I can haz weight loss surgery?
April 27, 2009 9:35 PM   Subscribe

Given my lifestyle, should I get gastric bypass surgery?

I know there have been other questions about gastric bypasses, I've read through them, but I was hoping for feedback on my specific scenario.

My entire life I have been overweight. I'm a male, mid 30-ish, married, and a BMI just north of 60. Given my weight we are constantly on watch for me to develop heart problems or diabetes. Not currently on any form of active diet. I work 3 jobs which take a total of 100 or more hours per week of my time (I mention this as it will come up later). One of the jobs is a full time day job. One of the jobs is a part time night job. The third job is a start-up company I am pouring my heart and soul into hoping that one day it can be the only job.

Recently my weight has been bothering me in ways other than aesthetic. I have muscle soreness and joint pain in my legs, my feet are a constant source of distress, and for the first time in my life I find myself unable to do things others can do, like walk fast up a hill. It's making me feel worse than fat, I feel like I'm on the road to being disabled. I also find myself tired a lot, relying more and more on caffeine and sugar to keep me going. I rarely feel very well rested on less than 10 hours sleep, but my lifestyle rarely gives me 10 hours. I usually get 6-8 at most.

I have tried, seriously tried, diets throughout my life and as I am testament to, all of them failed. At best I would lose 8% of my weight and then plateau inexorably. Reduction in caloric intake or type of food intake did not seem to break the plateaus. Here are some of the factors that have led to the ending of these diets:

a) I feel that the key is to also up my exercise, but this is hard for me to do. In addition to plain finding zero enjoyment in the activity, the act of doing it becoming an almost unfathomable chore, there is also the lack of time I have to do it given my work commitments. To work out for one hour even three times a week, which with travel to/from fitness center, clothing changes, etc. will become 2.5 hours per trip, I don't have the time. I barely keep up with everything as it is.

b) My wife (also overweight) does most to all of the cooking and often she is not as gung-ho on the diets as I am. She works full time and takes care of the house, and we are both "sympathetic feeders" and so it is hard to maintain a diet with each of us taking every opportunity to sabotage it, and bringing the other one down with us. I am not putting the blame on her; I could truly take control of the situation and prepare my own every meal, relying on her for nothing, and letting her do what she wants. But again the time thing comes into it. Often if she is not there to fix me food, I work constantly and forget to eat until I am extraordinarily hungry.

c) I enjoy food. I enjoy eating. A savory beverage, alcohol, or chocolate are very enjoyable things to me.

d) Our families do little for social occasions other than eat, and it is difficult to maintain a diet when eating out with family 1-2x per week.

I have seriously looked at the bypass three times since 2004. Two of those three times I did not go through with it, doing the "One last ditch attempt at a diet and, if it fails like the rest, then the surgery". The third time I had a job change, which changed my health insurance, and so I did not follow through, not wanting to have 8 weeks out of work while still proving myself at a new job.

Here is my dilemma. In my research I find that the bypass is not a fix, it's a jumpstart. However after the surgery I would need to eat right and exercise. But it's not like the surgery will remove one of my work obligations...if I had the time to eat right and exercise I'd be doing it now, rather than having surgery. I'd have done it right all along. And I've seen people who had the bypass, lost the weight, and then gained it all back...and I can't imagine being one of those people. It would be so depressing to have been better only to get so much worse...

Plus I am scared. The "dumping" scenario related to the bypasses sound awful, and like I said before, food is an enjoyment. The thought that for the rest of my life if I can't enjoy even in moderation something like a frappuccino sounds saddening. I feel like I should fight to take the weight off non-surgically so I COULD be normal, and not worry about "dumping" while at work, etc.

Moreover, I don't know what the long-term effects of the bypass are.

But right now I'm in an insurance situation where I can have the bypass with virtually no money out of pocket. And perhaps I need the dumping, vomiting, etc. to condition me to avoid those foods, and to simply stop eating. But I feel that if I don't have an exercise regimine then I will go through all this pain and irreversable body modification for nothing.

I have gone to group therapy sessions of people who have undergone weight-loss surgery and every single one of them is an advocate for the surgery. But I'm not sure I trust them...if I did something horrible and regretted it, wouldn't it be hard to admit to people that you've made a life-wrecking mistake? It seems psychologically people would say they made the right choice if only to seem happy and normal. Not one person seemed to regret getting it...and that's why I'm on MeFi. I don't want to hear from people who've had it and loved it...I want to hear either from people who had it and gained the weight back, or people who are close friends/spouses/etc. of someone who's had the bypass. Did it work for them? Was it worth it? Is their life constant vomiting/dumping? And did they keep it off?

(and FYI, I'm looking at the RounY more than the lap band due to (a) the lap band causes less weight loss and (b) I know so many people for whom the band was a total failure, taking away their money, and their happiness).
posted by anonymous to Health & Fitness (34 answers total) 10 users marked this as a favorite
I have had quite a few friends have this surgery. From what I have seen complications are common. One friend almost died from the procedure.

All of them have had to radically change their lifestyles. I don't think anyone regretted the surgery but none of them has the lifestyle you presently have.

One of my friends who has had it exercises quite a lot and told me she is the only one of her friends who has had it who has actually kept off the weight.

I think you really need to take a hard look at your life in total. Your schedule is killing you and the surgery is not going to change that. Making time to find an exercise you can enjoy, building up your muscle mass and your metabolism and being able to have healthy meals is something you would have to do whether or not you have the surgery. From what I observe from the people I know I would consider the surgery a last resort.
posted by St. Alia of the Bunnies at 9:44 PM on April 27, 2009 [3 favorites]

I work 3 jobs which take a total of 100 or more hours per week of my time

if I had the time to eat right and exercise I'd be doing it now, rather than having surgery. I'd have done it right all along.

Wow. This sounds so hellish to me that I can't even contemplate it. Is financial success so important to you that you would kill yourself for it?

Your life is out of balance. You know it. No amount of surgery can fix that.
posted by The Light Fantastic at 9:52 PM on April 27, 2009 [19 favorites]

Reduction in caloric intake or type of food intake did not seem to break the plateaus

if this is truly the case, a gastric bypass will do nothing for you, as all it does is forcibly restrict your caloric intake. rather than going through a drastic, irreversible and potentially fatal body modification procedure, have you thought about trying a really strict diet and exercise regimen, with a scale and log books and so on? one that you maintain come hell or high water, regardless of social outings, what your wife is eating, how hectic your schedule is, etc?

a really fit guy i used to know once gave me some really good advice, when i was bitching about not having enough time to exercise in college: "you have to make the time." in other words, losing weight has to be important enough to you to trump the income that comes from your second job, or whatever else is sucking away the time or effort. otherwise it'll fail. this is why people usually talk about "lifestyle changes" - it might be worth it to re-evaluate your time commitments in light of how you feel about your weight, and make some hard choices about what's important to you.
posted by sergeant sandwich at 9:56 PM on April 27, 2009 [1 favorite]

You have 3 jobs and your wife works full time also? What is the reason for this? Perhaps you can have one of the mods explain for you so that we can understand what your situation is.

You seem to comprehend that surgery alone will not solve your weight problem. And as St. Alia points out, successful results from the surgery depend on diet and exercise, the two things you can't find time for.

The hard decision to make isn't whether to have the surgery, but rather whether to drop one of your jobs to improve your health. If you can, drop the night job and make going to the gym your job. If you can afford it, hire a trainer to get you started on a workout program that fits your goals. They should be able to suggest exercises that you can perform. Not everyone can hop on a bike and burn 200 calories; not everyone can run for 20 minutes around the track.
posted by sbutler at 10:01 PM on April 27, 2009

You're looking for another excuse not to do something about your weight/health. I have no idea if the surgery is the absolute right thing or not for you. But it's a last resort scenario.

Your third job right now should be your health. Not a pipe dream for the future -- your body and happiness and comfort ARE your future. Put the other thing on the side and make it your duty, your job, your obligation, to getting healthier in the way that YOU know how to do.

Everything else is a distraction. Walking fast or up hills is hard? There's your exercise. With an iPod and some great podcasts or a book on tape. Or join a team. Or make a competition with your wife. You don't need 2+ hours a day. Walk fast for 45 minutes before work. Walk for another 20 after dinner. Keep a food diary EVERY single day. Talk to your doctor. Join one of those 2.0 fitness sites like gyminee. I bet after 3 months you'll start to see some changes.

Good luck -- I think you're wanting folks here to shy you away from the surgery for a reason. Because you know that the consequences of that might not be worth not trying other things first. Not just "trying" but DOING.

You can do it!
posted by barnone at 10:03 PM on April 27, 2009 [1 favorite]

My mom had a vertical sleeve gastrectomy* here 18 months ago and lost all her weight with a very committed exercise and eating regimen. I think if you don't have time for exercise, and your wife would not be supportive of your new eating requirements, you would be a poor candidate for the surgery.

*Vertical Sleeve Gastrectomy or VSG: This procedure involves reducing the stomach to the size of a ballpoint pen. There is no bypass of the intestines. It is ideal for patients who have very high medical risk, high weight or BMI, complex surgical histories or those who are fearful of potential complications from an intestinal bypass. Patients typically lose 100 pounds in the first year.
posted by QuakerMel at 10:06 PM on April 27, 2009

All the posts above are correct, but the question I would ask myself is: After spending the last ____ years wanting to lose weight, trying different diets and weight loss plans, and not succeeding, what are the chances that I will actually achieve a different result by relying on the same strategy of willpower, diet, and exercise? There are exceptions, but there are plenty of people who COULD lose weight through willpower, diet, and exercise, but will in practice never do it.

My dad had gastric bypass surgery a few years ago. I think he is an outlier and was pretty lucky because it was a fix rather than a jumpstart. He did not start exercising more or going to counseling or anything else you have mentioned, he just eats reasonable amounts of food now because he feels full sooner.

I am very, very happy he chose to have the surgery. His health is far better now than previously. He had the surgery long enough ago that I didn't really think of things in this way at the time, but really he went from the point where it would be glaringly obvious for his family to worry about him having a heart attack to where he is an essentially healthy adult.
posted by david06 at 10:24 PM on April 27, 2009

I had a gastric bypass 3 months ago. It is a very hard surgery. You will not enjoy eating after the surgery. The program I when through (Kaiser) required a 1 year commitment BEFORE the surgery for behavior modification and nutrition education. I have to be very careful about what I eat and how much, which is why I had the surgery. I get sick and throw up a lot. I am tired most of the time. I feel the surgery was necessary for heath reasons and would do it again. It is not an easy or quick fix. The surgery forces a major life change, so if you are ready for that, then you are ready for the surgery.
posted by fifilaru at 10:40 PM on April 27, 2009

You don't have the time or inclination to maintain the weight loss, surgery or no surgery, as things are now. Period. I think you're going to have to quit a job or two or just accept that you're going to be fat and risking your health, because the surgery is not gonna fix you (and add unpleasant side effects and life risking to boot).
posted by jenfullmoon at 10:43 PM on April 27, 2009

I had a gastric bypass several years ago. It likely saved my life, so I've never regretted it. Also, no real long-term complications, but YMMV.

Having said that:

1. It's real surgery, and real surgery involves real risk. I would not have considered it myself it I did not honestly believe I had exhausted every other option.

2. For the surgery to be effective, you have to commit to several lifestyle changes. Frankly, reading your question, it looks to me like you've already lined up all of your excuses for failure. (Ie, "Exercise is too hard." "I do most of the cooking.") I mean this in the kindest possible way, since I've been there myself.

I believe that the main reason for the success of my surgery was that I had already put the diet and exercise plans in place long before the operation. I had already lost over a hundred pounds before I turned to surgery. The surgery was truly the last resort to get that last 80 or so off after a prolonged plateau.

While group therapy was a good idea, I might suggest getting some personal counseling in this area, to help you discover if your emotionally prepared for this. It really helped me.

3. Your concerns about vomiting, dumping, etc, are legitimate, but I will offer my own experience: in eight years, I've never had a single instance of any of these symptoms.

4. Yes, after the surgery I lost most of my interest in eating. And thank goodness for that! In my old life, I couldn't finish one meal without planning the next one. Afterwards, I discovered that I could eat a small, reasonable meal, and be perfectly content with it without feeling the least bit deprived. For me, freedom from the food addiction alone was enough the justify the surgery.

In the end, it's your decision. If you are actually experiencing major health problems because of your weight, then surgery may be a reasonable option. Best of luck, regardless of what choice you make.
posted by SPrintF at 11:33 PM on April 27, 2009 [6 favorites]

Previously, and my response then:

My father weighed about 450 pounds at his peak, and even at 6'4, this meant he was VERY large. Seatbelt-extender-on-the-plane large.

He literally did try everything, from Jenny Craig to exercise routines, to prescription pills to other options. Nothing worked. So he researched, fastidiously, in his way, and determined that he'd like to go for the Duodenal switch form of weight-loss surgery.

Prior to his surgery, he had very high blood pressure, had just been diagnosed as a type II diabetic, had a chronic potassium deficiency that had led him paralyzed and close to death several times and had severe back pain, amongst a few other issues.

Blue Cross/Blue Shield of Arizona was not covering DS, only RnY. They cited lack of a sufficient body of work showing the efficacy of the surgery and willing surgeons. My father put together an 85-page briefing on the surgery and before it went to arbitration, a BCBS VP for Arizona called to thank him personally and to let him know he'd be the first DS surgery and that they'd begin covering it.

The surgery went very well. He lost over 250 pounds and is now down to 200-205 pounds. It's three+ years later. Initially, there were giant swaths of food he just couldn't touch. Dairy was nightmare, certain meats he had to be very careful about, and after the initial surgery, he could only eat about three tablespoons and he'd be full. This is a DRAMATIC LIFESTYLE SWITCH for anyone who is EVER used to sitting down and eating a meal.

Your force of habit makes you want to continue eating to the point you normally eat to be "full" or "overfull." When you do this after weight-loss surgery, you get very sick and nothing fun comes of this. With DS specifically, and others, I'm sure, you also no longer process fats properly. This means that no one will want to be in a 20-mile radius of the bathroom when you're done using it.

He could naturally write this better than I, but the lifestyle changes are significant. And you still require some semblance of discipline. Surprisingly, my dad now eats almost everything he ate before the surgery, and he eats regular meal quantities. I'm sure his stomach has re-stretched to a normal size, but DS features a malabsorption approach in addition to capacity, which causes a good chunk of your meal to bypass absorption entirely, without the pesky Dumping Syndrome RnY patients sometimes have. So he hasn't regained ANY weight. And I've seen him do some things that I question, but alas, it's been over three years and the malabsorption component does him well.

If you met him on the street, you'd have no clue he used to be 450 pounds. His face is thin, and he has a relatively thin build. 6'4 at about 205 lbs, looks about normal, if not a bit thin. Without his shirt, it's a bit different—you can tell there's extra skin there; he hasn't had any skin reconstructive surgery yet, since that's a bit involved and about the only person who might care would be my mother. Regardless, there's a bunch of excess skin that doesn't just go away.

On the flip side, what was once an annual trip to the emergency room for one epic failing of his body or another is no longer. His diabetes is completely cured, he no longer requires beta-blockers for his blood pressure and his potassium rates are normal. His heart is in good condition and I swear to you, I'm absolutely convinced that the surgery saved his life. (After the sixth or seventh trip to the ER in as many years, you start preparing for the news that he's just going to die. He came so close several of those times, especially with the potassium and blood sugar—his blood sugar was 600 once.)

He's happier, healthier and infinitely more self-confident.

You're a bit on the lighter side; but just a bit. You can probably find a doctor who will perform the surgery, but the insurance question comes up based on your provider and your plan. For my dad, who was paying $1,200 a month for HIS OWN policy with no other family on it, and visiting the ER at $15,000 a pop at least once a year, it was a bargain for BCBS to pay the $25,000 for the surgery and never have him in again.

It's a huge lifestyle change. Look up "bariatric surgery" since that's the technical term and you'll find plenty of support groups, etc. (My dad's surgeon ran a support group as well, which he found very helpful.) Remember that the different types of surgery are dire to varying degrees and also have varying degrees of bounceback. Do your research. Do a LOT of it. Understand what they're doing to your insides and why things are supposed to work the way they are. When you work to understand the core components and the underlying principles, you can make considerably better decisions from a more educated standpoint, instead of just hoping the first and second opinions you hear are right.

My dad had some side effects, but frankly, nothing as dire as "your hair will fall out" or anything. Your mileage may very will vary. But there are definitely things to do and NOT do to help mitigate those issues. If you're suffering from any other comorbidities, and frankly, having an old injury that still hurts you will only hurt less the less weight you have to truck around, the surgery is of significant more concern to you.

Finally, all surgeries carry significant risks with them. I think there's a flat-out 2% chance of dying during the surgery. The risk levels vary wildly based on your weight going into the surgery because of additional complications, naturally. You'll want to find a surgeon you trust and whom you can vet externally; this is very much something that leaves a lot of room for error, as all surgeries do.

This can change your life, but you may be in for a bit of an uphill climb. I think my dad would be the very very first to tell you that it's absolutely, 100% worth it. In fact, he'd go so far as to insist he wouldn't have progressed as far at his corporate job now if he hadn't lost the weight before the opportunity opened up—weight perceptions when you're as large as he was play directly into "how much longer is this guy going to be with us," and frankly, the answer was "probably not very."

I no longer worry that the next time my mom calls me, it'll be because it's finally happened. In fact, I don't worry about it at all. And I used to. All the time. Because he cheated death too many times. The surgery saved his life, which sounds dire, but it's absolutely the case. And it changed it immeasurably for the better.

Skinny folk don't necessarily understand the plight of the overweight. "Put down the fork" isn't enough, even when we so desperately want it to be. (Yes, I'm a bit overweight, but I've put in enough psychological stopgaps to ensure to the best of my ability I don't pass a certain weight.) It's hard and it makes life harder. It's one of the few areas where people don't feel bad being judgmental because, to them, it's OUR choice. Not like race, or sexual orientation. No, we *choose* to be fat. But we don't. God knows we don't.

You owe it to yourself to look into this in a very serious manner. You need to do the research, you need to involve yourself actively, and you need to treat it with the weight this decision has and not just hope and pray that those around you will direct you correctly. You make your own luck in a lot of ways and educating yourself completely on this is doable and needs to be done.

If you're interested more in the DS, or my father's surgeon, MefiMail or Gmail me.

And good luck, whichever path you choose!
posted by disillusioned at 11:52 PM on April 27, 2009 [13 favorites]

My aunt had gastric bypass surgery. She said it was hard at first because they put you on a liquid diet. This lasts for a few months. Not everyone has problems digesting foods after the surgery. She never had any problems keeping food down so while she is nowhere near as big as she was, she has gained back some of the weight she lost the first year, but honestly she looks better. She lost so much weight the first year she looked malnourished. Today she is very active and is glad she can pretty much still eat whatever she wants, but sh knows her limits and does not overindulge. She runs around with her grand kids and is frankly like the Energizer bunny. She was never like that when we were growing up. She says she would have the surgery again because it really did change her life and outlook on life really. She's so much happier than I've ever seen her and her self esteem is through the roof. She had the surgery when she was maybe 52 or 53 and she's 58 or 59 now. She was in the hospital for a good 3 weeks after the surgery (she had no complications) so you'll have to factor that time off of your busy 3 job schedule. She went through Kaiser.

My mom was about 100 lbs overweight at 5 feet tall and she just decided to start cutting her portion sizes in half one day. After about 2 years she's easily half the size she was and feels much better. She uses dessert plates to portion out her meals and always takes half her dish home if she goes out. She never stuffs herself and hardly eats any sweets. She does not drink soda. She has never exercised in her life. So she's an example that it can be done without the surgery, even without exercise, if you have tremendous willpower to eat as little as possible without starving yourself. She's also been doing Weight Watchers for the past 6 months which has taught her about good nutrition and gives her a support outlet.

I know you came up with it being a "2.5 hour trip" to go exercise but all you have to do is step outside your door and start walking and the pounds will melt off. Start slow and only when you think your body can take it then think about going to the gym. Definitely hire a trainer. Walking is plenty good enough to start. Moving is the key to see and feel a difference. Your legs and feet will hurt at first but they will hurt forever if you do nothing. I promise after a month you will be looking forward to taking a walking, you'll be able to breathe better and you'll hurt less.

posted by wherever, whatever at 12:43 AM on April 28, 2009 [1 favorite]

What about duodenal switch? A friend of mine just had the surgery a little less than two weeks ago and so far she's very happy with her recovery. I don't see her in person because we live a few states apart but from following her blog I know she looked into gastric bypass as well and decided firmly against it, mainly because of recovery issues and long-term lifestyle crampery. (Which is not to say she intends to live an unhealthy lifestyle from here out, just that the restrictions that came with the gastric bypass would have been extreme, too extreme for her.)

She's a healthy young woman (just turned 27) with three kids who decided to get the surgery while she was young and healthy before all those "secondary morbidities" started showing their heads. I don't know her BMI or whatever but she mentioned needing to loose 200+ pounds.

One thing to keep in mind was that her doctor demanded she lose about thirty pounds before the surgery even happened--IIRC it was a few months before the scheduled date for the procedure. (I don't now if that was the total amount he needed her to lose or if she was just updating her LiveJournal at a point where she'd lost thirty and that's what stuck in my head.)

Regardless of what path you choose (and maybe surgery isn't your answer), you know you're going to have to alter your lifestyle a lot. I think St. Alia of the Bunnies said it very well in her response: Making time to find an exercise you can enjoy, building up your muscle mass and your metabolism and being able to have healthy meals is something you would have to do whether or not you have the surgery. From what I observe from the people I know I would consider the surgery a last resort.

I'd say: pretend you've already had the surgery: live the reasonable, healthier lifestyle you know you'd have to adjust to post-op. Make some of those adjustments before you commit to a procedure, whether it's gastric bypass or duodenal switch or whatever. I think you have to prove to yourself that you can arrange your life in a way that keeps you healthy and active and sane.
posted by Neofelis at 12:50 AM on April 28, 2009

Spend some time at WLSInfo.org.uk

There has been a huge polarisation in the USA between bands and bypass that is clouding the issue, that hasn't really happened yet in the UK, this is an "expert patient" site (free of all industry adverts and open to all forms of WLS) I think reading through some of the threads, especially the "Stickeys" on banding and bypass will really help you. With a BMI of over 60 and the lifestyle you have you most definitely need some kind of kickstart. All of the surgeries have to be "worked with" with an increase in diet and excercise but what these surgeries help do is make that an easier prospect to fit into your life. Exercising when your feet are so painful is never going to be something you approach eagerly. Over 5 years I've seen thousands of people on WLSinfo really change to a joyful inclusion of exercise simply because when you drop 10-20-30 BMI points YOU CAN.

In the USA 3-4 years ago it was all "60% of bands fail and mini Bypass is the big thing!" I'm told by a few experts that this has changed in the USA very recently and there is a swing back towards banding (although I haven't seen evidence of this myself but they travel to the large bariatric units so I believe them). What you do see a lot off is individual surgeons advertising the technique they are most comfortable with and publishing stats that back up their surgery. Natch!

When you introduce new surgeries, the techniques, technologies and critically the aftercare knowledge improves all the time. What may not have worked for your bandster friends in the past may work for you now.

To be frank, and I'm involved in this professionally and personally, what I have observed is that bands fail when there is poor aftercare and support and when patients who are real "foodies" or are emotionally dependant on food find the fact that they can eat one small side plate max a big head issue, so they find ways of subverting their band (or worse they keep eating and become effectively bulemic). I have formed the impression over five years that patients are filled in too large increments and that smaller (and if necessary more frequent) "tweaks" in band fills would have really helped. This is my personal opinion only. Profesisonally I'm involved in writing the national policy guidance on bariatrics.

The longer term effects of the malabsorptive surgeries are quite simply unknown. Selecting the right type of the three surgeries for you requires a bariatric service that actually features them all, as a real factor in success is proper patient selection. If you were in the UK I would know exactly where to refer you.

What I can tell you is you will have issues with your wife and your family if you choose one of these surgeries. You will lose weight and this will make them uncomfortable. You'd have to deal with that bridge when you come to it but get involved as early as possible with a support group.
Feel free to Memail me for more advice.
posted by Wilder at 1:51 AM on April 28, 2009

From my involvement on the forums at Weight Watchers, I've heard success stories and horror stories, just like with any major surgery. The success stories seem to agree that significant lifestyle changes are critical to achieving weight loss goals and maintaining a healthy weight. The website I see recommended most for those inquiring about weight loss surgeries is obesityhelp.com. As I understand it, the site is fairly straightforward about the pros and cons of surgery.

Best of luck to you.
posted by contrariwise at 3:26 AM on April 28, 2009

I am very sorry you face this situation. Although I have no direct experience with bariatric surgery, I can describe how your post reads to a neutral third party.

It seems as if you are seeking an excuse or a solution that would allow you to maintain your present lifestyle.

As everyone has said, you will have to change your lifestyle in a major way to lose weight, or to even become a candidate for some kinds of bariatric surgery.

At the same time, from your post you sound like you have a really valuable asset-- the ability to analyze pros and cons. You can put your problem-solving talents to use with this problem too. Prioritize what matters most to you: exercise or work; limiting food or adding exercise; eating the same or different foods with your wife; acquiring wealth NOW or learning to maintain healthful living, and so on. Do that and you may able to see where to begin--surgery, food intake reduction, or gentle exercise. Obviously your physician should be part of that decision-making process.

One thing I shared with you was a dislike of exercise. At the end of week 2, I began to actually feel better after a workout. After that I began to look forward to the gym. If I missed a session I felt gross. (I also started a regimen during basketball playoffs so I could watch games on the machines.) It may take you longer to get to that point. But once you do, it's the best feeling in the world.
posted by vincele at 3:49 AM on April 28, 2009 [1 favorite]

Ugh. Sorry about the link in my response.

I'd also like to add that my experience has been that managing food intake is responsible for the greater part of weight loss. Exercise is certainly important, but don't allow yourself to believe that you can't lose weight unless you go to the gym for an hour several times a week, with all of the travel time and associated trappings involved. If you manage the food portion, you can definitely begin to lose by just taking a half hour walk around your neighborhood a few nights a week. For me, the key to exercise was easing into it. Excessively high expectations were always the basis of my excuse not to follow through.
posted by contrariwise at 4:59 AM on April 28, 2009

I had gastric bypass surgery almost 12 years ago and I consider it THE best thing I've done for myself in my life. While I still struggle with food intake, the surgery gave me a TOOL to help and it's done its job well. I can't eat a whole lot at one time (although I can and sometimes do graze more than I should) and that alone has helped me significantly.

It is NOT a magic cure all and the issues that I had before surgery were still ones I had to grapple with after but it certainly helped me learn to manage portions and food choices.

Please email me if you want to talk more. I was very active in that community when this surgery was not well known and have talked with a lot of people in addition to working with my surgeon's support group for many years.

As the saying goes: "I didn't say it would be easy. I said it would be worth it." And it was.
posted by Mysticalchick at 6:00 AM on April 28, 2009

I had RNY gastric bypass surgery on January 12th, 2009. So far I've lost 60lbs with about 50 left to go. I've had no complications, no dumping, have never vomited, and I do not regret my decision whatsoever. Five people in my immediate family have had it as well, none of them have had complications either - but two have gained about half of their lost weight back.

WLS is a tool to help you lose weight. It is not a magic fix, and it is NOT the easy way out. It is hard work. Food becomes a chore during the losing phase. If it's your only enjoyment and social activity then you need to find a replacement and set it in place before you have surgery. You cannot go back to your old habits.

You won't dump if you don't eat sugar. Simple as that. You won't throw up if you chew your food, eat slowly, and don't overeat.

And you can't have booze for about a year. And then afterwards you'll be a cheap date - it hits you really fast post-op (but strangely, you sober up really fast too).

WLS sounds like it could change your life, but you really need to be ready to make a lifetime commitment to it. I cannot recommend you pursue this surgery without therapy. You need to work out your issues with food first, otherwise you will have a miserable time and you will fail.
posted by elsietheeel at 6:03 AM on April 28, 2009

Also you say you rarely feel rested on 10 hours of sleep? You might have sleep apnea. I suggest getting a sleep study done ASAP. Sleep apnea puts a huge strain on your body and studies have shown that it makes it difficult to lose weight. Which makes the apnea worse. Which makes it difficult to lose weight. Obesity and sleep apena is a miserable cycle - and both can kill you.
posted by elsietheeel at 6:05 AM on April 28, 2009 [4 favorites]

My only experience with the surgery is knowing two people who had it and are doing well, one person who put the weight back on quickly. I know working too hard and stress, though, and I know being a big dork of a foodie.

So, I'm sorry, but I can't imagine how the surgery would be a good solution for you at this point.

You are unable/unwilling to make time for exercise, you have previously not had much success sticking to diets, you work incredibly demanding hours and put yourself under a lot of stress, you don't feel that you get enough rest, and you sincerely enjoy food.

You're proposing major surgery that requires you to make a lifetime commitment to all the things that you haven't been able to do so far, and takes away what, from your post, may be the only indulgence you allow yourself.

Please consider rethinking what you're doing to your body and mind by working like this before you consider surgery.
posted by desuetude at 6:39 AM on April 28, 2009 [1 favorite]

.if I did something horrible and regretted it, wouldn't it be hard to admit to people that you've made a life-wrecking mistake?

I'm sure that many people already believe that you have already made a life-wrecking mistake, by becoming this overweight. Just as that's really none of their business, neither is your decision to have the surgery.
posted by hermitosis at 6:56 AM on April 28, 2009

The "dumping" scenario related to the bypasses sound awful, and like I said before, food is an enjoyment. The thought that for the rest of my life if I can't enjoy even in moderation something like a frappuccino sounds saddening.

If you try to eat post-surgically the way you eat now, you are almost certainly going to make yourself horribly, horribly ill. If you don't change your eating style dramatically, you are almost certainly going to have constant dumping and may even wind up in the hospital with electrolyte imbalance. The folks here who don't have dumping are either consistent about eating for their reshaped digestive system or extraordinarily lucky.

Have you had thorough workups by endocrinologists? Someone at your extremely high weight who can't lose more than 8% of body weight through conventional approaches sounds like someone who has some seriously impaired regulatory function--are your thyroid, adrenal glands, etc., functioning properly.

Best of luck whatever you decide to do. This is major surgery, so you'll need to take several weeks off from work if you decide to do it.
posted by Sidhedevil at 9:31 AM on April 28, 2009

The "dumping" scenario related to the bypasses sound awful, and like I said before, food is an enjoyment. The thought that for the rest of my life if I can't enjoy even in moderation something like a frappuccino sounds saddening.

If you try to eat post-surgically the way you eat now, you are almost certainly going to make yourself horribly, horribly ill. If you don't change your eating style dramatically, you are almost certainly going to have constant dumping and may even wind up in the hospital with electrolyte imbalance. The folks here who don't have dumping are either consistent about eating for their reshaped digestive system or extraordinarily lucky.

I knew exactly what I was in for when I had surgery. I don't eat sugar. I don't eat fried foods. I eat less than 40 grams of carbs a day, and the carbs I do eat are complex. That's why I don't dump.

As for the OP, would you rather have a frappucino, or would you rather be fat and in pain? You don't sound like you want to give up all the things that made you fat. Why?
posted by elsietheeel at 10:01 AM on April 28, 2009

1) Healthy people don't "go on a diet." The FIX their diet, so that it is a healthy one. When you "go on a diet," you guarantee failure.

2) 85% of weight loss is your diet, not your exercise level. That said, there's no reason you can't work out. Do it at home -- for free -- using body weight exercises. Or go for a morning run. Or do some after-dinner heavybag punching. No one is all that thrilled about working out, but they make themselves do it because the benefits are worth it to them.

3) I have no problem with people having this surgery as a last resort to achieving healthfulness, but for you, it's first resort. Based on your question and accompanying information, you've made no effort to educate yourself about how to eat right, how to exercise, or how to be a healthy person in general. All of the excuses you have for being unhealthy apply to millions of other people who care enough about their health and their loved ones to live a healthy lifestyle.

Begin with therapy.
posted by coolguymichael at 1:12 PM on April 28, 2009

I have gone to group therapy sessions of people who have undergone weight-loss surgery and every single one of them is an advocate for the surgery. But I'm not sure I trust them...if I did something horrible and regretted it, wouldn't it be hard to admit to people that you've made a life-wrecking mistake? It seems psychologically people would say they made the right choice if only to seem happy and normal. Not one person seemed to regret getting it...and that's why I'm on MeFi.

eh. I would say the opposite, really. If you look at reviews of various prescription drugs, what do you hear about, usually? The side effects. Particularly in the case of psychiatric drugs, the bad side effects. People are more likely to complain about something than make an effort to make their feelings known when something is great.

Should you get the surgery? No, you should not, if I were to base it upon this post. You should maybe get some therapy to deal with your food & avoidance issues, first. Your weight may clear up on its own after that.
posted by kellyblah at 3:47 PM on April 28, 2009

Eat less meat, more green vegetables. Avoid all french fries and ice cream. Eat chocolate sparingly. Take a 20 minute stroll when you wake up every morning or before you go to bed every night. Not 2-4 times a week. Every single day. Walk incredibly slowly at first if that's what it takes to minimize those muscle aches and foot pains. Do this for 2 weeks. After 2 weeks you'll probably be able to increase to 25 or 30 minutes walks and possibly increase your speed a little.

Remember, you're not trying to set land speed records here, just start moving. Continue walking at this rate until you feel comfortable either increasing your duration or intensity. Over a 3-4 month period, you should be able to walk 45 min to an hour every day. You don't need to change clothes or go to a gym. Walking is free and the best thing us fat folk can do at the beginning. Yes, I am BMI challenged. And I'm still working on it, but I have lost 25lbs using this method in the last 2 months. I know it can be done without surgery.

When you talk about your wife not supporting the healthy eating and your family's only social outlet being food, I think that your biggest battle is not going to be your own motivation and will power, although that will admittedly be tough, but rather standing up for yourself against these temptations that are always there. When you try to better yourself others will try to shoot you down. Don't let them.
posted by aperture_priority at 5:07 PM on April 28, 2009

Addendum -- I know two people who had the bypass and two who had the lap band. They all experienced difficulty with the transition and got sick when eating due to change in portions and the way they processed fats and sugars, etc. I've seen the dumping syndrome triggered on several occasions and it is not something I'd want to ever have to go through myself. To me the surgical approach is a hardware solution to a software problem. Good luck with this no matter which method you use.
posted by aperture_priority at 5:39 PM on April 28, 2009

sergeant sandwich, I'd like to respond to this comment: if this is truly the case, a gastric bypass will do nothing for you, as all it does is forcibly restrict your caloric intake.

That's not true. There are substantial metabolic changes that happen due to these surgeries. For one, they cure diabetes in the vast majority of cases. They also seem to adjust the patient's metabolic set point, so that they equalize at a new, lower weight. the mechanisms for these are unknown.

Also, coolguymichael: 85% of weight loss is your diet, not your exercise level.

This isn't true either, at least for 100% of people. For many people, the equation is fairly simple, if calories in <>
If you read the scientific literature studying diets, the evidence that they work for most people is really slim. Weight Watchers is the most successful of the bunch, probably because it makes a lot of sense and the support they give can be really helpful. However, on average, their members don't lose that much weight.

From a somewhat recent study:
An analysis of data collected at the end of the two-year study found that Weight Watchers participants maintained a mean weight loss of 6 pounds whereas self-help participants had on average returned to their starting weight. Further, Weight Watchers participants who reported attending 78% or more group meetings during the last 1-1/2 years of the study achieved better results with a median weight loss of 10 pounds. Research has confirmed that obesity-related health conditions are significantly improved with a modest weight loss.

That doesn't mean that it's bad though. They do a good job of teaching people how to eat right.

You can read more of the study results that WW highlights on their site.

A friend of mine had the RnY surgery. She's had good success. However, it's not been an easy process. She barfs sometimes after eating. But it's not as gross as regular puking b/c there's no bile. It's more like ejecting food. Oftentimes she can't stand the thought of eating. She eats mostly protein and has many small meals a day. She gets tipsy a lot easier. The surgery took longer to recover from than she had been told / anticipated, even though it's laproscopic. Even w/ the problems that she's had, she says that it was the best decision she's ever made.

Dumping is not a foregone conclusion. My friend gets really tired, but the usual sweating things doesn't happen to her.

It's a lifetime commitment. You will have to change your lifestyle. Most likely you will not be able to eat the same kinds of foods that you currently enjoy, much less in the same quantities.

Some things to keep in mind when choosing your doctor:
- ask for stats on the outcomes of their patents
- they should make you go through a process to lose x% of your weight prior to the surgery
- they should have an aftercare program
- they should have you work with a nutritionist
- they should be able to help you decide on which type of surgery is right for you, not just based on what they do most
- get more than one opinion
- see people who have a high volume of these surgeries ( I hear that people go to Mexico or India!)

Also, don't drink your calories. No soda or juice, not even diet. There's some research that high consumption of artificial sweeteners screws up your metabolism somehow. People that either don't lose weight with the surgery or regain usually start with soda. They also eat a lot of surgery foods.

Eat enough protein.

Eat vegetables.

I'd reinforce that unless your wife gets on the health kick also, it will drive a wedge between you. I've seen it happen.

BTW, does anyone know why Opera dislikes weight loss surgery so much? She raves on and on about fad diets, but usually when she mentions surgery on her show it's in a negative light.

Sound like either way you have to change something about your life. Good luck!
posted by reddot at 6:48 PM on April 28, 2009

Is there a reason you can't quit the second, part-time job?
posted by showbiz_liz at 11:13 PM on April 28, 2009

there's some really good advice here but I would just like to say about exercise:-

"Or go for a morning run. Or do some after-dinner heavybag punching. No one is all that thrilled about working out, but they make themselves do it because the benefits are worth it to them."

....which is a very common piece of advice that people with a very minor weight problem or none often offer the super moridly obese.

Poster, please, with a BMI of 60+ DO NOT run around the block, even once, without getting a full work-up by your physician. And to those advocating it, it's BMI 60+ people, not the extra few pounds you put on over thanksgiving and Christmas, so please, put a 20 stone individual on your back and run around the block a few times.

Luckily because you probably enjoy good cardiovascular health you won't die, if you could even remotely complete a block. I will guarantee you will never do it again.
posted by Wilder at 2:27 AM on April 29, 2009

I had gastric bypass 8 years ago at 260 pounds and lost half my weight and have maintained the weight loss. There are so many good suggestions from those that have been there. I also have only dumped one time. In my 8 years of doing volunteer work online in a large weight loss surgery community it seems the men in particular are more worried about not being able to eat like they did before. One thing I've said is that being full is relative. Full is full. If it takes less time to get full, eat slower (which you should anyway).

Another great point was made:
4. Yes, after the surgery I lost most of my interest in eating. And thank goodness for that! In my old life, I couldn't finish one meal without planning the next one. Afterwards, I discovered that I could eat a small, reasonable meal, and be perfectly content with it without feeling the least bit deprived. For me, freedom from the food addiction alone was enough the justify the surgery.

I know for me that I am a food addict and because of that I used food to fill a hole in my heart, to numb feelings and I was extremely lucky to be able to work on the whole anxiety=stress=need for coping mechanism=trigger for eating food. The other MEGA concern for me is that your wife is over weight and what that involves. It is complicated and I have a great deal of information on my blog at Bariatric Girl.com.

After years of losing it the old fashioned way and gaining it back plus more every single time, my metabolism was shot. All I needed was this tool to return me to a normal size so I could manage my lifestyle and enjoy exercise. I could not run at 260 pounds. Yoga is an awesome way to exercise and deal with stress. I'm happy to help if I can answer any questions.
posted by Bariatric Girl at 7:16 AM on April 29, 2009

Here are my thoughts. I've never had to lose a dramatic amount of weight, so they may or may not be pertinent. But I am a fitness geek, and here are my thoughts-hope they help. I want to address three things: 1. your schedule 2. "working for health" and 3. the nuts and bolts of being healthy.

1. I think your current work life is a HUGE impediment to your health. You're not leaving yourself any time to work on your health. Let me crunch some numbers for you:

168 hours in a week-100 hours spent working weekly=68 hours left in your week.
7 hours of sleep per night X 7 nights per week=49 hours.
68 non-working hours in a week-49 sleeping hours every week=19 non-working or sleeping hours in your week. That's crazy! You have less than 3 hours a day to complete ALL of your non work responsibilities, spend time with your wife/family, and pursue a hobby or recreation. Also, when you figure in the incidental stuff like going to the bathroom, showering, brushing your teeth and stuff like that, you probably have 2 hours a day, at most.

Here are my philosophical questions for you: What is the use of having money when you literally don't have time to spend it on things you enjoy? What is the use of money if your health is shot? I strongly suggest the book Your Money or Your Life to put into perspective what exactly work and money are.

2. I think some people have a funny misconception that being healthy should be this effortless thing that involves lots of skinny people in leotards cavorting around with big smiles showing lots of shiny white teeth. Not true. Health involves effort. You have to eat well, and exercise. The people who have mastered health (in my view) are the ones who eat healthy, delicious food, and enjoy their exercise. But learning about nutrition and learning to cook is work. Learning some sport or activity can be frustrating, and people are bound to try things they don't like along the way=work.

The idea of effortless health is a terrible impediment to health in this country. This interview with Jack LaLanne is one of my favorites, and it talks about how hard it is to be really committed to being healthy, but it also shows the benefits-Jack is in his mid 80's, and is healthier, happier, and more physically capable than most people half his age. I'm honestly not exaggerating at all when I say that.

You need to decide if being healthy is worth working for it. If it, I believe you can be healthy. If being healthy is worth working for it, you won't be healthy-weight loss surgery or not.

If you are willing to work to be healthy, here are my recommendations.

1. You have got to quit one of your jobs. I just can't think of any way for someone to live healthily with as few free hours as you have. Is there any way for you to quit your night job?

2. Consider a vegetarian or vegan diet. There are a lot of health related reasons for this. The China Study does a great job of explaining them and talking about transitioning to a veggie diet. I am currently trying the vegan thing. I'm also trying hard to learn how to cook, and it's great-I'm able to eat really healthy food that tastes great-I'm not sacrificing taste for nutrition.

3. You need to ease into exercise. Start with just five minutes a day, and make it something really easy, like walking. Even with your current schedule, you should be able to find 5 minutes a day to walk around the block. Stick with that for a week-5 minutes of walking outside, every day. Next week, make it 10. The week after that, 15. The point is to start small, be consistent, and then make small, incremental progress when you are ready. Make this a habit!

4. Once you've lost some weight, and made exercise a habit, you need to find a physical activity that you enjoy. I'm thinking 3-6 months (or more) down the road here. But at some point, you'll make exercising much easier if you can find something you enjoy doing.

I'd wish you luck, but getting fit doesn't really have anything to do with luck. It has to do with wanting to be fit, setting realistic goals along the way, and working your ass off to stick with your program and achieve those goals.

PM me if you have any questions.
posted by HighTechUnderpants at 1:57 PM on April 30, 2009

Hey. It sounds like you're having a rough time. I'm sorry to hear about all that.

That said, gastric surgery of any kind is no joke, not least of all weight loss surgery. If you don't have the time or energy or resources to attempt to do something non-surgical about your health now, I'm wondering how you will have the time and energy and resources to both care for yourself post-op (which can be a really rough recovery) and pour your heart and soul into your business like you want.

I'm not going to tell you what to do, because it's obviously your choice. But I should say that I'm very, very wary of gastric bypass surgeries.

My suggestion would be that, if you feel like your eating is out of hand and you could use some resources to help with exercise, you should see a dietitian. A "diet" is not going to work -- you know that. They never have worked for you in the past, and it's unlikely they will work in the future. The only thing which might put you in better physical shape (whether or not it results in permanent weight loss) is to eat well and get the exercise your body needs.

I know it's hard, given all your other commitments. But if you're not able to move around in a few years, those commitments go out the window anyway. You want to stick around, and you want to be mobile -- so, I'm sorry, but making some changes to improve your health and mobility is gonna have to be your first priority for a while. Or you can kiss your current priorities goodbye.

Okay. So, I would suggest looking here for a dietitian who can teach you something called "intuitive eating" or "treating the dieting casualty" (most dietitians trained in this approach will have their area of expertise in eating disorders. Someone of your size, if you truly are overeating relative to your body's needs (rather than just having an abnormally high set-point, say) will lose weight when they normalize their eating. It is not a diet -- I cannot stress that enough. It is truly a skill you will learn, and pass on to your kids, and practise for life.

But that's only if you're interested, of course. Read the articles here to get an idea of the approach I'm recommending. It may sound counter-intuitive, but a close friend of mine lost a significant amount of weight doing this, because she'd previously been binge-eating. I've done it myself also, though my weight only stabilized and did not decrease (I'm smaller than you, however.)

The only person I kind of know who's had WLS has had some good, some bad things as a result. You can read all of her entries on it here. Whatever you decide, very best of luck to you.
posted by peggynature at 5:25 PM on May 1, 2009 [1 favorite]

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