Some questions about Weight Loss Surgery
November 23, 2022 4:49 AM   Subscribe

Considering weight loss surgery. I have some questions. Trigger warning for weight loss talk.

I am 5'5, 300 lb, high blood pressure but otherwise healthy, 40.

My mom has had a horrible year dealing with various illnesses, all of which arise from being overweight. I've been managing her care. This whole thing... It's scared the crap out of me.

A nurse at my GP surgery suggested I look into weight loss surgery, as I am young and healthy and would recover faster, and it would be good for my health. I'd honestly never considered this before. But with my mom's situation, it suddenly felt like something I should look into.

I am not going to jump into anything fast. That's like the opposite of how I roll. But the idea of lowering my risk of getting diabetes and kidney disease and heart disease etc... That appeals. I have A LOT of research to do. But I thought I would reach out to the hivemind with some of my more burning questions:

1) Is it true that most people can't digest various foods after WLS?
2) The Nhs says you might have to be on supplements for the rest of your life to make sure you don't get malnutrition - if you or a loved one had WLS, does this reflect your experiences?
3) A ridiculous question, this one, but... how badly could WLS affect my social life? I love going out with friends and trying new restaurants, it's one of the big pleasures of my life, although I'm more excited about variety and flavours than stuffing myself till I'm full. I'm ok with eating smaller portion sizes as long as I don't have to cut certain foods out completely.
4) Loose skin. Is this a thing that happens a lot? Does it require more surgery?!
5) Are most people really healthier after WLS?

A little about me and my... emotional context if that makes sense: I am just fat because... I am. I always have been. As a child I had a very difficult time around my weight, and people (incl family) being horrible to me about it. I used to have a binge eating disorder, which occasionally rears its head from time to time when I'm under stress, but I'm SO MUCH happier when I'm not thinking about my weight and just getting on with my life. I think I could cope with being forced to eat smaller amounts as long as I could eventually get to a point where I could eat anything I wanted. 'Type of food' restriction (and 'time of food' restriction, e.g. in intermittent fasting) is a big trigger for me and never goes well for me. I have been the same weight for at least 2 years.

I'm honestly not interested in losing weight to be 'attractive' although it would be less stressful to navigate the world without the various issues that being fat presents me with (not fitting in seats, not being able to ride rollercoasters, not being able to kneel, difficulty finding cute clothes that fit, not being able to hold babies on my lap because my stomach gets in the way). I like and enjoy my body, imperfect though it is, and I have a small and irrational fear of losing myself if I lost a ton of weight. The only reason I'm thinking about WLS at all is that I'm scared of getting sick.
posted by unicorn chaser to Health & Fitness (21 answers total) 5 users marked this as a favorite
 
I am a dietitian who previously worked with weight loss surgery patients, though I no longer do. Will answer what I can:

1) Is it true that most people can't digest various foods after WLS?
This is not my experience. Most people I've encountered after their surgery can eat all the types of foods they used to eat, just in smaller quantities. But it's a major surgery, and results may vary. The major exception I will note is that dumping syndrome is a not-uncommon complication, and people who deal with that generally have to avoid meals/snacks that are heavy on refined grains/sugars.

2) The Nhs says you might have to be on supplements for the rest of your life to make sure you don't get malnutrition - if you or a loved one had WLS, does this reflect your experiences?
YES YES YES YES. Depending on the type of surgery, a patient may be both restricted in the volume they can eat AND have malabsorption meaning their bodies cannot use the full extent of the calories AND the vitamins/minerals they consume. VITAMINS FOR LIFE. NON-NEGOTIABLE.

3) A ridiculous question, this one, but... how badly could WLS affect my social life?
This is NOT a ridiculous question. The rapid weight loss from surgery absolutely can have fallout in social life. This really depends on your ability to know your limits in an environment that doesn't really promote limits, and on how supportive your social circle is. If you think that you're able to go to a restaurant and try a bite of everything, and your friends and family will not push you to exceed your limits, it doesn't really have to affect your social life. Unless your social life is very alcohol dependent - the booze will hit you hard, and you'll really need to limit that.
posted by obfuscation at 5:43 AM on November 23, 2022 [8 favorites]


A couple of years ago I was referred to an obesity specialist and learned a lot about how the body works, about options for people in your approximate weight range. And we decided to put me on semaglutide therapy to start off with and see how far that gets me. The thinking was that it is a much less drastic measure and that my insurance would probably require we try such an intervention for a few months before approving WLS. And it has done a lot of good things for me. I am by no means slim but even losing 60 pounds has put me

- back in a normal blood pressure range
- has allowed me to move much more easily
- has reduced my snoring significantly
- has reduced my back pain
- has allowed me to go back to shopping in mainstream clothes size ranges
etc.

So I would encourage you to explore the various support available to you to reduce your weight. WLS is one option but other help is available that may be less drastic if you want to try that first. Even fairly modest measures can make a big difference to your well-being.
posted by koahiatamadl at 5:49 AM on November 23, 2022 [14 favorites]


All your questions assume a 100% successful surgery without complications. I would caution you to read all you can about this very major surgery, how often there are complications, how many people gain the weight back and how quickly, etc. If you are willing to take this very drastic step, then would you consider taking eight weeks or so to try, as koahiatamadl says, a less drastic approach. Not with a "diet", but a serious attempt at a low-fat, mostly plants new lifestyle under the care of a dietician? You are young and I hope you have a long life ahead of you. Just be sure you are aware of all the potential outcomes of this very major decision.
posted by Glinn at 6:43 AM on November 23, 2022 [6 favorites]


I know at least 5 people who have had WLS who ended up becoming addicted to various things (drugs, gambling, sex). And more than a few who have regained the weight and have developed other issues from the malabsorption. I honestly don't know of anyone who is healthier, they've just traded one set of risks to another.

I'm about the same weight / height as you. Have always been bigger than other kids, bigger than teens etc. I can binge but its not an issue. I've never particularly dieted, and for the most part accept my body for what it is. I struggle with IBS and that definitely effects my acceptance. I can still wear my wedding dress, 20 years on, so my weight is fairly stable. I've lost 40-50 lbs because of illness, but once that illness was resolved, I regained.

Anyways, I did consider WLS surgery, but decided to just move more. I'm more flexible, have more stamina etc. Moving more for me- 10,000 steps a day minimum. I often hit higher.

I am diabetic, and have been since 2010. The healthcare has really changed over the years. In the early years, it was blamed on me. With a lot of "lose weight you fat ass" messages.
Now, I get a lot more "this isn't your fault" from healthcare workers. Its been an interesting shift. And its a lot to do with research. The only doctor who is still at me is a respirologist but even she's calmed down over the years.
posted by Ftsqg at 6:44 AM on November 23, 2022 [2 favorites]


I have a relative who had WLS who gained much but not all of the weight back.

I also know someone for whom what had been a normal though regular amount of alcohol before the surgery (glass of wine most days, sometimes goes out to a restaurant or bar and has several drinks) pushed them into very dangerous organ-failure territory. It is far more dangerous to drink alcohol after WLS than popularly understood and even many respectable medical sources don't explain that you can literally die from drinking a normal amount that would not raise any red flags for someone without the surgery.

Obviously you're going to hear the bad stories more and you might also want to see if there are some good forums for people with the surgery (on reddit of all places) that might give you a wider range of experiences, but my sense is that doctors are so anxious to get people to lose weight that they minimize (or even themselves ignore/deny and don't read the literature) the risks of surgery and the commonness of complications. I was 5' 4", 175, a size 14 and very active when I was younger (heavier now) and I actually had a doctor tell me that WLS was an option for me, and ever since then I've been very skeptical.
posted by Frowner at 7:10 AM on November 23, 2022 [6 favorites]


Another vote for looking into semaglutide/ozempic. You wont get it on the NHS and its getting harder to get from private pharmacies. I'm on it through Juniper. My results have not been as drastic as some people's but loss is loss and I have PCOS so I'm used to having to fight so hard for every lb of loss. On ozempic, its not been the case. I've lost 25lbs in 18 weeks which doesn't sound a lot but its been fairly effortless. I'm sure I could lose more if I was in a position to try harder (life circumstances have been getting in the way as they tend to do but I'm still losing rather than stalling or gaining). For me, its like chemical WLS

Its a once a week injection so if it doesn't agree with you, none of it is permanent, I also find the effects tail off towards the end of the week and you can delay your dose by up to 5 days, so if I have a special occasion coming up, I can time my doses around it.

Its also been shown to reduce your risk of cardio vascular disease and it was developed as a diabetes medication so its already got that going for it.

I get mine through a company called Juniper, they're not the cheapest but charge the same price no matter what dose you're on, so I'm now on 2 pens a week and I'm paying the same as when I was on 1. There are plenty of places doing it now, if they have the stock but steer clear of anywhere that skips the ramp-up/titration phase because my friend did that and it was awful, the side effects were almost unbearable.
posted by missmagenta at 7:17 AM on November 23, 2022 [3 favorites]


I can't speak to WLS or semaglutide therapy personally however I did read this article recently about semaglutide/ozempic that was eye opening. The article talks about an ozempic weight loss support group you might want to explore as you consider your options.
posted by socrateaser at 8:15 AM on November 23, 2022 [1 favorite]


From what I understand, in order to maintain results, WLS recipients still have to make those lifestyle changes that lead to weight loss on their own, anyway. My thinking is, why not just make those changes, and avoid the risks of the surgery or later complications? As people are saying, if the habits and emotional side of things aren’t addressed, they’re likely to cause issues later anyway. So may as well focus on the habits and emotions alone.

A mechanical approach that effectively does something similar - limit the amount of space available for food in the system - is, believe it or not, using fibre supplement drinks - psyllium husk, eg Metamucil: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5114742/
Using more than is recommended can cause blockages so if you try it, stick to recommendations for sure.

Also if you do change your diet, please start and stick with a conservative deficit. Lots of apps - and even doctors and dietitians!! - want people to go with 1200 calories, which in my long observation of people losing weight, sets people up for failure (starving, then bingeing and feeling crappy about it), and, that’s hard to maintain… A conservative deficit - eating a *little* less than you do now, and burning a *little* more - is WAY more endurable and sustainable and less likely to set you up for guilt and bingeing. So what you might do is log what you’re eating currently for a couple weeks, then just cut 300-400 calories from that, and add a daily walk after dinner. Motivated people might balk at that approach - they often want to lose as fast as possible - but truly it is imo the safest and most sustainable way to do it.

Good luck, you can absolutely do this.
posted by cotton dress sock at 8:46 AM on November 23, 2022 [5 favorites]


(To add, and help set expectations: doing it the way I described is SLOW. You would lose maybe a couple pounds a month. So would have to let go of expectations of quick loss or how things look on the scale if that’s a motivator. Over time though the results will happen, just have to stick with it.)
posted by cotton dress sock at 9:17 AM on November 23, 2022 [2 favorites]


2) The Nhs says you might have to be on supplements for the rest of your life to make sure you don't get malnutrition - if you or a loved one had WLS, does this reflect your experiences?
YES YES YES YES. Depending on the type of surgery, a patient may be both restricted in the volume they can eat AND have malabsorption meaning their bodies cannot use the full extent of the calories AND the vitamins/minerals they consume. VITAMINS FOR LIFE. NON-NEGOTIABLE.


As a person whose BMI has always been at the bottom end of the standard range, I am here to tell you that malnutrition is a health risk that is not fully and easily mitigated by just taking a multivitamin.
posted by aniola at 9:26 AM on November 23, 2022 [4 favorites]


My fat person stats: I’m around your size, always been clinically obese, health wise have been fine except slightly high blood pressure, but worried about other diseases as I see my parents aging. I eat a balanced diet and am active but still have gained 5-10 pounds a year every year in adulthood. I recently found out I may have PCOS, which could be causing insulin resistance although currently my actual blood sugars are fine. I also struggle with any sort of calorie counting or other restriction—triggers obsessive thoughts of food and cycles of starve/binge. IF was a complete disaster for me.

I know a handful of people—4 or 5–who have had WLS. They’ve all had complications, mostly severe GERD. All of them were size 14 or above again when I met them, 2 have had their WLS totally fail and had a second procedure. For me, knowing them completely took WLS off the table as an option. I just won’t do it.

I’ve been on an oral form of semaglutide for 2 months and it has been great. If you do want some kind of medically assisted weight loss I would join the others in this thread in suggesting it. It does slow digestion so lessens hunger, but I can still eat normal things and enjoy them. So far, I haven’t had binging episodes on it—I don’t really even feel the impulse to continue eating more than a serving of anything out of a full box. I experience it as just a sort of quietness in a part of my mind that I didn’t even realize was always thinking about food.
posted by assenav at 9:29 AM on November 23, 2022 [3 favorites]


I have a sample size of one, so take it with a grain of salt. A high school buddy of mine who has always struggled with weight fluctuations had a very successful WLS, getting 3/4 of the way to her goal before the positive effects stopped. Eventually she had a second much more involved procedure, which led to her worrying that she would be wearing diapers for the rest of her life. Thankfully that did not happen, but it was a very real concern as during her recovery from the second surgery she became incontinent.
I used to have fantasies about WLS finally "solving" my lifelong weight issues but after that, no more.
posted by 41swans at 9:42 AM on November 23, 2022 [2 favorites]


I am a bariatric success story. I was 440 at 5'5". I got down to 165 and put on about 15 pandemic pounds, 5 of which I've lost.

My first surgery was the sleeve. They essentially remove most of your stomach. I had a somewhat bad reaction to anesthesia, which caused 5 days of delirum. Never had that before and haven't had it since. You VERY slowly ramp up to eating closer to normal but small amounts of food. For example, after surgery, you're drinking protein shakes from a medicine cup. You will have a dietician helping you. A few years later I had a bypass done because I was having reflux issues and I still had weight I wanted to lose. That was easier than the sleeve because they really didn't touch the size of my stomach too much.

Yes you will be on supplements the rest of your life. I take 2 centrum a day, 3 calcium + minerals, B12 and iron.

I can pretty much eat anything I want. The acidity of drip coffee bothers my stomach but cold brew is fine. I've had a few instances of dumping syndrome not tied to any one food.

The only impact on my (pretty much nonexistent) social life was having men hit on me. I found that difficult to deal with.

You absolutely have to change your diet. People can and do regain everything they lose. It's a drastic step and there are other alternatives as others mentioned. My program had support groups that had pre and post op people in them. If there's something like that I highly suggest going to them.

I had high blood pressure, prediabetes, and high cholesterol. All my numbers are now in the normal range. Actually, I'm hypotensive and take salt tablets so I don't pass out all the time.
posted by kathrynm at 9:45 AM on November 23, 2022 [4 favorites]


>something similar - limit the amount of space available for food in the system -

Surprisingly, this is probably not how most weight loss surgery works
posted by Easy problem of consciousness at 9:53 AM on November 23, 2022 [1 favorite]


Loose skin: yes, this can happen if you lose a large amount of weight (100 pounds or more). It can require surgery if it is bothering you -- for example, if there is pain from folds of skin hanging from the abdomen. This would be done by a plastic surgeon.
posted by shiny blue object at 12:08 PM on November 23, 2022 [2 favorites]


My story: had the Roux-en-Y gastric bypass in 2010, and consider myself a success story, though I'm by no means thin. I lost over 130 lbs and have gained back about 15 over the years. Before surgery, my diabetes was out of control, and now my A1c is in the normal range. I've greatly reduced the amount of medications I'm on. That being said, WLS does require you to take supplements and can cause issues like thinning hair. I use Rogaine and biotin to help with that.

1) Is it true that most people can't digest various foods after WLS?

I avoid sugar, which isn't good for me to have as a diabetic anyway.

2) The Nhs says you might have to be on supplements for the rest of your life to make sure you don't get malnutrition - if you or a loved one had WLS, does this reflect your experiences?

Yes, see my comments above.

3) A ridiculous question, this one, but... how badly could WLS affect my social life? I love going out with friends and trying new restaurants, it's one of the big pleasures of my life, although I'm more excited about variety and flavours than stuffing myself till I'm full. I'm ok with eating smaller portion sizes as long as I don't have to cut certain foods out completely.

Again, no sugar, but all other types of food is on the table (heh).

4) Loose skin. Is this a thing that happens a lot? Does it require more surgery?!

I have loose skin, but surgery is not required. Some people end up with an 'apron' of skin that rubs against your other skin and causes irritation, so surgery is recommended for that.

5) Are most people really healthier after WLS?

Not having diabetes any longer is life-changing for me. Being able to partake in physical activities that I couldn't before: life-changing.


But would I recommend surgery for others? I don't know. It is a really personal decision that was right for me, but it doesn't mean it's right for everyone. For example, my sister had a sleeve, but never really tried to change what she ate. I believe she thought the surgery was going to just magically make her thin. She lost weight at first, but stretched her stomach out over time, and gained it back.
posted by BeBoth at 12:15 PM on November 23, 2022 [2 favorites]


I had WLS and the results have been fantastic. 100% would do again. I wish I had done it earlier. YMMV and I think I'm among the best case results. I did some group therapy centered on eating/body issues for a few months prior and that was helpful.
posted by mullacc at 12:16 PM on November 23, 2022 [1 favorite]


I'm really sorry about your mom. That sounds extraordinarily stressful. Also, fatphobia is real, and sometimes fat people aren't treated the same or as well as folks who aren't fat, both in the world and in medical offices. So your mom's medical situation could be correlated with her weight in part because she hasn't always gotten great treatment from health care providers. I don't know if you've read much about this, and I apologize if I'm fatsplaining, but please do explore this if you haven't. I just want to encourage you not to presume that fat is the cause and the health situation is the effect. Things can be much more complicated than this:

"...studies and research have shown that higher-weight patients can experience shorter appointment times with doctors, and receive less patient-centered communication, meaning they have less opportunity to speak in their appointments. Physicians with weight stigma also commonly attribute an excessive number of health issues to a patient’s weight, in some cases failing to properly examine them."

A nurse at my GP surgery suggested I look into weight loss surgery, as I am young and healthy and would recover faster, and it would be good for my health.

I just want to say that this is one opinion, and I think the next step would be to have a conversation with your GP about this surgery.
posted by bluedaisy at 2:11 PM on November 23, 2022 [3 favorites]


Personal experience here:

1) Is it true that most people can't digest various foods after WLS?

I can't answer for most people, but for myself - yes, this has been true. It's unpredictable - some things you would think would be easier have been... not. Weird things: Tuna, even with a ton of mayo, is just too dry and makes me throw up every time I try it. Green beans, asparagus... long fibers that get trapped in my stomach, same result. My lifelong sushi addiction has suffered because nori wrap is a no-go for me. I had a stricture (basically narrowing of the opening from stomach to intestine) during the heart of COVID and for six months could only eat mush. That was pretty awesome (it was not awesome).

2) The Nhs says you might have to be on supplements for the rest of your life to make sure you don't get malnutrition - if you or a loved one had WLS, does this reflect your experiences?

You should take vitamins, especially iron and calcium. I don't. Most of my vitamin levels are totally fine, but my iron is getting low and I'm on for-real prescription iron supplements now. This is something not to mess around with, I really need to get better at it.

3) A ridiculous question, this one, but... how badly could WLS affect my social life?

The amount you will be able to eat is extremely small. REALLY small. And you should avoid things that are obviously not good for you, for the most part. Don't live on potatoes, for instance. But this is common sense. The problem is - in order to eat enough protein, when you can't eat much at all, most of what you eat will end up being protein. That said - if you're truly a person who can take one bite of thing to try it and then move on from it, you'll be fine. Just be aware that you have a very limited number of bites to work with after WLS. Like... ten. And 7 of them should be protein.

Additionally - a lot of people I was hanging out with on the WLS forums about the time I had surgery have experienced social problems as a result. There have been some divorces, and some friend-breakups. It's really hard to predict how the people around you will react to your weight loss. Some of them don't handle it well for various reasons. Just something to be aware of.

And... if you're a drinker, you have to be super careful after surgery. Alcohol hits you like a freight train, and people get addicted VERY easily as a result. It's a real, documented danger. Don't mess with it.

4) Loose skin. Is this a thing that happens a lot? Does it require more surgery?!

It does happen, especially if you start off really big. It happens to most people (though there are outliers who don't get it, mostly younger people). People do have surgery to remove it. People also just wear a lot of spanx and spanx alternatives for it, and that's fine too. Think about what you want out of surgery - do you want to wear a bikini? You will definitely want loose skin removed if that's the case. Do you have a partner who's going to have a problem with it? If so, get rid of either the skin or the partner (I'd pick the latter, myself). Do you just want to look good in clothes and be able to be more active? Spanx again. I have loose skin, and I don't do much about it. But I'm ace, and single. Jeans and long sleeves cover everything amazingly and there's no one to care if I'm a bit floppy about the underarms.

5) Are most people really healthier after WLS?

Yes, a thousand times yes.

I decided to do it because - like you - I had a parent who was really unhealthy due to excess weight. My dad actually passed away from weight-related illnesses. And I was right behind him on that road -- but WLS turned it around for me.

My blood pressure was edging toward medication-level before surgery; afterward it's been rock solid normal, even a little bit low sometimes. I was nearing a pre-diabetic range, but my blood sugar is amazing now and has been for many years. My resting heart rate is in the 50's. I was unable to walk further than the end of my driveway due to joint pain, had no cardiovascular endurance, was basically a physical wreck from my weight -- and now I can walk to the park, spend an hour walking around the park with the dog, come back, walk around the house... I'll never be a runner, my knees took too much damage when I was really heavy, but I could walk for days if I had to. I bike, I swim like a fish in summer, I play with the dog in the yard... basically live the life of a normal, active person.

I gained back about a quarter of what I'd lost over the years, and then... just sort of stopped? I'm not getting smaller but I'm not getting bigger anymore either. I just tell you this because people freak out about it, even when they're told it happens. You hit bottom, and then you bounce. But I'm still WAY smaller than when I started, way healthier, and it's amazing. It's really, really amazing - best thing I ever did for myself.
posted by invincible summer at 3:03 PM on November 23, 2022 [4 favorites]


Heidi, the blogger behind Attack of the Sugar Monster, wrote about her experiences with weight loss surgery, including NSFW pictures, here. It's worth a read.
posted by spiderbeforesunset at 7:33 AM on November 25, 2022 [1 favorite]


I know at least 5 people who have had WLS who ended up becoming addicted to various things (drugs, gambling, sex).

If we're doing anecdotes, that hasn't been the experience of any of the people I know who've had WLS, including me. This is the first time I've ever heard of anybody raise the issues you've mentioned in a WLS context.

Re surgery risks, it's one of the safest surgeries there is. Recovery is fast. Are there exceptions? Always. But people tend to focus on the worse thing that could happen now, but is extremely unlikely, and downplay the much worse stuff that will almost definitely happen down the track. t's certainly less risky than the hip replacement you'll likely need if you don't get it. Ditto that heart attack or stroke.

WLS is the only proven way for most people to lose most of their excess weight and keep it off long term. The caveat here is that the average is 55% of your excess weight, and you'll likely put 5 to 10% of this back on. Yes, some people lose a lot more, and some people regain more. But contrast this with diet-based approaches, where almost every single person will regain all of the weight, and then some. Even these modest reductions will make a massive difference to your overall health.

I pop chewable orange and choc multivitamins / calcium. So do lots of people who haven't had WLS. It's not a big deal.

It hasn't affected going out. You think you're going to miss eating. You don't. The best way I can think to explain it is if I said to you that you were once a ballerina. Try to think about how much you miss dancing. You don't, right? There's a flash of puzzled bewilderment but then nothing? Same feeling. There's initially a vague "I recall this used to be vitally important to me", but then there isn't. You eat your chicken wings and you're happy.
posted by some little punk in a rocket at 3:57 PM on November 25, 2022 [1 favorite]


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