitamins D, E, and A.   So, according to Gagner and this has been born out by 25 years of DSers, DSers absorb 100% of simple carbs, 60% of complex carbs, 60% of protein, and 20% of fat.  That means that they malabsorb 80% of the fat they eat. 

Check out the revision boards. some people are revising as soon as two years out, most it's 3-5. Also, manage how you define success. Very few people experience 100% EWL. anything over 50% EWL is considered success in medical literature. Some people hate those figures, but as drugs are considered successful if one can lose 5-10%, 50% is huge.

I don't recommend talking w/ people less than 2 yrs out about LT results because they are still in the Honeymoon phase. They are great for pre-op and post-op info.  I'll also add that people who have regain or who are not as successful, tend to stop posting on boards because they feel that they are being blamed.   Sometimes, the surgery was the wrong procedure for them.  So, for actual stats, please use peer-reviewed med journals.  Just because you meet 30 people on OH who have lost 100% of their EW, doesn't mean that everybody or even most lose that much.  Also realize that people lose interest in the boards, so it can be harder and harder to find people who are LT post-ops, except for the revision boards.  Some just start living their life...being obese/losing weight is no longer the focus of their lives.  (Yes, it's freeing not to fall prey to every new Fad diet or diet article. :))

PubMed has great articles.

All of the current WLS have very low surgical risk. Choose a surgeon that does at least the RNY, VSG, and DS...all three and does them regularly. Ask how many of each s/he's done in the past year. Check your insurance's revision policy too.  Oh, and most have some need for vitamin supplementation for life.  I've had PTH/Vitamin D and B12 issues since my sleeve.  I did not have any issues with my Lap-Band.  it is manageable...but they do exist.

Note: There are three new weight loss drugs on the market that you might want to try before surgery. If you don't need surgery, great. Qsymia, Contrave, and Belviq. My endocrinologist seems to be very impressed with Qsymia, but I have no personal experience with it. He's much happier with these than the older Xenical or Meridia.

 

I'll also add that you are not a failure for needing surgery.  You have a disease known as morbid obesity.  There is not one diet out there that has been proven effective in peer-reviewed studies in keeping excess weight off in morbidly obese (or even overweight people) long-term.  We're talking 2-5 years.  There is not one drug that has caused MO people to lose a significant amount of weight long-term and keep it off.  10% is considered a rip-roaring success.  Well, if you weigh 250, that's 25 pounds.  Whoop-de-doo, you're still fat.    If you had cancer, and you choose to have a tumor removed, you would not be a failure.  If you have heart disease and need a bypass, you are not a failure for choosing surgery.  It is a disease....and right now in 2015, the most effective treatment that gives the best and long-lasting results is surgery.

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I have considered surgery in the past too many times since I have dealth with almost 100 pounds excess weight for over a decade and constant food cravings up until I started Metformin and Contrave. Please see my post in the chat forum on this. They have been a godsend and I am down 20 pounds and over 98% of my cravings are gone. 

 

Metformin is used for diabetes and pre-diabetes. However, there are studies that habe shown weight loss benefit in obese patients without insulin or glucose abnormalities. I would ask for a 3 to 5 hour glucose tolerance test with both glucose and insulin levels drawn. Also have a glycohemoglobin done as ordered. Metformin is very safe and has been around for decades. It does cause usually temporary diarrhea in about 25% of those on it. However, if the extended release form of Metformin taken with meals is less likely to cause this problem. Also, starting out with one 500 mg pill and gradually increasing to ordered over a few months also helps.

 

 

Contrave tackles both food addiction and mood. There is a savings card. The wellbutrin component often causes jitters so you may find taking dose in am and early afternoon better as well as cutting caffeine. My jitters lasted 2 weeks  but are gone now. Also, I found that one pill in am works great for me, but my doctor ordered usual dose of 4 pills day so I can realize savings and increase if I need it.

 

I would consider meds before surgery since they may work with less side effects. These meds are unlike the fen-fen debacle 20 years ago since the meds have been used for decades.

 

 

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I've only known two people who've done it. My great aunt way back when it was still new -she had a lot of ongoing health problems afterward and was never "the same" emotionally. She went from happy-go-lucky and fun to serious and less fun, overall. Now, was it from not ever feeling well after the surgery with the ongoing issues, or realizing that surgery didn't make "everything better" in her life? I guess no one can say for sure.

 

The other one is more recent. Last summer. We had dinner together a few weeks after surgery when she was getting more mobile again, she ate about 3 bites then had to go throw up because she ate too much. :( I'm not sure how she's doing now, but hopefully can eat more than a few bites at a time.

 

I guess I really have nothing to offer you but :grouphug: and calming vibes while you contemplate what will work best for you. I wish you all the best with whatever you decide.

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I know five people who have had WLS.  One died from post-op complications.  

 

The second is on her second surgery because she has failed to follow the diet recommendations/restrictions, or to change much of her lifestyle.  

 

The third has lost some weight, but I don't think he was as good a candidate to begin with, he went in thinking it would control his portions.  Instead he is now on more medications than ever.

 

The fourth has done well and lost a significant amount of weight (going from about 24W waist to about a size 12 waist), but it took over 8 years.  She had to excuse herself to throw up during most meals for at least the first year.

 

The fifth had a major life change following surgery.  She had life threatening health problems prior to surgery and lost hundreds of pounds.  One wouldn't recognize her a year later.  The big difference I saw was that she had strict pre op criteria, where the others did not.  She is the only person of the group who had to see a psychologist, who had to loose 10 pounds before she qualified, had dietary restrictions and had to show that she was capable of keeping them for a certain period of time, such as only drinking water and following the post-op diet.  Her WLS preparation was a process that took over 3 months before they would schedule the surgery, and then she had to wait another three months.  She moved about a year and a half following surgery so I don't know what her long term result has been.

 

 

 

 

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:grouphug:  :grouphug:  :grouphug:

 

My friend's stepbrother had a gastric bypass in his late 30s.  He was just slightly over the minimum weight/BMI/whatever they use to "qualify"for the surgery. He thought he was lucky to get it, but he died in his sleep from a blood clot 2 weeks after the surgery, leaving 2 young kids. It scares me since he would not have been considered a particularly high-risk patient. 

 

Good luck! It's an incredibly hard decision.

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Just wanted to encourage you. If you decide to get the surgery you have not failed. I have not had the surgery. I sort of see it as I did when I was expecting my first child. I wanted to have a natural birth. I planned for a natural birth. I did everything I could to have a natural v birth, but that didn't happen. I had a surgery to have to the result I wanted ... A wonderful son. Maybe not the best annology. My sister had lap band and was able to keep most the the weight off that she lost in spite of a thyroid problem. She lost 75 kept 60 off, but needed to loose 150. She is healthier, but food is still an issue, she is not at peace thinking about food and exercise is still consuming.

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I had a full Roux-n-y procedure 10 and a half years ago now and lost 110 lbs.  I also know many people who've had surgery including my cousin, sister and 2/4 of my SILs.  Only one of them had the gastric sleeve (which was not successful) and ended up moving to a gastric resection later. ALL GASTRIC PROCEDURES ARE NOT THE SAME!  Please do your homework on that front and, if you proceed, choose a doc with LOTS of experience and success.  

 

I agree with what others have said about it being a tool that can work if you a) are completely honest with yourself about how you came to be overweight and b) are willing to listen to your new body's signals.  Those instances where people are unsuccessful after surgery are often, IMHO, related to a and b.  They often choose the wrong type of surgery given their history and/or refuse to heed their new body's warnings.

 

Yes, some people do very well with an adjustable band or sleeve, namely, those who have a lot of self control and do not see adjustment/loosening as an option to relieve discomfort.  But most folks that I've seen who get the sleeve kid themselves about their willpower and determination.  It's the discomfort that actually forces dietary change for most of us.  People who fool themselves into thinking the weight loss can come without major change (physical and/or emotional discomfort) are living in dream land.  The first year (or two) are HARD, not just physically but emotionally.  

 

I have suffered from depression (both before and after) and can go downhill pretty fast although my low patches are fewer and less severe than pre-surgery. I also have a lot of alcoholics in my family and know when I'm drinking a glass of wine every other night, I'm in a bad patch.  Alcohol goes STRAIGHT to my post-surgery brain so I have to be extra vigilant about that (DH watches out for me too).

 

If food is your best friend, you will lose that relationship.  If food is your stress reliever, you will need a new outlet.  If food is your secret pleasure/source of shame, you will need a new way to deal with guilt. IMHO, you have to be willing to do not just the physical healing but the emotional healing too.  It's not easy but has been worth it for me.

 

Good luck with your journey!

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I know several people who had the surgery. It is an extremely hard decision. I know one person for whom it did not work (she ended up on a binge cycle because it was so painful to eat that she would not eat much at all for days, then binge and suffer--not binging a ton, but enough to basically undo the surgery's benefits). I know another person who had an early version of the surgery and who had complications related to vitamin and mineral absorptions until the end of her life. :(

 

I also know two people who had the surgery and, with changed habits (eating less even though they did not eat what I'd consider massive amounts in the first place), successfully lost weight and kept it off even after kids.

 

I wish you the best of luck. It's an incredibly hard decision. If you don't have a lot of existing health issues, i.e. if it's really weight alone and not back, joint, and blood pressure issues, I'm not sure I'd go for it because of the risks. On the other hand, back pain is crippling and I can see doing anything to stop it.

 

Hugs and you're in my thoughts.

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I'm pretty sure everyone I know who had some type of WLS HAD to lose a certain amount of weight before hand.

 

It was part of the preparation and if the person didnt lose, the surgery was pushed back/rescheduled until the person lost.

 

I don't know how that would work with someone who can't lose weight. It's a Catch-22.

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I know two people who have had it done.

 

The first, M, is a friend of my mom's. She had the surgery done 20 yrs ago. She is a recovered alcoholic (forgive me if any of my terminology is incorrect). M was in her 40s at the time of her surgery. She was celebrating 10 years of sobriety (I don't know if any of this is relevant, but since I know these facts, I am sharing them). She lost about 150 lbs rather quickly. Had to take supplements as I don't think she was able to eat more than a few tablespoonfuls of food a day. A friend who is a doctor described M's new eating protocol as starving herself for the rest of her life. About 10 years ago, M began drinking again. That was the first I had ever heard about that being a concern in individuals with a history of addiction. She entered rehab. The life she had built for herself (Master's Degree, bought a house, active in many activities) is no longer the life she is living. I believe she was in counseling throughout the process. I don't know why it did not work.

 

A friend of a friend had lap band surgery about 10 years ago. She wanted to lose about 60 pounds. She had no health issues. She just wanted to lose the weight. Ten years later, the weight is still off. She looks fabulous. She seems fabulous. My friend tells me that she essentially still runs to the bathroom to vomit after every meal which is only a tablespoon or so of food. The woman who had the surgery done says she would do it again in a heartbeat.......she does not mind the collateral GI issues with which she deals.

 

Best wishes whatever you decide.

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Please, please, please don't suggest that I move more and eat less. I have done everything "right" for weeks and months several times in the last 5 or so years and can not lose weight according to the calories in/calories out model. Yes, I've had my thyroid checked.

 

As far as the surgery - I qualify. Although I don't "feel" as fat as I have in my head for people who "qualify", I do qualify.

 

My 3 barriers:

 

  1. Reasonable concern about the risk vs reward on elective surgery.
  2. The substance abuse/addiction and WLS correlation - again, a reasonable consideration given my background.
  3. The stupid, old, defeating idea that **I** will have failed to master something "simple" if I have to get WLS.

 

2 things bring this to the forefront of my thinking:

 

A recent plan trip

Speaking with a nurse at my weekend job who had it done last year

 

I would like to discuss this, with the one boundary.

I'm just going to say that you should evaluate your responses to surgery...if you know. 

 

It's freaking HARD to recover, the older you get.  I think you are younger than me, but in my most recent surgery, I had some blood-clotting factor thing, as well as both a hematoma AND a seroma (look those up, blood-filled and fluid-filled huge swellings) and it will be months before I feel really normal again.  And that is much, much less invasive -even though it was abdominal - than this surgery.  I am STILL sleeping in a recliner, so as not to unduly pull on the area.  I don't respond to medications very well, and the side effects are difficult. 

 

I would have to be pretty close to death to get another surgery at this point.   I'm also allergic to all categories of antibiotics but one.  All of these factors may not be true for you, of course, but things can happen.  

 

Maybe you can get on, "The Biggest Loser".  ;)   That sounds miserable but would be preferable to the trauma of surgery, I think. 

Just my two cents.  I have some pounds to lose, but it is -very, very slowly- happening.  Just the nature of being older and not having the metabolism of a hummingbird anymore. 

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The surgery is a tool. I know people who have had it done and years later have lost and maintained at a healthier weight. I also know people who had it done and gradually undid it by not sticking to how they were supposed to eat as a couple years went by afterward, and had less success.

 

If a doctor (such a your GP) who doesn't specialize in the surgery found you to be a good candidate AND the specialist agree that you're a good candidate, it's certainly worth considering doing.

 

For me, moderate calorie restriction and limiting my carb/sugar together, along with exercise, help me lose weight, but I have yet to make permanent changes to sustain it so I've gained back. It's the permanent lifestyle changes that are the hardest for most people. Surgery won't actually help with that part.

 

Finally, there's the question of overall health. Do you feel that you need to lose weight not just because you're not at some "ideal weight" a doctor or chart says you should be at, but because as it stands you're not healthy/"in shape" enough to do the things you want/like to do? Being fit for the lifestyle you want is more important than weight/BMI measures in my book. If your weight is affecting your quality of life, it's something to consider very seriously.

I agree with all of this.  Depending on the person, it can be more about addressing why you are doing it and maybe what isn't working for you (inflammation from grains, maybe?  I don't know -lots of sugar?  ) than trying to fix it externally, because it can be undone. 

And NO KIDDING....it is the permanent change that is harder, because we can't just walk away from food entirely, like we can from alcohol or other substances.  We still HAVE to eat.

 

Of course, that all must be counterbalanced by whether one will be dead within a year because his heart can't take it, such as in last week's "My 600 pound Life" that I happened to catch (he was 735 pounds, and only still mobile because he happened to be in his mid twenties!).   

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Unless you have signifigant health concerns I would be very cautious.  Very.

 

Do you have a lot of addictions in your family?

 

Have you tried eating a spoonful of saturated fat every day, and avoiding vegetable oils, corn syrup, and processed foods?

 

If you're walking an hour 5 days a week, eating 6-10 servings of produce every day (mostly vegetables), not smoking, have good friends and a rich spritual life, and don't have serious health problems related to weight (diabetes, etc), being overweight is not as dangerous as people would have us believe.

 

If you have addictions in your family, you might look into MTHFR genetic issues.  It's fairly common, and all of the fortefied processed foods have made things worse for those with that defect, which, at least for me, made me feel like I was driven to overeat.  When I learned about it after having several miscarriages I switched vitamins and started avoiding fortefied foods, and I've found that when I'm consistent with taking the right vitamins my appetite is FAR less.   People keep telling me I look thinner, but I haven't lost more than a few pounds, I'm just getting less puffy. I'm now to the point that I'm starting to think that weight is driven by biological issues, not character ones. Maybe B-vitamins aren't the issue for you, perhaps fat soluable ones are.  If I were you, I would try really hard to make sure you're getting the nutrients you need before you do anything that's dangerous and life altering.

Like Katy, I notice a vast difference when I eat mostly organic and high fat (olive oil, avocados, coconut oil, nuts, lots of eggs).  No puffy eyes and more energy.  I actually look 10 years younger now in the face than I did 10 years ago when I ate lots of bagged, packaged crap.    I still have some weight to lose but feel better and blood levels are perfect in every category, which I know because I recently had surgery and they did a CBC.  Also not true 10 years ago. 

 

So I think this is good advice, to make sure you are doing everything possible to meet your particular needs and avoid your particular problems with food (like for me, it is grains - I get itchy skin and all kinds of weird stuff - you may have something else) before you undergo something so serious. 

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I knew a couple who had surgery together..  the husband died from complications of surgery, and she's been quite ill ever since .  I don't think surgery is something I would do for cosmetic reasons whatsoever.  Basically life-threatening reasons only, and even then I'd try a full-on ketogenic diet first, with lots of greens and one small serving of berries per day.

Yes, but that is easy to say but when you have the disease of obesity it can be like climbing Mt. Everest. And obesity is truly a disease IMHO. It may start off with some bad choices in some people but when obesity gets you in its clutches, it truly becomes a full blown metabolic disease and addiction disease in my understanding.

 

How is it that almost all of my cravings for sweets and excess food were gone the very day I started metformin? These cravings plagued me for over a decade. I was able to muster the strength to eat properly and exercise for about 3 months at a clip ,many times while constantly battling cravings a hundred times a day. And, of course, I succumbed each time. It is almost 3 months now on metformin and contrave which helped even more and it has been almost effortless. For once, I have satiety at every meal and eating normal portions and staying away from sweets is easy. I am grateful that meds and surgery are available. I recommend meds first now that we finally have some promising ones before surgery. 

 

I also recommend seeing Dr. Lustig on sugar the bitter truth on youtube. He explains how obesity is disease and not just sloth and gluttony.

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The requirement to lose a certain amount pre-surgery are  usually imposed by the surgeons themselves, not the insurance companies.  Not all surgeons do that.  Mine didn't.

 

None of the surgeons I went to, or have worked with, had pre-weight loss requirements or diets other than immediately pre-op for a day or two.  Usually those who have worked with the morbidly obese long term know that asking them to lose weight using a diet is ridiculous--if they could do it, they would not be having surgery.  :)  Some insurance companies want to see that you've tried other things before surgery.  

Of course, there is a post-op diet, but the ability to stick to it is night and day.  With the Sleeve Gastrectomy, you have the absence of ghrelin for about a year or more, plus there's the fact that you really only want to eat liquids...then purees...etc.  It feels right.

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Yes, but that is easy to say but when you have the disease of obesity it can be like climbing Mt. Everest. And obesity is truly a disease IMHO. It may start off with some bad choices in some people but when obesity gets you in its clutches, it truly becomes a full blown metabolic disease and addiction disease in my understanding.

 

How is it that almost all of my cravings for sweets and excess food were gone the very day I started metformin? These cravings plagued me for over a decade. I was able to muster the strength to eat properly and exercise for about 3 months at a clip ,many times while constantly battling cravings a hundred times a day. And, of course, I succumbed each time. It is almost 3 months now on metformin and contrave which helped even more and it has been almost effortless. For once, I have satiety at every meal and eating normal portions and staying away from sweets is easy. I am grateful that meds and surgery are available. I recommend meds first now that we finally have some promising ones before surgery.

 

I also recommend seeing Dr. Lustig on sugar the bitter truth on youtube. He explains how obesity is disease and not just sloth and gluttony.

 

 

Thank you for sharing this. And someone else mentioned Contrave (was it sneezy one?)......thank you to that person.

 

I lost 10 pounds in a flash with Metformin, but just last week my endo increased my dose as my blood sugar is creeping up again. I am tonight reading about Contrave and the other two meds.

 

Thank you to everyone who posted in this thread......I found the info fascinating and helpful.

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I'm pretty sure everyone I know who had some type of WLS HAD to lose a certain amount of weight before hand.

 

It was part of the preparation and if the person didnt lose, the surgery was pushed back/rescheduled until the person lost.

 

I don't know how that would work with someone who can't lose weight. It's a Catch-22.

That's what I've been thinking while reading through this thread...If a person is unable to lose weight through calorie restriction, how would the surgery help?  Isn't it just a way to restrict calorie consumption?  Or is there more to it that I'm not aware of?

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I don't think Katy was disagreeing with this, or blaming moral character. A ketogenic diet is therapeutic for cirvumventing what tends to be at the root of metabolic syndrome, of which central body obesity is a symptom. I know for men to is almost entirely biochemical, and I can't manage it with a high sugar or starch load (hence low carb).

 

The meds are not suitable for every body or without side effects, and for a number of targeted dietary and supplement interventions are highly effective. I went from a prediabetic young person to having an A1C, during *pregnancy*, of 4.7 and 4.4 the last two babies. This was with no medication and entirely dietary and exercise insulin control. Metformin wouldn't have done that for me, even if it assisted in my weight loss. It can help some women, especially with PCOS and similar hormonal issues, and even appetite suppressants and amphetamines are tools that might not be off the table. But without permanent dietary changes to support that lasting changes are hard to come by. And with weight loss surgery the same issues stands - permanent changes to intake and habits surrounding it. And if an insulin resistance is underlying the cravings, crashes, and abnormally rapid regain issues will still occur.

 

I so wish this wasn't true. For me, ketogenic diets aren't absolutely necessary. Just going whole foods and 35-40 net carbs, almost every day with consistency, is all it takes. Exercise helps with fitness but didn't make much of a difference for weight manage for me.

 

We are all different, and these tools will vary in quality for us depending on specific physiology. It isn't a moral failing, it's physiological in our HPA axis. And unfortunately all long term management has a dietary component to some degree or another. Trying to avoid that is where a lot of these post surgical issues seems to come about - addressing the reasons for weight gain, from habitual to hormonal, is crucial for whatever interventions we use to succeed.

 

I'm actually surprised at the board agreement we have on this thread. It seems a lot of us are in a similar boar and have come to similar conclusions. We are cheering for you, whatever you choose, Joanne :)

I am not disgreeing with a low carb or lower carb diet. In fact, I and my doctor strongly believe that is the way to go as well as whole foods. However, without the constant cravings, it is much easier to follow a lower carb diet. These meds have helped me to follow good eating habits and the improvement in my metabolic functions have helped me get off the couch. If it was as simple as diet and exercise there would not be a 98% failure rate when it comes to weight loss. 

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That's what I've been thinking while reading through this thread...If a person is unable to lose weight through calorie restriction, how would the surgery help?  Isn't it just a way to restrict calorie consumption?  Or is there more to it that I'm not aware of?

 

I've known probably 15-20 people who've had WLS surgery, some are required to lose weight first, others aren't.  Some of it is surgeon specific some of it is due to a specific set of issues.  For instance, some surgeries require the surgeon working around the liver area.  (not the lapband but most of the others), Overweight people tend to have fatty livers and it makes it harder to work in the area.  Some surgeons will require a minimal weight loss of 15-20 pounds (for the average person this isn't minimal but remember we are talking patients who have 100+ pounds to lose).  Those first few lost pounds have a dramatic affect on the liver area making it easier for the surgeon to do a good job.  So the weight loss isn't about seeing if the person can lose weight and/or keep it off, it's so the surgeon has the best chance of doing the surgery well without any leaks. 

 

Secondly the surgery affects far more than just calorie restriction.  Any WLS surgery that involves the intestine (RNY and duodenal switch), also include a malabsorption portion.  This prevents the body from fully absorbing calories from fat.  Thus a person might eat 1800 calories but the body is only able to absorb 1500 calories (I just randomly picked numbers to explain my point), the extra calories are flushed out of the body unused.  So the person eats fewer calories because of the restriction on the stomach size, then they absorb even less than that so the overall outcome is the person has far fewer calories for the body to use and thus loses weight. 

 

Thirdly, depending on the type of surgery, the hormone levels in the body are altered.  For instance in the duodenal switch the lower portion of the stomach is removed.  This is the part of the body that is responsible for the produce of gherlin (not sure of spelling), this hormone controls appetite/food cravings.  Many patient report a reduced desire for sugary foods and carbs after the DS simply because the body is no longer signaling "feed me" these things. 

 

So there are many more factors at work with WLS surgery than just restriction of food intake.

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We are all different, and these tools will vary in quality for us depending on specific physiology. It isn't a moral failing, it's physiological in our HPA axis. And unfortunately all long term management has a dietary component to some degree or another. Trying to avoid that is where a lot of these post surgical issues seems to come about - addressing the reasons for weight gain, from habitual to hormonal, is crucial for whatever interventions we use to succeed.

 

I'm actually surprised at the board agreement we have on this thread. It seems a lot of us are in a similar boar and have come to similar conclusions. We are cheering for you, whatever you choose, Joanne :)

 

THIS, YES!!

 

I just wanted to add that the last ditch effort approach to surgery is not necessarily great advice either.  My surgeon was positively giddy to have me come in at 28 and 258 lbs vs. 45 and 300 lbs. No, I didn't have major co-morbidities like diabetes but I had PCOS. No, I didn't have arthritis or bad joints but the damage was already there. My hands ache and my knees are stiff now because of the damage I did in my 20s. 

 

I ended up with virtually no recovery time and no sagging because my skin was still elastic (and I had been athletic as a child/teen). I was able to give birth with the help of IVF and I have many, many more good years ahead.  When I went to see the surgeon it was because I knew more 'trying' wasn't going to cut it for me.  Everyone is different.  When you reach YOUR limit, you should act.

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