Should I ask the surgeon for extra restriction?

[putasleeveonit 16]

I've been looking at videos all day! I'm not terribly obese (BMI 35) but I'm a compulsive overeater and I've struggled with yo-yo dieting for the past almost 13 years now. Should I tell the surgeon I need my sleeve to be extra tight or do they do all sleeves the same size? Sorry if this seems like a silly question! I just need to be stopped from overeating!

[RickM 1,747]

It is certainly something to discuss with your surgeon (and maybe the psych, too,) and get their views on the pros and cons of it. Sleeves are not made the same size- there is some controversy amongst the surgeons as to how big to make the sleeves - too big and weight loss may be insufficient and regain may be more problematic, while too small and reflux can be a bigger issue. They're waiting for more 5 year data to provide more guidance. As is often the case in this world, this may not be a simple case of more (restriction) is better. You may not actually need the smallest sleeve, which may be more appropriate for someone in the 50-60 or more BMI range; a somewhat larger sleeve will probably allow you to lose all that you need to lose if you eat reasonably well with it, and a smaller sleeve may not help you if you don't. Also, the sleeve may not be the right procedure for you. The duodenal switch, for instance, often provides better loss (which you don't really need at your moderate condition) and also better resistance to regain. It tends to allow one to eat more normally and somewhat larger quantities (it uses a larger version of the sleeve as its basis) while still keeping the weight off. As always, there are tradeoffs to consider carefully. Of course your surgeon may not make such a suggestion if he doesn't do them. I chose the sleeve because I have not had major regain or yo-yo issues and had already made substantial lifestyle changes which helped keep my weight fairly stable, but volume was still an issue keeping me from losing more than I was able to "the old fashioned way". YMMV

The major "cure" that comes from any of these surgeries comes from the lifestyle changes that you make, which the surgery helps you make. At your moderate size, most any size sleeve will likely provide enough restriction for you to be successful - even the smallest sleeves can be defeated if you drink your calories. The RNY typically leaves a smaller stomach and more nominal restriction, but regain is still a problem with many RNYers.

It can be a tough decision deciding which procedure is right for you, as none of them are a silver bullet that will cure all. They all take commitment and a willingness to make changes, though these are somewhat different for each procedure.

[putasleeveonit 16]

Thanks Rick! Your post is very helpful!

It is certainly something to discuss with your surgeon (and maybe the psych, too,) and get their views on the pros and cons of it. Sleeves are not made the same size- there is some controversy amongst the surgeons as to how big to make the sleeves - too big and weight loss may be insufficient and regain may be more problematic, while too small and reflux can be a bigger issue. They're waiting for more 5 year data to provide more guidance. As is often the case in this world, this may not be a simple case of more (restriction) is better. You may not actually need the smallest sleeve, which may be more appropriate for someone in the 50-60 or more BMI range; a somewhat larger sleeve will probably allow you to lose all that you need to lose if you eat reasonably well with it, and a smaller sleeve may not help you if you don't. Also, the sleeve may not be the right procedure for you. The duodenal switch, for instance, often provides better loss (which you don't really need at your moderate condition) and also better resistance to regain. It tends to allow one to eat more normally and somewhat larger quantities (it uses a larger version of the sleeve as its basis) while still keeping the weight off. As always, there are tradeoffs to consider carefully. Of course your surgeon may not make such a suggestion if he doesn't do them. I chose the sleeve because I have not had major regain or yo-yo issues and had already made substantial lifestyle changes which helped keep my weight fairly stable, but volume was still an issue keeping me from losing more than I was able to "the old fashioned way". YMMV

The major "cure" that comes from any of these surgeries comes from the lifestyle changes that you make, which the surgery helps you make. At your moderate size, most any size sleeve will likely provide enough restriction for you to be successful - even the smallest sleeves can be defeated if you drink your calories. The RNY typically leaves a smaller stomach and more nominal restriction, but regain is still a problem with many RNYers.

It can be a tough decision deciding which procedure is right for you, as none of them are a silver bullet that will cure all. They all take commitment and a willingness to make changes, though these are somewhat different for each procedure.

[A New Day 5]

I was wondering the same thing!

[Heatherr 149]

It seems most surgeons have a size that they use as their standard, but I suppose you could ask.

[emily_0192010 168]

I've been looking at videos all day! I'm not terribly obese (BMI 35) but I'm a compulsive overeater and I've struggled with yo-yo dieting for the past almost 13 years now. Should I tell the surgeon I need my sleeve to be extra tight or do they do all sleeves the same size? Sorry if this seems like a silly question! I just need to be stopped from overeating!

Well it can't hurt to ask your surgeon's opinion. Some good points were made before about small vs larger sleeves and the amount of reflux you can expect. What you said about being a compulsive overeater though, that won't change with the sleeve. Whatever is causing you to over-eat is still going to be there. Having a smaller sleeve would only force your body to react quicker. I would suggest going to a therapist to figure out why you do this in the first place and then work on methods to change it. All the while using your sleeve as a tool to help keep you on track. No matter what going to talk will only help so it is worth a try

[dragon 1]

Your surgeon will make the size of sleeve he is comfortable making, and you wouldn't want it any different. Ask him about the size, and the volume that patients a year or two out can eat, but don't worry too much.

Before the sleeve, I was ALWAYS hungry. I could eat amounts of food that would be positively gross to list, and still feel hungry. Now, three ounces of Protein, and I feel FULL. There are new physical signs telling you to stop eating with the sleeve, and you will learn to listen. (And you will, because the one or two times you think "aah, this is so good, I just want one more bite", you may be regretting it for hours).

If over-eating is your big problem, this surgery will work really well for you. At 5 months out, I am down 65 lbs from my high, and I can still get full on a half of a small chicken breast. What's funny is how different portions begin to look after a while. The thought of a full plate of food is gross to me these days.