Frustrating Weight loss workup

[Ruth1ess 494]

First post..

I'm frustrated and need a place to vent. I've been browsing these forums for the past week reading up on the gastric sleeve procedure, success stories, and complications. Here's some history on me:

Last week, I went through the bariatric workup program at a very prominent, high profile, good reputation clinic. My goal was to meet with the physician and his team to help me lose weight non-surgically. I'm 34, just weighed in at 295 (my absolute highest, I was mortified), and have tried several attempts at low carb resulting in 20, 40, or 60 lbs lost. I was able to keep off the weight for about two years with maintaining a low carb lifestyle and running in the mornings until I injured my knee at my old job. I regained the weight quickly and have been discouraged many times since.

The really discouraging part, though, happened during my appointments. I met with the nutritionist and she listened carefully; we mapped out a diet program for me and I left the office feeling positive about making smaller, incremental changes instead of drastic 'no sugar ever' changes that I've fallen from before. Next was the psychologist.

The first question that the psychologist asked was, "So, what kind of surgery are you contemplating?"

I told her politely that I hadn't been interested in surgery, that I was coming for a doctor-guided weight loss program since I've until now just worked on my own. That's when the appt went downhill..

From there on, she told me that I would not ever be able to break the cycle of weight loss/frustration/weight gain. She said my body would always want to be 295 now that I'd topped out at this weight, and that nothing would work for me except for biological intervention (cutting out that hunger center in the stomach) through surgery. She said choosing not to do surgery would be choosing to be morbidly obese for the rest of my life, and spent the rest of the appointment going over the two kinds of surgery they provide (bypass and sleeve).

I left that appointment feeling miserable. I'm a very rebellious person, so my tendency is to want to prove her wrong and double down on my weight loss attempts. The other part of me is miserable and worrisome, and concerned that she's just telling me a hard truth that I don't want to swallow.

I don't know what to do. I'm conflicted, sad, and frustrated. That appointment has left me an emotional mess as I try to sort out the truths and fallacies in her statements towards me. I'm open to the concept of having surgery, but I have avoided serious consideration until now because it seems like such a drastic intervention.. but now I feel like I've been punched in the gut saying that I can't do this through dieting and never will be able to. I'm 34 and I've been heavy since I was a teenager. I've failed multiple attempts at diets. But does that really mean I'll never be able to do it?

Would love to hear your thoughts

Edited January 7, 2016 by Ruth Shepherd

[LATINGODDESS 31]

First off, I'm sorry you were treated that way by a so called professional. The first thing you need to do is find a new psychologist. They are supposed to at least attempt to help you work through your issues first. Not just jump to the conclusion that you are a hopeless case. My psychologist asked me first if I wanted to work through this with diet and exercise or if I was contemplating surgery. I made that choice. If you feel that you aren't ready for surgery, don't let anyone bully you into it. You are the only one that can choose what happens to your body. I truly wish you the best of luck. Kick that dr to the curb.

[Inner Surfer Girl 12,015]

I do understand your frustration and anger. I have been there.

I was 150% opposed to the idea of surgery, even though I was: a lifelong dieter and have been in a battle with my weight since adolescence; have tried everything (including successfully losing a tremendous amount of weight with a medically supervised liquid diet in my 20s); was over 500 pounds; and on disability.

Being obese, dieting, food addiction, and obsession with food has had a major negative impact on my quality of life, career, and relationships as long as I can remember.

I had a lot of pre-conceived ideas about weight loss surgery, most of it based on old and incomplete information.

Fortunately, I was at the end of my rope and I have a very wise PCP. I had given up dieting because it has become impossible to lose even a few pounds due to my lack of mobility and healthy issues and that if I were successful, the next rebound would put me at over 600 pounds. The next diet would surely lead me to be bed bound and death.

I had always been a "healthy" fat person. That is until I suddenly wasn't.

My PCP suggested I just make an appointment to talk about the possibility with a bariatric program. I didn't have to decide anything, just learn about options.

I was so blessed to be referred to an outstanding bariatric team with an awesome and very skilled and knowledgeable surgeon.

This is a long-winded way of saying from everything I have learned, the psych counselor is absolutely right. I have learned that through my own experience and my surgeon and NUT have been instrumental in helping me understand why and how diets don't work.

It is a combination of evolution and physiology. Our bodies are designed biologically to efficiently store energy and resist losing weight. We were designed for extremes of feast or famine but not times of extreme abundance. When we lose weight, our bodies remember the starvation part and are programmed to gain back that much weight plus a buffer. Hence the yo-yo dieting leading us to weigh more than when we started the diet. Our set point is raised each time we diet.

Edited: because I accidentally hit save before I finished.

I encourage you to keep researching and considering all of your options. You don't have to decide today. It may not be right for you today.

For me, the right weight loss surgery technique, and right surgeon came along at the right time for me. Even though it would have been great to have this surgery when I was your age, the surgery that was available then was completely different and I probably wouldn't even have been eligible.

I was sleeved April 20 of this year and couldn't be happier with my progress and results. I had an easy and uneventful surgery and recovery. None of my fears about pain and failure have come to pass. I am regaining my mobility and my life. Most importantly, I am recreating my life and not planning my funeral.

[CowgirlJane 14,259]

I tried to join a"lifestyle" type program- 2 years long and a huge commitment. I have to say it was the best thing ever that they wouldn't take my money and referred me to a bariatric surgeon with a strong 2 year follow up (nutrition,activity and medical).

I am sorry you are upset and that person was so rude, but statistically, you were told the truth.

I spent DECADES losing some weight, maintaining for a range of 3 minutes to 3 years, but always weighed more at the end.

Obesity is now being thought of as a disease process....and in my case it was quite advanced. I am 5'5" and I thought it was great if I could maintain around 240, my highest weight was nearly 350. I started the sleeve preop diet at 308. That was 4 years ago and I maintain at half my former size.

WLS is a big deal, and I always encourage people to be sure they have really tried EVERYTHING before jumping in, but my personal experience matches what you were told. After every weight loss attempt, never getting to a normal body size, I would eventually regain to a higher weight than I started. The sleeve has saved me..or rather helped me save myself... from that hellish cycle.

[JamieLogical 8,684]

I think that psychologist was a big poopy head, but what she said wasn't wrong. Study after study has proven that long term maintenance of weight loss is almost impossible. Are there people who do it? Yes! Are you likely to be one of those people? The odds are NOT in your favor.

I was just like you. I'd lost weight many times on my own. The largest amount at once was 90 pounds over the course of a year. But I'd lost 60 here, 40 there, 25 there. You get the idea. My problem was never weight LOSS. I am a pro at weight loss. If weight loss were an Olympic sport, I'd have at least three gold medals! My challenge was always weight maintenance. And that's the true challenge for the VAST majority of obese people. With conventional forms of weight loss (diet and exercise), the problem is, it's always a "diet". It is, by definition, a temporary thing. We set a goal. If we work hard we get to that goal. And then once we are at that goal, we are "done". And even if we do have the discipline to get to that goal and stay there for some period of time, something always happens that throws us off our game. An injury, an illness, a death in the family, real life..... Something gets us off track and we gain a few pounds and we're like "no big deal, I'll get back on track when this crisis is over". Then next thing you know, it's a year later and you are right back where you started!

In July of 2014, I was back within 10 pounds of my highest weight. I was looking at that long road of diet and exercise to lose the weight once again, but I just KNEW that even if I did lose the weight all over again, it would be the same old tune. I would just gain it back again eventually. So I decided to break the cycle. I researched WLS and I took the plunge in September 2014. It was one of the best decisions I've ever made. Now I am at goal and I have a tool to get me through all those road blocks that would have sent my weight skyrocketing back up in the past. I've been maintaining for 4 months. In those 4 months, I've sold and moved out of my old house, moved into my new house, hosted people for Thanksgiving, Christmas, and New Year's, been sick a few times... You know what? I haven't gained back one single pound! Stress of moving? No problem! Holidays? Easy! Sick and unable to exercise? Oh well!

With my sleeve, I am never "done" like I would have been on a "diet". When the going gets tough, my sleeve is still there to support me and do its thing. Does it work better when I work with it? Sure! But now I feel like I have this safety net to get me through rough times and give me the chance to get back on track again without having to regain 50+ pounds in the interim.

[Miss Mac 6,261]

Here is my favorite thread on this forum:

http://www.bariatricpal.com/topic/219831-what-was-your-final-straw-that-broke-the-camels-back/page-122#entry4029249

We share when it was that we finally decided to take the plunge. Another recurring theme is that many if not most of us wish we had done this sooner.

[Babbs 14,680]

I always take a little offense to people who are so adamantly against surgery, like those of us who had the surgery are weaker because we needed surgical intervention. That couldn't be further from the truth.

What the psychologist said was exactly right, whether you want to hear it or not.

Is it a bummer that we have a disease where surgical intervention is almost necessary to get it under control? Sure. But so is having to have surgical intervention for cancer or heart disease.

Sometimes we gotta do what we gotta do, and put old stigmas to bed about it. At this moment, my disease of obesity is under control thanks to surgery. While it's a constant struggle I will deal with the rest of my life, at least I actually have a fighting chance now.

[AvaFern 3,516]

From a professional perspective, that psychologist is clearly in a situation where she has a conflict of interest. You are either a psychiatrist (therapist, psychologist, counselor, whatever the degree) or you are a consultant for a surgeon who also happens to have some kind of psych degree. It sounds like the person you met with was the latter, which is a misrepresentation. Unless she is a psychiatrist, she is not an M.D. and therefore has no qualifications for directing you toward a surgical intervention. If she represents herself as first a therapist and not as a consultant for the surgeon, she is almost at a point of an ethical violation when she didn't bother to get to know you at all before she pushed the surgery option. That is absolute garbage and I would have called her out on it. If she is a consultant who is clearly representing the surgeon, then eh, she sort of did her job even if I find her actions for her actual profession to be questionable.

That said, she isn't entirely wrong in the sense that a lot of studies show a continued pattern of weight loss and gain in non-bariatric surgery patients. To be fair though, there are also plenty of studies that show a person who has had surgery can eventually gain all that weight back as well. There is one popular study that says that people are more likely to keep weight off when they've had bariatric surgery if they've also had plastic surgery. If you look hard enough there is a study that supports almost everything in some way.

I personally did the weight loss and gain thing for years. I'd regularly lose 60-90 pounds, keep it off for a year or two, then gain it right back. I am very happy that I had the sleeve procedure done, although I am only 29 months post-op, so who knows if I will maintain over the next decade or even the next few years. I have had a far easier time maintaining at my goal weight now than I ever did in the past and I give my sleeve and it's penchant for making me puke if I eat the wrong thing the credit for that.

Bariatric surgery is a very good option for many people and most of us are happy we had it done. It is however a personal decision and one that a person who claims to be practicing in the area of psychological counseling has absolutely no business making for you or pushing you toward. Her job was to guide you toward making whatever decision was right for you AND IF that was surgery, to determine if you are psychologically a candidate for the procedure, not to act like the doctor she most likely is not and tell you that only one type of action is going to help you lose weight. Professionally and ethically her actions are questionable, however that being said, if you take what she said and have it come from your surgeon or a friend who has had the surgery and who is well-researched on the topic, the points she made would not be entirely off base.

[2goldengirl 2,076]

You've gotten a lot of tough love here, and while I may wonder at the manner in which your psychologist delivered the message, there are some hard truths to face before you make your decision.

But here's the most telling from my POV. You are 34 years old. You say you have been fighting obesity since you were a teenager. That's roughly half your life. if you decide that WLS surgery is a good option for you, what you then have to look forward to is having a healthier life for many, many decades.

I say this because I'm in my 60's. I have been fighting the notion of surgery for more than five years while at the same time working with individuals who are on the surgical journey. I've read countless reports from Registered Dieticians, Psychologists, primary physicians, and surgeons. Only a very few of those clients had any kind of complications after surgery. All would do it again. All had tried over and over again to lose weight without surgery. All failed to maintain their weight loss without having surgery, despite multiple and very sincere efforts on their part.

Having made the decision to have surgery myself, I wish so badly that there had been a way to treat my obesity successfully and definitively when I was your age. I don't know necessarily that I would have been happier or had a better life (I'm well and truly blessed), but I'm now staring down the last third of my life knowing the damage that decades of obesity have done to the only body I have. I won't ever get those healthier years back.

One final note for you, and that's about your "I'm a rebel" comment. I get it, I'm kind of a rebel myself. Tell me I can't do something, and I tend to see that as a challenge. One thing that is absolute where surgery is concerned: rebellion needs to be able to come off the table in terms of pre and postop directives. I only mention this because it's something that is part of my preop self-reeducation. Good luck with whatever you decide.

[Ruth1ess 494]

Thanks, everyone, for helping me through what was a really very emotional couple of weeks. My doctor said yes, the psychologist was right, but in a much kinder way. After doing a lot of research on the sleeve and reading through posts here, I decided to pursue surgery.

There's still a stigma there, I won't lie. Some part of me still says surgery is drastic and unnatural and I don't need it.. then the practical side of me shuts me up because I'm done fighting my weight. I need a drastic tool like this to help me, and I want to get on with my life knowing I'm not alone in my fight.

I'm ready. I'm about halfway through my presurgical prep, and the excitement is growing.

[JamieLogical 8,684]

Glad to hear you are feeling confident in your decision. The social stigma and general misconceptions about WLS are tough to overcome. It's not until you do some research and realize what it really takes to be successful that you realize it can be an invaluable tool, but is by no means s "the easy way out". Please feel free to post your questions, concerns, and insecurities here as you begin your journey. This community has so much to offer in the form of knowledge, wisdom, experience, support, and tough love!

[Ruth1ess 494]

My opinion of this psychologist isn't really changing. I had my first day of educational classes (1 of 2) yesterday, of which she taught the first half.

First off, big hats off to this community for the education here. I feel as if I already knew 95% of what was covered yesterday, and that's incredible!

So, the psychologist.

She is very firmly implanting in our minds that we will not lose beyond the average of 27% total body weight with the sleeve. Very firmly. I realize in her mind she is trying to manage expectations (so we don't all think we're going to be a size 2 and be disappointed down the line), but she went so far as to kind of shoot me down in front of the group when I said I was an overachiever and would still try to lose more weight after the first year. She also said we should not begin any exercise routines (going to the gym) that we would not be able to keep up with for the rest of our lives, and that we would not lose past our set point. She even suggested I would get "bypass envy" and should consider bypass over the sleeve for an extra 7% loss.

I understand that this first year is to build healthy habits that will carry over into maintenance and for the rest of our lives. I know that our bodies have a 'set point' that it will want to stop at. But I'm also being told in thread after thread on this forum that it IS possible to lose more with effort.

Just venting, I guess. I really am a bit frustrated with her. I'm going to stop thinking about the numbers and continue to prep for surgery and believe that I am not limited by her or anyone else. Will I be happy with the 27%? Yes of course! 77 lbs would be an incredible loss. But people here have given me hope to know that more is possible.

[CowgirlJane 14,259]

I have never heard this 27 percent thing. Usually they measure percentage of excess weight lost.

I lost 150# in 14 months - which is about half my starting weight. I am 4 years out, a few pounds under goal, a few pounds over my lowest weight.

My surgeon didn't give out goal weights because it is absolutely the truth that the heavier you start the less likely you are to maintain at a "normal " weight. They told me they didn't want me to feel like I failed if I lost 100, and not the full 150.

Either procedure is a good surgery, have an open mind as the risks and issues are different.

I don't think I would like the way this person communicates and a bit of advice. . You'll never win an argument with her so just let it go. Is this the only center of excellence around? I would rather they talk about which surgery you are best candidate for and why rather than these strange stats.

Sent from my SAMSUNG-SGH-I337 using BariatricPal

[Inner Surfer Girl 12,015]

My opinion of this psychologist isn't really changing. I had my first day of educational classes (1 of 2) yesterday, of which she taught the first half.

First off, big hats off to this community for the education here. I feel as if I already knew 95% of what was covered yesterday, and that's incredible!

So, the psychologist.

She is very firmly implanting in our minds that we will not lose beyond the average of 27% total body weight with the sleeve. Very firmly. I realize in her mind she is trying to manage expectations (so we don't all think we're going to be a size 2 and be disappointed down the line), but she went so far as to kind of shoot me down in front of the group when I said I was an overachiever and would still try to lose more weight after the first year. She also said we should not begin any exercise routines (going to the gym) that we would not be able to keep up with for the rest of our lives, and that we would not lose past our set point. She even suggested I would get "bypass envy" and should consider bypass over the sleeve for an extra 7% loss.

I understand that this first year is to build healthy habits that will carry over into maintenance and for the rest of our lives. I know that our bodies have a 'set point' that it will want to stop at. But I'm also being told in thread after thread on this forum that it IS possible to lose more with effort.

Just venting, I guess. I really am a bit frustrated with her. I'm going to stop thinking about the numbers and continue to prep for surgery and believe that I am not limited by her or anyone else. Will I be happy with the 27%? Yes of course! 77 lbs would be an incredible loss. But people here have given me hope to know that more is possible.

What planet is she on?

I am really curious to know about her credentials and experience. She sounds like a loon.

[Ruth1ess 494]

She gave me the number of 27% of total weight, whereas my physician gave me the typical response of 60% of excess weight (but said my metabolism was good so he expected me to exceed it). There's about a 15 lb difference between them for me, which is why I'm pretty much ignoring the numbers now and going with my gut, no pun intended, in regards to my expectations.

I really believe fully in my clinic, which is why I'm staying here (as well as my insurance benefits limit me to this facility for the best coverage, it's a work thing), I just really don't like the psychologist. A lot of what she said was on point, I'm only really talking about the things that sounded 'off' and were contrary to the experiences of so many here. /rant rant rant. Grr.