I have a question that's been haunting me for a while.

Why would anyone pick the least effective surgery for their particular needs (obesity level, food addiction, prior health issues, other mental health concerns,etc)?

Is it lack of research or self sabotage?

Edited August 20, 20187 yr by GreenTealael

Yep. I wanted a "one shot deal." My doc doesn't do DS and I wanted to stay within my health system cuz of all the cancer and surgeries. So I chose RNY.

The only thing I can come up with after thinking a minute. They feel they don't deserve any better. So often they have been told ( and yes I was told and believed) that obesity was something they willfully did to themselves. The old "Think Hard enough and You'll Never Get Fat" ploy, Closely followed by " Only stupid lazy people get obese"You're only doing this to get attention" and finally the one that hurts me Because of you pushing yourself to the front of the line, a younger more deserving person can't get an operation!" Ooh that one stings, because I have more earthly years I am vastly,undeserving? So my vote would be Self Sabotage. They are asking for what the outside world said they merited.

I can't speak for others, but I chose my surgery based on the least invasive. Having had cancer 6 years ago, I am leery of doing too much to my body but wanted to have the surgery done. I hope that makes sense? So far so good as I have lost quite a bit of weight already, but I have more to go to get to a healthy BMI. The part that I do know, is I CAN get there. I have had the surgery and I work with a psychologist that is helping me emotionally and that balance has been tremendous. The tool is only as good as what we put into it.

Most good surgeons will suggest the more aggressive surgery (better outcomes,less revision/failure rates factors into their records) lazy ones will do what's comfortable for them.

You have to ask for a lower level. I just wonder why if someone knows they have maladaptive eating practices (binging, purging, etc) , tendency to graze, very high start weight/very low goal weight why get a half measure?

Why not go DS, where you have the highest rate of loss, highest level of malabsorption to combat all of the behavior? DS not available, cool RNY second best for your situation ( and of course this is all situational and hypothetical)

But why with a history of binging not well controlled through meds/therapy, very high starting weight, lack of support, stressful job, would anyone go for VSG let alone band or balloon?

Edited August 20, 20187 yr by GreenTealael

Mine really wanted me to have VSG based on the amt of weight I had left to lose and the level of my diet compliance. She arbitrarily chose to give me a "short bypass." And I'm thinking she may have left my RNY purposely bigger too. I need to order a copy of my surgical report from the hospital...

2 minutes ago, SleeveinIL said:

I can't speak for others, but I chose my surgery based on the least invasive. Having had cancer 6 years ago, I am leery of doing too much to my body but wanted to have the surgery done. I hope that makes sense? So far so good as I have lost quite a bit of weight already, but I have more to go to get to a healthy BMI. The part that I do know, is I CAN get there. I have had the surgery and I work with a psychologist that is helping me emotionally and that balance has been tremendous. The tool is only as good as what we put into it.

Yes I understand completely when you make educated rational health based choices , you understand expected outcomes and make your peace with them. I choose VSG over RNY because I was dealing with other health issues and I was certain a super rapid decrease in weight would have screwed me , gut instinct, i was right.

But I mean the people who can't wait to go back to everything they used to do/be.

2 minutes ago, FluffyChix said:

Mine really wanted me to have VSG based on the amt of weight I had left to lose and the level of my diet compliance. She arbitrarily chose to give me a "short bypass." And I'm thinking she may have left my RNY purposely bigger too. I need to order a copy of my surgical report from the hospital...

Wait what does that mean?

Excuse my VSG ignorance...

Just now, GreenTealael said:

Wait what does that mean?

Excuse my VSG ignorance...

Which part. LOL?

My doctor recommended sleeve at first. I actually had my mind set on DS, but he said he could only do it in a two step process, and that wasn't something I was willing to do. I chose RNY because I had a lot to lose. The percentages of excess weight loss were in my favor with RNY. This is not to say that sleeve patients haven't been successful with large amounts to lose, but why risk it? Sure, RNY is more invasive, but I don't think anything has been more "invasive" with RNY verses if I would have had the sleeve. I'm more restricted due to the possibility of dumping, but that is a benefit in my opinion.

3 minutes ago, FluffyChix said:

Which part. LOL?

Short bypass... Left it long...

1 minute ago, AshAsh1 said:

My doctor recommended sleeve at first. I actually had my mind set on DS, but he said he could only do it in a two step process, and that wasn't something I was willing to do. I chose RNY because I had a lot to lose. The percentages of excess weight loss were in my favor with RNY. This is not to say that sleeve patients haven't been successful with large amounts to lose, but why risk it? Sure, RNY is more invasive, but I don't think anything has been more "invasive" with RNY verses if I would have had the sleeve. I'm more restricted due to the possibility of dumping, but that is a benefit in my opinion.

So these surgeons are out here pushing sleeves, huh?

Apologies

then its a lack of information/advocation...

Just now, GreenTealael said:

4 minutes ago, FluffyChix said:

Which part. LOL?

Short bypass... Left it long...

Ok, so last appointment before surgery the doc throws out, "Oh, btw, I'm gonna give you a shorter bypass..." And I was into my uber-compliance doc-pleasing phase and didn't think to say, "Wait! Whah? NOOOOOOOOO!!!"

Her reasoning I believe is because by that time, I'd already come down from 287 to 234lbs. And my RD was reporting "super-compliance" and over-attention to details and self-restriction--which they already knew anyway. So she could have been hedging her bets that she would give me an RNY style food restriction in a low pressure system (not as much GERD issues cuz of low pressure system and not as much reflux from acid due to stomach partitioning--which is why she agreed with no VSG in the first place. I have pre-cancerous cells in tummy and duodenum).

I think she maybe didn't want to do as much bypass to reduce a little of the malabsorption and maybe not run into issues with the effectiveness of my cancer drug being absorbed.

If she'd had her way I would have had a VSG--so no cancer drug absorption to worry about, and lower weight at time of operation, etc.

3 minutes ago, GreenTealael said:

So these surgeons are out here pushing sleeves, huh?

Apologies

then its a lack of information/advocation...

Yes. The most recent studies are trending toward VSG, short op time, lower complication rate, and they think that malabsorption isn't as great as it was with the longer bypasses from the old days. After about 18mos to 5 years, the malabsorption level is minimal anyway. Microvilli in the gut regrows at an alarming rate so that the body can "clean" more nutrients and calories out of the food that is swiftly passing through the gut. It's an adaption process the body goes through.

Crazy, I just see so many posts where I think, maybe that person should have chosen a different surgery, but ...

2 hours ago, GreenTealael said:

Is it lack of research or self sabotage?

Or availability? Or insurance coverage? Or wanting the least invasive procedure?