MaineDoc

My weight has fluctuated so much over the years that I had clothes in essentially 4 different sizes:
XXXL, XXL, XL, and L

Over the past 10 years I kept all of them because I always worried about going back even when I had successfully lost lots of weight and was comfortably wearing an L.

This time, however, has been different. I *did* get rid of all my clothes XL and above once I got into an L. I finally had my surgery 3 days ago and I expect I’ll probably be in a medium when all is said and done. I’ll plan on getting rid of my Ls once that happens.

It is so interesting how we all experience things so differently.

I’m day 3 post-op and it is legit work for me to get the daily Fluid requirements. Drinking, even relatively small sips, can often lead to it feeling like my stomach and esophagus spasming. I’ve tried fluids at different temperatures-I think warm works the best, but even that’s not perfect. I’ve tried using hyoscyamine which has been somewhat helpful. But even with that I’m having to be exceedingly mindful of how much I’m drinking. Basically I try to make sure I’m drinking at least 2 Dixie cups of fluid each hour. Usually at first I’m ok but over the course of a couple hours it becomes increasingly uncomfortable.

And in terms of hunger-I have ZERO appetite. I have absolutely no desire to eat or drink. Even seeing my family eat things I’ve historically enjoyed has not tempted me at all. It all just seems so off putting. And as others have experienced it feels like my tastes have changed. I used to genuinely enjoy Protein Shakes, even before I ever started in a weight loss program, but now I find them fairly revolting. I’m drinking them because I have to but it’s not easy.

Anyway just sharing my experience to perhaps provide another data point in the conversation.

So I’m preop, a little under 3 weeks to go until my surgery. I’ve lost almost 70 lbs.

As many of you have experienced I’m sure, a number of people have complimented me/made comments about how much weight I’ve lost.

However I still myself as a “fat” person. When I look in the mirror, my eyes go to my “big” belly which I guess isn’t so big anymore but to my eyes really doesn’t look any different. Whenever I’m out and about, I still have a perception that people look at me as the “big” guy but that may not be the case.

Have you all been through something similar? What has it been like to change your self-perception?

I’ve lost close to 70 lbs prior to surgery, which is scheduled for March 11. My primary reason for going forward with surgery is that I’ve successfully lost very large amounts of weight before (probably lost and gained 500 lbs in my life) but I’ve never been able to maintain it. My thinking is that the surgery will (hopefully) be the key tool for me to lock in the changes for the long-term.

My starting BMI was 39.7 (with hypertension and high cholesterol) and after about 6 months of participating in the medically supervised weight loss program, my BMI is about 29.8. During the first few months of participating in the program I thought strongly about not pursuing surgery. However after giving it serious thought and reviewing my own personal weight loss history of having gained and lost about 500 lbs in my life and discussing with my surgeon it really became clear that this is the right (and really only) decision for me.

My hope is that I can finally get down to a weight I’ve always tried to get to, have come close to, but have never attained (about 185 lbs, BMI would be about 26 but I have a good amount of muscle mass). More than that, though, I hope to use the surgery as a tool to lock in long-term habits and changes so that I can maintain the weight loss long term and stop all this yo-yo’ing I’ve been doing for 20 years.

Just sharing in the event this perspective is helpful.

On 01/28/2020 at 01:30, athea.lei said:

So you were still able to get insurance approval even though your BMI dipped below 35? My BMI is currently at 44. But if I lose more than 20 lbs, it will place me at 40 BMI, and I'm scared insurance might reject me. I have 5 more months to go.

Sent from my SM-N975U1 using BariatricPal mobile app

Following up on this-just found out that I have been approved! Just wanted to let you know since I also was wondering.

On 02/05/2020 at 13:00, MaineDoc said:

I’m scheduled for March 11. Just waiting for insurance approval. best of luck!

Got insurance approval so it’s finally really real!

March 11 sleeve here

On 02/08/2020 at 07:01, danielleleigh90 said:

Just an update-really good news guys! The cyst is actually forming from my kidney. Soooo the doctor has decided to monitor it every 6 months since cytology came back with everything being non-malignant. This means after my March 3rd psych appointment everything will be sent into the insurance! I’m super excited & ready.

Awesome! Super happy for you. What a relief!! Happy vibes your way 😀

Nice job! If you don’t brag here where the hell will you?!

I’m scheduled for March 11. Just waiting for insurance approval. best of luck!

On 01/28/2020 at 16:00, Pansypicker said:

My sleeve is scheduled March 6th. Super excited and scared at the same time. I am doing the self pay thing in Las Vegas because WLS is excluded on my insurance. I tried doing the 6 month program with my insurance years ago just to be denied. It was a heat breaker for sure.

Man that is a heart breaker. I give you credit for rebounding from that and committing again to the process, not to mention having to pay out of pocket. How are you feeling about things? Do you have a 2 week preop diet?

Not trying to sugar coat things, but simply trying to offer a hopeful/optimistic perspective:

The good news with your decision to take better control of your health by pursuing WLS necessitated that this pancreatic issue got worked up prior to going ahead with WLS. Perhaps if you hadn’t made this decision, the pancreatic issue would have become more of a problem if it hadn’t been discovered or if you had waited longer to have it worked up.

Again not trying to minimize your anxiety and how frustrating this whole process can be for so many reasons, but just trying to maybe reframe your outlook on this as something else that will lead to improved health for you.

I hope that you get an answer quickly, that it’s benign, and that you can proceed with WLS ASAP. My best wishes to you.

On 01/28/2020 at 01:30, athea.lei said:

So you were still able to get insurance approval even though your BMI dipped below 35? My BMI is currently at 44. But if I lose more than 20 lbs, it will place me at 40 BMI, and I'm scared insurance might reject me. I have 5 more months to go.

Sent from my SM-N975U1 using BariatricPal mobile app

Good point-I haven’t received official word yet on insurance approval. I had the very same concern you expressed. According to the administrator in my program, insurance looks at 2 BMIs-one at the time the PCP makes referral to the program and one at the first appointment with the program. Based on that, I would qualify. She said she was unaware of anybody who completed the program requirements ultimately being rejected by insurance for having a BMI too low and she was aware of people with BMIs close to 30 who qualified. So at this point I’m cautiously optimistic but certainly not out of the woods yet. Please wish me luck!

On 01/27/2020 at 23:51, asnirak said:

I am also on March 11! But I am doing bypass. I hope we’ll be able to support each other, though! And my process has also been so, so slow. I started working on my requirements a year ago. Good luck!

I debated between sleeve and bypass-like most of us on here I suppose. The surgeon thought either would be reasonable but seemed to slightly favor sleeve, so I opted for that.

Regardless, yes let’s support each other! I wish you good luck over these next few weeks. In some ways, it feels long enough in the distance that it’s still not going to happen and in other ways it feels right around the corner!

6 hours ago, AZhiker said:

What you are experiencing is something called "Self Licensing." It's where you justify misbehavior after being "good." People do it all the time. We really know how to do it with food, for sure. "I deserve it," "Just a bite won't hurt." "I've been good all week (or day) so I deserve a treat." We sabotage our forward progress with this self defeating mind set. Some of it might be based in fear - a fear of success or a fear of change. Anyway, it goes hand in hand with the "What the heck" mindset, which says, "Well I've already blown it today, so I might as well eat the whole thing. I can start fresh tomorrow." I don't know exactly how to "cure" these negative mindsets, but I do know that recognizing them and naming them is very helpful. If you find yourself starting to self license, take a second to identify and name what you are doing. Naming the behavior tends to objectify it and take it out of the emotional response realm and put it more into the thinking/rationale realm. Also see if you can identify the "What the heck" mindset. Again, naming it helps me a lot.

Once you know that it is actually a known human behavior that has a name, I think it is easier to deal with it. The key is to get back on track immediately. Don't blow the whole day just because of one bite. Get out and take a walk!!! I am glad you are dealing with this now, because believe me, you will deal with it after surgery, as well. Yes, the early days are easier when you have no appetite, but learning some tools to handle this kind of thing now will help you so much down the road when the appetite returns, the restriction is less, and you have no limitations as to what kind of food you eat. Turn this challenge into a learning experience and it really can be a good thing!

Thank you, this is great and helpful! I'd just add, that the "fear," at least from my perspective, is a Fear of Missing Out--it's that voice that says to you, "if you don't eat this (yummy whatever) right this instant, then you may not ever get to again! you don't want to miss that, do you?" it's similar to the other fears you mentioned and I think what you said about simply labeling these reactions as being really important makes a lot of sense, but I just wanted to add this to the discussion.

Congrats dude. Awesome and inspiring! You must feel so good!

Not that I’m a veteran by any means but I guess I’ve been here longer than you so I’ll take the opportunity to say welcome! This really is a great community ripe with knowledge and support! Congrats on your decision and well wishes on your journey.

39 minutes ago, catwoman7 said:

I didn't in the months leading up to WLS, but all of my weight loss attempts before surgery ended up like this. I'd cruise along for a few weeks or months, drop 20-30-40-50 even 60 lbs, hit a brick wall, and then the weight would come back. Happened a zillion times. Which is why I decided to have WLS.

I think diet fatigue sets in after awhile, and also, yes, you're fighting biology (like your set point). Your body wants to get back to where it was before. WLS resets the biology part to a decent extent - but you do still have to watch for diet fatigue and letting old habits back in after you have WLS.

less exercise could be part of it, but gaining/losing weight is supposedly 80% diet and 20% activity, so the effect of that is probably minimal. I think it's the eating. Just white knuckle it and keep on going. You don't want to have to re-lose the weight you worked so hard to take off. Once you have surgery, you're likely to lose your hunger for awhile, so things will get easier.

cravings can be tough to deal with - maybe add a little more fat to your diet (but not enough that you're eating out of calorie range) - or maybe more Fiber. Sometimes when I'm feeling like an eating machine, I'll eat a big bowl of bran to stop it. Or something with (healthy) fat in it. Both of those things can be pretty filling... But watch those calories - again, you want to keep them within range so you're not putting on weight.

Thanks fort the tips. I agree about the diet fatigue. Perhaps some of my problem is that over the past few weeks, I had been increasingly strict with my eating, basically limiting myself to about 1000 calories a day. My rationale was to try to prepare for life after surgery as much as possible ahead of time--I've been measuring things, eating very specific amounts, and in a quite regimented way. Honestly, it's felt good and on a day-to-day basis, it's felt totally fine. My energy level has been great even with a high exercise volume. But I think in the past week it's just caught up with me. Your suggestions to help cravings are helpful.

39 minutes ago, Fatboyslim1 said:

There is a lot of data out there, which basically flows your own, showing that it is virtually impossible (but not entirely impossible) to lose a ton of weight and keep it off, without surgery.

For reason yet known, the metabolic reset of your weight set point and also the reduction of comorbidities only seem to occur after WLS, not with conventional dieting.

Add to that the new science that "pre surgery" weight loss diets are potentially unhealthy and at the least serve no purpose.

my opinion is you e done a great job with this stage of the process, and you should just fight it out and be proud of your progress. Not many people bring their BMI down that significantly on their own.

Thanks for the kind words. I hadn't heard about the presurgery weight loss programs serving no purpose or even being counterproductive. Where have you seen that? I'm curious and I'd like to learn more. It sucks to think that I'd have done all this work for nothing!

I’ve been participating in my medically supervised weight loss program for 5 months. I’ve lost over 60 lbs and got a surgery date last week (March 11). I felt like I was cruising along.

The past week, however, has been incredibly hard for me. My cravings have been really intense and it’s been so tough to consistently make the right decisions. I’ve definitely deviated from my plan more in this past week than I have in the 5 months before. I feel guilty and I’m angry with myself.

Honestly I feel like this is a pattern that’s always happened in the past when I’ve lost weight. Around this point, several months in and down a lot of weight, it’s become increasingly hard for me to maintain my progress and stay on track. What sucks this time is that I’ve handled things differently-I’m participating in the program, I’m taking a medication (phentermine), and I’ve gotten support from this forum. It just sucks that in spite of all that I’m still having a hard time.

I feel like it’s probably a combination of factors—my set point fighting harder against my weight loss, the fact that I actually have a surgery date and on some level I’m justifying my indiscriminate eating by saying to myself “well you’re not going to be able to eat like this in a few weeks so you might as well get it in now,” and some (minor) injuries I’ve sustained recently that have made participating in my usual gym routine more difficult. Not making excuses, just trying to understand myself.

Anyway, I’m not really sure of my point but felt I needed to get all this out somewhere. I’m pissed at myself but I hope I can forgive myself and just get back on track.

Any of you WLS veterans struggle like this once you got your surgery date?

I’m currently taking phentermine. I haven’t noticed a huge difference-maybe about half the time it lowers my appetite about 10-15%. I’m on a relatively low dose (10 mg) so perhaps that’s why?

Interestingly, I haven’t taken it the past few days and my appetite had been off the charts high. I also have encountered several side effects, nothing horrific but things that I’d prefer to avoid. My plan, if my team agrees, is to take it up until the time of surgery in a few weeks and then stop.

My insurance has required 6 months a pre-op medically supervised weight loss program. The program I'm participating in, itself, is also quite up front and says that they require multiple visits with a nutritionist and social worker, in addition to a medical work up (e.g., endoscopy, sleep study, cancer screenings if applicable, etc.) and so even without insurance requirements, they're clear that it's likely a several month process on their end. In fact, I started participating in August and just got cleared by the program last week. They will submit the prior authorization request to my insurance in the next few weeks.

When I first started looking into the surgery, I wanted to get it ASAP. I was annoyed by the insurance and program requirements as I did not want any delays. However, having gotten this far, I have to say I'm glad to have gone through this deliberate, fairly lengthy process. The changes I've already made with what and how I eat, I think, will make post-surgery transition easier (TBD of course, but I'm optimistic). I basically already am eating quite similar to what I'd have to eat post-op--small meals, small Snacks, high-protein, low-carb, lots of veggies. As I don't eat meat and I'm a picky eater in general, I was a bit hesitant at first as to whether I'd find enough foods that met the post-op Protein requirements. I've had time over the past few months to explore a variety of food options and feel pretty good that I've identified foods that will meet nutritional requirements but also enough variety so that I won't get bored, assuming that my tastes don't change drastically after surgery.

In terms of BMI requirement, you can see that I'm close to dropping below 30, having started at 39.7 with multiple comorbidities (hypertension, dyslipidemia). The program I'm participating in is confident that I'll still get covered as they have said that the insurance looks just at the weight/BMI at the time the PCP referred me to the program and my initial weight/BMI upon starting the program. Incidentally, as others have suggested above, I contacted the insurance company directly to ask this question, but got a non-answer. I am going to keep my fingers crossed that I get approval, given that I have my surgery scheduled for March.

As everyone says, things seem like they take forever and then all of a sudden you get a date!

I began this process last May. The program I’m participating in is quite thorough and comprehensive so it took a couple months just to get in for the orientation session and then I’ve been formally participating since August. It’s been a combination of insurance and program requirements that have led to the progression to surgery take so long.

At first I was frustrated with how long the process would take-I just wanted to get going with the surgery. But having gone through the process, frankly I’m glad it’s structured as it is. It allowed me to make serious changes that I think will be vital to the long term success of this.

At this point my BMI has gone from 39.7 to 32.1, weight from 285 to 230.2. More important than the numbers though are the changes that led to getting here. I’ve totally changed how and what I eat. I feel like I’m set rrriessentially eating a diet in line with what I will have to do after surgery. I must say as someone who has gained and lost probably 500 lbs over time, I’m relieved that I have the surgery date. As my weight has gotten lower, I’ve been more tempted to return to old habits, and I think that drive to return to the set point weight is really kicking in. I’ve been able to resist falling back to old habits knowing surgery is imminent and using other tools I’ve gained since participating in this program.

Anyway just thought I’d share if this as at all helpful to someone who’s been in a similar situation to me or if anyone else has a shared March 11 date!

I haven't had surgery yet--still waiting for my date. Only my significant other knows and I plan to keep it that way. Unfortunately, the lay public still does not understand the disease of obesity. Even medical professionals don't understand. When I asked my PCP for a referral to the medical and surgical weight loss program, she was skeptical and said "what do you think this is going to do for you that you can't do for yourself?" I just don't think most people can appreciate the decision we're faced with: a) stay on a path of poor health with attendant medical complications or b) have someone cut into you and fundamentally alter your anatomy and physiology. It's not exactly like "b" is an "easy" choice but for those that don't understand, I guess it appears that way. It's funny, culturally, we don't perceive other elective surgeries as the easy way out. I can't imagine anybody passing judgment on someone who has knee replacement surgery and frankly in many ways, the more I learn about bariatric surgery, the more easily justifiable it is compared with many other surgeries.