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I also take prescription NSAIDS due to significant back issues, so I initially thought I could not go with bypass. However due to the risk of GERD (symptomatic and verified by endoscopy), my doctor did not recommend sleeve. The resolution was to go ahead with the bypass. With my doctor's blessing, I have continued to take the NSAIDS and have been successful because she also prescribed a Proton Pump Inhibitor for me. If you have any history of GERD, it would be best to at the very least have an endoscopy done to make sure you are still a good candidate for the sleeve. I don't know what the overall revision statistics are, but there sure are a lot of folks on here that initially had sleeve and had to get a revision to bypass. Some of those were due to poor results, but a lot seem to have been due to GERD.

I am...now. I had a sleeve in 2022 and had SO many complications and I was miserable. I had a revision to bypass in 2023 and honestly, it's been amazing. I 100% love that I had the revision. I recommend the bypass to everyone. It literally solved all my issues. And I'm so thankful that I got my life back. I take meds for severe anxiety, for MS, and for lupus. The only real issue with meds are extended release with the bypass. But if you can find a way around that then you'll be fine.

I appreciate all the advice and kind words of encouragement. I bounce between the scary feelings I have about eating and being excited to lose weight and be a healthier me to enjoy life with my family as much and as long as I can. I was and am just a little overwhelmed because I initially went to my surgeon about the hernia repair. He informed me of this sleeve-to-bypass revision that would be in my best interest which I was not expecting. Hence, this isn't so much of a weight loss journey for me as it is a quality of life journey, With that being said it brought me back to confronting my unhealthy relationship with food and took me back to a time after my sleeve in 2009 where the smell of food would take me into an anxiety-riddled panic attack. All the byproduct of not taking the appropriate steps in getting my mind right before the procedure since I went to another country for my initial procedure. The hernia repair to me has now taken a back seat to the lifestyle changes needed to move forward with the bypass and everything that entails. This time I hope to do it a little better and taking the appropriate steps to making my lifestyle change more healthily. It's still very early in my journey. I don't have a date yet. Tomorrow is my initial consultation with the registered dietician and nutritional counselor and hopefully I will feel comfortable discussing my fears of failure. Again thank you for the advice I am truly humbled.

Well there is never a 100% guarantee because we are all different but I would say that your response so far makes it very likely that you will be a success story based on my personal experience and the knowledge that I have of others experience who have lost and kept it off vs those who have regained a significant amount. I had my sleeve surgery 3/9/2021 so I have been on these boards since then and I have been going to in person support groups since a couple of months prior to my revision and my personal experience and learned experience is that one of two four things happen to cause regain. 1: the person never really does change what they eat. This is a problem when the anatomical changes control portion of less nutritious foods for a while so they lose some but then as the stomach stretches they can eat more and they regain or they are able to have just a taste of things in the beginning but when appetite comes back that changes (note that some people can have just one bite of a brownie forever but that didn’t work for me so we just have to be mindful of how our body reacts and stop doing it if we can’t stop ourselves at a small portion). 2: the surgery was never a good fit. I know that this was part of problem with the sleeve for me because I never did feel ANY metabolic changes. I still absolutely hated healthy foods that I didn’t like before and I did not have any additional energy or motivation after the surgery. Basically I think for me the surgery was probably like Wegovy would be. The hunger hormones went away for a while and I was able to eat less until that came back. But nothing else changed for me. I never felt a change in energy and I was never about to get start r with exercise and healthy food options did not appeal to me in the slightest. I ate alot of chicken breast and a few veggies that I don’t mind in the beginning but there was no variety so like most diets I couldn’t sustain it when the hunger came back and I wasn’t moving my body to help my physical and mental health to keep it going. 3: This would be a combo of the two which would be where i would actually say that I fell with my sleeve. Because I didn’t like enough of the healthy food even a little bit I started having less ideal foods far more often. I mean i wasn’t eating McDonald’s ever and I wasn’t having poor choices all the time but I would have like a quarter of a frozen pizza or a lean cheeseburger with a roll several nights a week thinking it was okay because calorie wise it wasn’t much worse if that was all ate. The problem was the other macros and the fact that for me they were slippery slope foods and they made me crave more. I wasn’t gaining on that but carbs make me crave carbs so that little devil voice took over and I tested the waters a bit more by having just a few fries or a bit of cake with that but it was way too often and far too early out for me to know my limits. Then, to make matters worse, my mental health issues kicked in where I had not only stopped losing but gained 20 pounds and when I couldn’t reverse it even when I tried my hardest to rein it in (because I was now craving the carbs again bad) i just considered that I was a complete failure and they didn’t say it but i could see it that my friends and family felt that way too and I just slowly just quit trying. This is when the support of people who get it would’ve been sooooooooooo very important. Never been obese people are never going to be able to get it or be able to help. Reach out to your bariatric support if you struggle. Even if your disgusted. They get it and never judge. 4: Some people even though the surgery is a success and they make all the lifestyle changes and everything is working lose sight of their lifelong goal for one reason or another and let bad habits slowly slip back in and they gain. I think this is probate going to be the hardest one for me. To not take my eye off the prize 5 years down the road. But we can do it. I think that staying active in these support groups and checking in with my team is going to be key for me. I am going to ask to have my follow ups a couple times a year even when I’m a ways out just to keep me in check. I know that I am able to gain a lot of weight in a year!! I never did the In person support groups at all after my sleeve and I stopped posting here for a while and didn’t go to my follow up appointments when things were out of control and I needed the help the most. Basically for me the sleeve was just one of my longer and more successful diets that started with the curved appetite and a lot of hope that it would work this time but slowly ended when the hunger came back, bad habits slipped back in, the cravings got unbearable and my all or nothing thinking finally got the best of me. I think I probably would have leveled out somewhere between my starting and my low weight if I had not given up but since I started at a relatively low BMI to begin with that did not seem like a success to me at the time. 89 pounds later I only wished I had been back to that weight though. I learned a lot from the sleeve experience though and I think that knowledge is helping me now. Hopefully, it helps others too. I try to let my experience be a cautionary tale without scaring anyone too much. Anyways, based on your nutrition changes, steady loss and your activity I do not think you are like me with the sleeve or others who I’ve seen who never even tried to eat differently or exercise so I don’t think your surgery was a bad fit at all or that your just expecting the surgery to do all the work. I think that your surgery is doing what it was designed to do for you and so as long as you keep doing your part you should get your where your body needs to be. Just don’t get caught up in a certain number and let your brain get the best of you like I did. That last 10 or 15 pounds may feel like a lot but your already so much healthier and happier that you were before. Keep striving for that goal but don’t let it be the only thing that matters. To me it will be icing on the cake to what is already a success story Your body will have its own idea of what is an ideal size for you and you may have to just accept that it may not be exactly what you have in mind (it could be lower but it could also be a bit higher. It may be a sorry to accept where your body is happy and healthy if you don’t want to be really working hard at this forever. Honestly, I imagine we will have to work at it for the rest of our lives to some degree. By that I mean that we will probably never have it as easy as someone who has never been obese. You are doing so incredibly well, though, making actual lifestyle changes and I have listened to anyone who is willing to share whether they were successful or not and that seems to be the biggest piece of advice. This is not a diet it is a lifestyle. Your surgery is working for you and you are working hard for you as well. Those two things are key to this journey long term. Just keep it up and I really believe you will reach all of your goals. ❤️

Congratulations on your loss. I was a savory girl Lee bariatric world and post sleeve I became a sweet girl too. Then post SAFI that went away but has started to come back. I think MAYBE it’s just our bodies wanting carbs and sweet food is usually the absolute highest in carbs so the quickest way to get them. I did not have the bypass but I don’t think your friend is correct about eating whatever you want. I know that was for sure not true for the me with the sleeve. I started at 235, lost down to 168 then gained it all back plus some to 258 and was still gaining when I started the preop diet for my revision. I have also heard plenty of regain stories on here about the bypass. Now, does it malabsorb some of your food, absolutely. So if you were like 900 pounds before it’s possible you would stay a bit smaller just because you pretty much already ate all you wanted volume and calories wise before and the malabsorption would in theory make you weight a bit less if you ate the same exact food, but it would only be a bit less anyways and who of us wants that. . As far as a more common starting weight I really don’t think so because even at our high weights we still weren’t eating absolutely all we would have liked to or we could have and if we ate any and everything we wanted, even with some calories not absorbing that’s still probably giving our bodies more than we were eating before. I do know from experience that what fuel I put into my body changed how I feel, though, so even if I could get away with eating anything I wanted cosmetically, I know that I wouldn’t feel as good as I do when I eat a balanced diet and keep up my activity. That processed junk that most of us used to eat all the time is not good for us and it doesn’t give your bodies what it needs to run efficiently. Another thing to keep in mind is that we are still pretty early out to be relaxing too much. Most people have a 10–15 pound bounce back even if they keep working at it. I don’t know about you but I’ve still got more that I want to lost. I definitely don’t want to be bouncing back!! for the sweet cravings try the sugar free popsicles again. They can trick my brain sometimes and others i Have fruit. I figure calorie wise they may be more calories but at least it’s not added sugar. I try to avoid that as much as possible because that makes me have more cravings the next day and for like a week.

Hi all, New here names Kat. 46 years old. In 2009 I had a gastric sleeve and hiatal hernia repair in Colombia. In 2020 I had horrible GERD and had another hernia repair as my stomach was in my chest cavity behind my heart at that time. I was doing ok until last week. I work in an animal hospital and I assisted in lifting a 90lb dog that fell off a table during a surgical prep and instantly felt I had injured myself when I lifted this dog. The next day I went to the ER and was told I had a large hiatal hernia which incorporated my entire stomach as well as part of my large intestine and my liver was also coming up through my diaphragm. I consulted with the surgeon that did my repair in 2020 and he is recommending a sleeve to bypass revision as he does not want to risk my sleeve slipping and the hernia recurring because going in for a 4th abdominal surgery isn't ideal and becomes quite difficult as scar tissue accumulates with every repair. Needless to say I am terrified. Having done my original procedure in another country I did not follow America protocol when it came to the appropriate mental health to go along with a bariatric procedure. I have never had a healthy relationship with food and have continued with a poor diet throughout the years. My fears are not so much surrounding the procedure more so the lifestyle change that must be made post surgery. The liquid diet pre and post surgery, the portion control, the protein and water intake that's require the regiment of vitamins and supplements needed to stay alive. Over the years I've never even been good with taking a daily multi vitamin. I'm not really sure what Im looking for by posting this thread as I'm sure I will get plenty of negative comments about just having to do what I'm told but was hoping that someone anyone can relate to the anxiety I am feeling about not being successful in what needs to be done. I know I WANT to do the right thing. I know I want to see my 9 and 12 year old grow up. I know I don't want to leave my husband heartbroken and alone. I know that even if I suck at doing the right thing for myself I need to do the right thing by my family. Im just freaking out a little. I just dropped of the CT scan cd to my surgeon yesterday and am waiting to hear back from him this coming week about talking to a bariatric dietician and discuss a date when this is all going to happen. Looking for any insite and honestly from people with similar fears sticking to post op care and life long lifestyle changes. Thanks in advance and please be kind.

I agree with the previous poster also keep in mind that it may be an option to just get IV fluids outpatient. I didn’t need them after my safety because they didn’t operate on my stomach. I was a revision but after my sleeve I did and it was just like an office co-pay basically for me to get my fluids. It was that in the hospital, but in the different part of the hospital and you just sit in a recliner and get your bag of fluid and then leave.

I had a sleeve in 2022 and had a revision to bypass in 2023 due to complications. I had little to no pain, I was up and moving around with ease, I've really had a great experience. And I've lost quite a bit of weight with the revision, even though that wasn't why I got the surgery to begin with. I have ZERO regrets.

You ready for a long story? 😎 My exercise history is definitely one of extremes. I was very athletic in High School (Secondary School). I played football (American), was on the swim team, and ran track and cross country (not all of those every year). Afterward I spent time in the US Army where running was the norm, so I ran quite a bit. My recollection is that I was running roughly 30 miles a week at that time, so actually a lot more than the minimum required. Unfortunately I was badly injured while I was in the service and was barely able to even walk for a long, long time. Once I mostly recovered from that, I got heavily into powerlifting for almost a decade. I had convinced myself that due to bad knees I shouldn't run anymore, so instead i just focused on the strength training as well as a tiny bit of cardio on the elliptical. Unfortunately, I tore up my back in a workplace accident, so from that point on, no more heavy lifting for me. This was really the beginning of my descent into inactivity and severe weight gain. The heavier I got, the less I was able to even move, until using a cane or walker had become the norm. In addition, during this time I ended up having multiple surgeries, including 5 different shoulder surgeries, multiple knee surgeries culminating in a total knee replacement, and even open heart surgery for a bad heart valve. Fast forward a lot and about 9 months after my bypass surgery, I was walking and backpacking pretty consistently. A bit like you, I decided mostly on a on a whim to just try jogging a bit. It was more to see if I could even do it than anything else. You have to understand with my health history, lots of my doctors would say I shouldn't run. I say I'm going to do whatever I need to do to keep myself healthy because I suspect at some point, I'll need both a revision to the knee replacement and a new heart valve. My ability to survive those surgeries at an advanced age is going to be highly dependent on my overall health. Anyway, back to running. I was so shocked at how well and relatively pain-free the running went, that I decided to start training for a 5k. From there it's just snowballed and I've now done around 20 or so different races between 5ks, 10ks and Half Marathons. I'm not super fast (I am 60 afterall), but I am still pretty competitive in my local races, at least for my age. I'm also lucky that I'm now retired. This means I have the time to train appropriately. I typically run 4 to 5 days a week and average between 25 and 35 miles a week. I'll probably ramp that up in 2025 because I'm targeting a fall marathon and I'd like to be around 50-60 miles a week at peak fitness before the race. At this point running is my passion, but I do still strength train twice a week to keep what strength I do still have. As an aside, I'm strongly considering becoming a Certified Personal Trainer. Not really because I needed the knowledge, or because I expect to work in the industry (I am happily retired after all). My real goal is to help others where I can on their journey to fitness. I feel I can better relate to those that are struggling than a lot of CPTs that have always been fit. I also at least want those I work with to know I do have some knowledge of the subject (even though I've frankly probably forgotten more about training than a lot of CPTs even know). I'm really glad you're going to keep after it. You might surprise yourself in terms of what your capable of!

You sound like me. I was lapband to RNY revision. 5 weeks out. Not a single issue. I can eat and drink anything I try. Scale is moving and I am not hungry.

@ShoppGirl I am being a good patient, and its hard! There are times when I'm thinking a lower body workout wouldn't hurt but like you said I do not want to pay for a revision so I wear my post op bra 23/7 only off when I shower. I don't bounce, workout, and lift anything over 10lbs. I will say that I have tried on all the things without the bra and man it can't come soon enough to taking these girls out for a stroll LOL I am trying to give myself leniency but its so hard! I am staying on track for the most part, I cut my calories down by a lot since I am not working out and it seems to be going well.

I was sleeved in 2016. Lost weight, but no where near goal. Gained it all back. I just had a revision to a bypass this week (Jan 13). Things are going fine, almost too fine. Minimal discomfort, I have no problem keeping fluids or protein down. I am eating about 600 calories per day with 80 grams of protein. I’m not hungry. (I am on a 3 week liquid diet post op at the moment.) I also haven’t lost any weight. Does this sound normal?

Having recently had biopsies in my breasts and they tried to use bandages to create compression I am very aware of just how much our boobs juggle when we walk so I totally get why this could create an issue in your situation. You do not want to have to pay for a revision surgery so just do what your told. If your like I was with my implants, you will want to take them girls out for a stroll just as soon and as often as you can once your cleared to do so safely so I am not worried that your going to fall back into old habits. Give yourself a little leniency for the short time it takes to get back to your routine. I’m certain that your new look will be all the motivation you need to get back out the door and right back on track.

OK, so post surgery I have a scar under my belly button that was hard, but the nurse practitioner said it was just because my surgery was a revision and they use that same spot twice. Well now the scar part feels loose, but if I put my finger inside my belly button, I can still feel something hard underneath there. My husband had me feel his and it’s hard too but different. He says that’s just how my belly button feels without all the blubber on top of it, but I don’t know. I don’t remember ever feeling that when I was thin. Has anyone had an umbilical hernia? Is that something that could be caused by the surgery? Am I describing anything close to that? 😂 I plan to ask the surgeon eventually. Actually, I’m doing the bowel prep for a colonoscopy right now and endoscopy for something unrelated but I thought I would ask her tomorrow if she has any idea. I’m just curious what others have to say about their experience. It doesn’t hurt or anything and if it’s a hernia, I am assuming it’s very small but I just really don’t recall anything hard of being there. Maybe it’s just because it’s been a while since I could really feel it. 🤷‍♀️

I was on tricare for a short time years ago but didn’t have it for my bariatric surgeries. But after dealing with the revision process with any insurance I I learned that them covering it for GERD would be far more likely than just for weight regain. GERD it would be repairing a complication or side effect of surgery instead of just doing another bariatric surgery. They consider that more of a medical necessity If that makes any sense.

That’s awesome. I have been very pleased with my revision to SADI. My surgeon didn’t mention the intestine length thing but he did have me do the barium swallow, an endoscopy and a gastric emptying study before saying that the SADI would be an option as well as the bypass and it was up to me which I wanted to do. There are pros and cons to the SADI revision. statistically (which by definition means there are outliers that are more or less) but the majority of people lose faster and the loss is more durable which got my attention but the possibility of bathroom issues is significant (fortunately I didn’t have this at all until I recently started chemo but I don’t think it has anything to do with the surgery). One con though of SADI is that many doctors have never heard of it. From my family Dr, to the urgent care, ER physicians, gyno, radiologies, breast surgeon, etc. Even the gastro dr who will be doing an endoscopy and colonoscopy on me Monday has never heard of the SADI but my bariatric doctor said he will explain my anatomy to her and it will be fine. I always tell them it’s a modified version of the Duodenal Switch with one anastomosis instead of two and if they still look confused I tell them it’s not exactly but kinda like a bypass and a sleeve combined. But obviously I need the person putting a camera in there to understand better than that. I think you will be very pleased with your results from either one but another thing to consider is if you have a complication or need revision to the SADI how many doctors are able to operate on you. My surgeon told me that if I had a complication he would stabilize me but he would send me to a nearby hospital if I needed any type of revision. I appreciated that he was willing to admit his limits and I was okay with that but I guess it is a risk you may want to ask about. Your surgeon may very well have done lots of these but mine had not. Also, not a lot of doctors will do a revision to the SADI just because of regain. You would be more likely to find someone to revise a bypass. Not that we are hoping to need a third surgery but obesity is complex and a lifelong struggle so it’s something to think about. I wish you the best of luck. And hope to hear about your surgery date soon.

Thank you so much for your response. It’s perfect timing that I saw this as I just left the Bariatric surgeon’s office. My experience with GLP-1s was quite discouraging. I was just about ready to give up trying to lose the weight I regained. However, my appointment with the Bariatric surgeon was quite encouraging. He agrees that I qualify for a revision surgery. He laid out the revision surgery options: Bypass, SADI-S or SIPS. Apparently the final revision surgery method will be determined during the surgery when he is able to assess my intestine length for the bypass/malabsorption effect. So for now, I’m going to focus on completing the program steps (Barium swallow, Psych appointment, Nutrition appt, support group, etc) so they can submit the PA for revision surgery. So I’m going to focus on completing the insurance requirements

Great idea to speak with your bariatric doctor but discuss the Wegovy with them as well. I have not discussed Wegovy with the bariatric surgeon post surgery but I mentioned it to the PA as a possibility if I am to gain during my cancer treatment over this year if that would be an option and he say it may. I mean he could have assumed that I just meant any GLP-1 and assumed either would do but he didn’t say that Wegovy was not okay for me and I had sleeve prior to my revision to SADI and my surgeon leaves the sleeve as is and does the bypass portion to make up the modified duodenal switch surgery (SADI). Also, post sleeve but pre SADI, I discussed GLP-1 as an option for regain and he said it was a serious contender in terms of what he thought would work for me but the insurance coverage was the issue. I went with the revision and it’s been night and day In terms of the surgery being a better fit for me so I’m not trying to deter you, but maybe the redo was all I needed because I wasn’t mentally ready with the sleeve. I guess I honestly can’t say 100% for certain. Either way, don’t give up. The bariatric doctors won’t give up on you either, together you will find what works for you. Consider what your coverage is and what the cost will be long term though and whether your team will keep prescribing it as a maintenance thing or what happens when you get to goal too because there are pros and cons with both. I mean Wegovy is not surgery and that’s a pro anytime you can avoid surgery but the cost, long term side effects of the shot and regain stats are all things that I would be asking about.

This is my current situation except I’ve been on Wegovy for only 3 months. I haven’t lost any weight. The food noise is there and I don’t feel I’m eating less. I tried to get Zepbound (my insurance will cover it) but I haven’t been able to find a doctor who will prescribe it (because of my previous VSG surgery). I’m planning to meet with a Bariatric surgeon this week to discuss a possible revision surgery.

I had a revision to SADI on 8/7/2024. Lost 70 pounds but then I started chemo for breast cancer that I was diagnosed with a day shy of my 3 month surgiversary. I was told not to lose quite as fast by the oncologist and the oncology dietician so I have since only lost ten more in 2.5 months. Anyways, my double mastectomy is tentatively scheduled for 5/8/2024. During that surgery they remove all the breast tissue and put in Empty bladders they call expanders and then they slowly fill them each week with saline in the office to stretch the skin making room for the implant. The cosmetic dr says that I could take my time and try out all the sizes and go up and down and then do the reconstruction surgery to put in the saline implant when I’m sure of the size I want and I loved that idea because I want to go smaller but I know it’s going to take a while for my brain to get used to it. The problem is that I have to begin radiation 6 weeks post surgery and the process does something to your skin that makes it very hard to stretch so the radiation Dr says I need to decide on a size before I start radiation treatments. Well I don't think it would be a good idea to postpone radiation just to decide on a breast size so I kinda need to know what my goal is right away so he fills it fast enough for me to get there within 6 weeks. At the same time it will hurt worse the faster we go. I am currently a 36 G. I was thinking maybe a 36 C or D would be small enough that they don’t get in the way with exercise and hurt my back and neck but not look too small after seeing myself larger for so many years. Also if I drop more weight and get to say a 34 I would be a D or DD but what if I lose more weight I mean I want to keep going if I can and then I’m a 32 DDD. I was a 32 C when I was younger and I think when I got my implants I went to a small DD but I sorta doubt i will get that small again, honestly. how much weight did you guys lose between band sizes. I was thinking that if I get to 158 I would be thrilled and that’s only 20 more pounds so I know that I won’t get to a 32 at that size. Do you think it’s possible I will get back to the 120’s. I know the last two months threw my pattern off a bit but I was losing steady at 3-4 pounds a week before all of this. Is there anyone with similar stats that can tell me about their experience with SADI or maybe a virgin bypass. My loss trend was similar to that according to the NP at 3 months out. I really wish I could do this after I get to my low weight and stabilize. All I want is to be able to buy bras in a normal store and not have to pay a fortune for lunch lady bras anymore or have my back breaking and poor posture from a too large chest. But at the same time I don’t want to look too small. I figure that I would find the smallest size that I could get used to so when I lose more weight it will probably be perfect but I won’t have time to get used to it like the surgeon and I hoped. 😢 So I get that cup size is a matter of preference but can anyone with similar stats tell me how much they ultimately lost if they were losing 3-4 pounds at 3 months or how much weight they lost between band sizes or 36-34 and 34-32. Or anything else that may help me. I’m so scared I’m gonna decide on a size and my body is going to change but since it’s all implant after this surgery my boobs won’t change with me with loss or gain and I will be way too big or small for my frame.

Well post sleeve alcohol has absolutely no effect on me. I figured it’s a waste of Callie’s and money and stopped drinking. Post revision I figured why try it now that I’m used to not having it

Hello everyone! I kind of disappeared during the holidays but came back by to poke my head in and see how others were doing. Seems like most of us are plugging away at this 'getting healthier' thing. Reminder (and FYI for any who read this and didn't know) I got the SADI surgery, which is the intestinal revision with the sleeve all in one go initially. This makes me feel extra obligated to update for some reason - maybe because I had to dive so far into my journey to find this option and how eager I was to hear about the results from others. So - my surgery was Sept 5th, and I lost 10 lbs in my pre-surgery liquid diet, which I had for one full week. On the day of surgery I was 352 and now, about four months out, I've lost right at about 70lbs. The weight loss has slowed a bit as I found my balance but I'm still losing 1-3lbs per week on average, about 7 lbs lost in the last 30 days. I got through my weight loss stalls by eating more, as I was only getting around 500 calories per day for a while as I maintained ketosis, with VERY few carbs. That was nice, but my energy was lacking. I shifted to included more fruits, veggies, and upped my protein from 60g per day to more like 75g. Now I get around 900-1200 calories per day, try to really focus on getting my water for the day, and angle for simple protein snacks with a small carb total when I get hungry. I have found cottage cheese to be a life saver as a replacement 'side' - and stirring it into my salads gives the salad more bulk and makes it easier for me to feel full. Eggs are not quite as weird for me as they were for a while - I still prefer boiled eggs over scrambled or fried. I do aim to get at least 5k steps per day and usually make that goal.I definitely slacked on exercise around the holidays and did snack more than a few times on things I shouldn't have. I feel lucky that my intestinal malabsorption keeps me accountable for poor choices. I have gotten the foamies once - and have overeaten like three times by a few too many bites. I feel like my relationship with food is much healthier and am far more likely to cook now as opposed to grabbing greasy garbage food. However your path feels like it's going - this is a great time to correct the course if it feels a bit off track. Your bodies are working for you, and you are working for those bodies! Kudos to all of us for taking these steps to a healthier lifestyle! Remember, too, that no one day of slipping up is going to sink you. As I said to my perfectionist son the other day - an A in school is 90%-100% (generally, anyhow!) so it's still an A even if you slip up one out of ten times ❤️✨

Surgeons will have their preferences based upon their experience and background. When I had my VSG around 14 years ago, the sleeve was fairly new, but most surgeons included it in their practice, though most were not that experienced with it yet (and it often showed in the outcomes, with quite a few rapid revisions needed.) I travelled to SF to have my sleeve done as there wasn't anyone in the LA area where we lived that was very experience with them, but there were several good BPD/DS surgeons in the Bay area, and as the DS uses the sleeve as its basis, those are the guys most experienced with it - my surgeon had been doing them for around 20 years at the time. Note another difference is that we do see more revisions of the sleeve, in part because of that "infant mortality" problem of when most surgeons were still working up the learning curve on it, but also because it CAN be readily revised, whereas the RNY is difficult to revise, so it, or reversals, are not done commonly owing to the complexity. So, if one does wind up with, say, a GERD problem, which does happen occasionally with the RNY, too, then one is stuck with medicating it, or reversing it if things are that serious.

Another factor is insurance. For example, I know my insurance would happily (as happily as they do anything) cover sleeve or bypass. Meet the requirements and you could have either one of those, no questions asked. Everything else was considered "experimental" and was not covered. Based on my brother's experience of significant regain after sleeve, plus not wanting to risk GERD and the possibility of a revision, I opted for bypass right out of the gate. I felt like that would be a one-and-done surgery, and I have zero regrets. A few key differences to consider are bypass is a stronger metabolic surgery, so you tend to get more durable weight loss if you look at 5-10 years post-op. But weight regain after sleeve can be managed with GLP-1 meds (if you have coverage or can pay out of pocket). If you have reflux or diabetes/pre-diabetes, seriously consider a bypass as this surgery is great for reducing or eliminating these conditions. If you smoke or require a lot of pain meds, seriously consider sleeve because your risk of ulcers with bypass is elevated by smoking and NSAID use, and the ulcers are very hard to cure. Dumping can be unpleasant but managed through dietary choices. I have had a couple very minor instances of dumping. Once after eating too much sugar (I absolutely knew better when I did it), and once after a few bites of a very rich, very fat-filled Thanksgiving side dish (this one surprised me). In both cases, my heart raced for about 15 minutes to the point my Fitbit thought I was exercising and awarded me "zone minutes." For me, that was the extent of it and nothing I couldn't handle. I'll just avoid that green bean dish next time. Some people do get worse responses. A lot of people never dump at all. One thing to consider if choosing a less-known surgery in the US is your doctors outside the surgeon who performs it may not be very familiar with it. Everyone should know what a bypass or a sleeve is. Hospitals or EMTs might not know much about your anatomy with a MGB or a DS, and that could cause delays in treatment, which in an emergency might become an issue. Not to say don't get those if they're right for you, but you may have to spend more time educating yourself and your healthcare team if you do.

My understanding is sleeve is more prevalent as a first time surgery, but a not-insignificant number of people have revision from sleeve to bypass down the road because of GERD or insufficient weight loss. There are reasons you may choose one over the other, and you want a surgeon who is just as comfortable with either. If he is suggesting one because he's better at it (sleeve is a much easier surgery to perform) then he is not the surgeon for you! This video has some good information on both surgeries from a doctor who does both: