I posted this in the pre-op section but I thought it might be better if I ask the question of people that have already been through it?

I am considering RNY and am in the last stages of approval. Of course I have questions and am seeking input. I am a male and 53. As a kid I was rail thin (having graduated high school weighing 140 lbs). Over the years the weight slowly accumulated.

One year and eight months ago I started on a medically supervised low carb diet and lost 65 pounds in six months. It was Protein shakes and as I transitioned off I gained back about half. I have so many co- morbidities (Diabetes, sleep apnea, high BP, high cholesterol) I feel I have to do something drastic. For me it is a health issue, plain and simple. A family member had great success several years ago (and is still doing great) with a sleeve so I am considering surgery.

For me I am pretty much decided on RNY, my logic is that if I get the sleeve and it doesn't get me where I want to be, I can't change it. I have known my medical team (nurses, endocrinologist, nutritionist, exercise person) this entire time. The surgeon and psychologist were just added. They are all very confident that I will be successful....me not so much. My BMI is 38ish so I have some weight to lose (maybe 50 or 60 lbs) which I know is not as much as others. I think I am, at least, a semi intelligent person. I have researched the procedures, the pluses and minus, the risks, and life after surgery. Nothing is like actually having gone through it but at least I think I understand what I am getting into (as best as I can).

I guess the question is "WHY IS THIS DIFFERENT"? Let's face it, if I was that good at following a directed diet, I wouldn't be looking at surgery. If I was motivated get up and exercise I would be doing it. So what makes me think that altering by body will change my mind and life.

The teams feedback is that because I have lost weight in the past (not just last year but multiple times in my history) that I have proven I can make changes. The surgery will help the changes stick. I am not sure I understand this. The only things I can think of are Volume, Dumping and Relationship.

V - I get that I will eat less volume and that makes a difference, but I also know that this alone won't be enough long term. The pouch can stretch and you can sabotage the volume thing with bad choices. I am not to worried about volume but, again, if I was any good at making good choices I wouldn't be here.

D - I think dumping can give you immediate feedback when eating the wrong volume or type. I am not sure this is a valid tool but it is there.

R - I know that for the first year or so you are not physically hungry. I also know that this disappears and that most of my eating is NOT driven by hunger. I guess my thought is that if I am not driven by hunger for a year I can focus on recognizing and controlling eating for other reasons (boredom being the biggest). The psychologist also mentioned that my energy would be higher and I would be more active, hence less bored.

I would appreciate input, not only to the central question, "Why is this different?" but also if you have any insight into my thinking. Is my mind in the right place? Does the VDR logic make sense to those that have gone through it? Really any input would be great.

I had the same concerns as you, and spent some time reading research on the ASMBS site. There are actual metabolic changes that take place with the RNY procedure that do affect the long-term outcome compared to regular dieting. One example is our metabolic rate: through normal dieting, our metabolism slows down. But with RNY, it doesn't slow down as we drop weight -- it may even increase for some time.

There's also some malabsorption for awhile. I'm not sure what the role is of malabsorption in early weightloss, as it doesn't seem like a terribly lot that's malabsorbed, but even 10-20% would have an impact.

The stats on weight regain with RNY compared to just diet & exercise at the 5 year mark suggest that there is definitely a difference between having the surgery and not.

My lapband did not work long term and caused various problems for me. I've got more hope for the RNY, even if I don't get down as far as I'd like to with it.

I'm post op and still have the same concerns! But what I'm thinking is that with typical diets I will lose some, really slowly and then get frustrated and go back to old habits before I really have a chance to feel the benefit of weight loss. With this, I'm hoping the restriction, fear of dumping and rapid weight loss during the first year or so will get me to a point where I can really see and feel the benefit and make some legit lifestyle changes. Then when the honeymoon is over I won't be as tempted to go back to my old ways.

23 minutes ago, Sadiebug said:

I'm post op and still have the same concerns! But what I'm thinking is that with typical diets I will lose some, really slowly and then get frustrated and go back to old habits before I really have a chance to feel the benefit of weight loss. With this, I'm hoping the restriction, fear of dumping and rapid weight loss during the first year or so will get me to a point where I can really see and feel the benefit and make some legit lifestyle changes. Then when the honeymoon is over I won't be as tempted to go back to my old ways.

I "just" lost 65lbs and wasn't able to keep it off so I did get to feel the of being thinner but it was 100% lost on a medical program using low carb Protein shakes. I did three shacks a day every day for six months. I was personally OK with continuing with the shake program but they wanted me to transition off because you can't live on shakes for ever. When I transitioned off the shakes that is when I had a problem. It wasn't drastic, 1 or 2 pounds a week but I couldn't stop it unless I was VERY careful with my food. As we all know "diets" fail so I don't think looking at this as a diet the right way. I mean I get that I can't eat two bowls of ice cream or a whole pizza, but I also know that I can't eat carrot sticks for ever. Again, if I could have done it, I would have. My hope is that the restriction reminds me to stop eating before it gets out of hand and the dumping reminds me not to eat crap.

The surgery is a BIG deal. No going back and a major mutilation of internal organs. I don't want to go through the surgery, the recovery, the adjustments and the side effects for life without having a good chance of success.

This is one point I am fixated on. Fortunately I have time to work though it in my mind!

So thanks for the input!!!! Keep it coming!

I would not count on losing your hunger. I never did. The restriction helps for sure, at least for the first six months. I can eat a lot more at 8 months post rny. Dumping has not been a problem/solution for me. I am struggling now to lose my last 30 pounds. What helps is that I look better which is motivating and exercise is easier without the extra weight. As far as the surgery everything went smoothly and I have no regrets. If you decide to have surgery my advice would be to use those first six months to develop a habit of exercising and work with a therapist on why you turned to food in the first place and to learn better coping methods.

J16 totally agree and your results are amazing!

For me I have discovered that there is 4 types of eating drivers.

1. Having an appetite (craving something to eat) and grazing (mindless eating). With the recent weight loss I learned that you can control the carb cravings by really limiting them. I was on a ketogenic diet (>50 g a day) and after a few days didn't crave carbs at all (and I have/had a huge sweet tooth) so I think I can control that. At this point I really don't consume "any" carbs. What I mean by that is that I don't eat things that are heavy carbs (e.g. Pasta, bread, chips, etc). I really don't have a desire. I still have a little bit of a sweet tooth and added chocolate back in (those mini bars) which is not good! (and of course I am not so good on volume)
2. Low energy (like a low blood sugar). The low energy happened a lot while I was an active type 2 diabetic due to injected insulin but still happens now while not taking any insulin. This is planning. I just can't skip meals or at least at the first sign of a problem, correct it by eating something small. If I waited until I was really in hypoglycemic mode it was panic time. This doesn't happen much now.
3. Hungry (physically empty stomach), The other two is where I THINK the surgery can help. Again asking for a reality check here! By drastically changing my stomach and hormones the physically empty part is supposed to be less, at least initially.
4. The second one on grazing should also be limited due to the restriction. Right now I have a habit of eating until full (which is actual over full). The expectation is that is limited by the surgery and the desire to grave will be reduced and the volume that can be graved is also reduced.

So my hope is that during the Honeymoon period I can get exercising at least a little more then I am now and ingrain it into my life and get a better relationship with food and eating. I always make the analogy that I want food to be like mowing my lawn, yeah have to do it but I don't wake up everyday preoccupied by it. It is just a think that has to be done.

I can only speak for myself. I had rny 13 years ago and kept a 105 ll weight loss for 12 years. it was thro both the small amount I can eat at one time which has never changed and exercising. this last year I started grazing mostly at night and slowed down on the exercise thinking I had this licked. I rarely dump and when I do it is because I am talking or being with folks and forget to chew and go slow to listen to my body. I can eat almost anything except sweets ( three bites and I will start to feel sick so have to stop and I love that) and salads or raw veggies. I can eat bread of any kind and most meats. I wish this were different. I found that I had stopped paying attention to my foods and started grazing. I have gained 20 lbs and am now back on track and have lost 15 of the 20 in two months. I started going to the support groups and really paying attention to my food choices and emotional behaviour. I never lost my small tummy but did allow the head hunger to take over. I am also going to overeaters anon for that same reason. bottom line-- they can fix your ability to eat large volumes at one time but can not fix your emotional need for food. this is a lifelong change you must be willing to undertake and make the necessary lifestyle changes necessary to keep the weight loss. it is a TOOL not a permanent solution. I have never regrated having the surgery and am so thankful for the support group and the program that saved my life. now it is to me to continue to use the TOOL properly and be willing to put me and my health before that immediate gratification of that bite of food that is not good for me. love the mowing the yard analogy. it is so true. I have to remember to do it but don't think of it all the time. good luck to you and your journey

The surgery will balance your blood sugar which will help with losing your 65 pounds and improve your health. I was pre-diabetic and it's a non issue now blood sugar and cholesterol all good.