A few days ago I had my regular appointment with my Rheumatologist who monitors my injections of Humira for my Psoriasis and Psoriatic Arthritis. I advised him that I had started on a path towards weight loss surgery and I wanted to get his input towards med management after, etc.

He basically told me my weight is definitely a factor in some of the issues he's involved with treating, my med regimen won't need to change and with weight loss most patients find relief of symptoms BUT. (Ugh, there it is.) But, he has some patients that have had the surgery and been successful but tell him they 'wish they would have just eaten correctly prior to getting the surgery and they wouldn't have needed it.'

I get that point. I still felt agitated and a little insulted. I have tried eating correctly but I can't sustain it long term and gain it back plus and weight loss is very slow for me. Also, with my conditions and recent injury (broken leg/ankle) if I don't get some weight off exercise is a very slow build that may not get much of anywhere, but I'm working on it.

Am I flawed in thinking that weight loss surgery is going to help me? Aren't there factors having to do with hormones the stomach produces etc. that will be impacted? If I've done my research and listened to my WLS Doctor why is this Doctor's conflicting attitude shaking me so bad? This is common, right? Help talk me down a bit please.

If you were my patient I would say the same thing. Your rheumatologist wasn't trying to be insulting, they were simply stating fact. Be honest with yourself...wouldn't you avoid surgery IF you could lose the weight on your own? I know I would have. With that being said, having WLS was the best option for me at the time so I have no regrets.

If you were my patient I would say the same thing. Your rheumatologist wasn't trying to be insulting, they were simply stating fact. Be honest with yourself...wouldn't you avoid surgery IF you could lose the weight on your own? I know I would have. With that being said, having WLS was the best option for me at the time so I have no regrets.

I thought there were other benefits to the surgery other than simply making us temporarily eat less... Otherwise what assists us from eating through? I know a significant number of folks regain due to not sticking with the lifestyle. What separates the surgery from simply doing it on my own? There HAS to be a difference. Right? Otherwise, why would we do this to our bodies? I'm feeling confused. :-/

I would agree that losing or maintaining a normal weight by means that do not involve surgery would always preferable. WLS is risky in an of itself, both during surgery and long-term.

Having said that, people (like me) who were never successful losing or maintaining, NEED something more. Personally, there is a night and day difference in my ability to lose and maintain. I've been successful for almost three years, which is something I wasn't able to do on my own. Still takes work, but at least I can do it now. I am the same person - I had plenty of will power, desire, and resources before surgery. The ONLY thing that changed was having the surgery.

One thing I find surprising - I've never heard one person who lost and maintained say they were sorry they had the surgery because they could have done it on their own. The only regrets I ever hear are people who have complications, people who don't lose, or those who have psychological problems making them unable to cope with change in lifestyle. I just went back and reread what you wrote - that people "...wish they could have done it without surgery'. I wish that, too. I also wish I'd win the lottery! Wishing you didn't have a disease needing treatment is different than wishing you didn't have the treatment.

There IS something more than the surgery simply reducing the size of the stomach. There are hormonal changes that help us lose weight rapidly. Doctors aren't 100% sure what causes it, but the surgery seems so reset our body's "weight set point". This explains why I've spent so many years dieting "the right way" and exercising to only lose a few pounds. Or after a month of dieting and exercising I eat one meal off plan and gain 5 pounds.

I was nervous surgery wouldn't work for me since I had PCOS and insulin resistance which made losing weight close to impossible. But it's come off relatively easy. I'm interested to know how the surgery resets the body's set point but it obviously has in my case since I was never successful losing.

In considering weight loss surgery I've never labeled my thinking on the matter, or anyone else's for that matter, as "flawed" - it was more like enlightened!

Sure, if I had found a proven way to keep the weight off long term that didn't involve surgery, AND actually worked, I would have been all over it. But after decades of being a card carrying ticket holder on the yo yo diet merry-go-round, and watching my body and health deteriorate rapidly as I entered my 50's, I was more than ready to try something new.

There is no way I could have made the progress I've made in only two months with surgery, with any other non-surgical option. I have zero regrets, and I'm filled with hope and visions of a more healthy future in my 50's, and well beyond than I ever obtained on my own in my youth.

It was so worth it. So very worth it!

Sometimes you've just got to silence that doomsday voice in your head, close your eyes, and take a blind leap!

I expect that Dr does not have weight issues. Anyone who has struggled with their weight and yo yo'd for years would see this a little differently. Gaining and losing is not good for ones body either. Surgery helps you not feel as hungry and therefore as tempted to "fall off the bandwagon". It is also "so huge" in your life that I think I really makes you remember all the time what you have done, why you did it and that you need to stick with the plan, the one that will keep you thinner and healthier for life. Just as people have varying opinions about most things Drs have varying opinions about WLS.Do not let this one Drs opinion put you off something you have obviously already researched and decided about. I have spent most of my adult life fighting the weight loss battle. I thought I had won the battle once and stayed at a normal weight for 7-8 yrs but eventually all the weight I lost and more came back. Then age and diabetes kicked in and losing even a pound or two took a huge amount of work let alone 50 or more pounds. I had surgery 2 months ago and though I am losing slowly I am so glad I did it. I have hope now that in a yr or so I will reach a maintainable weight for the rest of my life. Good luck to you.

First, I have had the same issues with some if my doctors. My endocrinologist was all for it but he studies weight/metabolism/hormone issues (not to mention treated me for diabetes). He has been very supportive. My other doctors aren't as educated in that specific area. Second, I was just thinking about the whole "can't u just eat right" comments. And almost 4 months in, here is what I decided. I am eating right now but without the surgery, I just couldn't sustain on this low calories. Iowa's so hungry and would go to bed hungry. (I'm talking my stomach growling hungry). With the surgery, I am not hungry and WHILE I am learning new habits and getting my body out of the heavy carbs cravings, I am able to lose weight which then encourages me to stay on track and lose more. It is a tool and if u do not use it correctly, it will not work but if u treat it as the tool it is and then use that time to get healthy with a NUT and therapist, then it gives u the time u need to get it done and get to the maintenance faster using the tools u learned along the way.

I have also never heard a person who was successful with their wls say they wish they would have just ate better and lost the weight... seriously, like we haven't all tried that before we considered the sugery????

Sounds to me like your doctor was trying to sway you to 'try it on your own'. Like I said before, if you are anything like me, you have tried that dozens of times without results!!

I used to be a person that could easily drop weight when I wanted to. After I had my son at age 35 that all changed. Within a year of his birth I had gained over 100lbs. No matter how hard I tried for the last 5 years, the weight would not come off. Before his birth I maintained a size 8-10 for years and years (since my 20's). After, I ballooned up to a size 24 and tried like crazy to loose the weight the way I always had (very similar to what I am doing now- small portions of high protein, low carb meals, protein shakes

and I excersized 5-6 days a week and walked 7 days a week. It didn't work.

What finally worked is the sleeve surgery! Something about the surgery just kick started the weight loss for my body.

If weight loss was easily achieved through dieting and exercise, most of us would have been there, done that. But it is almost impossible following that regime. That is why we seek an alternative, especially one that has a proven track record. I don't know if significant weight loss will affect your medical conditions of Psoriasis and Psoriatic Arthritis, but I do know that surgery put almost all my medical conditions into remission very, very quickly; where they have remained ever since. I am 28 months post-op RNY and I would do this surgery over again in a heartbeat.

I am 4 years out and been maintaining 150 pounds loss for over 2.5 years. I eat way less (and of course good choiced) then I could ever manage Pre WLS. No wonder I could not maintain before, resuming "normal" eating I gained weight.

I did of course overeat and made some bad choices to get over 300, but maintaining a normal size/weight was just incredibly difficult perhaps impossible for me pre sleeve.

Perhaps he has had a patient regret WLS and that is what comes to mind. When i meet a new doc I tell about the sleeve but I don't gush about how wonderful it is...maybe I need to start to balance out the universe!

If you were my patient I would say the same thing. Your rheumatologist wasn't trying to be insulting, they were simply stating fact. Be honest with yourself...wouldn't you avoid surgery IF you could lose the weight on your own? I know I would have. With that being said, having WLS was the best option for me at the time so I have no regrets.

I thought there were other benefits to the surgery other than simply making us temporarily eat less... Otherwise what assists us from eating through? I know a significant number of folks regain due to not sticking with the lifestyle. What separates the surgery from simply doing it on my own? There HAS to be a difference. Right? Otherwise, why would we do this to our bodies? I'm feeling confused. :-/

A few things help, loss of the ghrelin, the greatly reduced stomach size for starters. Also that post-op period where you go from liquids-purees-soft foods is a prime time to relearn new eating habits, along with exercise. Does this guarantee you will not regain? Sadly no. I know people who have gotten bypasses and even with the malabsorption factor still managed to regain.

A large part of it depends on the individual and how they use this tool. It makes it's easier, but it's not a magic wand that banishes fat from your life forever.

In my opinion, this comes from our "pull yourself up by the boot straps" puritanical work ethic that has been so engrave in our American psyche. As if the millions and millions of obese folk on planet Earth haven't tried that oh-so-simple method of "just eating better" and somehow statistically (and overwhelming) failed. There is a reason why weight-loss is paved as an elusive road to success, there is a heap of factors that work against us in our efforts to shed. Those who have are versed and understand all the components that adverse us in our efforts (the Good Lord knows) would think thrice about making such a comment. Obesity is a disease and yet it is still being treated and reflected in our minds as an inability to somehow fail to "get it together," which, in my perhaps hypersensitive mind, I feel this Rheumatologist comment implicitly captured.

The truth is there is a mount of biological, psychological, physiological factors that work against our favor and make it extremely hard to lose and most importantly maintain. Our bodies are wired to hold on to fat for survival sake, not vis versa. Sure, superficially logic would dictate this simplistic view and of course there are always the (God bless them) successful outliers who prove that weight-loss can be attained and maintained, but the truth of the truth is that they are the rare needles in the stack, not otherwise. If it were as simple as such, we would all be thin by now.

My soapbox, which I'll get off off, is rising because I feel this type of attitude, which seems harmless on the surface and of course makes sense to those who are ignorant on the nature of obesity and weight-loss, leads to the perception of us "fat" folk as somehow not being able to manage our lives properly because some type of inheirant character flaw (lazy, stupid, weak-willed, no-will, pick-your-poision etc.) because after all, if we had just "eaten correctly" all would be well. But us fat people, aesthetic failures as we are, just can't seem to even do that one gosh darn simple thing right. What a group of defects..sigh.

Now, I realize your docs rabbit hole of thought may not run so deep, but I have come to see that there is general ignorance about the realities of weight loss and here is the shocker...even in the medical community. Doctors are not Gods, they miss beats and can have pockets of ignorance too. I recently mentioned to my derm (I also have psoriasis) that I was planning on having weight loss surgery in December and her sentiments were to summarize very much "eat less, fool. you don't need no weight loss surgery." But for those of us who are beyond doctors and have lived with this and maybe even taken some steps educated ourselves on this issue, I reckon it ain't that easy.

Surely, we have all tried eating correctly and massively failed, otherwise why are we on this board. I wish it were that simple for most of us, but give the biopsychosocial realities of this beast, this is mainly like wishing I looked like Jennifer Lopez. Nothing but a pipedream..lol. Yes, there are those who are victorious in their natural efforts, but for how long? And let's not forget those who are obese may have been dealt a different deck than the average Jane, that our bodies may be even more stacked to stack than the average human anatomy which is also predisposed to hold on to fat in general.

I would love no surgery. Lord you know that. And God knows I've tried. If it were that simple, then the statistics would tell that tale, but it doesn't. There too much working against us. And well intentioned comments like that (whether truly from other weight-loss patients or perhaps from just one person who has experienced difficulties in the surgical route. To be even more cynical, perhaps your docs way of letting you know what they thought without potentially offending you) are flat out ignorant and problematically and don't hit us as they should. Many of us harbor that same frustration and guilt of "what the f+++ is wrong with me, why can't I just keep this weight off/take this weight off!" and I think it is high time we recognize that yes while it is possible in theory, life moves so far beyond into the realities of practice, it's not even funny. The truth is (recommended read "The Fat Trap" to name one) telling somehow who is clinically obese to just eat better is like telling a clinically depressed person to just smile more to be happy.

@@CowgirlJane

And let's be honest. There isn't one person who you would meet and knew your story who wouldn't be convinced that WLS is absolutely the right thing for certain people. You are living, breathing proof of that.

Can we all just borrow you to take you around to all these nay sayers to shut them the hell up?

I would agree that losing or maintaining a normal weight by means that do not involve surgery would always preferable. WLS is risky in an of itself, both during surgery and long-term.

Having said that, people (like me) who were never successful losing or maintaining, NEED something more. Personally, there is a night and day difference in my ability to lose and maintain. I've been successful for almost three years, which is something I wasn't able to do on my own. Still takes work, but at least I can do it now. I am the same person - I had plenty of will power, desire, and resources before surgery. The ONLY thing that changed was having the surgery.

One thing I find surprising - I've never heard one person who lost and maintained say they were sorry they had the surgery because they could have done it on their own. The only regrets I ever hear are people who have complications, people who don't lose, or those who have psychological problems making them unable to cope with change in lifestyle. I just went back and reread what you wrote - that people "...wish they could have done it without surgery'. I wish that, too. I also wish I'd win the lottery! Wishing you didn't have a disease needing treatment is different than wishing you didn't have the treatment.

YES. He basically put it in such a way that suggested if I just did the right things now I could lose... However, my metabolism is dead and my primary care physician that first referred me to my WLSurgeon has worked with me to try to get weight off and seen the issues I'm struggling with. I have and still am trying. I'm simply not seeing progress. He absolutely made the other patients out to be regretful and I feel that is probably misinterpreted on his part.

Of course we would all rewind to a heathy slim body if that was ever an option for us. Some of us, like me, have never really had a thin baseline we trashed. I like many have battled my weight my whole life.