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For BMI > 60, GBP instead of Lap Band?



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Hi all, I just saw a doctor yesterday and discussed getting lap band surgery. She does not suggest that I get it because of my extreme obesity. She feels the gastric bypass would be more effective. Apparently, you can cheat easily with the band and it will take alot of will power to actually have the band be effective. I am 335 lbs now and want to lose 185 lbs. Should I just get the more aggressive surgery, even though it is much more extreme? I have PCOS, insulin resistance and many other problems and I am only 30 and still want to have a child. Please help with some advice! Thanks.

Nicole:confused:

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Hi Nicole,

For my money, the two surgeries are equally easy to "cheat" and over the long term have very similar results. Banding takes more patience and -- in the short term, at least -- a bit more participation from the patient. RNY will result in drastic, immediate weight loss no matter what the patient does, but after about two years the patient's behavior becomes pivotal again and it's very possible to gain the weight back.

When considering between the two, it seems to me most important to decide whether short-term or long-term results are more important. If one is in need of immediate results for health reasons, the RNY makes a lot of sense. But if one is otherwise healthy, and wants to learn how to eat less permanently without running the risk of malnutrition, the band would seem to make more sense. (I believe it always makes more sense for younger people, too, because the negative effects of RNY stay with patients for life.)

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My BMI was 68 when I was banded. I was not interested in the bypass as a first course of surgical action. I'm not saying that I'm anti-bypass -- if the band hadn't worked for me (or if, God forbid, I ever lose my band), I might have had it. That said, I don't think for someone in their 30s who wants to have a child (like you and, maybe, me), any doctor should be pushing you into the bypass. The band lets you absorb the nutrition you need to carry a child to term. My view is a doctor who puts weight limits on the band might not really believe in the band, which is a red flag on that practice for me.

My advice is to continue your research. You need a practice that fully supports your long term goals. Follow up care with the band is paramount. There's no medical reason to go bypass with BMI>60 that I know of unless you've got a pressing co-morbidity that could take your life if you don't lose the first chunk with incredible speed (something like uncontrolled BP).

Don't give up on the band. Find the right doctor.

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My BMI was 62, I weighed a good bit more than you, and I had a number of co-morbidities..and I have done extremely well. However, I eat by the same regimen that an RNY person has to use. There are people who say an LB can "eat whatever they want, just less of it", are, in my opinion, dreaming....either that or they just don't have as much to lose as you and I do.

In fact, I chose LB because I needed to lose 200+ pounds. RNY is good for only about 18 months ('window of opportunity')....after that you are on your own. I doubted being able to lose 200 lbs in 18 months, so I went with the band - it's there forever and can be adjusted to suit your needs as you progress thru the wls journey. If you backslide it's still always there waiting for you to get your mind right and get back on track with your lifestyle modifications.

I know there are many successful pregnancies that have taken place after GB, but it would make me a little nervous knowing that my re-routed innards were not absorbing the nutrients I put in my body and that baby and the mother are both totally dependent on Vitamins and supplements.

It is my understanding that RNY may be preferable for people who are sugar addicts whereas LB is best for people who are volume eaters. (RNY makes you very ill ('dump') when you get sugar in your system).

That's just my thoughts on the situation....I wish you well!!!

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I have a BMI in the mid 50's and I need to lose at least 170lbs maybe more like 180lbs. I first went to see a doctor about the band over 4 years ago. After talking to him he said "well i'll do the band if you really want but i don't think it will work that good". He really just wanted me to do the RNY.I should also say i was 100lbs less then now. I was so turned off i just said forget it and didn't do anything until i found out about NYU this year. I have a team of people that one understand the band and know it can help and two are not pushing me to do something i don't want to. It just makes you feel so much better going into it. If you think the band is right for you then i would say find another doctor.

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My Doctor was the same way. He pushed for me to get the bypass also. My answer to him was it took me 30 years to put it on and if it takes a few months longer to take of then its fine by me ! My BMI was around 56 when I started this and now its 48 and I only started the journey 4/27. Its coming off pretty good so far. Its ultimately your decision but the advice given so far has been pretty spot on. Good luck either way you choose.

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Hi all, I am so glad for everyone's input. You confirmed the things I was thinking as well. Knowing that there are other lap band users who are successful at higher weights gives me hope that it will work for me. I may still use the doctor, cuz the hospital is rated very high. She said she would do it, just didn't recommend it. My parents are coming down to visit the doctor in july so I think then we will finalize what I will be doing.

Again, Thanks so much for your help!

Nicole

Fat Life

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I had a BMI pretty close to what you're talking about, and my surgeon didn't have any objection to me getting the band.

Personally, I feel that the gastric bypass should be considered a true last resort due to that permanent malabsorption aspect to it, and the amount of weight I've lost with teh band has definitely had a dramatic positive impact on my life, so I am glad that I had the option to go for the band. :(

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My surgeon explained the difference by what kind of approach you have to eating. He broadly categorizes people as either 'grazers' or 'portion control problems'. Not clear cut, and plenty of spots in between, but generally:

- grazers eat pretty much all day...lots of Snacks in between meals and in the evening. He recommends bypass for folks that eat like this and have trouble not snacking.

- Portion Control problems (like me) eat very large meals, but snack very little between meals and in the evening. Banding generally works well, since it helps you control the amount you are eating at a meal.

He didn't seem to look at BMI as a differentiator as to which surgery you should get.

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I too am 30 and want to have a baby, so I chose the lapband. My starting BMI was 57 and I also weighed 335 lbs. Since May 15 I've lost 47 lbs and now my BMI is 47. I feel great and I think this was a great choice.

I was also encouraged to considerr RNY, but it was just too drastic. I need to be able to nurture that baby when it's time!

MaryumC

weight.png

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Hi Nicole,.... i agree with your doctor the gastric bypass will be better for you. my name is Ann and i am having trouble with my lap band i actually have to see a new surgeon in albany med on june 26th of this week coming in. my lap band has been giving me trouble since 2005 and the doctors i had keeped telling me i was crazy and now it is worse the band part in my stomach and the port on my left side. i wish you lots of luck.

and you can reach me @ fordforda9466@aol.com hugs Ann:)

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As a midwife I would be concerned about the malabsorbtive aspect of the bypass. It is the primary reason that I did not consider it as I would like to have more children and worry about being able to provide incredibly important nutrients to a developing baby.

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I had my Lap Band placed in July 2006, My BMI was 103 and my surgeon too tried to push the bypass or vg and I said no because I wanted the slower and more permanent weight loss in my opinion and I also felt that I could lose the weight I needed to lose. My year is coming up and I have so far lost 130 lbs, I have to update my ticker. It does require work on your part, but worth it in my opinion. My hardest times for me are in between fills. I say get as many as you need, I didnt at first but now I am getting them alot more. I hope this helps. Good Luck in what ever surgery you choose.

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