Demographics - Opinions - Weighing Options (no pun intended)

[P-Diddy 4]

So I've found out my employer covers Bariatric Surgery for weight loss and I have been considering the surgery for some time. I had recently decided that I was interested in the Gastric Sleeve as I didn't want to take Vitamins and was overall scared of the intestinal re-routing of the Bypass. The specific program with my employer is a pilot program and only one surgical center in the US is allowed, luckily for me it was only 200 mi away since we're nationwide that isn't the case for a lot of employees. After attending my initial consultation I was met with some resistance over wanting the gastric sleeve. The wife of the surgeon who is also a family medicine doctor said that Gastric Sleeve surgeries are ineffective for people with my BMI (hovering near 60) and that if I was going to have surgery I should consider a surgery thats more likely to achieve the results I want. I've been leaning towards their advice and am now considering the Gastric Bypass more heavily.

My reservations are thus: Currently I feel like the biggest impediment to my natural weight loss is a simple lack of energy. I can put together months of working out or even diet and lose weight. I won't bore you all more with that sentiment because I feel you've all been there. The gastric sleeve was more resonable to me because I feel if I could get under 300 lbs my activity would increase significantly. I'm no stranger to the gym as is and feel very comfortable weight training and exercising in the gym. Just by being under 300 lbs I would likely be meeting strength goals that are common among athletes (squating 1.3 times your weight, etc). So I feel like my weight loss would go fairly well sub-300 with any method.

My questions: I've looked on the forums and have seen numerous people with lots of weight loss with the gastric sleeve. I'm worried that the Doctor could be right and that a gastric sleeve would be ineffective. My initial reaction to the doctor was that she was being a bit negative. She said that at my BMI it would be unlikely I'd be in the upper percentages of weight loss (60%+) with the gastric sleeve because I have so much weight to lose. My reaction was that this was faulty logic and that a person with a high BMI would likely lose more weight than someone with a BMI closer to 40 for instance as the closer you get to goal the harder it is to lose.

Is gastric sleeve effective for people with High BMI's nearing 60+? (I've googled the hell out of this trust me.
Does anyone know of a place that has demographic data so that I could get a picture of statistical groups that include my age and gender?
Do men have better, worse, or equal success as women?
What about different age ranges? Do younger people have better success than older people. (Older and younger is relative) We'll say sub 45 and above 45. But more importantly an age group that quantifies me in it.

I want the surgery to go well, I want to be successful and I don't want to deal with a lot of complications. Does anyone have any advice or insight to help me reason this out?

Edited July 2, 2017 by P-Diddy
clarification

[seashell29 19]

Go to website obesityhelp.com I found alot of info there.

Sent from my SAMSUNG-SM-G750A using BariatricPal mobile app

[Introversion 1,876]

I am pleased with my sleeve. I attained my goal weight and have been maintaining the loss.

Nonetheless, someone with a BMI of 60 is an appropriate candidate for a more powerful bariatric surgery such as the duodenal switch, gastric bypass, or mini gastric bypass.

Weight loss after bariatric surgery is influenced by facets such as age, genetics, gender, ethnicity, pre-existing disease processes, and your starting weight on the day of surgery.

Specific groups of people tend to lose weight rapidly such as men, women under age 35, super-obese patients (BMIs greater than 50), and "healthy fat folks" who have no metabolic derangement.

Those who often lose slowly include older persons, menopausal women, racial/ethnic minorities, 'lightweights' who weighed in the high 100s/low 200s on surgery day, and individuals with metabolic disease such as diabetes, PCOS, and hypothyroidism.

Another pearl of wisdom: in the first year, rate of weight loss after surgery is connected to genetics, at least during the first year (honeymoon period). Markers on chromosome 15 dictate the pace.

Lucky people with two copies of the chromosome 15 gene variant lose rapidly. People with one copy lose at an average speed, and unfortunate folks with no copies of the gene variant become non-responders or very slow losers.

https://hms.harvard.edu/news/genetics/gene-variant-linked-weight-loss-surgery-success-5-2-13

[P-Diddy 4]

18 minutes ago, Introversion said:

Those who often lose slowly include older persons, menopausal women, racial/ethnic minorities, 'lightweights' who weighed in the high 100s/low 200s on surgery day, and individuals with metabolic disease such as diabetes, PCOS, and hypothyroidism.

Thats alarming as I do have Hypothyroidism. But when I diet I lose weight rapidly. For instance I tried to do meal prep and lost nearly 20 lbs in a month. Wouldn't Hypothyroidism restrict my weight loss now TOO if it was going to be an indicator for gastric bypass?

19 minutes ago, Introversion said:

Markers on chromosome 15 dictate the pace.

I found the article interesting. While its interesting it has no practical use. I can't test for these chormosomal markers @ Walgreens.

[Berry78 4,259]

I have a theory that I want to share.

When I was in college, I ate at the all-you-can-eat buffet style cafeteria. I lost weight. Being confronted with so many choices, I naturally gravitated to eating pretty much the exact same meal for Breakfast every day, and dinner was essentially the same each night as well. I found comfort in a consistent meal routine.

Getting married, having children, fixing dinner that kids would eat, having leftovers, not wanting to waste food.. all these things really played a part in my gaining 150lbs after leaving college.

During the preop and post op diets, I had to completely separate my eating from that of the family. I actually found it extremely easy with our set-up, and so it is now 2nd nature. I eat the same things every day, and it is comforting to me (not boring). I always know what I'm going to have, so that stress of "what's for dinner" doesn't apply to me anymore. Granted, I'm only 3.5 months out of surgery, so we'll see how I feel in a couple more years.

My theory is that people that don't mind a limited palette of foods do exceptionally well (mentally) after surgery. Those people that always want something different all the time.. they are going to have a harder time. There are a ton of ways to make salads, but ultimately, it's still salad.

How does all this play in for you? Are you someone that would say "But we had chili last night!" or "Do we ALWAYS have to have spaghetti Mondays?!".. you would probably do better with a bypass. But if you're more like me (and have no history of GERD), then the sleeve would probably work well for you.

Men lose about twice as fast as women in general. I think the ultimate success is up to your individual body and mind, and less about the procedure you choose.

Another thing to think about is your willingness to undergo a second, revisional surgery. Sleeves leave this as a possibility, whereas a bypass is "one and done". A revision doesn't have the dramatic success of an initial surgery, but sometimes is needed if the weight loss stops too soon, or you develop severe GERD.

[Berry78 4,259]

Oh, and wanted to add.. with your height, a "normal" weight would be 165lbs. (unless you work out and have tons of muscles). The bypass could be expected to get you to about 225lbs, the sleeve 235lbs. The duodenal switch should get you lower still.

But, your comment about not wanting to take vitamins....

You'll HAVE to take Vitamins with any of the procedures. But, with the sleeve, it'll be swallowing maybe 2-3 pills. The bypass is around 5-6 pills I think. The duodenal switch is a handful of pills, several times a day.

Not knowing your situation.. I think you'd be happiest with a sleeve, and keeping the potential for a revision open down the line. (Unless you have GERD). If you only get heartburn after a heavy meal or specific foods.. that's different. GERD happens regardless of what you ate, and is HORRIBLE. You'd know it if you had it.

Many times insurance won't cover a revision unless it's from medical necessity. So keep that in mind too..

[sgc 538]

I weighed 470 pounds and had a BMI over 63. At the time of the surgery, I weighed 389 with a BMI of 52. Currently weigh 198 with a BMI of 26. (I don't like this website rounds up in my profile )

[Introversion 1,876]

10 hours ago, P-Diddy said:

Thats alarming as I do have Hypothyroidism.

I've also got hypothyroidism. I've had it for 12 years.

I was sleeved two years ago and managed to lose all my excess weight. However, the pounds dropped at a painfully slow rate. It took me 17 months to lose 100 pounds.

My point is that we all lose at different, individual rates. You won't know how rapidly or slowly you'll lose until you actually undergo weight loss surgery.

[TheBearguy8 58]

I'm only 2 months out, but I have a few things to contribute that I feel are appropriate. I stressed a lot over which surgery to have. BMI 40 at the highest. I wanted something reversible. I was scared. My mother had early bypass in the 90's and she suffers terribly now from mal-absorption, cant swallow important meds, can't eat.

I got lucky with a rep for a travel surgery company over the phone who spent time with me discussing sleeve. Thank goodness she was insistent.

I'm having an experience that seems not typical, but I am believing one thing from research and limited experience.

Gastric sleeve makes the most logical sense as a concept when you break it down. Individuals vary but logically . . .

• It does not actually change the flow of the human body, or digestive system, it just keeps the natural flow, but reduces the pouch of your stomach size.
• It does not leave foreign objects like the band, port, etc in the body.
• Scarring is minimal, invasion is lower, recovery is faster. For me the recovery has been so fast it's almost unbelievable.
• It simply restricts you from overeating and presents you with a nauseous reminder to STOP, or SLOW DOWN constantly.
• Recovery seems to be the fastest for a general observation,
• Side effects for me have been nearly non-existent.
• I had a home made seltzer yesterday as an experiment (I do NOT call that "soda") and surprise, I did not die, explode, tear out my staples. Like all things in life, be smart, listen to your body. Seltzer provides an oral stimulation I enjoy within reason, and a squirt of some taste also can happen.
• Vitamin effectiveness is too early to gauge at 8 weeks, but at least taking those larger pill presents no problem like the eternal suffering my mother's radical bypass endures for 25 years, causing non adherence to Vitamins, which then causes more problems.
• My anecdotal research tells me men have a vastly different easier experience when compared to women overall. ANECDOTAL.

I'm just 2 months out, and of course years of a journey lie ahead. Oh by the way, I'm also HIV positive, 35 years healthy, never needed meds until proactive treatments started recently, and even those I have no problems with post surgery.

Negatives I'm becoming aware of . . .

• you can find unhealthy high calorie foods that can slow or stop weight loss and slip by the restriction process. My personal example is Low Sugar Fudgesicles. I'm craving chocolate, I did not used to. I used to binge eat popsicles in general, now regular popsicles taste weird, but the Sugar Free Chocolate products like Peppermint Patties, dark chocolate, in general also help because they have a laxative effect. I ate too many "Outshine' fruit low sugar popsicles last night watching Netflix (with no chill unfortunately) - and I vomited in my sleep, which strikes me as a bit potentially dangerous. I hope the negative reinforcement works.
• Tastes seem to change a bit. Cravings change. Whiskey/Scotch/Vodka tastes gross now unless it's an expensive super high quality bourbon. That may seem minor to you, but taste and craving changes can seem bizarre.
• I can sense a long term danger that mentally, I will "figure out" how to outsmart the surgery when I'm stressed and resorting to old eating behaviors and patterns. Last week I went to support a friend who is a cabaret theater singer, and there was pressure to order food and drink to keep the prime seating location we were in. I felt guilty for the waiter with me milking an appetizer and one drink for an hour and I pushed it ordering more food, and more alcohol, ill advised. I gained 2 pounds just from that stupid exercise. Thankfully avoided vomiting, but perhaps that would have been better mentally.
• My weight loss was so slow at first I was genuinely scared then angry. Then I resumed cardio exercises and teaching Zumba, which is twice as much exercise as just taking Zumba. Then the weight started falling off.
• Muscle tone is weird. I need to lift weights as I did when very overweight. It feels different.

Hope this contributes and helps.

[P-Diddy 4]

4 hours ago, TheBearguy8 said:

Hope this contributes and helps.

It does help.

4 hours ago, Introversion said:

My point is that we all lose at different, individual rates. You won't know how rapidly or slowly you'll lose until you actually undergo weight loss surgery.

Its a valid point. But you're also terrifying me. God forbid I end up getting a bypass and I have to deal with malabsorption the rest of my life for nothing. Don't you think if I can lose weight rapidly say for a few months when restricting my diet that this is a good indicator that I'll probably continue to do so when I've undergone surgery? This topic seems to be a many headed hydra. You answer one question and introduce more. I appreciate your input. I'll have to take these things and unpack them and see what other people think about them.

[OutsideMatchInside 10,166]

@P-Diddy

I started with a 60/61 BMI I'm 5'6 but they measured me at 5'5. Anyway.

I have cut my BMI in half in 2 years.

Even if you have the sleeve you are still going to have to take Vitamins. I took vitamins before surgery and I basically take the same vitamins, so there is no change for me. The amount and type of vitamins you take with the sleeve is less than with Bypass.

I think this DR is full of it. I mean if they were really going to push the most effective surgery on you, they would be pushing the DS, which is flat out the highest weight loss period. It is also the most radical with the most maintenance required.

Honestly, it doesn't matter what surgery you have. What matters is your dedication, will power (yes you still need will power after WLS). You can eat around any surgery.

I have lost more weight than most people in my weight range that had Bypass and I just had a sleeve. My way of eating works for me, I like it and don't feel deprived. I am not in diet mode and I don't cheat. I have a way of eating and I follow it. My sleeve makes it easy for me to follow, because I have very little to no appetite and I am satisfied with very small amounts.

Yes, when you weight less you move more. In big and small ways. I used to kill myself to make one trip up the stairs with shopping bags, now I will make multiple trips, I don't care. I used to take relaxing food vacations, now I have active vacations with hiking and watersports.

The key is to lose enough weight, fast enough that you feel the benefits of weight loss and want to maintain it and keep going. I think a lot of people don't see results, they never get close to goal so eating poorly doesn't matter to them, they have nothing to lose.

Good luck.

[Thucydides 250]

I faced the exact same question between bypass and the sleeve when I first started out the process (my surgery was November 2015). In the end, I decided on the sleeve because a less invasive surgery at my initial weight (518 lbs, 67 BMI) seemed safer and I thought that I would be happy if I could just get done to a weight where I could simply be functional. My surgeon flat out told me that I "would never be normal" and the stats backed that expectation up. For gastric sleeve, average weightloss is 60% of excess body weight. That meant that I should have expected to have lost 202 lbs and gotten down to 316lbs. I decided that I would be good with that.

As of today, I have lost 304 lbs and am at 214 lbs. This is beyond anything that I ever expected. The key to remember is that the averages are just that, averages. They include people who have really seized this lifeline and run with it, others who have struggled a bit more, and still others who have not changed their eating & exercise habits. I have been one of the lucky ones. Look around at this forum and you will see a good number of men who have made amazing progress with a remarkable level of commitment.

Whatever you decide, best of luck to you. I have absolutely no regrets and I cannot begin to describe how big of a difference the surgery has made for me.

[P-Diddy 4]

16 minutes ago, Thucydides said:

This is beyond anything that I ever expected. The key to remember is that the averages are just that, averages.

Well, I agree, and thats why I wish medicine had demographics for us to look at. I think clearly its the case that a person with a higher BMI would be MORE likely to lose more weight than a person with a lower BMI. Mostly because of Basal Metabolic Rate. A person who weighs more has a higher metabolic rate than a person with a lower weight (all other things equal). Thats why I was dubious when she said "People with high bmi's don't lose as much weight as people with low bmi's" that contradicts what I know about BMR. Given that I lose a lot of weight anytime I diet, which has been too numerous times to count, I think its safe to assume I'll also lose weight rapidly with any surgery.

2 hours ago, OutsideMatchInside said:

The key is to lose enough weight, fast enough that you feel the benefits of weight loss and want to maintain it and keep going.

Thats what I think too! I think that if I can get through say 80 lbs or so by next summer (surgery wouldn't be til fall). Not only would I have a significant gain in energy but also the introduction of summer and wanting to be more active and simply having more opportunities to be active socially it will only continue to spurn on quality weight loss.


I've given it some thought and I've settled on two factors.

A. If there is some genetic ailment or physical condition that limits my weight loss like one of the responders was discussing then it seems logical to have the Sleeve. If I don't lose weight I don't lose weight but I don't have a lifetime of malabsorption problems and thousands more in medical costs for potential problems.

B. If I lose in the upper percentages like many of you have (go you!) than I'll just be that more happy that I chose sleeve than bypass.

Thanks for everyones input. I'm leaning more towards the Sleeve again.

[OutsideMatchInside 10,166]

11 hours ago, P-Diddy said:

Well, I agree, and thats why I wish medicine had demographics for us to look at. I think clearly its the case that a person with a higher BMI would be MORE likely to lose more weight than a person with a lower BMI. Mostly because of Basal Metabolic Rate. A person who weighs more has a higher metabolic rate than a person with a lower weight (all other things equal). Thats why I was dubious when she said "People with high bmi's don't lose as much weight as people with low bmi's" that contradicts what I know about BMR. Given that I lose a lot of weight anytime I diet, which has been too numerous times to count, I think its safe to assume I'll also lose weight rapidly with any surgery.

Actually that is kind of correct. Most people that are super morbidly obese never lose enough weight to get close to a healthy weight. Even with WLS. Most people that are super morbidly obese are food addicts on a different level. Without significant therapy and life style changes they just are not successful.

Think about it like this. If someone is 100 pounds overweight but loses 50 pounds, yes they are still obese but they are a lot closer to a normal range. Going from 250 to 200, puts you closer to normal and since most people are over weight you won't stand out too much.

If you are 200 plus pounds over weight and you lose 100 pounds, you are still morbidly obese and possible on the low end of super morbidly obese. When you are more to lose, you have to lose a lot more to make a dent.

When I lost 100 pounds my life wasn't that different. I was still wearing plus sizes and shopping at the same stores. When I lost 160 pounds my life became radically different. The chances of starting at the weight I started at and losing 160 pounds in 2 years with WLS is less than 20%. I have actually managed to lose more than that, but 160 is the number when I got into normal sized clothes not plus sizes and I had to change a lot about my life.

Almost most people who don't make real life style changes, start regaining their weight around 18 months. The people that keep losing well into year 2 and 3 are rare.

[P-Diddy 4]

2 hours ago, OutsideMatchInside said:

Actually that is kind of correct. Most people that are super morbidly obese never lose enough weight to get close to a healthy weight. Even with WLS.

Than the bypass vs sleeve argument is moot. The Dr. should simply let the patients choose.

2 hours ago, OutsideMatchInside said:

The chances of starting at the weight I started at and losing 160 pounds in 2 years with WLS is less than 20%.

Congrats! But thats what I want to know. What predictive factors do you have, and how would we know there are or aren't any? We're constantly being tasked with listening to our doctors. We have to simply listen to them. No doctors ever disagree...nothing is ever pseudo-scientific for them...etc. Of course Doctors ARE wrong all the time, of course personal bias DOES become a factor in someones recommending one surgery over the other. I was given an 80% of excess weight lost with a bypass vs 50% of excess weight lost with a sleeve. Why if I look at other websites do they say up to 70% of weight lost for the Sleeve? Why do some people here quote 60%? I've seen other studies simply quote a BMI reduction number. Why isn't there better information? If I lost 50% of excess weight I'd be right around 280. That would be great! Everything would be soooooo much easier. But if the surgery itself doesn't help why is everyone on this forum able to lose any weight and why is there an expected % of excess weight lost? If super obese are just food addicts and they can't lose weight...how do they lose weight? I'm confident based on my previous attempts at weight loss that weight loss would be rapid. At 1500 calories per day I lose currently 6 to 8 lbs a week. Given the numbers I've seen on the forum I'd lose probably another pound or 2 per week based on the restrictive diet. The fact that I'm a man seems to be a benefit as well as most of the people I see on these forums so far that have issues are women.

I just wish there was some statistical data that could be seen that WLS patients could use to make decisions. Instead of relying on strangers less interested in your results than you are to be as up to date as possible on the numbers.