Which would you get if you were me:
Sleeve or Bypass?

I currently weigh 304 lbs down from 324 (I am 5'8")
My adult average was 312
I have been obese since early childhood
I have never been able to get below 280 for more then a few days
I find hunger painful.
I get crazy hungry if I eat refined carbs

I have bad knees and a dislocated clavicle that never healed (is still in 2 peices) after a bad car accident 3 years ago. So I take a lot of Naproxin for pain.

I enjoy exercise to some degree, I enjoy swimming, hiking, softball, yoga, going out and doing things like zoo, beach, etc.... But to be honest I do most of my exercise on the weekends (am considering picking up weight training again but a little worried about my shoulder/clavicle)

Intended long term diet:
Paleoish with occasional milk and beans.
(Lower carb but not keto, whole food, 1 serving of fruit a day, maybe 2 long term etc)

Weakness:
Being around tastey food. I get suggestibale and want what everyone else is eating.

Mild high blood pressure (140/70) that just started (kinda comes and goes, no treatment)
No other comorbidities (except bad knees)
No reflux
No medication except NSAIDS and Tylenol

I am lower income and on Medicaid in Oregon

I am leaning towards sleeve because I take NASIDS and as a lower income Medicaid person I fear what will happen if Medicaid gets de-funded or drops me some day in the future... Then I would want least side effects or potential things to go wrong long term

BUT

I am very, very large with a lot to lose and have been heavy since early childhood and never successfully able to lose down to normal with diet and exercise.... Which sounds more like a Bypass recommendation.

What would YOU do?

Bypass, I'm your height, started at 355, at least that's when my wake-call came, might have even gotten a shosh higher, that was a year ago. 335 in April-May when after I escaped an asshat surgeon, went to Ohio State University where I was treated with respect, kindness and they were not afraid of my age-72, 330 when I got my date of September 5th, that was July, did liver shrinking diet the month of August, Surgery morning at319, bypass surgery was success, at 6 weeks I am down to 293 (this Am) , I have a natural sluggish BMR, plain diets didn't help me , and I have tried everyone out there and some few have heard up to and including strucured starvation. The b6pass for me is a wonderful tool. Hope to use it clear down to my dream of 175 if I can. And I am losing fat in the dangers places, neck, forearms, but the belly that no before diet touched, its actually not as blubberific, my rump, well I am losing my fat pad there, hurts to sit too long on hard chairs, but guess what? I have renewed energy, I don't want to sit down as much! Oh I had and still a few blips on my road, but still I have more hopes at 293 than I did over 350, and I would not change or regret the surgery I have gone through.

Bypass.

You will need an alternate solution for NSAIDS.

Gastric Bypass. I had horrible knee pain and GERD pre-gastric bypass and both have resolved. I don’t think I would have lost enough with a sleeve to improve my mobility and pain issues to the degree I have. I’ve also heard of too many people that have VSG but later need to revise to RNY to correct newly developed GERD or poor weight loss results. This is hard because many insurance only pay for 1 weight loss surgery per lifetime so if you require additional surgery later it might require self-pay or none at all. With your financial situation it may be too risky to have VSG because of the possibility of needing another procedure down the road.

I had the same starting weight (304) and some similar NSAID issues (have inflammatory arthritis). After talking to the DR I went with a sleeve, but knew I'd need to work hard to make sure I got the weight loss I wanted out of it. It's been 10 months and I'm VERY glad I made that decision. Here are some key points to think about:

- I eat out a lot for work, so wanted to be able to continue that. The sleeve lets me do this, albeit with a smaller portion, the bypass wouldn't have
- I NEED NSAIDs unfortunately, right now I'm having a severe flare up of arthritis and am using NSAIDS, which are ok with the sleeve per my surgeon (just liquid caps VS pills). If I couldn't take them I'd be on some other much more severe drugs.
- I can eat a somewhat normal and varied diet. This is important, especially now that I've hit goal and am struggling a bit to keep weight on (I'm very active). I think I'd have a serious problem with the bypass and my physical activity would be limited if I wanted to maintain weight. I do a mostly protein diet now with some fruits and vegetables and limited carbs.
- I was worried about long term nutrition and with the sleeve I'm able to maintain my nutritional levels mostly via diet (I have to take a multi vitamin).

I would sit down with your surgeon and ask them what they would do in your situation. That's what I did and he didn't hesitate when he said do the sleeve. The surgery was fairly easy and recovery was quick. I'm sure the bypass would have also been effective, but am really happy with what I chose to do and glad that I can be sort of normal now.

I will ask about non NSAID anti inflanatory options. Maybe they will prescribe something else that works as well?

If I keep Medicaid (and Medicaid remains funded) I could conceivably move from sleeve to bypass if I choose sleeve and struggle with regain...

I understand the long term difference is about 10% or 10-20 lbs.

If it's a difference of a new setpoint of 220 with NSAIDs and less chance of malnurishment vs 210 with no NSAIDs and more risk I'll accept the 10 lbs. But if it is 180 vs 240 then it's worth the risk and finding some way around the NSAID problem.

I wish there was a crystal ball to see how I would personally react.

A lot of the literature has HUGE degrees of margin: like "lost an average of 60% of their extra weight (plus or minus 35%)"

Are you kidding me?! That's 25-95%!!! And sometimes people do everything right and lose less and some others don't change their habbits at all they just eat smaller portions and lose more... It's apparently impossible to predict!

I started at 365 - surgery weight was 327 (on October 10th) - current weight is 319. I went with the sleeve because I was afraid of the complications with the bypass. Another reason is my surgeon told me that down the line - if I wasn’t happy - I could convert to the bypass. I have never been a “risk taker”, so for me, this was the right choice. Whatever you decide, I’m sure will be the right choice for YOU! Good luck!! ?

Well CyndieRI, we are about the same size, let's see how we can rock this ?world! Watch out folks, 2 very pretty women??are coming through!

12 hours ago, Medowsweet said:

If I keep Medicaid (and Medicaid remains funded) I could conceivably move from sleeve to bypass if I choose sleeve and struggle with regain...

IMHO

If I were you and not really confident (sorry but that line sounds you're already planning for failure) I would go with the bypass, and just forget about a future surgery possibility. Take care of it all now in one shot.

Edited October 22, 20187 yr by GreenTealael