piper

I am 45 YO female. I have been contemplating the VSG for a couple years now. At five feet nine inches and 230-235 pounds my BMI is 34. Like many folks, I have lost and gained weight over the years with weight watchers, Atkins, Jenny, Slimfast and last but not least, Optifast. The latter cost four thousand dollars and I lost 55 lbs in six months then gained it all back, plus 20, over the next year. The Optifast experience was so discouraging and I feel like a failure for the regain. When I got off the 800 calorie a day liquid diet it seemed that anything I consumed was not burned by my body and was instead stored for a rainy day. It appears that the process itself had a negative effect on my metabolism. My self-esteem has been the greatest casualty of years of obesity. I have also begun to really feel the effects in terms of quality of life. I avoid social events, had to bail out of my daughter’s college tour due to the college being perched on a hill (I became too winded and needed to rest). My LDL cholesterol is quite high, and my blood pressure is sneaking up (140/96). I ruptured a lumbar disc last year, which I think was due to age as well as the extra 80 pounds I carry around. The weight surely aggravates the back pain. I have proceeded with the pre-op requirements and will have an endoscopy this week. The surgeon was ready to go ahead and schedule the VSG the following week but I have not been able to bring myself to the point of moving forward. My main concerns are the post op lifestyle adjustment, aging and the irreversibility. I wonder how I will adjust to this new lifestyle of eating very little, the psychological as well as social implications? I am also concerned about the aging process. How well does one progress into their elderly years having had the surgery? Does one chronically suffer from mild malnutrition? What are the effects in one’s seventies or eighties? I am sure this post is an echo of so many others. I appreciate your taking the time to address my concerns. I need to get off the fence and rule in or rule out this surgical option. I feel that without this option I may spend the remainder of my days as a reclusive obese woman with chronic back pain and escalating health issues. However, removing 80% of my tummy so that I will consume less food seems to be such a drastic and final measure. Why have I been unable to eat less food on my own? I have tried to eat only 200 calories four or five times a day but have consistently failed around day four. A fall from the wagon takes me several weeks to come back from before I try again. Being unable to maintain a restricted diet, losing ten, then regaining the same ten month after month is just so futile. Thank you.

I am also wondering in what way it is relevant if one has not been obese their entire life? I concede that becoming obese was of my own making. However, I wonder if one patient has been obese since 2006 while another patient has been obese since childhood in what way does this impact their eligibility for vsg? Is it not true that both are in the same boat? Is the assertion that one should have the obesity gene in order to truly qualify for surgery? In which case, when the technology is available the medical community would screen candidates and only approve those with the gene? I am curious as to whether the assumption is that in the absence of lifelong obesity one is just more capable of dropping a massive amount of weight. I feel that my metabolism is just not functioning correctly and that this is impeding my ability to sustain weight loss. If I do not somehow lose the weight my future is negatively impacted and lifespan shortened, same as a person who has been obese their entire life. I am not trying to be a contrarian just wanted clarification. Thanks.

June, I really appreciate your thoughtful response. I will certainly consider your points regarding my ability to lose the weight without intervention. Thus far I have only managed to gain with each failed attempt over the last 6+ years. My weight lingers btwn 230-235 so I have about 80-85 lbs to lose if I were to shoot for 150-155. My "healthy' range is 128-168 however, I don't mind being 160, it is a whole lot better than 230.... Anyhow, based on your post I feel that you believe my BMI of 34+ is just too low for VSG and will potentially put me at risk of "losing too much". I wonder, has this been something that folks with "lower" BMIs have experienced? This concern is not one that my surgeon had expressed. In fact, he seemed to feel that it made a great deal of sense to intervene now rather than later as increased weight can increase potential for post surgical complications. I gathered that he had performed this surgery on folks with lower (than 40) bmi's and felt that the insurance companies were shortsided in their high bmi requirements. Do you know if folks have indeed experienced too much weight loss when starting with lower bmi's? It seems to me that one's body would begin to level off in terms of weight loss once they reached ahealthy weight that was supported by their caloric intake (equilibrium) rather than a specific time frame, like the six month time frame you suggested. Thanks again for clarifying.

linkybo, Thank you for your sunny reply. Your observations are so true. Although folks seem to go through an adjustment period that seems to be harder for some than others, it appears as though people are quite pleased in the long run as they have finally been able to attain and sustain meaningful weight loss. I have a tendency to over analyze things and get "stuck" when making difficult choices. I guess in some ways it's better than being impulsive. Off topic, love your golden puppy picture and envious that you live in seattle. I am very excited for your upcoming surgery and will have you in my thoughts, sending positive energy your way.

Thank you Rootman for the comprehensive reply regarding malnutrition, aging and decreased cognitive acuity. Your answers were very helpful. Wow, 173 pounds lost, amazing. Congrats. June, I am sorry if my reply seemed vague. When I stated that "things" had "changed" around 40 I merely meant from the standpoint of my metabolism and body weight "set point" and was not implying something more sinister in nature. I am not sure what your are referencing as "extreme behavior". I reread my posts and did not see evidence supporting that assumption. Anyhow, thanks for your input and congratulations on your remarkable weight loss.

No June, my weight snuck up insidiously. Before pregnancies my normal adult weight was 145. After pregnancies my weight seemed to settle around 160-180. As I approached 40 things changed and the scale crept upwards, it seemed my body settled on an astonishing new weight of 230. I understand that when our fat cells fill up to capacity they split. It's just conjecture, but a suppose that during the last 6 years or so my fat cells have been doing just that, filling-up and splitting. Now I have too many and they all want a full tank, hence the new set weight. Congratulations on losing 102 pounds, what a remarkable victory.

I have not had WLS surgery yet so I cannot speak to the post surgery hair loss that seems to be a result of drastic weight loss except to say that one's new cell growth is diverted from what one's body perceives as nonessential in order to maintain more fundamental functions during the adjustment phase. Hence, this process is, in my opinion, unlike the process of post pregnancy hair loss. From what I undertand during pregnancy one does not lose hair at the non pregnant rate and experiences a boost in new cell growth. So, the hair loss following pregnancy is actually "extra hair" you developed during the pregnancy as your hair volume returns to normal.

Thank you for your supportive responses. Have you found any insight into my question regarding general "aging with the sleeve" or chronic malnutrition inquiries? The latter of which was brought to my attention by a therapist I saw recently to help out with this choice. However, although she practices counseling bariatric surgery clients her thoughts are totally rooted against WLS and she holds many erroneous beliefs; E.G. "One month after WLS the majority of patients will need to return to the OR to have their galbladders removed as surgery will place one at risk for stones." However, being obese and middle aged, I am presently at risk for gallstones. I assume this risk will actually decrease if I lose the weight. She also stated that due to chronic malnutrition my cognitive acuity would decrease (as in I will "get stupid"?). Needless to say I am shopping for a new therapist.