To begin with - this is very difficult for me to do. By that I mean talking to strangers about something I'd much rather ignore. This path however, is no longer open to me and if I don't do this now - it'll never get done and by that I mean serious weight loss and the route to achieving it.

I'm not sure how familiar you good people are about how things work in the UK so a little background info is unfortunately necessary or you'll think I'm just barmy! Which may be the case but I don't want to frighten you too soon.

The NHS run a 4-tier programme that deals with tackling obesity with surgery offered at the end funded by the NHS. This is a one-stop option whereby if after surgery, the person regains the weight, a second chance is NOT an option. The NHS will only pay for ONE operation. Additionally, any cosmetic procedure to deal with flaps of skin post surgery is also NOT funded by the NHS.

I entered at Tier 2 which is a monthly series of appointments with an advisor to steer people in the direction of self-help. The Starting weight I've listed is my weight at the start of my Tier 2 journey. Ultimately it's more of a self help stage whereby you discuss options with the advisor and have monthly weigh-ins. The result of this is that I joined a gym near where I live and started going religiously. I also started looking at my diet and trying to come up with ways to cut down on calorific intake. My progress was slow but steady but I stalled at month 5 and after discussions with my advisor, was referred onward to Tier 3.

Tier 3 lasts from 6 months to a year and deals with all the psychological issues surrounding a persons relationship with food. It also provides additional support in the body of a dietician, an 8 week series of group sessions (which are compulsory) plus a follow-on seminar "Bariatric Surgery - warts and all!" which is also compulsory. Upon acceptance to Tier 3, the question "Are you looking towards bariatric surgery at the end of this process?" is asked. If you answer no, then you can still go through the programme but surgery is taken off the table and if you request surgery at a later date, then you have to repeat Tier 3. Another part of this stage is that you have to lose between 5% and 10% of the starting bodyweight to even be eligible for surgery. For me that equates to losing between 30lb and 40lb.

I'm currently half way through this stage, completed the group session and attended the seminar and at my last appointment with the dietician at the beginning of May had lost 10lb since February. I started writing a food diary at the beginning of the Group Sessions and my dietician recommended between 1800 and 2200 calories a day. This has helped reduce portion size and focus my mind on just how much I am eating and of what - most beneficial even if really inconvenient at times (both in terms of writing the thing and of what it reveals).

I've since joined a second gym so that I can continue my exercise regime (mainly cardio) before I start work. I work shifts - 12 hours, days and nights, 14 shifts in 28 days. This has allowed me attend a gym from between 4 and 6 days per week. I don't attend when I'm on nights because sleep is also important and due to the nature of my job, I will not sacrifice more sleep than is necessary by getting up early just to go to the gym.

Tier 4 is the surgery itself with all that that entails. I have yet to investigate this in depth and quite frankly, I'm frightened to do so in any depth but basically requires collaboration between 6 different professionals including a psychologist and the main players in the surgical team led by the Surgeon.

So back to my original question: "Am I making the right decision?"

This question is more a way of focussing my mind on the whole topic of surgery.

The whole idea of going under the knife frightens me silly. I'm afraid of the process. I'm afraid that the Surgeon will dictate a different operation from that which I want. I'm afraid of the risks. I'm afraid that after all is said and done, it won't work. I'm afraid of what happens if I don't take the surgical option. I'm afraid of the dietary restrictions pre and post surgery. I'm afraid of what will happen financially when, if I opt for surgery, the whole process starts, as I will need to arrange time off for pre-op appointments at a location to which I will have to travel. I'm afraid of the next 30-50 years post surgery and the dietary restrictions over that length of time and will I be able to continue with those restrictions? I'm worried how I'll be able to do mundane things like food shopping post surgery. And I'm also VERY afraid if all other steps short of surgery don't work and I'm left with only one course left open to me.

I'm getting advice from a variety of sources. Close friends and my life partner say that if I can do it without surgery, do it that way. It'll take longer but would be more beneficial. My dietician is stating that having the op could seriously help with my Type 2 Diabetes (tablet and diet controlled) and potentially cure me of it (my current HbA1c, cholesterol, BP, liver and kidney functions are all good as were the results from my recent retinal photography). Also that I'd lose a lot of weight very quickly so any up-and-coming mobility impairments are mitigated before they even become a problem. This would also address my original concern - weight loss while there is still time to benefit from it. I have yet to speak to my diabetic nurse about it but I've an appointment with her in September so I'll raise it then.

In the meantime. I'm lost. I know of no-one within my acquaintance that has undergone this form of surgery to ask. It was suggested that I join a forum and get the story straight from the horse's mouth as it were. How did you good people come to terms with the implications of surgery? How did you cope with all the life changing decisions required by surgery? What advice did you get? Which did you follow and which did you discard? And why?

I'm not even sure that I'll get a response from you good people but I must try and get more information from those that have gone through the process and what the successes were and where the potential pit-falls are.

Thank you in advance and apologies for the length of this post.

Dave

UPDATE.

Before I continue with my update, I'd just like to wish all our American cousins here a happy July 4th - be safe and enjoy all the festivities but don't sabotage all the excellent work done be each of you up until now.

Apologies for seeming to disappear but I've been away on vacation to a remote part of the UK where mobile phone and internet access was non-existent at worst and patchy at best. Anyway - I've started the cost/benefit analysis that I was going to do but all the research I was hoping to get done whilst on vacation didn't happen - which was a disappointment to say the least. I've begun it at least now and I can now do some serious internet research so that I can make an informed decision when the time comes.

I'm still generally opposed to surgery but not so vehemently opposed to it as I was when I started this thread so I have made some progress on this issue. I've also had some serious discussions with both my partner and my mother-in-law about the whole process. I know that sounds strange but my mother-in-law is a retired Ward Matron who worked in a Children's Hospital in Glasgow so has a medical background and we have had some serious non-judgemental factual discussions. These were both helpful and distressing at the same time but managed to identify some issues I'd never thought of before. She was quite blunt with me which I found helpful - if a bit hurtful at the time. My parents on the other hand, although well meaning and concerned for my welfare, aren't really the type of people with whom to have a serious factual conversation on the subject. As much as I love them both, it's just not something I can discuss with them on the level that I need.

Some excellent news for my weight loss journey. I attended a Dietician's appointment last Thursday and am happy to report that I've lost a further 12lbs since May 11th. I have now reached the pre-required weight loss of 5% referral weight during my Tier 3 programme to qualify for Tier 4 - the actual surgery - providing I can maintain the loss.

I have a further 5 months to go on Tier 3 so have time to complete my cost/benefit analysis before having to make the decision on whether I take the surgical option and to lose more weight. If I continue to lose weight at the rate I have done so up until now (net 24lbs since June 2016 - I had a little hiccup in the late summer last year - the less stressful the whole surgical question becomes. I still have a lot of reading and investigation to do. Not least what my employer will allow in terms of time off etc. and I can't even ask those questions until I know what the timescales are pre- and post-operatively. This will be my next task. Any information will be very much appreciated.

In the meantime, I feel empowered by my success to date and am optimistic for the next 5 months and beyond.

Keep up the good work y'all.

Dave

<a href='https://www.bariatricpal.com'><img src='https://www.bariatricpal.com/tickers/319706-tbh183/bodyweight.png/?ts=1498920688'></a>

Edited July 1, 20179 yr by TBH183

Great job Dave! Keep up the good work! Whatever you decide you will make the right decision for you!!!

Hi Dave,

I hope all's well with you. By the looks of it we have a lot in common, similar age, height and starting weight - and we're both in the UK. I'm having a bypass (that's the plans anyway) on 12th July. I think, whatever way I look at it, it's bloody daunting and the closer it gets the less able you are to kid yourself about the implications.

I have no more experience than being exactly where I'm at. I don't know if sharing my experience will help you, but I'm on a constant journey of working out how I feel so I'll share/

I've always been 'a bit overweight', you would have called me 'chubby' for most of my life, but have always been pretty active and relatively fit. That started to change about five and a half years ago when my son was born. Sleep went out of the window (we ended up in a residential sleep school, when he was one, for a week). To cope I ate an awful lot of carbs and would have a drink to help me relax. So gained about 5 stone (60 pounds) in a couple of years. I did a 12 week diet at one point and got 25kg off (I was living in Australia and thinking in kilos) but it came back with a vengeance. Around two to three years ago I started to have string of symptoms that were related to weight - I was glucose intolerant and heading for diabetes, sciatica, skin breakouts, never could shake colds and infection and of course just feeling tired and awful.

In the last twelve months I've had a big change as we moved back to the UK. I've put on more weight. More importantly my back's always bad and my ankled always hurt and I can't run to play with my son and I sweat constantly.

The weight just doesn't come off. I feel like I'm swimming against a current. I've started to worry about how much of my son's life I'll get to share with him. My confidence has been shattered as my self image has taken a dive.

Going down the path of surgery is something I never expected to do. It's scary as hell as, being overweight, we're always told we're high risk for surgery anyway. I've spent a long time getting my head round it though and now I feel massively positive.

Firstly I'm looking at it as a circuit breaker not a cure. I feel I need to break a cycle and the way the surgery works makes me think it can help. If I do the right things it is a tool I can use to limit my eating. I'm hoping the extreme weight loss at the start will allow me to get back up and active quickly and I can get into a virtuous cycle.

Secondly I know a lot of this is in the head but it's still behaviour that needs to change. I know a lot about food and nutrition but that's never helped me too much. I need something that's more direct than education. The appetite supressing nature of the surgery will help, so will the enforced abstinence. Those will help - but I need to maintain that shift for it to be a lifelong change.

Thirdly I'm not thinking about this as something 'I'm having done' or that is being done to me. It's just a part of something I'm doing. That might sound a bit abstract but for me it means I'm not thinking about 'things i'll miss' or what the limits are or whether I can eat XYZ again. Rather I'm thinking that this is now how it is - I am what I do. I don't even know if I'm expressing it properly here, but it's been a massive mindset change for me (and not one I was aiming for - it's come about recently thanks to considering a lot of stuff I see on here and because of following my pre-op eating plan rigorously). It's bene really liberating and it makes me feel optimistic about my chances of long term success.

Dave, I don't know if any of that helps mate. I reckon I now know it's the right thing for me because I feel like I'm doing it for the right reasons and because I've made some kind of link between it and the future. I'm sure you'll get your head round it somehow - either way. In the meantime good luck and all the best.

Cheers,

John

Hi Dave-
I'm so happy for you that you've come so far! Not just in your weight loss- which is fabulous!- but even just having the fortitude to get to Tier 3, qualify for tier 4 AND come here to look for more information, education and others' advice is so, so brave! Please pat yourself on the back for us all and know that when we say encouraging things like this- we mean every word- we have all been where you are- in the "researching" the phase.

We came through it with as much info as we could stand at the time- and eventually a feeling- or change in perspective hit us. We just knew it was the right thing for us. This will happen for you too- just be open to this whole experience- it's a journey- not a destination even though that's what brings us all to the table. Just keep researching, asking tons of questions, reading, asking more questions- even when you think you're asking too many- you're not- we're here to help each other- were all at different stages of the game so we can help wherever you are in yours. You're on the right path- and as we all know- dipping our toes into a brand new pool that we don't know is intimidating! But you just keep going- keep doing what you're doing
I've amassed a bunch of quotes and tips along the way because I'm always researching still [emoji849]- but my favorite has been
"Courage is taking those first steps to your dream even if you can't see the path ahead"

As for my story - I was always chubby- "thick" as some people told me- and just plain bigger than I needed to be- after the birth of my second child I never lost ANY weight- I was at 240 lbs and I never came back down- it was horrible! I didn't even look like myself- I didn't know who I was- this was 10 years ago.
During that pregnancy I was told I had to have surgery at 20 weeks pregnant to remove what they thought was ovarian cancer- they took out my uterus with our daughter in it, removed what was left of my right ovary, tube, and a bunch of other tissue- the surgery was a success- out daughter was fine and after 4 horrible days we got the pathology back that it was "only" endometriosis- what a relief! What the surgery put me into preterm labor and I ended up on meds and bedrest for 17 1/2 weeks! Not that we counted- lol- I ended up with other major complications and toward the end my kidneys and liver kind of shut down and my body stopped making platelet- not a good scene- so we delivered at 37 1/2 weeks- she was perfect! And still is [emoji5]
The problem though is that all this "trauma" left me with autoimmune diseases, chronic infections, insulin resistance, PCOS, metabolic syndrome and migraines every month-even though I was on 13 meds (!) I could not get it together- I just kept gaining and losing multiple times- I couldn't walk well and definitely couple exercise because of my fibromyalgia and rheumatoid arthritis- it was a never ending cycle or so it seemed- I asked my PCP and he said to start looking at it more seriously- so I started the phase that you're in right now-
I was desperate for answers on how to get back to a healthy weight which I hadn't been since high school (I'm 43 now)- I found the best doctor and a Center of Excellence- in the US this is like a special designation for programs of different specialties that are vey highly rated and most importantly that have passed rigorous qualifications set forth by accrediting bodies that look over medical centers, hospitals, clinics, etc- So basically, a Bariatric Center of Excellence is one that has a multidisciplinary team of at least 3 board certified bariatric surgeons, a psychologist, an exercise physiologist, nurse practitioners or physician's assistants, registered dietitians and therapists that work with patients' food issues (God knows we all have those!)- I would think in your health system they have the same types of practices though I don't know- if your practice doesn't include all of those specialties please find these specialists individually- each one of them plays a huge role in patients' successes-

Hang on a sec- I have to start a new page- I've written too much at once- I'm sooooo sorry! I'll finish in a sec-

Hi Dave-
I'm so happy for you that you've come so far! Not just in your weight loss- which is fabulous!- but even just having the fortitude to get to Tier 3, qualify for tier 4 AND come here to look for more information, education and others' advice is so, so brave! Please pat yourself on the back for us all and know that when we say encouraging things like this- we mean every word- we have all been where you are- in the "researching" the phase.

We came through it with as much info as we could stand at the time- and eventually a feeling- or change in perspective hit us. We just knew it was the right thing for us. This will happen for you too- just be open to this whole experience- it's a journey- not a destination even though that's what brings us all to the table. Just keep researching, asking tons of questions, reading, asking more questions- even when you think you're asking too many- you're not- we're here to help each other- were all at different stages of the game so we can help wherever you are in yours. You're on the right path- and as we all know- dipping our toes into a brand new pool that we don't know is intimidating! But you just keep going- keep doing what you're doing
I've amassed a bunch of quotes and tips along the way because I'm always researching still [emoji849]- but my favorite has been
"Courage is taking those first steps to your dream even if you can't see the path ahead"

As for my story - I was always chubby- "thick" as some people told me- and just plain bigger than I needed to be- after the birth of my second child I never lost ANY weight- I was at 240 lbs and I never came back down- it was horrible! I didn't even look like myself- I didn't know who I was- this was 10 years ago.
During that pregnancy I was told I had to have surgery at 20 weeks pregnant to remove what they thought was ovarian cancer- they took out my uterus with our daughter in it, removed what was left of my right ovary, tube, and a bunch of other tissue- the surgery was a success- out daughter was fine and after 4 horrible days we got the pathology back that it was "only" endometriosis- what a relief! What the surgery put me into preterm labor and I ended up on meds and bedrest for 17 1/2 weeks! Not that we counted- lol- I ended up with other major complications and toward the end my kidneys and liver kind of shut down and my body stopped making platelet- not a good scene- so we delivered at 37 1/2 weeks- she was perfect! And still is [emoji5]
The problem though is that all this "trauma" left me with autoimmune diseases, chronic infections, insulin resistance, PCOS, metabolic syndrome and migraines every month-even though I was on 13 meds (!) I could not get it together- I just kept gaining and losing multiple times- I couldn't walk well and definitely couple exercise because of my fibromyalgia and rheumatoid arthritis- it was a never ending cycle or so it seemed- I asked my PCP and he said to start looking at it more seriously- so I started the phase that you're in right now-
I was desperate for answers on how to get back to a healthy weight which I hadn't been since high school (I'm 43 now)- I found the best doctor and a Center of Excellence- in the US this is like a special designation for programs of different specialties that are vey highly rated and most importantly that have passed rigorous qualifications set forth by accrediting bodies that look over medical centers, hospitals, clinics, etc- So basically, a Bariatric Center of Excellence is one that has a multidisciplinary team of at least 3 board certified bariatric surgeons, a psychologist, an exercise physiologist, nurse practitioners or physician's assistants, registered dietitians and therapists that work with patients' food issues (God knows we all have those!)- I would think in your health system they have the same types of practices though I don't know- if your practice doesn't include all of those specialties please find these specialists individually- each one of them plays a huge role in patients' successes-

Hang on a sec- I have to start a new page- I've written too much at once- I'm sooooo sorry! I'll finish in a sec-

On 7/1/2017 at 3:40 PM, TBH183 said:

UPDATE.

Before I continue with my update, I'd just like to wish all our American cousins here a happy July 4th - be safe and enjoy all the festivities but don't sabotage all the excellent work done be each of you up until now.

Apologies for seeming to disappear but I've been away on vacation to a remote part of the UK where mobile phone and internet access was non-existent at worst and patchy at best. Anyway - I've started the cost/benefit analysis that I was going to do but all the research I was hoping to get done whilst on vacation didn't happen - which was a disappointment to say the least. I've begun it at least now and I can now do some serious internet research so that I can make an informed decision when the time comes.

I'm still generally opposed to surgery but not so vehemently opposed to it as I was when I started this thread so I have made some progress on this issue. I've also had some serious discussions with both my partner and my mother-in-law about the whole process. I know that sounds strange but my mother-in-law is a retired Ward Matron who worked in a Children's Hospital in Glasgow so has a medical background and we have had some serious non-judgemental factual discussions. These were both helpful and distressing at the same time but managed to identify some issues I'd never thought of before. She was quite blunt with me which I found helpful - if a bit hurtful at the time. My parents on the other hand, although well meaning and concerned for my welfare, aren't really the type of people with whom to have a serious factual conversation on the subject. As much as I love them both, it's just not something I can discuss with them on the level that I need.

Some excellent news for my weight loss journey. I attended a Dietician's appointment last Thursday and am happy to report that I've lost a further 12lbs since May 11th. I have now reached the pre-required weight loss of 5% referral weight during my Tier 3 programme to qualify for Tier 4 - the actual surgery - providing I can maintain the loss.

I have a further 5 months to go on Tier 3 so have time to complete my cost/benefit analysis before having to make the decision on whether I take the surgical option and to lose more weight. If I continue to lose weight at the rate I have done so up until now (net 24lbs since June 2016 - I had a little hiccup in the late summer last year - the less stressful the whole surgical question becomes. I still have a lot of reading and investigation to do. Not least what my employer will allow in terms of time off etc. and I can't even ask those questions until I know what the timescales are pre- and post-operatively. This will be my next task. Any information will be very much appreciated.

In the meantime, I feel empowered by my success to date and am optimistic for the next 5 months and beyond.

Keep up the good work y'all.

Dave

<a href='https://www.bariatricpal.com'><img src='https://www.bariatricpal.com/tickers/319706-tbh183/bodyweight.png/?ts=1498920688'></a>

That's great Dave, well done mate!