rjan

I love this! And what a great reminder that in the long term, your eating can get back to mostly normal - just with smaller portions and some tweaks to up protein and reduce carbs.

I'm 9 months out, and I am very, very happy with where I am at. I had my surgery March 11, 2020. I've lost a total of 52 pounds since I started - 48 pounds since the surgery date. SW: 208 CW:156 GW:149 and I'm 5'5". This means I lost about 90% of my excess weight, which studies show is a very typical result for a patient like me who started out with a relatively low BMI (35). Of course I would still like to lose those last few pounds and officially make it to a normal BMI, but I am very happy with where I am now and would still consider it a resounding success if I can maintain at this weight. I am big boned, and people tell me that I look like a completely normal thin person when I am clothed. You can certainly tell I have lost a lot of weight when I am naked. Even at my heaviest, I never had big breasts or thighs, so most of my lose skin is on my arms and belly. I am very happy not to have saggy breasts. The belly skin makes it so pants that fit great when I am standing feel uncomfortable when I sit, but that's a minor annoyance. I was very strict with my diet for the first 3.5 months. At that point, I had to have another surgery and was feeling bad for quite a while, so I was not so careful and more carbs and some sugar crept into my diet. However, I continued to lose well through that time. At this stage, it feels like I am learning how to maintain, although I am still losing a pound here or there. It is true that your appetite comes back at some point, and sugar definitely increases my appetite a lot. However, I had been having really bad problems with hunger and sugar before my surgery - I was about to get diabetes, and that is basically why I got the surgery. Right now, the techniques I was using before surgery to try and keep my hunger under control actually work. I eat pretty strictly during the week, and get about half my protein from my wonderful morning protein powder latte. I still eat a lot of eggs and cottage cheese - luckily I have always like them. During weekends, I eat more freely and allow myself to have some sugar. I don't count calories anymore since month 4, but I still weigh a couple times a week. I plan to keep this routine up for the rest of my life, and I think it is very doable. I kept a detailed weight chart. I did not record every up and down - I only recorded a weight if I had lost from the previous recorded weight. For the first two months, I lost about 3-4 pounds a week. Then I had a 1 month long stall, which was really nerve wracking because it was right at my lowest adult weight, where I'd gotten stuck with weight loss before. There were lots of ups and downs during this period that are not recorded on this chart, but still freaked me out. After I finally broke through the stall, I lost at a 1.5-2 pound per week rate during months 4 and 5. Since then, I've sort of slowly slid into maintenance with a total 7 lb loss over months 6-9. Before - my 40th birthday Dec. 2019 After - Nov. 2020 After Oct. 2020 (I'm on the left) Thank you so much to BariatricPal and all the amazing posters here, especially for the long term members who provide a great outlook for how things will change as time goes on!!!!

It's so hard to give advice on specific things to say to specific family members because you know much better than anyone else what story he's likely to "buy" and how convincing you are at telling stories. Saying you are sick is certainly one way to go. But for me, since I am not that great of a liar, I find it's best to come up with a story that is actually true, but leave out certain key details. So I would say something like you are on a strict medically supervised diet. Just leave out the surgery part.

I was never sipping every 5 minutes like that, and I had no problem getting my water in. (I'm a naturally thirsty person, so I've never had trouble with drinking enough water.) For about two months after surgery, I definitely had to take much smaller swallows than normal. But I could still down a cup of water in 5-10 minutes pretty soon after surgery. I think at two weeks out, you'll be just fine with water breaks every hour or two.

Don't worry about it too much. But at that point, I was eating ~800 calories a day. Now I'm 5 months out and am eating 1000-1400 calories a day and still losing at about 1.5 lbs a week.

I had another surgery 2 weeks ago for an unrelated matter (giant lipoma removal on the upper back), which was 3.5 months after my sleeve. This surgery was shorter (1 hour), but still under general anesthesia. These were my first ever surgery experiences. Now that I've had the second one, I can tell a lot better which post-op issues were related to the bariatric aspect of the surgery and which were just general surgery things. I was exhausted for 4-5 days after both surgeries. I'm thinking that's just my response to general anesthesia. But with the WLS, some fatigue lingered for a couple months. My throat hurt like hell after both surgeries. After the WLS, I was more focused on the fact that mouth and throat were so dry because my surgeon didn't let me have any fluids by mouth for 2 days and the gross taste in my mouth from that leak test fluid they use during the surgery. After this surgery, since it hurt just as much, I realize that was probably mostly from being intubated. For both surgeries, my incisions didn't really hurt that much. With the WLS, I was thinking that was just because I was having so much pain from the gas and anytime I drank anything that it was just distracting me from any incision pain. But this time, still not all that much pain - like a 2-3 on the pain scale, even though the incision was huge this time - over a foot long. I find that really surprising - why doesn't it hurt more where they cut into you?!? One thing that was different is that for the WLS, it didn't hurt that much when they removed the drain about 2 days after surgery - just felt really funny. This time, it hurt like hell when they removed the drain at 9 days. In fact, it was the worst pain I had during the whole experience. It was a 6-7 on the pain scale and lingered for a few days. Maybe it was worse because the drain was in for longer? I'm curious how other people found their weight loss surgery vs. other types of surgery? Definitely curious to hear from people who got plastics, since these come with big incisions too. How was your pain and recovery time compared to your WLS?

Thanks for the useful story! I feel like it makes sense that the abdomen and lower back area would be a particularly painful place to have surgery. There's basically no way to move, sit, or lay without putting pressure on those areas and/or using the muscles in the vicinity. The lipo/tightening does sound like it would make things worse too, just because basically they are messing with every type of tissue in the area. Ow. How long did it take before the pain was gone entirely? How long were you wearing binders? How long did the incisions look scary?

I told my immediate family and a few friends. My mom went with me. She was mostly worried about a) a surgery and b) having it in Mexico. My sister-in-law is an endocrinologist. When my mom asked her opinion, she said I was actually a great candidate for WLS since I was probably going to get diabetes soon, but didn't have it yet, and it would probably end up adding years to my life for a relatively low risk for a surgery that's been pretty developed and standardized. Then my mom felt pretty OK about the surgery. She felt a lot better about doing it Mexico after we got there and she saw how nice the hospital was. I haven't told most other people. But after I lose the weight, I expect I'll tell anyone who asks the truth. I'm not one to advertise my business, but I'm not good at hiding things either. And I feel like I wish someone would have told me about the huge health benefits in reducing long term mortality for diabetes and cancer, not to mention the fact that it works 20 times better than dieting, and then I might have gotten it sooner. So I'd rather share the news with anyone who might find it helpful, and just deal with the a-holes. But not until after. I don't need the extra anxiety of people's expectations when I'm losing.

I had surgery 4 months ago. It was my first surgery ever too. Surgery is scary! But it's turned out great so far. Hopefully it will for you too.

I think you look pretty cute in both pictures. But I'm sure you're feeling great now, too.

I wouldn't rely on a random FB post for your dietary guidelines since they vary widely by surgeon. What does your surgeon say? I love pickles, and I was eating them at 1 month out - I just chopped them up and chewed carefully. My surgeon had no restrictions after 1 month besides carbonated soda.

Sorry for not wording it better - I know the post-op diets are the same. I just meant that bypassers are more likely to end up with certain dietary restrictions if they are one of the unlucky dumpers.

This clinic reports their results for different BMI ranges on their website; results are shown all the way up to 5 years out. https://mercybariatrics.com.au/obesity-surgery-2/bariatrics-at-the-edge/low-bmi-patient/

Studies do show you are over 10 times more likely to have dumping syndrome with bypass than sleeve, although it's still fairly infrequent for both. In LSG group (Group A), only 4 patients (1.49%) reported episodes of DS at M1 and 3 (1.12%) at M6. In Group B (LRYGB with mechanical gastrojejunoanal anastomosis), 41 patients (17.90%) reported episodes of DS at M1 and 43 (18.78%) at M6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4875983/

Studies do show significant differences in nutritional deficiencies in sleeve vs. bypass. The incidence of ND at 1 year postoperatively was generally less after SG than RYGB (34% versus 37% for zinc; 18% versus 28% for iron; 4% versus 8% for albumin; 32% versus 52% for vitamin D; and 18% versus 58% for vitamin B12) except for folate deficiency which was higher after SG than RYGB (22% versus 12%). https://www.emjreviews.com/gastroenterology/article/nutritional-deficiency-after-sleeve-gastrectomy-a-comprehensive-literature-review/

I am a 40 yr old female, starting BMI 35, and I had the sleeve 4 months ago. I didn't have diabetes yet. But I was clearly on the fast track to get there in a few years. (I also had really bad fatty liver and high triglycerides since my early 20s.) My dad got diabetes at about the age I am now, and he's absolutely miserable now in his mid 60's. I was on metformin, I was hungry all the time even after eating, and my fasting blood sugar had been in the pre-diabetic range for 4 years and was continuing to inch up. Preventing diabetes was the MAIN reason I went ahead with the surgery. Looking better is nice and all, but I take surgery pretty darn seriously and would have never done it just to lose weight. Back in January, I read some articles about how bariatric surgery cures diabetes about 80% of the time. (It also causes similar significant reductions in long term mortality from other conditions like cancer.) 2 months later I went under the knife. I did self-pay in Mexico - you may also have to do self-pay since your BMI is low. Surgery certainly comes with risks, so don't let anyone make your decision for you (surgeons always think people should have surgery. 😂) But if I had it to do over again, I would have gotten the surgery about 5 years ago if I had known these facts sooner. Diabetes is a chronic, progressive disease. Even if it's relatively controlled (or even if you're not actually diabetic yet), the fact that your blood sugar and insulin is elevated compared to a normal person is causing damage to your body every single day. The sooner you treat it, the longer you're likely live and the healthier you're going to be while you're alive. My mom was pretty worried when I told her this plan, especially since I did it in Mexico. But after she talked to my sister-in-law, who is an endocrinologist, my mom felt a lot better. My sister-in-law tends to be the cautious type, but even she told my mom that I was the perfect patient for bariatric surgery, and that earlier was better than later for my long-term health. I googled around, but couldn't find any specific information about OCD and bariatric surgery. In general, obese people tend to have more psychiatric conditions than the average population, and on average, psychiatric conditions tend to improve a bit after surgery. However, surgery does about double the suicide rate. People also can struggle with their self image changing and things like that. I'd be sure to talk to your psychiatrist/therapist before and often about this, but I wouldn't necessarily let that hold you back. As far as the eating with clients issues, I think those are manageable long term. Especially if you go with the sleeve over a bypass type surgery, what you can eat won't change too much long term - you'll just eat less. At 4 months out, I'm having steak for dinner and enjoying the heck out of them - just 4 oz instead of 12. Men are less likely to get intrusive comments about their diet and body than women, so hopefully it won't matter much in the long term. You'll want to figure out how you'll deal with it in the first few months though, while your diet is still pretty restricted, and you might be dealing with pain or nausea when you eat. You could certainly tell people you recently had some other type of gastric surgery during this time. In fact, they often repair a hiatial hernia at the same time they do a sleeve, so it wouldn't even be a lie. Gallblader removal is also a common procedure that comes with dietary changes.

I started with a BMI of 35 and had the sleeve 4 months ago. Unless the patient has GERD, I'd tend to lean towards suggesting a sleeve for a fellow low BMI patient. Low BMI patients tend to have the the best results - on average they lose 80% of their excess weight, compared to 60% for the higher BMI patients, and many reach a normal weight. There's only ~5% difference in weight loss between the sleeve and bypass type surgeries, but bypass surgeries are more likely to lead to certain types of vitamin deficiencies in the long term. A high BMI patient might want that little extra kick of a malabsorptive procedure, while a low BMI patient is likely to not need it, so why take the extra risk?

I haven't heard about any differences in regain depending on where you do it. If anything matters to regain, it's probably the surgeon, not the location. But I think genetic differences and how well you stick to the diet are even more important than the surgeon. I had my surgery in Mexico - Dr. Cordova at Hospital Angeles. I have absolutely no regrets about it. In fact, it was one of my best medical experiences in terms of how I was treated by the staff. I feel like they were really attentive and took good care of me. As long as you do your homework and choose a super experienced surgeon, why not save a few K?

Now that's definitely true. I remember a post a few months back from some poor guy struggling with losing too much weight after a bypass, which is definitely a real thing that sometimes happens. The first people here who responded to him were "nice" enough to believe him, and he was so grateful that a few people were taking him seriously and not accusing him of lying or looking for an excuse to cheat on his diet or trying to sabotage others. I felt so bad for him. It was kind of like the rescue dog I had in my 20s, who always seemed to look at you like "thank you for not beating me." Opinionated arrogant a-holes are everywhere though, unfortunately. Some of the comments on that Roxane Gay article were from people in the fat acceptance movement who seem to view anyone who gets WLS as a traitor. That ain't healthy either.

Maybe that's what her nutritionist was thinking - but that seems really uninformed to me. I would think that reading forums makes you more likely to go forward with surgery, and less likely to develop bad habits. Like you say - reading the forums shows you are engaged with the process. The people on the forums are more likely to be the successful, committed ones that are most inspiring. The people who are eating badly and regaining are not writing posts about it. I've sure never seen anyone around here saying "it's fine, eat all the ice cream you want" or whatever. 😂 She does still seem frustrated with her body, and I felt sad for her about that. The issues she describes are definitely real, but also totally normal stuff that people here talk about all the time. It seems like she'd at least feel less alone to talk with her peers.

Thanks for the link! I heard her on This American Life talking about fat acceptance, and it's really interesting to read her WLS experience. I thought this was crazy: "A nutritionist cautioned us not to visit online forums about bariatric surgery, and I heeded her advice" What kind of frigging advice is this? I understand doctors don't like patients to hear competing medical advice. But this is also a terribly emotional process, and the medical staff often don't understand those issues if they haven't been through them. So many of the issues she talks about are things people here talk about. I feel like Roxane wouldn't have to feel so bad and confused about how the surgery has changed her life if she had the chance to talk more with others going through the same things.

That color looks great on you!

They do vary a lot by surgeon, but they don't seem to change much between a sleeve or a bypass. My surgeon's plan was very restrictive at the beginning - no fluids by mouth except ice chips until they did a leak check about 38 hours after surgery. Then I was on clear fluids for a week, and full fluids for another week. In contrast, other people say they were offered fluids right after surgery, were on full fluids when released, and moved to purees after only a week. On the other hand, my surgeon's plan had me on normal food after a month with no long term restrictions other than carbonated soda (which they ban forever). Other plans may take 2-3 months to get you to mostly normal food, and tell you to wait even longer for certain things, like 3-6 months for raw veggies or 1 year for caffeine. Here's a representative diet plan with a really detailed list of foods for each stage. https://www.tuftsmedicalcenter.org/~/media/Brochures/TuftsMC/Patient Care Services/Departments and Services/Weight and Wellness Center/GBP Diet Manual12611.ashx

Yeah, it's kind of hard to tell since most people never get the chance to compare how the different surgeries feel. For people who get revisions, the fact that they had a 2nd surgery may make how they feel different than someone who just had 1 bypass surgery originally. More scar tissue, less elasticity, lots of things could depend on how many surgeries you've had. Physically, though, sleevers still have their pyloric sphincter working to control when the stomach empties into the intestines, while for bypassers the rate of stomach emptying depends mainly on the size of the bypass outlet. So it at least makes sense that you'd feel full longer with a sleeve. Google found this surgeon who offers a version of DS that preserves the pyloric sphincter. They say they do it to prevent long term regain in bypass patients whose stomach can empty too fast if the outlet gets bigger over time. https://nwhsurgicalweightloss.org/learn-about-your-condition-and-treatment/pyloric-preservation

Yeah, I don't think the surgeries differ much in terms of average weight loss. Otherwise most people would probably just choose the one that works best. (Probably one reason why no one likes the lap band anymore - it definitely doesn't work as well.) Since you said you're a grazer, perhaps you'd prefer a bypass or DS. With the sleeve, you feel much more of a restriction - I feel absolutely stuffed for an hour or two or three after a meal that would have been an appetizer before. It's that drastic reduction in the amount you can eat that does the work with a sleeve. In contrast, I've read comments from people who revise from a sleeve to a bypass, and they often say that they feel less restriction afterwards than they did with the sleeve. With the bypass, things slide through your system faster so you don't feel full for long, but you absorb less calories. I like the restriction, and I feel like it works really, really well for me. But I've never been a snacker - I like my 2-3 meals and that's it. I think people who like to eat often can make up for the reduced volume by increasing meal frequency if they try. I didn't really know that when I was deciding though. I decided on the sleeve because I prefer a less invasive procedure (all other things being equal), and didn't want to have to worry about malsorbtion, and I didn't have much of a reflux problem.