I'm so sick of being fat
August 17, 2008 6:55 PM   Subscribe

I'm thinking about having gastric bypass surgery. Anyone have experience with this who would like to share?

I'm 29 years old, just shy of 5'3" and my weight has been stable between 220 and 235 lbs for several years. I've been heavy my whole life, most of my family is heavy.

Due to some old injuries that are pretty serious (technically, unrelated to my weight, I should use a cane) I'm severely limited in the exercise I can physically do without pain. When I do exercise it doesn't seem to make a difference. I went to the gym three times a week for 45 min, did elliptical and recumbent bike... and lost four pounds. And, because of my weight, these injuries are aggravated and I'm in pain pretty much all the time.

I went to weight watchers a few years ago, stuck to it religiously... and lost six pounds after as many months. I found it easy since I'm not a heavy eater normally (it is very rare I go over 2000 calories in a day, and usually it's much less. That would be like "on vacation, all restaurants" eating.)

I honestly don't know what to do at this point. I see my family tree full of heart attacks, blood pressure pills, diabetes, and I am terrified that's my future. I've noticed I'm starting to get kinda shaky if I don't have lunch on-time at work, and my brain screams PRE DIABETES!

I have a couple acquaintances who have had the procedure. One years ago, who says it was the best thing she ever did. The other just a couple months ago who said even recovering from the surgery she feels better than she ever has since dropping fifty pounds.

I do have plans to discuss this with my doctor. I have had full bloodwork to rule out any chemical or hormonal issues, and have a script in my purse to try it again this week. I am, despite my weight, in average health otherwise. Allergies and stuff, but no blood pressure issues or anything. I've had extensive surgery in the past that is seen as being far more painful than this so I'm not too concerned about that. I just want some advice from people who have had the surgery, and also from people who have looked into it and decided against it.

I have about a hundred pounds to drop, that seems to be the low end of the acceptable scale. Is my insurance company going to argue?
How long were you out of work? was yours done with the large incision, or laparoscipally? Will insurance balk at the latter more than the former? Would you do it again?

(if any medical professionals have insights and advice it would also be appreciated. I do have a doctor who I plan to ask about this, I just want wider perspective and some more information to bring with me to my appointment.)
posted by anonymous to Health & Fitness (32 answers total) 4 users marked this as a favorite
I'm not gonna say that it would be easy for you to lose weight--I don't know your situation. But it's a pretty solid biological fact that if you use more calories than you consume, you'll lose weight. I'd guess that you'd probably have to go a few hundred calories lower to start seeing real results (without exercise, that is). But you absolutely can lose weight simply by eating less.

Of course, I am not your doctor, and this is not medical advice.
posted by mpls2 at 7:10 PM on August 17, 2008

Make sure you do your research on your doctor. There are many options (variations) of weight-loss procedures. Research Research Research. Ask your primary doctor his/her opinion. Realize that the surgery is NOT fool-proof. Maybe see an orthopedic specialist about your injuries and ideas on how to fix them so you can work out? You might be able to get a physical therapy referral to help with those.

Good luck to you!
posted by 6:1 at 7:10 PM on August 17, 2008 [1 favorite]

My best friend is 11 years post-op of a Roux-en-Y. She had severe complications including a hernia within the first 6 years after the surgery. When they went in to fix the hernia, they left a staple in her esophagus. It took them 3 endoscopies to find the staple (she was having trouble swallowing and they couldn't figure out why). She had such severe esophagitis that for one complete summer she was fed by a gastric feeding tube hooked to a backpack that fed her something like Ensure.

These days she's had more than one ulcer and she vomits a lot, even when she only eats a little bit. (I have seen her eat 2 Chicken McNuggets and vomit it up.) She battles esophagitis and gastritis constantly and also severe anemia. She vomits so much that her teeth are badly damaged.

For a while she was a size 4 and everyone told her she looked unhealthily skinny. She went back up to around 230 pounds and has just in the past couple of months gone back down to 198. (There are studies to show that yo-yoing with your weight is worse than steadily being overweight.

I didn't know her pre-surgery at 350 pounds, nor at her skinniest. I think she's beautiful right now at a size 12 but she still suffers a LOT of self esteem issues and thinks she's hideously fat.

I am your height and have about 30 pounds more weight than you, but after seeing all my friend has gone through, I don't want a bypass. It's not worth it. And yes, my family is heavy, I get shaky if I don't eat, I have PCOS (which predisposes me to diabetes) and a family history of diabetes and hypertension. It *is* possible to be heavy and fit.

May I suggest to you some size acceptance blogs, such as Big Fat Blog and Big Fat Deal, if you need help with your self-esteem. Junk Food Science is a great blog that calls out the obesity epidemic nonsense and discusses that fat people can be healthy. (Also if you like Penn & Teller, their show Bullshit! has an episode on the obesity epidemic.)

Feel free to Mefi Mail or email me if you'd like to talk more.
posted by IndigoRain at 7:27 PM on August 17, 2008 [2 favorites]

I realised something about dieting a long time ago: there are so many overweight people in this world because losing the weight is really really tough. it's okay for you to be frustrated. it's okay for you to wonder what's not working here. it doesn't work for most people on a larger scale. most of us deal with this all out lives. becoming the exception is hard.

you're going for the most intense option with the bypass when you're probably going to be a borderline case for it. why are you jumping right past the lapband, which is a smaller and reversible (if desired) operation?

you state you consume about 2000 calories max and usually more like 1500 ("much less") during a day. 1500 calories is serious dieting and I am sceptical about your claim here but let's assume it's true for sake of argument: you are putting in less than your more or less idle body burns in a day, so you should be losing weight. 1500 cal is pretty close to your body going into crisis mode, where it's trying to burn as little as possible until it gets more. you're actually going to lose weight quicker giving it just enough, which is what 2000 calories should be.

the frustrating part about dieting is that it's slow and that it takes one single day of "being bad" to undo all the good you did in a week. don't expect to lose more than one or two lbs per week on a steady diet. you can expect to lose more in the beginning but then you'll hit a plateau, so it's normal for it to even out.

I can't answer your question about the surgery being covered as I don't know what country you live in and what kind of medical insurance you have. ask your doctor and also ask your insurance if they'd get you a personal trainer/gym membership. they may be able to cover that, which should help you find exercises you can do considering your health impairments. you are not going to make serious inroads without exercise. it's just not going to happen. you need to get yourself to sweat profusely every single day. yes, sweat. if you don't feel half-dead after working out you are wasting your time.

what I can tell you about is my personal experience. I had the lapband surgery in 1999. I was 6"4 and 347lbs. I'm 198lbs today. that's the good news. the bad news is the surgery itself didn't help me lose weight. it just managed to keep my weight steady. suddenly I felt full after a single meal, not two or three. I lost weight because I started working out and dieted for years. I have been running up to 8km each and every day for four years now. 3-4lbs is what I lose in good months, in bad months I don't lose anything at all. I still pay every time I eat a mars bar. it's not a magic bullet.

you claim to already not fill in more than 2000 calories each day now. in that case you must already have a pretty damn great control over your hunger. 2000 is not a lot of food (and not a lot of yummy food at that). if that is the case, then the gastric bypass will not make a bit of a difference. putting in less than what you currently claim to be consuming would only make you sluggish and tired, not thinner faster.

when talking to your doc, consider asking for a xenical prescription (or buy alli, which is half a dose of xenical for twice the price but doesn't require a prescription). just try it out on a weekend (NOT a workday if you don't know how it works!) with your regular meals and find out how much fat you really still are consuming. just for comparison eat a pizza while you're doing xenical - I promise you that you'll never look at pizzas the same way. xenical, if nothing else, is an eye-opener. it makes you realise pretty quickly just how flawed the "oh, just this once is ok" logic is we all fall victim to every now and then.

I know I sound frustrating but as a person who has fought these very same challenges for a very long time I felt I should do you a favour and manage your expectations a bit. again, it is a very long road and it takes just one day to undo a week's work. that's why so many people fail. it's also a very expensive road to take.

someone once told me "you pay for every pound you lose in gold" ... considering what this has cost me, I'd say he was right.
posted by krautland at 7:37 PM on August 17, 2008 [9 favorites]

You will absolutely be able to find a doctor to do this, if you want it. Be aware that you're signing up to be a sick person FOR THE REST OF YOUR LIFE as "payment" for losing weight this way. I know two people who've had it, both of whom convinced themselves and the doctors that they'd "tried everything". One of them actually found the weight at which it's acceptable to have the surgery and GAINED UP to that weight (about 75 lbs) so she could have it, rather than reducing her intake. She had to have several subsequent surgeries due to hernias and infections, she then became addicted to painkillers and eventually lost her job because of the addiction. She is still not thin.

The other started at 300 lbs, has lost almost 100lbs very quickly, and has had SERIOUS issues with kidney stones and a few subsequent surgeries for that. Her hair is already starting to fall out.

The people I've seen who have had it all have thinning hair, a gray sickly look, and just...aren't healthy. If that's a sacrifice you're willing to make, including not being able to enjoy food again because you've mutilated your insides, then the surgery is for you. You'll lose the weight, though many gain it back. And not to mention the hanging skin that rapid weight loss results in, which requires either more mutilating surgeries, or having to cover up as you did when heavy because the hanging skin embarrasses you as much as the weight did.

I think it's dangerous and only to be used as an ABSOLUTE last resort, but it's ultimately up to you. Good luck.
posted by FlyByDay at 7:56 PM on August 17, 2008 [3 favorites]

I had a laparoscopic RNY in January 2007. To directly answer your questions, I was back at work in 3 weeks. I think that was due to my youth (early 30s) and the fact that I was relatively healthy going into it.

My insurance didn't seem to care which option I chose as long as I met their criteria. It was the surgeon who decided which way to go based on my fat distribution and if he thought it will be too difficult to manage with lap. They can also decide to convert to open during the procedure.

I have not had many complications. You would probably not know I had ever had the surgery if you met me today. Despite my relative success, I am not a WLS cheerleader. I think it can work for some people but you have to go into it with a thorough understanding of what you're in for. It's not a cure-all.

Keep in mind that every WLS site out there is biased. There are the horror-story sites and there are the cheerleader sites. Reading both sides of the story is essential.

I don't really want to go into my whole life story here so please Memail me and I can tell you all about it or answer any other questions you might have.
posted by cabingirl at 8:26 PM on August 17, 2008

you claim to already not fill in more than 2000 calories each day now. in that case you must already have a pretty damn great control over your hunger.

I gotta say- every time I've tracked my eating I've eaten far less than the supposed 2000 calories per day it takes to sustain human life. More like 900-1500 over long periods. I doubt I could eat much more without feeling uncomfortably full. I'm very active and have been thin but not skinny (muscular for a woman) my entire life so I think the 2000 number is bogus for a lot of people.

If I wanted to lose significant weight through dieting alone I'd have to eat incredibly little, like malnutrition amounts of food. I'd suggest the OP start working with a PT to find exercise she can do. Swimming, aqua aerobics and weight lifting would be my suggestion. Getting in shape does a ton for those nagging injuries.
posted by fshgrl at 10:36 PM on August 17, 2008

I can't offer insight about weight loss surgeries, but after reading about your cane, I was inspired to second fshgrl's suggestion of trying swimming or other water-based exercise.

I took up swimming a few years ago specifically because I have severely flat feet and weird biomechanics in my ankles and knees as a result. I am doing OK now in my late 30s with orthotics, but eventually I think some chickens will come home to roost and weight-bearing exercise is not going to be a viable option as I age.

Being in the water is a fun and wonderful way to exercise. My local municipal pool (Seattle) has several ways to accommodate getting people into and out of the water more easily than ladders up the side (i.e., portable stairs, and a chair lift device).

Sometimes on weekdays there are groups of very elderly ladies at the pool, some of whom are in wheelchairs or assistive scooters. When I was just getting started w/swimming they were very inspiring--if they can do it, so can I! And so can you.

I'm a big lady, too, and over the past few years I've gotten a lot more fit--I have way more physical strength and ability than I used to--but my mass hasn't changed by much. I say, keep an eye on the number on the scale, but put more stock in measures of ability (how many laps you can swim, or blocks you can walk, or something). Maybe work on improving those for a while and see what happens before going under the knife.
posted by Sublimity at 10:56 PM on August 17, 2008

Response by poster: To the people who track calories--how closely do you track them? Do you ACTUALLY weigh and measure everything that goes into your mouth, or do you say "That looks like a cup" and throw it up on FitDay? Do you use the generic "chocolate ice cream" suggestion in the online database, or do you enter in the calories for Haagen-Daaz Triple Chocolate Cream Fudge Chunk (Now With Extra Chunks!)? And do you record EVERYTHING, even the little snacks? Seriously, it makes a HUGE difference.

You don't have to believe me, either. Obesity researchers have found again and again that obese patients severely underestimate both their portion sizes and their caloric intake.

As for gastric bypass--I don't have personal experience, but the accounts I've read of people who've had it done reflect what others have said here. It's not a magic bullet. It won't fix emotional eating problems. If you don't get fundamental eating issues under control the weight will come back on, and the surgery itself is dangerous and can have a whole host of repercussions.
posted by Anonymous at 11:47 PM on August 17, 2008

I have not had WLS. I have serious questions about it, and there seem to be many examples of people who get WLS and lose lots of weight but then have gained most or all of it back after a few years. I mean, it gets touted by the industry as a solution to being overweight, but after looking at examples in the media (Carnie Wilson and Randy Jackson, to name two), it seems that it can be just as temporary a solution as fad dieting, but you've permanently altered your body with WLS.

I think that anyone seriously contemplating something as permanent as WLS should truly exhaust everything else first. Someone in your condition - overweight and unable to exercise - is the perfect person to use Dr. Joel Fuhrman's Eat To Live program (it's a book: Eat to Live). I followed the six week plan and went down two dress sizes without exercising at all (yes, I know that sounds like hooey, but it's true), and I've been overweight my whole life.

Since you say one of your biggest motivations for losing weight is to be in good health and avoid things like diabetes and heart disease, then Eat To Live is especially ideal for you. The idea behind EtL is that nutrition equals health, and it's all about packing each bite you eat with as much nutrition as possible. There is no calorie counting and very little food measuring and weighing (and what there is is mostly about making sure you are eating enough of a certain kind of food rather than eating too much of it). And in the end, you feel so incredibly healthy and vital. It will improve your sleep, your energy levels and even improve your skin tone. Yes, the six week plan is challenging, but very worth it, and very non-surgical.

There are over 200 reviews for it on amazon right now. I suggest you go there and just read some reviews and see if it doesn't sound like something worth trying.

I suggest you try this temporary, measurable change to your eating style before you try a permanent surgical change to your body. If you don't see any results after following the six week plan, then schedule surgical consults.

(sorry if I sound like a shill for EtL. I don't work for Dr. Fuhrman's publisher or anything)
posted by Brody's chum at 12:11 AM on August 18, 2008

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 1:18 AM on August 18, 2008 [3 favorites]

My roommate of 13 years now had the surgery about a decade ago. She lost a lot of weight, the ability to consume dairy products or sugar, her uterus, one ovary, and the ability to stand up for more than twenty minutes.

She has severe nerve damage due to malnutrition. Complications from surgery caused buildups of scar tissue around her organs that necessitated a hysterectomy. She went from being a quick-witted radio DJ to someone whose speech is slow and labored, but that may be a side effect of the massive painkiller, antianxiety and antidepressant cocktail she's on. She can hardly get out of bed long enough to make herself instant noodles, much less work.

And she's still not happy about her weight.
posted by darksasami at 1:31 AM on August 18, 2008

If the horror stories above turn you off of surgery:

According to this, you need about 1800 calories a day to maintain your weight if you are a relatively inactive person. If you eat 300 calories less than that, you'll lose a little less than a pound a week. Or, you could exercise away 150 calories a day and eat 150 calories less for the same effect.

I've had good success with calorie counting and tracking via Excel. I look at net average over a week, which is how I get to have a couple of restaurant meals a week (I'm not shooting for the same daily total every day.)

Bottom line, it's just math, and there are lots of sites out there to help you do it -- Fitday, Calorie King, Spark People (I think) and good old Excel. Nutritiondata.com will tell you how many calories are in various foods, and you can buy a cheap food scale anywhere. I lost a bunch of weight a few years ago and I'm about to do it again because I just had a baby--the first time, I tracked calorie intake and output via a little spiral notebook, until I got sick of doing the calculations and went with Excel. My boyfriend used to like Calorie King. More social people than I am have great success with Weight Watchers.

You can do it. I really found focusing on "it's only math" and having faith in the math to really help me a lot...Before I lost weight, I think I thought there was some sort of special Oreo cookie voodoo that only worked on me that made me gain weight but not other people. I gained weight because I ate too freaking much for my body and didn't exercise enough to burn it off.

At the time, I ran up to and past twenty miles a week. I thought if you ran twenty miles a week you couldn't be fat -- I hadn't done the math. You can easily be fat and run twenty miles a week when you have room in your life for beer, fried food, ice cream, chips, cookies, etc.

It's not a matter of giving all that stuff up, but of learning how it can mathematically fit into your diet while you're losing weight.
posted by A Terrible Llama at 4:42 AM on August 18, 2008 [2 favorites]

Do you have a throwaway email address? Can you ask a mod to post one for you?
posted by prefpara at 5:04 AM on August 18, 2008

I'm 5 years out, had no complications and despite gaining some weight back, feel like it was one of the best decisions I ever made. I got my life back. I was much heavier than you are and it was a drastic change but a good one and I've never regretted it. MeMAil me if you have questions. I'll be glad to share.
posted by pearlybob at 5:36 AM on August 18, 2008

I have no experience with the surgical procedures, I'll just say that right off the bat. But I'll come with another research option -- Gary Taubes' Good Calories, Bad Calories. It's really a history/research review on the science of human energy metabolism and obesity, and comes to some pretty striking conclusions. I'd wager that the baseline, uncontroversial stuff about the functionality of fat metabolism by itself would drop many a jaw (that's without his main premise, which is a bit more controversial).

It's a long read, but worth it; I would suggest reading EtL AND GCBC before changing much of anything -- they wind up at very different ends of the spectrum. I went in to the book skeptical of any type of radical claims, and came out the other end fairly well convinced.

I've modified my diet very slightly over the last few weeks, and am all of a sudden 6-7 pounds down without even really trying ... this after holding steady at a base weight for years now.

Think of it as more research to inform your final decision.
posted by ahhgrr at 6:31 AM on August 18, 2008

You are eating more than 2000 calories a day. Once you accept this fact, you will be able to change your life without having to resort to weight loss surgery. (Please don't do it at this weight!!)

Track your calories religiously using a website such as Fitday or The Daily Plate and determine how much you are really eating. This includes EVERYTHING you ingest -- drinks, butter on a biscuit, dips for snacks, everything. Once you have a clear picture of what you are ingesting, you will be more easily able to see what needs tweaking and fixing. Each of these sites offers estimates for how much of a calorie deficit you should use to lose X amount of pounds per week. Please give one of these sites a try (a REAL TRY) for at least a couple of months before you resort to such a drastic measure, and which will change your life for the worse for literally the rest of the time you are alive.

(Please note: I am not against weight loss surgery. For many people, the digestive issues that come hand-in-hand with WLS are utterly worth it. But these people weigh a hell of a lot more than 235 pounds!)
posted by srrh at 6:54 AM on August 18, 2008

I haven't seen any of the WLS recipients in this thread mention it, but I was under the impression that most surgeons have a lose-and-maintain requirement before they will proceed with surgery.

To that end, since you'd have to do it anyway, why don't you get a referral to a nutritionist or dietitian from your doctor and start there? You'll either get some answers and results, or you'll start the paper trail that you're going to need for your insurance company anyway. There are software solutions available under medical supervision that are more extensive and helpful than you'll find on a web-based solution, and I think that having a human to work with makes a lot of difference for tough cases.
posted by Lyn Never at 7:40 AM on August 18, 2008

fshgrl: More like 900-1500 over long periods. I doubt I could eat much more without feeling uncomfortably full.

your average mc donalds meal will set you back 1200 calories. a yoghurt can easily provide 100-300 calories if you don't pick the right one. I do know that it is possible to have a decent balanced lunch that weighs in at no more than 450 calories (go nukitchen food!) but when you're talking 24hours, I don't buy that a normal person would feel filled at 900 calories for a second. 1500 cal is doable for a thin woman who does not exercise too much.

I'd suggest the OP start working with a PT to find exercise she can do.
second, third, n'thing. op, this will cost you a bit but it's worth it. a PT will save you from injury and wasting your time.

disillusioned: 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.

OP: this is very true and I forgot to talk about that at all. the surgery will make you throw up. yes, really. yes, all the time. spaghetti or steak did it for me all the time in the beginning. you eat a little bit too fast and suddenly you can't swallow, it's as if it's stuck in your neck, your eyes tear up, you can't breathe, you want someone to heimlich you and end up throwing up in the bathroom. it hasn't reached the stomach, so it's not acidly-burning but it's pretty gross regardless. it comes up automatically, you don't have to do anything. massive change. what does not change is your ability to eat little calorie-intensive bombs of joy like mars bars. 300 calories in ten seconds in? that's an hour on the treadmill to undo and only then are we BEGINNING to talk about losing anything on top.

Lyn Never I was under the impression that most surgeons have a lose-and-maintain requirement before they will proceed with surgery.
nope. if you're obese and considering such a drastic step, you have the sob story of having tried and failed again and again. every last case has. perhaps some insurers require proof now but I wouldn't know about that. I chatted my MD up in 1999 and had a recommendation to this then relatively new procedure within five minutes flat. the guys at that hospital didn't even blink after measuring me.
posted by krautland at 8:38 AM on August 18, 2008

But I'll come with another research option -- Gary Taubes' Good Calories, Bad Calories.

Second that.
posted by callmejay at 9:08 AM on August 18, 2008

krautland: actually, Lyn Never is not that far off, at least for my experience. My surgeon required me to lose a certain amount of weight in the month or so leading up to surgery. This is done to shrink the liver so that it isn't as fragile during the procedure. Most people go on a liquid diet for 2 to 3 weeks. If you show up and haven't lost the weight they told you to lose, they can postpone or cancel surgery.

I've also heard of surgeons who want you to lose weight before they will approve you, especially if you are extremely obese and it would be dangerous to do the surgery.

Still, lose-and-maintain is not a universal thing. I didn't have to. But I did lose 10% of my body weight in 3 weeks of protein shakes.

Oh, and I'm sorry - not everyone throws up all the time. Seriously. Why do people insist on perpetuating that myth?
posted by cabingirl at 9:31 AM on August 18, 2008

fshgrl: More like 900-1500 over long periods. I doubt I could eat much more without feeling uncomfortably full.

your average mc donalds meal will set you back 1200 calories. a yoghurt can easily provide 100-300 calories if you don't pick the right one. I do know that it is possible to have a decent balanced lunch that weighs in at no more than 450 calories (go nukitchen food!) but when you're talking 24hours, I don't buy that a normal person would feel filled at 900 calories for a second. 1500 cal is doable for a thin woman who does not exercise too much.

I tracked my calories pretty religiously for a couple months using Fitday and trust me when I say I can ~easily~ go days or weeks at a time eating 900 -1,500 calories with moderate exercise (work out 4-5 days per week). I never eat McDonalds and very little prepared food at all, mostly because I don't care for sweet things and that's everything they sell at Safeway, even the bread!

I do eat more if I'm backpacking or swimming a lot and I definitely ate more when I worked on a farm but not four times as much or anything. Apparently I just don't need a lot of food to survive.
posted by fshgrl at 9:54 AM on August 18, 2008

Make sure your doctor is fully committed to helping you and has the right expertise. There should be forms of exercise that will not cause pain. I sympathize because I have arthritis & other health issues that affected my ability to exercise & my weight went right up. When I went on new meds, and had more energy/less pain, my weight went down because I was able to be more active.

If necessary, go doc-shopping and find someone who can help you try every alternative before surgery. This article is quite discouraging. It's serious surgery and should be a last resort.
posted by theora55 at 2:31 PM on August 18, 2008

Response by poster: fshgrl, if that's the case you really should go bring your case up to nutrition researchers. Because 900 calories a day is pretty much universally considered starvation level of calorie intake, and for an adult human being to very comfortably survive on it and maintain weight, much less extra weight, is a magical miracle of metabolic activity that should be brought to the attention of scientific research as soon as possible. I am absolutely serious in that suggestion.
posted by Anonymous at 2:33 PM on August 18, 2008

Have you thought of getting your thyroid checked? It might be the reason why you are having a hard time losing weight.
posted by vermontlife at 6:18 PM on August 18, 2008

Well, I had a Roux-en-y in December of 2002. The main reason I wanted it was because it was supposed to cure my diabetes. I haven't had the severe complications some people have had, but I'm still diabetic and I'm still fat. I'm maybe 10 pounds lighter now, whoop-de-doo. The only benefits to it were that it cured my GERD (although I imagine that probably could have been accomplished with a much less complicated surgery) and that when doctors start their "lose weight, fattie" spiel I can shut them down by saying "I already had a gastric bypass and it didn't work."
posted by Shoeburyness at 6:54 PM on August 18, 2008

Like krautland, I had Lapband surgery, except mine was this past April 2008. I'm 5'1"ish, and at my highest weight, was 253. I've lost a total of just about 65lbs since last September; roughly 35lbs of that is post operative loss (Aetna required a 6mo supervised diet before they would cover the surgery). I'm down from a size 24 to a 16, and still have another 40lbs that I'd like to drop.

I would say that most days, I try to stick to a 1200-1500cal diet. A bad day for me is 2000cal. I don't exercise as much as I should, but on average (as in - regular everyday activities), I burn about 2100cal/day according to my nifty bodybugg toy. So, as long as I continue to burn at that rate, I'm at a calorie deficit and keep losing weight. Slower than I would be if I got my ass on the treadmill, but I am losing.

I extensively researched both the Lapband (I have the Realize Band) and Gastric Bypass, and I couldn't bring myself to do such radical surgery. The surgeon left the choice up to me, and the bottom line was that I didn't want to rearrange my insides if I could avoid it. If I had a couple hundred pounds to lose? Maybe. If research didn't show that both Lapband and Bypass patients tend to end up at the same place, but on different time lines, I might have reconsidered. Bottom line, I just didn't think that Bypass was right for *ME*.

I also very highly recommend logging your food - ALLLLL of your food - even the sugar you put in your tea in the morning and the mayo you put on your turkey sandwich - to see just how much you're actually consuming everyday. (I use dailyplate.com and really like it.) Also, just for a few days, weigh/measure what you eat. Don't go to the trouble of pre-measuring it out. Just put what you *think* is a normal serving onto a scale and see how accurate are. I think you will be really surprised at how off your guesstimates might be.

To answer more of your insurance questions, there are usually quite a few very large, very intentional insurance hoops you will need to jump through. Psychology consults, upper GI studies, gallbladder ultrasounds, extensive bloodwork, nutritional counseling, cardiac and pulmonary workups, possibly sleep studies just to name a few... All of these things will need to be documented. As I said, most importantly, they will expect to have full documentation of all your previous weightloss attempts. And don't be surprised if they come back and expect that you do another six months of documented/monitored dieting. That means going to your surgeon or PCP every single month to be weighed, have your BP taken, have your diet discussed, etc. The more detail, the better.

You have not listed any major co-morbidities such as sleep apnea, GERD, asthma, heart problems (I had all of those), and your BMI is actually pretty borderline for WLS. I would suggest, as PPs have, that you look into physical therapy and a nutritionist. Most insurance companies won't pay for Lapband/Bypass without a BMI of 40+ unless you do have co-morbidities (with them, they tend to drop the BMI limit to 35).

It's a long road, and not necessarily a pleasant one. As I mentioned, I was able to drop about 30lbs before the surgery, itself. That was kind of bonus, and really just demonstrated to me that I could get my shit together. But it's hard. Much harder than you probably realise. WLS is probably 90% mental and only 10% physical. Unless you've been there, I don't think that people realise that. You have to be willing to make complete 180 degree lifestyle changes. Ones that I'm still struggling with, and probably will always struggle with. But as a lifetime fatty, I know that I'll always have a weird relationship with food.

So, whatever you choose to do, please don't think that this is a quick fix. If you want to chat offline, feel free to memail me. Good luck.
posted by dancinglamb at 7:54 PM on August 18, 2008 [1 favorite]

Have not had this. Know someone who does it. He has turned down everyone I sent to him (a half-dozen people).

If you do see a doctor about this, and that doctor does not act like you need to answer a lot of questions before they consider doing your surgery, leave that office.

They guy I know also does a lot of repairs.

People want these procedures and there are plenty of quacks out to make a buck.

29 is quite young. I hope you can find a better alternative - such as people who have more personal experience with this have suggested above.
posted by Lesser Shrew at 8:25 PM on August 18, 2008

Ultimately, what gastric bypass does is prevent you from eating more than a certain amount of food at a time. If you can do this yourself without the surgery, you should definitely try it first. Look at what the dietary requirements are for someone who's had it, and just imitate that for as long as you can.

I'm not saying that you absolutely shouldn't get the surgery. But, you should take a crack at getting the benefits of it without actually going on the table and getting operated on.

Good luck!
posted by Citrus at 6:47 AM on August 19, 2008

Nthing Gary Taubes' book. I read it AFTER losing 60 pounds, and it kinda blew my mind. (I did a modified Hacker's Diet, used Physicsdiet.com for weight tracking, Daily Plate for calorie counting. Changed some of my food choices, but not all.) You really get a sense of how much we DON'T know about food, exercise, metabolism, etc.

Also nthing PT and/or water-based exercise. And who knows: maybe that blood work will tell you something useful. A good friend used to always get hassled by his doc to lose weight; turns out he had an entirely undiagnosed thyroid condition. Finally had a heart attack, clinically died, spent some time in a coma. The good news is that he suffered minimal long-term damage...and over the last year or so has lost about 200 pounds. (Very-low-carb diet combined with running and now, bicycling.)

Good luck.
posted by epersonae at 11:32 AM on August 19, 2008

cabingirl I did not perpetuate a myth, I spoke about my personal experiences. I threw up in the beginning until I learned how to deal with it and every now and then I still do. the first six months were nothing short of insane for me.

I was also not required to prove anything to a doc, which is exactly what I said above.
posted by krautland at 1:33 PM on August 19, 2008

I wasn't trying to discount your personal experience, krautland. I was taking exception to your statement that the surgery will make you throw up all the time. That may have been your experience, but it was not mine, and I know plenty of other people for whom it was not a frequent issue.

The reason I called it "perpetuating a myth" is because when I decided to have surgery, most of the people I told (family and friends) knew someone, or had a friend-of-a-friend who "threw up constantly." And yet, almost no post-ops I know have that issue. I don't get that disconnect.
posted by cabingirl at 9:28 PM on August 20, 2008

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