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This is along the same lines as a thread I started. It's called, "What is the real point of this surgery?" You can look it up on my activity feed if you want to see what people have to say to my query. I'm in pre-op and still pondering whether to have the surgery. Trying to think it all through exhaustively. I think what happens is that people do regain some amount of weight, but you really have to be going out of your way to TRY to gain back all of the weight. Whereas, conventional weight losers have almost a 100% chance of regaining all the weight they lost and then some.

Thanks @@QueenBeeBee I'm pretty chuffed to be here. Congrats on your sleeve btw... was the first post I read. @@steveelea thanks for that! the IIH is idiopathic intracranial hypertension.. too much cerebral spinal Fluid (CSF) which causes headaches. which I ignored for years. It was only after losing some of my vision in right eye that I started looking into it and after a bucketload of tests got diagnosed in April. I'm on tablet to reduce fluid but neurologist is hoping that rapid weight loss with cure it and hopfeully give me back the perception in my right eye (reversing the optic nerve damage) and I'm having the Roux-en-Y Gastric Bypass op which I have seen abbreviated to RYGB and which I have nicknamed rainbow bypass because it reminds me of the colours (red yellow green blue lol) I was going with the sleeve but after speaking with my surgeon have decided on the bypass as it better suits my needs and is a better resolution for the IIH long term we think. I'm really happy with choice, now just getting head around all the new information. Anyway, hope that answered your query. I'll be around and about... stalking all the posts on the forums *evil chuckle* Hope everyone is having a wonderful weekend. Cheers Cath

Thanks for responding to my query. I hope I feel well enough though, I'm his only parent and they are honoring him. Arghh makes me think I should have scheduled it for the summer break.

Sounds like what you are describing is the effects of ketosis occurring in your body. It's when your body is burning fat at very high rate and using that fat fuel for energy. I made the same query today at my monthly check up - told to drink as much Water as I can manage - not sure if it's what you mean you are experiencing though. Google ketosis breath and see if that's what you mean. Good luck. thank you all for your advice, and thank you GoldenGrl, I am always struggling with water, I will try and get more in. Thanks you.

Sounds like what you are describing is the effects of ketosis occurring in your body. It's when your body is burning fat at very high rate and using that fat fuel for energy. I made the same query today at my monthly check up - told to drink as much Water as I can manage - not sure if it's what you mean you are experiencing though. Google ketosis breath and see if that's what you mean. Good luck.

This is the post I made to another query asking about the psych evaluation. I hope it helps you. I've been through two evals (one for the Lap-Band and one for the sleeve revision). The second psychologist did a great job. I believe they truly want to clear you and use this time to identify and educate. I was given an action plan with a generic part and a personalized section. Here's what is covered. 1. Specific, concrete ways to eat 3 meals per day, Protein first at each meal. 2. Strategies to manage your environment to reduce opportunities to eat inappropriately. 3. Identify triggers and risky behaviors. List ways to avoid or interrupt them early. 4. Identify alternatives to emotional and stress eating. 5. Identify your support system. 6. List activities you enjoy. My personalized section listed... 1. Practice eating slowly. 2. Practice avoiding liquids 30 minutes before/after/during meals. 3. Attend the bariatric support group. 4. Revisit this psych in 3 months post surgery. 5. Support groups a. church b. best friend c. family 6. Follow up with personal psychiatrist and psychologist. 7. Weight training post surgery when cleared by surgeon. 8. Document "hygiene issues" with PCP. This particular psychologist is the exclusive one used by my bariatrics group. She was no stranger to the content and context of obesity. I'm glad I had this opportunity. .

Hi, I'm from Perth and I was sleeved on 31st March by S Watson at SJOG Murdoch.... I'm 2 weeks post op and going in for my first post surgery consult next week.... Just finished up on the liquid diet and am struggling to find purees that don't cause an upset tummy:) let me know if you have specific queries or concerns and I am happy to answer based on my own experience:) I am SOR- female, 26 and pre surgery BMI 38 but I am now down 8kgs in 2 weeks...

Hi, I'm from Perth and I was sleeved on 31st March by S Watson at SJOG Murdoch.... I'm 2 weeks post op and going in for my first post surgery consult next week.... Just finished up on the liquid diet and am struggling to find purees that don't cause an upset tummy:) let me know if you have specific queries or concerns and I am happy to answer based on my own experience:) I am SOR- female, 26 and pre surgery BMI 38 but I am now down 8kgs in 2 weeks...

Same here Tracy. I was out of the office for the hip surgery, and when I got back, everyone really noticed the weight loss. I've heard everything from 'you look great' to 'I don't even recognize you'. I also feel that while it's nice to be noticed, I'm just as happy to have this part of it be in the past and have everyone get used to the smaller me so it becomes something they are all used to. I've also had those queries as well about how I lost the weight. I tell them I needed to lose it because of the hips and I eat around 1,000 calories. That part is true and that's all anyone needs to know. Because my coworkers were aware of my joint issues (limping and in pain as I walked the halls), they accept my explanation and don't ask too many other questions.

Have you looked into Dr. Nick Nicholson in Dallas? If not I suggest at least checking in with them, you might like it better. If you put in a query on the website the coordinator gets back to you very quickly. They are extremely nice there and the hotel room is included with your price (nice plus). I am trying to go through insurance in my state, but have already decided to go with Nicholson if insurance falls through. I originally was thinking about Dr. Kim but the office was not very responsive and was dragging thier feet for like a week just to look at my medical history packet that I had filled out, AND then I also read some very un-flattering things about him online (bedside manner, possibly rude to patients) and so that's when I got in touch with Nicholson's office and loved the service and just overall information and vibe that I got over there. Good luck!! I know how hard it can be to choose a doctor, especially from out of state. ETA: I have no way of knowing if any of what was written online about Dr. Kim is true or not, it's just stuff I read in some online reviews.

Mick, whether you are a man or a woman doesn't come into it. I have just turned 62 and I was sleeved on 09/18. The last time I looked I was most definitely a woman! Since my op I have lost 46 pounds (still to update my ticker!) and I do not regret it for one moment. I only wish I'd had the funds sooner as I was self pay. Of course you want a better quality of life and it is NEVER too late to do so. I am down from 7 HBP tablets to 1 and feel and look so much better. Your daughter should understand rather than query your motives. I sailed through my op and with HBP and asthma I thought otherwise. You go for it and start writing up your bucket list of things to do!

did the best i could. made a huge effort. not perfect. it is not about the weight i lost but about the emotional and mental place i was at. in short, was i willing to do what it took for the surgery to work. note that fully 40% of sleevers do not reach a minimal success! i was determined not to be one of those. that said, it is easier after the surgery but IMHO you have to give it your all, a full court press, including exercise. i read here how only after months of failure do some people decided that perhaps exercise will help. if you query vets they will tell you that the first 6 months is the honeymoon phase, where the weight comes off easily. that is when the exercise will accelerate your weight loss.

Here is an academic overview of the various bariatric procedures with a bit of excess 'science stuff' thrown in. No opinion. No bias. Published 2012 by the UK Royal College of Physicians. If anyone requires further clarification to the sources contained (hopefully its been copied successfully), please see the reference list at the end. This will provide you (licensing permitting) with a link to those original source documents so you can do your own further research/analysis. Any questions or queries, please do not hesitate to ask. Revs x Overview of bariatric surgery for the physician Keng Ngee Hng, Specialty registrar in gastroenterology1⇓ and Yeng S Ang, Consultant gastroenterologist and honorary lecturer2 + Author Affiliations 1Salford Royal NHS Foundation Trust 2Faculty of Medicine, University of Manchester, Oxford Road, Manchester Address for correspondence: Dr KN Hng, 4 Fern Close, Shevington, Wigan WN6 8BL. Email:keng_ngee@hotmail.com Abstract The worldwide pandemic of obesity carries alarming health and socioeconomic implications. Bariatric surgery is currently the only effective treatment for severe obesity. It is safe, with mortality comparable to that of cholecystectomy, and effective in producing substantial and sustainable weight loss, along with high rates of resolution of associated comorbidities, including type 2 diabetes. For this reason, indications for bariatric surgery are being widened. In addition to volume restriction and malabsorption, bariatric surgery brings about neurohormonal changes that affect satiety and glucose homeostasis. Increased understanding of these mechanisms will help realise therapeutic benefits by pharmacological means. Bariatric surgery improves long-term mortality but can cause long-term nutritional deficiencies. The safety of pregnancy after bariatric surgery is still being elucidated. Introduction Obesity is a worldwide pandemic,1–4 with the number of obese children and adolescents increasing alarmingly.5 This has serious health and socioeconomic implications due to the attendant increase in related comorbidities.1,2,4,6 Obesity causes type 2 diabetes, hypertension, dyslipidaemia, cardiovascular disease, obstructive sleep apnoea, obesity hypoventilation syndrome, cancer, steatohepatitis, gastro-oesophageal reflux, gallstones, pseudotumour cerebri, osteoarthritis, infertility and urinary incontinence.1–6 Severe obesity reduces life expectancy by 5–20 years.1 Diet, exercise and drug treatments for severe obesity have been disappointing.1–3,5–12 At the present time, bariatric surgery is the only treatment that reliably produces substantial and sustainable weight loss.1–7,9,13 It is indicated in people with BMI >40 kg/m2 or with BMI >35 kg/m2 in the presence of significant comorbidity.3,5,7,14 Bariatric surgery is cost effective,3,6,15 achieving weight loss, as well as improvement or resolution of associated comorbidities.1,2,5,6,9,15,16 In the past decade, the development of centres of excellence,5,6laparoscopic techniques,2,5,6 improved safety profiles2,6,9 and better documentation of clinical effectiveness2,6,15 have fuelled an increase in the number of procedures performed. Types of surgery Bariatric surgical procedures are traditionally classified as restrictive, malabsorptive or combined according to their mechanism of action. The procedures most commonly performed are laparoscopic adjustable gastric banding and roux-en-y gastric bypass.3,13 Sleeve gastrectomy is increasingly performed.2,6,7 Biliopancreatic diversion and biliopancreatic diversion with duodenal switch are much more complex and performed infrequently.2,5,17,22 Other historical procedures are no longer in common use. In addition to restriction and malabsorption, recent evidence suggests that neurohormonal changes are an important effect of bariatric surgery.2,6,7,17,18 Bariatric surgery is only part of the management of severe obesity. Careful patient selection and preparation are extremely important, as are long-term compliance with diet, nutritional supplementation and follow up.2,5,6,19 Laparoscopic adjustable gastric banding2 A purely restrictive procedure, laparoscopic adjustable gastric banding (LABG) is the least invasive procedure, is completely reversible and has the lowest mortality.19 A silicone inflatable band is placed around the stomach cardia immediately below the gastrooesophageal junction (Fig 1). This is connected to a subcutaneous port that is used for band adjustment.5,6 The band compresses the cardia to generate a sense of satiety and reduced appetite, which is thought to be mediated via vagal afferents.2 Roux-en-Y gastric bypass (RYGB) is a combined procedure that is also performed laparoscopically. A 20–30-ml gastric pouch connected to the jejunum forms the Roux limb (Fig 2). The disconnected duodenal limb is anastomosed 75–150 cm along the Roux limb, forming a Y configuration. The distal stomach, duodenum and part of the proximal jejunum are thus bypassed.5–7,20 Despite the traditional classification of the this procedure, malabsorption is not significant with the standard RYGB surgery.7 In an extended gastric bypass, the Roux limb is lengthened to increase the malabsorptive component.6,20 In sleeve gastrectomy, 60–80% of the stomach is removed along the greater curvature to leave a restricting ‘sleeve’ of stomach along the lesser curve (Fig 3).5,20,21 Originally the first step of the biliopancreatic diversion with duodenal switch (see below), sleeve gastrectomy has evolved into a staging procedure for super obese or high-risk patients.2,5–7,20 It is also increasingly used as a standalone procedure.2,6,7 Biliopancreatic diversion (BPD) and biliopancreatic diversion with duodenal switch (BPD/DS) are malabsorptive operations that result in bypass of most of the small intestine. With BPD/DS, a sleeve gastrectomy is performed, leaving the pylorus intact. The duodenum is then disconnected and the stomach anastomosed to the distal small bowel (the ‘duodenal switch’), creating a short alimentary limb. The long biliopancreatic limb is then anastomosed to the ileum 75–100 cm proximal to the ileocaecal valve, so digestion and absorption occurs only in the short common channel.5,6,20 With BPD, a partial gastrectomy leaves a 400 ml gastric pouch and the common channel is shortened to just 50 cm.5 Safety profile and complications Bariatric surgery is safe.2,5,6,9,22–24 High-volume centres of excellence deliver bariatric surgery with inhospital mortality of 0.14% and 90-day mortality of 0.35%, which is comparable to that for cholecystectomy.6 Acute complications, including haemorrhage, obstruction, anastomotic leak, wound infection, cardiac arrhythmias, pulmonary emboli, respiratory failure and rhabdomyolysis, occur in 5–10% of patients.5,6,9,10,25 Long-term complications include internal hernias, anastomotic stenoses, marginal ulceration, fistulae, diarrhoea, dumping syndrome, gallstones, emotional disorders and nutritional deficiencies.5,6,13,15,20,25–27 Patients with LAGB can experience port problems, stomal obstruction, band slippage/erosion, pouch dilation, gastro-oesophageal reflux and oesophageal dilation.5,13,19,25 Malnutrition is a concern with BPD with or without DS.1,17 Long-term risks for sleeve gastrectomy are unknown.5 The Longitudinal Assessment of Bariatric Surgery22 reported overall 30-day mortality of 0.3% for 4,610 patients having LAGB or RYGB for the first time, with 4.3% of patients having a major adverse outcome within 30 days. This was most frequent among patients having open RYGB (7.8%). A meta-analysis involving 85,048 patients reported a total 30-day mortality of 0.28% and a two-year mortality of a further 0.35%.24 The most complex malabsorptive procedures had the highest perioperative mortality at 1.11%. Mortality for gastric banding is between one in 2,000 and one in 5,700.2 Effects on weight, comorbidities and long-term mortality After RYGB, patients lose 60–70% of their excess weight over two years, and this is largely durable.1,2,6,9,15,16,28 Weight loss is dependent on long-term compliance with dietary recommendations.2,5,6 Sugary, energy-dense foods and drinks can ‘bypass the bypass’. After gastric banding, patients lose about 50% (range 39%–59%) of their excess weight at a slower rate, often continuing into the fifth year.1,2,5,6,9,19 Regular band adjustment is necessary.16 The Swedish Obese Subjects (SOS) study reported a reoperation or conversion rate of 31% for gastric banding and 17% for gastric bypass among patients followed for ≥10 years, excluding operations for postoperative complications.16 However, at the centre in Melbourne, only about 10% of patients after LAGB need some revisional procedure, including band replacement, in the following 10 years.2 Biliopancreatic diversion with or without DS produces excess weight loss of 70.1%9sleeve gastrectomy produces initial excess weight loss of 55%, but this may not be durable.2 Bariatric surgery also produces significant improvement in obesity-related comorbidities, with the most remarkable effect being resolution of type 2 diabetes (T2DM). A meta-analysis encompassing 22,094 patients reported complete remission of T2DM in 76.8% of patients,9 and a registry from the UK with data on 8,710 patients reported resolution of T2DM in 85.5% of patients.29 Major improvement often occurs within days after RYGB, before significant weight loss is achieved.5–7,17,18 After LAGB, improvement in T2DM occurs more slowly as a result of weight loss.2,7,19 Combined or malabsorptive procedures produce greater improvement than purely restrictive procedures.1,2,5,9,18 Diabetes less than three years in duration, no insulin requirement, milder obesity with BMI <40 kg/m2 and weight loss ≥10% predict complete resolution of T2DM.18,19 Bariatric surgery is now advocated by some for the treatment of T2DM in patients with BMI <35 kg/m2.4,7,30,31 Bariatic surgery effectively treats all other associated comorbidities: from steatohepatitis and pseudotumour cerebri to urinary incontinence.1–3,5,6,15 Meta-analysis showed that hyperlipidaemia improved in ≥70% of patients, hypertension resolved in 61.7% (and resolved or improved in 78.5%) and obstructive sleep apnoea resolved in 83.6%.9 At five years, the risk of cardiovascular disease had decreased by 72%.3 The incidence of cancer also reduced markedly,6,15,16 as did the risk of developing new comorbid conditions.15 Long-term efficacy is well documented.5,6,28 At follow up after 10 years, the Swedish Obese Subjects (SOS) study showed a 29% reduction in adjusted all-cause mortality, primarily because of decreases in cancer and myocardial infarction.16A retrospective cohort study of 7,925 patients after RYGB reported a 40% reduction in all-cause mortality during mean follow up of 7.1 years.23 Specific mortality decreased by 56% for coronary artery disease, by 92% for diabetes and by 60% for cancer. A large observational study, in which the vast majority of patients had undergone RYGB, reported an 89% risk reduction in five-year mortality.15 Energy homeostasis and hormonal changes Weight loss after bariatric surgery is not explained by volume restriction and malabsorption alone.17 Indeed malabsorption is estimated to account for only 5% of the weight loss following standard RYGB.17 Bariatric surgery causes significant changes in the neurohormonal profile, which contributes to sustained weight loss through changes in appetite, satiety, food preferences and eating patterns and explains the remarkable effect on T2DM.2,5–7,17,18 The hypothalamus32 Hormonal signals provide information about energy status to the hypothalamus. Adipokines are secreted by adipose tissue and enterokines by the gut. Incretins are enterokines that stimulate release of insulin after food intake.18 Two hypothalamic circuits influence food intake, and both contribute to acquisition and storage of nutrient energy. The homeostatic circuit increases appetite and locomotion in response to energy shortage. The hedonic circuit is engaged at stable weight plateaus in association with increases in body fat. It heightens finickiness to taste of food. Obese animals overeat palatable food but undereat bland foods and lose weight. In our current obesogenic environment, the hedonic circuit facilitates the seeking of energy-dense foods uncoupled from energy status. Enterokines Ghrelin,33 which is mostly synthesised in the stomach, is a potent appetite stimulator involved in hunger and meal initiation. Circulating levels are inversely proportional to BMI and respond to changes in body weight. Ghrelin enhances gut motility and speeds gastric emptying.17 It promotes lipid accumulation and weight gain, favouring glucose utilisation. It also inhibits insulin secretion and impairs glucose tolerance.18 Levels of ghrelin reported after bariatric surgery have been variable, which may be due to differences in surgical techniques and research methods.7,18Overall, the trend is for a decrease in ghrelin levels after RYGB and an increase after gastric banding.7,17 Sleeve gastrectomy, which removes most of the ghrelin-producing stomach, reduces levels of ghrelin. Peptide YY (PYY)34 is secreted postprandially by L cells in the pancreas, small intestine and colon. It suppresses appetite and promotes satiety via signalling actions in the brain. It also delays gastric emptying (the ileal brake) and enhances insulin sensitivity.7 Secretion of PYY generally corresponds to the energy ingested, although it may vary depending on the macronutrient content.17Interestingly, levels also correlate positively with exercise intensity, with resulting decreases in food intake. Glucagon-like peptide 1 (GLP-1) is co-secreted postprandially with PYY in the distal intestine.17 A powerful incretin, GLP-1 potentiates glucose-stimulated insulin secretion, enhances β-cell growth and survival, inhibits glucagon release and enhances all steps of insulin biosynthesis.7,17 It also slows gastric emptying to produce greater gastric distension and helps regulate appetite and body weight.7,17 Obese individuals have lower levels of PYY and GLP-1, and levels are decreased further in patients with diabetes.5,17,18 Two hypotheses exist to explain the hormonal and metabolic effects of the RYGB: the hindgut hypothesis the foregut exclusion theory. The hindgut hypothesis postulates that after RYGB and malabsorptive procedures, rapid nutrient delivery to the distal gut L cells and their increased exposure to incompletely digested nutrients lead to an early and exaggerated PYY and GLP-1 response, contributing to early satiety, reduced meal size and early resolution of T2DM.7,17,18 Ileal transposition studies provide strong evidence for this. Interposition of an ileal segment into the proximal gut in rodents produced exaggerated PYY, GLP-1 and enteroglucagon responses, reduced food intake, weight loss, improved insulin sensitivity and overall improved glucose homeostasis.7 The foregut exclusion theory proposes that exclusion of the duodenum and proximal jejunum after RYGB is the mechanism that mediates the effects of bariatric surgery.7,18 However, duodenal–jejunal bypass experiments in rats supporting this theory are compounded by the accompanying pyloric disruption that results in accelerated gastric emptying and rapid nutrient delivery to the hindgut.7 The endoluminal duodenal–jejunal sleeve also accelerates gastric emptying by abolishing duodenal osmoreceptor control of pyloric contraction.7 This 60 cm-long sleeve prevents nutrient contact with the duodenum and proximal jejunum, while biliary and pancreatic secretions flow outside the sleeve, delaying digestion.35 A possible mediator of the foregut exclusion theory is the gastric inhibitory polypeptide or glucose-dependent insulinotropic polypeptide (GIP), which is secreted by K cells in the duodenum in response to nutrient absorption.18,39,40 In addition to its incretin action, GIP promotes lipogenesis,41 with GIP receptor knockout mice protected against diet-induced obesity and insulin resistance,39 while antagonism of the GIP receptor improves glucose tolerance and insulin sensitivity and partially corrects pancreatic islet hypertrophy and β-cell hyperplasia.40 Levels of GIP are suppressed after malabsorptive procedures.18,41 Adipokines Adiponectin17,36,37 is synthesised primarily in adipose tissue, with levels inversely correlated with BMI. It is an important insulin sensitiser, and hypoadiponectinaemia causes insulin resistance and T2DM. Adiponectin also possesses antiatherogenic, anti-inflammatory and cardioprotective properties and may act centrally to modulate food intake and energy expenditure. Weight loss following bariatic surgery increases levels of adiponectin. Leptin38,32 is secreted by adipose tissue and regulates body weight via its action on the hypothalamus. It increases nocturnally to stimulate lipolysis but also increases postprandially to induce anorexia. In addition, leptin plays an important role in glucose homeostasis. Levels of leptin are proportional to body fat, with starvation or energy shortage activating the homeostatic mechanism in the hypothalamus to restore energy balance. However, leptin resistance develops in obesity. Weight loss from bariatic surgery reduces leptin levels.17 Many other enterokines and adipokines exist, some of which may also play a part in producing and sustaining weight loss or diabetes remission after bariatric surgery.17,18 Understanding the mechanisms of action of bariatric surgery will help realise therapeutic benefits by pharmacological means.6,7,19 Nutritional deficiencies Nutritional deficiency is common after bariatric surgery and the risk increases from LAGB through SG and RYGB to BPD with or without DS.20,26,31 The problem is heightened by the fact that micronutrient deficiencies are already highly prevalent in obese patients before surgery.21 After surgery, patients are at particular risk of deficiencies in Vitamins B1, B12, C, A and D and folic acid, as well as Iron, Calcium and Protein.20,26 Lifelong prophylactic supplementation is often necessary, and regular monitoring is essential.26 Investigation of clinical syndromes resulting from malnutrition can be challenging. Anaemia20,27 After bariatric surgery, patients are prone to iron deficiency because of intestinal bypass, pouch hypoacidity and intolerance of red meat. Obesity creates a state of chronic inflammation that can contribute to anaemia. Anaemia can also be caused by deficiencies in folate, Vitamin B12, vitamin E (haemolytic anaemia), copper (anaemia and neutropenia), Vitamin A and zinc. In refractory anaemia, gastrointestinal blood loss must be considered. Bleeding in the excluded stomach, duodenum or biliopancreatic limb is problematic as the usual endoscopic access route is no longer available. Neurological problems6,20 Neurological symptoms can result from deficiencies in thiamine, vitamin B12, niacin, vitamin E and copper or from hypocalcaemia secondary to Vitamin D deficiency. Clinical syndromes includes Wernicke's encephalopathy, peripheral neuropathy, dry beriberi, neuropsychiatric beriberi, pellagra, ataxia, spasticity, myelopathy, muscle weakness, posterior column signs and ptosis. Oedema6,20 Patients with oedema may have underlying heart failure, which can also be due to wet beriberi (thiamine deficiency) or selenium deficiency. Hypoalbuminaemia may be caused by liver cirrhosis secondary to steatohepatitis; severe protein/calorie malnutrition; kwashiorkor; and diarrhoea secondary to bacterial overgrowth, malabsorption of bile salts and niacin deficiency. Eye, skin and hair problems20 Vitamin A deficiency causes difficulties with nocturnal vision and reduced visual acuity. Vitamin E deficiency can cause retinopathy. Thiamine deficiency can present with blurred or double vision. Dry skin, pruritus and rash can be caused by deficiencies in vitamin A, niacin, riboflavin, zinc and essential fatty acids. Hair changes can be due to zinc deficiency or protein malnutrition. Pregnancy after bariatric surgery About half of patients undergoing bariatric surgery are women of childbearing age,8 which introduces specific concerns. Obesity is strongly associated with infertility8 and increases the risk of obstetric complications.8 Yet the effects of rapid weight loss and potential malnutrition in pregnant patients are of concern. Bariatric surgery improves fertility42,43 and reduces the incidence of obesity-related complications such as gestational hypertension, gestational diabetes, pre-eclampsia and foetal macrosomia when compared with obese controls. The effect on premature delivery, miscarriage, intrauterine growth retardation, low birth weight and neural tube defects and the need for caesarean section are unclear.8,43 Maternal surgical weight loss reduces the prevalence of obesity and cardiometabolic risk factors in offspring until the adolescent years.42 Pregnancy seems to have little effect on the surgically induced weight loss.8 Patients are generally advised to delay pregnancy until after the period of maximal weight loss (12–18 months).8 Extra vigilance in preconception, antenatal and obstetric care is required. Conclusion In summary, bariatric surgery is a safe and effective treatment for severe obesity and its associated comorbidities. It is particularly effective in the treatment of T2DM. Neurohormonal changes that affect appetite, satiety, glucose homeostasis and long-term energy balance contribute to its long-term efficacy. Two hypotheses exist to explain how hormonal changes produce these effects, and both may contribute. Patient adherence to postsurgical aspects of management is very important. Pregnancy after bariatric surgery brings additional considerations. Finally, the indications for bariatric surgery are being widened. Acknowledgements Dr Keng Ngee Hng is a specialty registrar in gastroenterology and has previously submitted part of this work for her Master of Science in gastroenterology (Salford University). Dr Yeng S Ang is the educational supervisor for Dr Hng and has refined the ideas, concepts and layout of the previous work. Recent updates are also included within this paper. © 2012 Royal College of Physicians

So I have a history of hair loss with weight loss, this is nothing new. I am kind of glad because at least I have already had all those terrified search queries, tried all the shampoos, joined the hair loss forums.... So really I feel pretty prepared for this, but still, it sucks. This is 3 showers worth and doesn't count everything at my bathroom sink, in my brush, on my sweater, in dinner.... ????

Hi, I've had to have Fluid removed from my band as I couldn't eat much of anything The surgeon removed 3 1/2 and I can eat! I know I'll have to be careful but as I'm haveing to re-learn healthy eating I decided to make it easier on myself. If I can't cope i'll just have to restrict again. My query is, is it normal for my stomach to feel sore? I can eat and drink but I'm achy and sore where the band is. I'm scaring myself by thinking 'corrosion'! Thanks peeps xx

To be blunt and to not waste anyones time.. Asking a surgeon for a detailed response about the effects of bariatric surgery on an individuals metabolic rate (particularly as we're all different) is like asking a baker to fix a rare sports car. In short, you need an endocrinologist. As for the impeded weight loss. You sadly had a bit of a rough trot of it immediately after your surgery - so this would definitely have short-circuited the system - giving much credence to the points made by our learned friends on this site, that you may have to wait it out and see how your body normalises. As far as references for current academic research go, please see below. As you'll know, academic research is normally very narrow in its focus, so you'll have to go through quite a few of them in order to assimilate a potential 'ground truth' for yourself. However, there are some articles which offer the generic information you seek which might at least allay your current fears. Naturally, this comes with the caveat that without full knowledge of the endless subtleties and nuances the endocrine system plays on our bodies, it might appear attractive to propose one hypothesis for your current predicament, for it to then be incorrect because of a previously unidentified and unevaluated interaction. Consequently, if you want your rare sports car fixed? Go see a specialist mechanic Hope this helps. Any questions or queries, please do not hesitate to ask. Best of luck, Daydra x Bariatric surgery in obesity: Changes of glucose and lipid metabolism correlate with changes of fat mass Original Research Article Nutrition, Metabolism and Cardiovascular Diseases, Volume 19, Issue 3, March 2009, Pages 198-204 F. Frige', M. Laneri, A. Veronelli, F. Folli, M. Paganelli, P. Vedani, M. Marchi, D. Noe', P. Ventura, E. Opocher, A.E. Pontiroli Show preview | PDF (216 K) | Recommended articles | Related reference work articles 2 Effect of bariatric surgery on liver glucose metabolism in morbidly obese diabetic and non-diabetic patients Original Research Article Journal of Hepatology, In Press, Accepted Manuscript, Available online 20 September 2013 Heidi Immonen, Jarna C. Hannukainen, Patricia Iozzo, Minna Soinio, Paulina Salminen, Virva Lepomäki, Ronald Borra, Riitta Parkkola, Andrea Mari, Terho Lehtimäki, Tam Pham, Jukka Laine, Vesa Kärjä, Jussi Pihlajamäki, Lassi Nelimarkka, Pirjo Nuutila Show preview | PDF (808 K) | Recommended articles | Related reference work articles 3 Dramatic Reversal of Derangements in Muscle Metabolism and Left Ventricular Function After Bariatric Surgery Original Research Article The American Journal of Medicine, Volume 121, Issue 11, November 2008, Pages 966-973 Joshua G. Leichman, Erik B. Wilson, Terry Scarborough, David Aguilar, Charles C. Miller III, Sherman Yu, Mohamed F. Algahim, Manuel Reyes, Frank G. Moody, Heinrich Taegtmeyer Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 4 Bariatric surgery and its impact on sleep architecture, sleep-disordered breathing, and metabolism Review Article Best Practice & Research Clinical Endocrinology & Metabolism, Volume 24, Issue 5, October 2010, Pages 745-761 Silvana Pannain, Babak Mokhlesi Show preview | PDF (355 K) | Recommended articles | Related reference work articles 5 Progressive Regression of Left Ventricular Hypertrophy Two Years after Bariatric Surgery Original Research Article The American Journal of Medicine, Volume 123, Issue 6, June 2010, Pages 549-555 Mohamed F. Algahim, Thomas R. Lux, Joshua G. Leichman, Anthony F. Boyer, Charles C. Miller III, Susan T. Laing, Erik B. Wilson, Terry Scarborough, Sherman Yu, Brad Snyder, Carol Wolin-Riklin, Ursula G. Kyle, Heinrich Taegtmeyer Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 6 ESR1 gene and insulin resistance remission are associated with serum uric acid decline for severely obese patients undergoing bariatric surgery Original Research Article Surgery for Obesity and Related Diseases, In Press, Corrected Proof, Available online 14 November 2012 Weu Wang, Tsan-Hon Liou, Wei-Jei Lee, Chung-Tan Hsu, Ming-Fen Lee, Hsin-Hung Chen Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 7 American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient Review Article Surgery for Obesity and Related Diseases, Volume 4, Issue 5, Supplement, September–October 2008, Pages S109-S184 Jeffrey I. Mechanick, Robert F. Kushner, Harvey J. Sugerman, J. Michael Gonzalez-Campoy, Maria L. Collazo-Clavell, Safak Guven, Adam F. Spitz, Caroline M. Apovian, Edward H. Livingston, Robert Brolin, David B. Sarwer, Wendy A. Anderson, John Dixon Show preview | PDF (1294 K) | Recommended articles | Related reference work articles 8 Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Review Article Surgery for Obesity and Related Diseases, Volume 9, Issue 2, March–April 2013, Pages 159-191 Jeffrey I. Mechanick, Adrienne Youdim, Daniel B. Jones, W. Timothy Garvey, Daniel L. Hurley, M. Molly McMahon, Leslie J. Heinberg, Robert Kushner, Ted D. Adams, Scott Shikora, John B. Dixon, Stacy Brethauer Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 9 Bariatric surgery and the gut-brain communication—The state of the art three years later Review Article Nutrition, Volume 26, Issue 10, October 2010, Pages 925-931 Maria de Fátima Haueisen S. Diniz, Valéria M. Azeredo Passos, Marco Túlio C. Diniz Show preview | PDF (156 K) | Recommended articles | Related reference work articles 10 Postoperative Metabolic and Nutritional Complications of Bariatric Surgery Review Article Gastroenterology Clinics of North America, Volume 39, Issue 1, March 2010, Pages 109-124 Timothy R. Koch, Frederick C. Finelli Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 425] Bariatric surgery has become an increasingly important method for management of medically complicated obesity. In patients who have undergone bariatric surgery, up to 87% with type 2 diabetes mellitus develop improvement or resolution of their disease postoperatively. Bariatric surgery can reduce the number of absorbed calories through performance of either a restrictive or a malabsorptive procedure. Patients who have undergone bariatric surgery require indefinite, regular follow-up care by physicians who need to follow laboratory parameters of macronutrient as well as micronutrient malnutrition. Physicians who care for patients after bariatric surgery need to be familiar with common postoperative syndromes that result from specific nutrient deficiencies. 11 Update: Metabolic and Cardiovascular Consequences of Bariatric Surgery Review Article Endocrinology and Metabolism Clinics of North America, Volume 40, Issue 1, March 2011, Pages 81-96 Donald W. Richardson, Mary Elizabeth Mason, Aaron I. Vinik Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 425] Obesity is a disease state with polygenic inheritance, the phenotypic penetrance of which has been greatly expanded by the attributes of modern civilization. More than two-thirds of obese persons have comorbidities, many of which are characteristic of cardiometabolic risk syndrome (CMRS) in addition to other life-quality–reducing complaints. The CMRS is associated with increased cardiovascular events and mortality. Individuals with a body mass index greater than 35 infrequently achieve or maintain weight loss adequate to resolve these metabolic and anatomic issues by lifestyle or pharmacologic strategies. Data suggest that some of these patients may be better served by bariatric surgery. 12 Secretion and Function of Gastrointestinal Hormones after Bariatric Surgery: Their Role in Type 2 Diabetes Review Article Canadian Journal of Diabetes, Volume 35, Issue 2, 2011, Pages 115-122 Alpana Shukla, Francesco Rubino Show preview | PDF (1234 K) | Recommended articles | Related reference work articles 13 Cirurgia bariátrica: como e por que suplementar Review Article Revista da Associação Médica Brasileira, Volume 57, Issue 1, January–February 2011, Pages 113-120 Livia Azevedo Bordalo, Tatiana Fiche Sales Teixeira, Josefina Bressan, Denise Machado Mourão

To be blunt and to not waste anyones time.. Asking a surgeon for a detailed response about the effects of bariatric surgery on an individuals metabolic rate (particularly as we're all different) is like asking a baker to fix a rare sports car. In short, you need an endocrinologist. As for the impeded weight loss. You sadly had a bit of a rough trot of it immediately after your surgery - so this would definitely have short-circuited the system - giving much credence to the points made by our learned friends on this site, that you may have to wait it out and see how your body normalises. As far as references for current academic research go, please see below. As you'll know, academic research is normally very narrow in its focus, so you'll have to go through quite a few of them in order to assimilate a potential 'ground truth' for yourself. However, there are some articles which offer the generic information you seek which might at least allay your current fears. Naturally, this comes with the caveat that without full knowledge of the endless subtleties and nuances the endocrine system plays on our bodies, it might appear attractive to propose one hypothesis for your current predicament, for it to then be incorrect because of a previously unidentified and unevaluated interaction. Consequently, if you want your rare sports car fixed? Go see a specialist mechanic Hope this helps. Any questions or queries, please do not hesitate to ask. Best of luck, Daydra x Bariatric surgery in obesity: Changes of glucose and lipid metabolism correlate with changes of fat mass Original Research Article Nutrition, Metabolism and Cardiovascular Diseases, Volume 19, Issue 3, March 2009, Pages 198-204 F. Frige', M. Laneri, A. Veronelli, F. Folli, M. Paganelli, P. Vedani, M. Marchi, D. Noe', P. Ventura, E. Opocher, A.E. Pontiroli Show preview | PDF (216 K) | Recommended articles | Related reference work articles 2 Effect of bariatric surgery on liver glucose metabolism in morbidly obese diabetic and non-diabetic patients Original Research Article Journal of Hepatology, In Press, Accepted Manuscript, Available online 20 September 2013 Heidi Immonen, Jarna C. Hannukainen, Patricia Iozzo, Minna Soinio, Paulina Salminen, Virva Lepomäki, Ronald Borra, Riitta Parkkola, Andrea Mari, Terho Lehtimäki, Tam Pham, Jukka Laine, Vesa Kärjä, Jussi Pihlajamäki, Lassi Nelimarkka, Pirjo Nuutila Show preview | PDF (808 K) | Recommended articles | Related reference work articles 3 Dramatic Reversal of Derangements in Muscle Metabolism and Left Ventricular Function After Bariatric Surgery Original Research Article The American Journal of Medicine, Volume 121, Issue 11, November 2008, Pages 966-973 Joshua G. Leichman, Erik B. Wilson, Terry Scarborough, David Aguilar, Charles C. Miller III, Sherman Yu, Mohamed F. Algahim, Manuel Reyes, Frank G. Moody, Heinrich Taegtmeyer Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 4 Bariatric surgery and its impact on sleep architecture, sleep-disordered breathing, and metabolism Review Article Best Practice & Research Clinical Endocrinology & Metabolism, Volume 24, Issue 5, October 2010, Pages 745-761 Silvana Pannain, Babak Mokhlesi Show preview | PDF (355 K) | Recommended articles | Related reference work articles 5 Progressive Regression of Left Ventricular Hypertrophy Two Years after Bariatric Surgery Original Research Article The American Journal of Medicine, Volume 123, Issue 6, June 2010, Pages 549-555 Mohamed F. Algahim, Thomas R. Lux, Joshua G. Leichman, Anthony F. Boyer, Charles C. Miller III, Susan T. Laing, Erik B. Wilson, Terry Scarborough, Sherman Yu, Brad Snyder, Carol Wolin-Riklin, Ursula G. Kyle, Heinrich Taegtmeyer Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 6 ESR1 gene and insulin resistance remission are associated with serum uric acid decline for severely obese patients undergoing bariatric surgery Original Research Article Surgery for Obesity and Related Diseases, In Press, Corrected Proof, Available online 14 November 2012 Weu Wang, Tsan-Hon Liou, Wei-Jei Lee, Chung-Tan Hsu, Ming-Fen Lee, Hsin-Hung Chen Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 7 American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient Review Article Surgery for Obesity and Related Diseases, Volume 4, Issue 5, Supplement, September–October 2008, Pages S109-S184 Jeffrey I. Mechanick, Robert F. Kushner, Harvey J. Sugerman, J. Michael Gonzalez-Campoy, Maria L. Collazo-Clavell, Safak Guven, Adam F. Spitz, Caroline M. Apovian, Edward H. Livingston, Robert Brolin, David B. Sarwer, Wendy A. Anderson, John Dixon Show preview | PDF (1294 K) | Recommended articles | Related reference work articles 8 Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Review Article Surgery for Obesity and Related Diseases, Volume 9, Issue 2, March–April 2013, Pages 159-191 Jeffrey I. Mechanick, Adrienne Youdim, Daniel B. Jones, W. Timothy Garvey, Daniel L. Hurley, M. Molly McMahon, Leslie J. Heinberg, Robert Kushner, Ted D. Adams, Scott Shikora, John B. Dixon, Stacy Brethauer Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 9 Bariatric surgery and the gut-brain communication—The state of the art three years later Review Article Nutrition, Volume 26, Issue 10, October 2010, Pages 925-931 Maria de Fátima Haueisen S. Diniz, Valéria M. Azeredo Passos, Marco Túlio C. Diniz Show preview | PDF (156 K) | Recommended articles | Related reference work articles 10 Postoperative Metabolic and Nutritional Complications of Bariatric Surgery Review Article Gastroenterology Clinics of North America, Volume 39, Issue 1, March 2010, Pages 109-124 Timothy R. Koch, Frederick C. Finelli Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase Bariatric surgery has become an increasingly important method for management of medically complicated obesity. In patients who have undergone bariatric surgery, up to 87% with type 2 diabetes mellitus develop improvement or resolution of their disease postoperatively. Bariatric surgery can reduce the number of absorbed calories through performance of either a restrictive or a malabsorptive procedure. Patients who have undergone bariatric surgery require indefinite, regular follow-up care by physicians who need to follow laboratory parameters of macronutrient as well as micronutrient malnutrition. Physicians who care for patients after bariatric surgery need to be familiar with common postoperative syndromes that result from specific nutrient deficiencies. 11 Update: Metabolic and Cardiovascular Consequences of Bariatric Surgery Review Article Endocrinology and Metabolism Clinics of North America, Volume 40, Issue 1, March 2011, Pages 81-96 Donald W. Richardson, Mary Elizabeth Mason, Aaron I. Vinik Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase Obesity is a disease state with polygenic inheritance, the phenotypic penetrance of which has been greatly expanded by the attributes of modern civilization. More than two-thirds of obese persons have comorbidities, many of which are characteristic of cardiometabolic risk syndrome (CMRS) in addition to other life-quality–reducing complaints. The CMRS is associated with increased cardiovascular events and mortality. Individuals with a body mass index greater than 35 infrequently achieve or maintain weight loss adequate to resolve these metabolic and anatomic issues by lifestyle or pharmacologic strategies. Data suggest that some of these patients may be better served by bariatric surgery. 12 Secretion and Function of Gastrointestinal Hormones after Bariatric Surgery: Their Role in Type 2 Diabetes Review Article Canadian Journal of Diabetes, Volume 35, Issue 2, 2011, Pages 115-122 Alpana Shukla, Francesco Rubino Show preview | PDF (1234 K) | Recommended articles | Related reference work articles 13 Cirurgia bariátrica: como e por que suplementar Review Article Revista da Associação Médica Brasileira, Volume 57, Issue 1, January–February 2011, Pages 113-120 Livia Azevedo Bordalo, Tatiana Fiche Sales Teixeira, Josefina Bressan, Denise Machado Mourão Show preview | PDF (548 K) | Recommended articles | Related reference work articles Open Access 14 Tratamiento quirúrgico de la obesidad: recomendaciones prácticas basadas en la evidencia Original Research Article Endocrinología y Nutrición, Volume 55, Supplement 3, March 2008, Pages 1-24 M. José Morales, M. Jesús Díaz-Fernández, Assumpta Caixàs, Albert Goday, José Moreiro, Juan José Arrizabalaga, Alfonso Calañas-Continente, Guillem Cuatrecasas, Pedro Pablo García-Luna, Lluís Masmiquel, Susana Monereo, Basilio Moreno, Wilfredo Ricart, Josep Vidal, Fernando Cordido Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 15 Micronutrient deficiencies after bariatric surgery Review Article Nutrition, Volume 26, Issues 11–12, November–December 2010, Pages 1031-1037 Padmini Shankar, Mallory Boylan, Krishnan Sriram Show preview | PDF (376 K) | Recommended articles | Related reference work articles 16 Xeroftalmía bilateral por déficit de vitamina A secundario a cirugía bariátrica Endocrinología y Nutrición, Volume 54, Issue 7, August 2007, Pages 398-401 Beatriz Alonso Castañeda, María Ángeles Valero Zanuy, Paula Soriano Perera, Francisco García Ruiz, Roberto López Lancho, Susana Perucho Martínez Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 17 Metabolic surgery and gut hormones – A review of bariatric entero-humoral modulation Review Article Physiology & Behavior, Volume 97, Issue 5, 14 July 2009, Pages 620-631 Hutan Ashrafian, Carel W. le Roux Show preview | PDF (403 K) | Recommended articles | Related reference work articles 18 Bariatric surgery in duodenal switch procedure: weight changes and associated nutritional deficiencies Original Research Article Endocrinología y Nutrición (English Edition), Volume 58, Issue 5, 2011, Pages 214-218 Francisco Botella Romero, Marta Milla Tobarra, José Joaquín Alfaro Martínez, Llanos García Arce, Angélica García Gómez, M. Ángeles Salas Sáiz, Antonio Soler Marín Show preview | PDF (188 K) | Recommended articles | Related reference work articles 19 Alteraciones del metabolismo óseo en la cirugía bariátrica Review Article Medicina Clínica, Volume 136, Issue 5, 26 February 2011, Pages 215-221 Virginia Ruiz-Esquide, Pilar Peris, Laia Gifre, Nuria Guañabens Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 20 Bariatric surgery in patients with late-stage type 2 diabetes: expected beneficial effects on risk ratio and outcomes Original Research Article Diabetes & Metabolism, Volume 35, Issue 6, Part 2, December 2009, Pages 564-568 E. Renard Show preview | PDF (212 K) | Recommended articles | Related reference work articles 21 Reversible neurologic dysfunction caused by severe Vitamin deficiency after malabsorptive bariatric surgery Surgery for Obesity and Related Diseases, Volume 2, Issue 6, November–December 2006, Pages 656-660 Michael M. Rothkopf Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 22 What can bariatric surgery teach us about the pathophysiology of type 2 diabetes? Original Research Article Diabetes & Metabolism, Volume 35, Issue 6, Part 2, December 2009, Pages 499-507 F. Andreelli, C. Amouyal, C. Magnan, G. Mithieux Show preview | PDF (245 K) | Recommended articles | Related reference work articles 23 Seasonal changes in serum 25-OH-Vitamin D3 after bariatric surgery e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism, Volume 3, Issue 5, October 2008, Pages e208-e210 F. Granado-Lorencio, A. Simal-Antón, I. Blanco-Navarro Show preview | PDF (176 K) | Recommended articles | Related reference work articles 24 Decreased dopamine type 2 receptor availability after bariatric surgery: Preliminary findings Original Research Article Brain Research, Volume 1350, 2 September 2010, Pages 123-130 Julia P. Dunn, Ronald L. Cowan, Nora D. Volkow, Irene D. Feurer, Rui Li, D. Brandon Williams, Robert M. Kessler, Naji N. Abumrad Show preview | PDF (640 K) | Recommended articles | Related reference work articles 25 Nutritional Deficiencies in Obesity and After Bariatric Surgery Review Article Pediatric Clinics of North America, Volume 56, Issue 5, October 2009, Pages 1105-1121 Stavra A. Xanthakos Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase

Mis73 is right, many people here want sunshine and roses blown up their butt, and NOT THE TRUTH. If the truth "stings" this is probably not the place you should post, no one here can diagnose your symtoms, we can ONLY TELL YOU ABOUT EXPERIENCES WE'VE HAD, or seen others have , or studies we've read. There was a post recently about someone reporting "night time coughing and reflux" I told the poster THE TRUTH based on what I've experienced and what I've seen so many others lose their bands over. And guess what? I was told I was "scaring the newbies"...for crying out loud.... I am over 8 years post op, I don't have to post here either, or share my wisdom, but as I've seen the band has a VERY HIGH complication rate, most of it preventable, I feel sometimes "SOME" newbies would "LIKE" to hear the TRUTH, about the lap band, I am sure...SOME may not want to hear it from ME, but many do. Many surgeons don't know any signs of danger with the band, they don't live with it, WE DO, so we can only advise you of dangers of what we've seen, but our ADVICE SHOULD ALWAYS be take with a grain of salt, since we are NOT MEDICAL professionals....anything that's related to your port, port pain, incisions, frequent vomiting SHOULD ALWAYS REQUIRE PROMPT ATTENTION FROM YOUR SURGEON...YOU CAN'T GO CHEAP by querying this board on your lap band health. Also, many people don't even want to hear the TRUTH from their surgeon either, they'd rather ask a ridiculous question here about breaking fill rules with their bands -- and see if it'll fly...LOL. Now back to my vacation at the beach.

You're more than welcome and thank you. Us Brit sleevers are thin on the ground ('scuse the pun!), so it's nice to meet some others. As for the surgery, I think things went relatively well. Surgery is surgery and I had some trapped wind and anesthesia issues, but on talking to the nurses in the ward, apparently I was good in dealing with it (Who knew I'd be capable of that?!) Here I am, day two, sat in bed with my man beside me, feeling pretty chipper. Plus a bit out of my head on pain killers, so it's all good! I can walk, I can sip things, sometimes I ache, sometimes I burp, sometimes I go for a little walk and feel better, sometimes I get tired and have a nap. I think the best thing I can say (and this is obviously based on VERY limited experience), is something I read from a sage person on this site previously: Listen to your body. It won't put you wrong. I certainly found that out when they tried to give me dis-solvable paracetamol. I'd let it sit, so the bicarb had 'evaporated' ; but as soon as it went in, it came straight back up! So, guess what was first off my list of 'acceptable drugs to take'?! Either way, you'll be great. Keep positive, keep your eyes on the prize and keep in touch. If you have any questions or queries you feel I can answer or help with, or you just want to have a natter; give me a shout. Best of luck! xx

You are not failing if you are doing all the right things. Sounds like you are so don't stress it. I have bad joints as well. Can you join a gym or Y with a pool? I swim and that works great for me. Also..tell your family to stop asking how much weight you lost. Their queries do not help even if they mean well.

It is personal to tell or not. Isn't it? People do notice if you have lost a considerable amount. Sometimes I Reply "I had a lot of help". Most don't query further. Close friends know. I've stayed close to the same weight range for over 6 yrs so I don't feel needy about discussing it. I think that happens more at the beginning of the journey

Welcome! We all were nervous in the beginning; buy, keep coming back and reading the pre-surg and post-surg posting. Listen to your Doctor and query the internet for information on bariatric surgery - sleeves, dieting and Protein supplements. The more you learn, the better you will understand going with the sleeve's advantages of banding. The more you know - the better you will feel!

I don't understand these attempts (by women) to shame women out of talking about sex, as if it's not a vital part of any relationship. Discussing this does not make one a "horndog," merely a human. I'd like to thank those women who spoke frankly about why they might have been attracted to a particular body type in a man; for being proud of their sexuality. I believe the points they brought up were perfectly relevant to the OP's query.

Sooooooo. I did get an answer to my Salad,bread, and fruit issue . My Surgeon, who is awesome and i totally respect gave me this concise and simple response to my query " Stop it ".... Needless to say he has a dry sense of humor . he explained that its just the normal noises of the body adjusting to the new plumbing. I need to wait several weeks and try introducing it into the rotation again. Apparently every one has there own issues but they all work back into your diet eventually. Oh, and im officially down 103 Lbs ... this is a very good day! RJ

Beauty, I posted this a week ago on another thread and it sounds like you could do with reading it. As the knowledgeable ones above have said; if you're not comfortable, get a second opinion. I have a BMI of nearly 36 and there's no way, given the amount of academic research I've done, I would consider a band. Closer to home, I know a lady who had the band operation, had three corrective surgeries on it and then had to go to sleeve, which due to the scar tissue the band had left, failed, so it had to be revised into a bypass. An absolute mess. This, of course, is an isolated case - but the academic research proves that the band is simply not as effective, you don't lose as much weight, but does, on the plus side, have a lower mortality rate. If you have any queries about the below, please do not hesitate to contact me. All the best, R x "I posted this on another forum and felt it might be useful for other people to have a read of, if like me, you like your scientific facts. Maybe the below will provide a bit of clarity as to the 'nuts and bolts' of some of the bariatric procedures and their long-term (within the limitations of the data) efficacy. This first academic journal quoted was published in May 2013. So, it doesn't get more 'up to date' with regards to evaluating the comparative effectiveness in the three biggest weight loss procedures. I have only reproduced the abstract and have quoted the source below as the abstract covers the salient information we'd be interested in. The second section is all about the metrics, with a snapshot of all the procedures being evaluated in a tabulated form (the table was removed from the cutting and pasting process, so read left to right) and the risks associated with the operations. The primary and secondary sources are also cited. Better to make decisions based on rigorous scientific research, than hearsay and charasmatic sales pitches, I feel... Hope it helps. Article 1: Abstract: Objective: To evaluate the comparative effectiveness of sleeve gastrectomy (SG), laparoscopic gastric bypass (RYGB), and laparoscopic adjustable gastric banding (LAGB) procedures. Background: Citing limitations of published studies, payers have been reluctant to provide routine coverage for SG for the treatment of morbid obesity. Methods: Using data from an externally audited, statewide clinical registry, we matched 2949 SG patients with equal numbers of RYGB and LAGB patients on 23 baseline characteristics. Outcomes assessed included complications occurring within 30 days, and weight loss, quality of life, and comorbidity remission at 1, 2, and 3 years after bariatric surgery. Results: Matching resulted in cohorts of SG, RYGB, and LAGB patients that were well balanced on baseline characteristics. Overall complication rates among patients undergoing SG (6.3%) were significantly lower than for RYGB (10.0%, P < 0.0001) but higher than for LAGB (2.4%, P < 0.0001). Serious complication rates were similar for SG (2.4%) and RYGB (2.5%, P = 0.736) but higher than for LAGB (1.0%, P < 0.0001). Excess body weight loss at 1 year was 13% lower for SG (60%) than for RYGB (69%, P < 0.0001), but was 77% higher for SG than for LAGB (34%, P < 0.0001). SG was similarly closer to RYGB than LAGB with regard to remission of obesity-related comorbidities. Conclusions: With better weight loss than LAGB and lower complication rates than RYGB, SG is a reasonable choice for the treatment of morbid obesity and should be covered by both public and private payers. SOURCE: Carlin A, Zeni T, Birkmeyer N, et al. The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity. Annals Of Surgery [serial online]. May 2013;257(5):791-797. Available from: MEDLINE with Full Text, Ipswich, MA. Article 2: September 2012: Morbidity and mortality associated with LRYGB, LSG, and LAGB from the ACS-BSCN dataset LRYGB LSG LAGB 30-d mortality (%) 0.14 0.11 0.05 1-y mortality (%) 0.34 0.21 0.08 30-d morbidity (%) 5.91 5.61 1.44 30-d readmission (%) 6.47 5.40 1.71 30-d reoperation/intervention(%) 5.02 2.97 0.92 SOURCE: Data from Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg 2011;254(3):410–20 [discussion: 420–2], in: Timothy D. J, Matthew M. H. Morbidity and Effectiveness of Laparoscopic Sleeve Gastrectomy, Adjustable Gastric Band, and Gastric Bypass for Morbid Obesity. Advances In Surgery [serial online]. n.d.;46(Advances in Surgery):255-268. Available from: ScienceDirect, Ipswich, MA"