hey, i was wondering if there is anyone who has had a BMI over 40 that has had the gastric sleeve and been successful with keeping the weight off. The surgeon is suggesting the bypass because of the BMI being over 40. But im not a fan of the bypass because it bypasses part of the small intestines where the nutrients gets absorbed. I am currently 6'4 and 470lbs and I'm trying to choose between the sleeve or the bypass. Any input would be helpful.

41 minutes ago, new_lease_on_life said:

hey, i was wondering if there is anyone who has had a BMI over 40 that has had the gastric sleeve and been successful with keeping the weight off. The surgeon is suggesting the bypass because of the BMI being over 40. But im not a fan of the bypass because it bypasses part of the small intestines where the nutrients gets absorbed. I am currently 6'4 and 470lbs and I'm trying to choose between the sleeve or the bypass. Any input would be helpful.

I started at BMI of 43 and I chose the bypass and my blood work have been fine just gotta take vitamins... Literally no complications.. lost weight really well and consistently and I'm now in maintenance mode for the past 3 months keeping the weight off

I did bypass for another reason (i.e., I had GERD), but yes - there are people who've been very successful with the sleeve - even those who started out at fairly high BMI's. Statistics show that people can lose more with the bypass, but it's like 60 or 65% of excess weight vs 70% with the bypass - so it's not like it's A LOT more. And also, those are just averages. With both surgeries, you'll find lots of outliers - people who lose more or less than the average. It's really your level of commitment that makes the difference -- not so much which surgery you get.

Yes as above it all comes down to how serious you are as how strict and compliant you are with the new diet; for me and my personality I dove in headfirst and was very strict on myself from day 1 and lost all 100% of my weight

It actually should come down to looking at many many things. Like your age, illnesses you have or genetic tendencies toward any. Are there medications you take that you cannot take if you have RNY that will limit absorption of certain medications.

My BMI was 58. I weighed 320 pounds. I was 54 years old. Could not have RNY due to meds needed that are absorbed and distributed by intestines. I lost 140 pounds. I did have a gain back over 7 years - of 40 pounds but had both medical problems and life happens. Back to where I was now. What is my BMI now ? According to most charts 32. Charts that account for age ( I am now 64 ) about 30. No plastics. I have saggy baggy skin. All over . but not having any elective surgeries at my age. If I had my bat wings taken off I am sure I would lose another 5 pounds easily !! I am very very pleased with my sleeve.

As far as long term weight maintenance, there is very little difference between the sleeve and the bypass as they are both metabolically similar after a couple of years. Early on, the bypass may allow for a bit faster weight loss owing to its' malabsorption, but that caloric malabsorption dissipates after a couple of years and you are left in the same basic position as those with a sleeve; sadly, the nutritional malabsorption persists with the bypass, so it will continue to be a bit fussier on the supplement needs.

The basic choice really comes down to other individual factors rather than weight loss needed or maintained, Are you subject to GERD, ulcers, stomach polyps, arthritis or other medical conditions that need medication that may be influenced by the changes, etc. etc, etc.

If one feels that maintenance will be a problem (from a history of yo-yo dieting, for example) or one knows that there are already significant metabolic problems then the duodenal switch (DS) should also be considered as that is a metabolically stronger procedure than the sleeve or bypass, but it does have its own trade offs as well (that's life!)

I did the sleeve and I can say I am happy with it - Everyone above nailed it but i just want to say been a easy ride blow off all the weight and Having no problem keeping it off. But this is sometimes a pain in the ass i end up malnourished and dehydrated alot. Not sure if the other methods make it easier then the sleeve to stay nourished and hydrated.

Either way you decide you gotta do it best decision i have ever made

I'm three years out and prior to surgery, I had a BMI of 50. My surgeon recommended the sleeve because I was still young-ish then, e.g. early 30s and nutrient absorption is pretty important. My surgeon felt that the calcium/vitamin D malabsorption may lead to bone density issues later on in life (and after obesity, people generally don't have great bone density and are prone to fractures). Most of bariatric surgery is relatively new, so there aren't a ton of long term studies, so my surgeon is just guessing. And most people on the bypass seem to be pretty good about taking their vitamins (which is something you should do with the sleeve anyway).

A couple of months after my sleeve I was diagnosed with a range of painful, chronic autoimmune diseases and I'm very thankful that I went with the sleeve because of the issues with drug absorption with the bypass (I have to take a ton of oral medications). Of course, I did not deal with GERD, which means that the bypass is right for many people.

With the sleeve, I was able to take my BMI from 50 to 25. Due to aforementioned illnesses and medications, I did deal with some regain, which I am slowly working on. At the moment, my BMI is about 29. I have never felt like the sleeve wouldn't be enough to help me achieve success.

All that to say, you can definitely have success with the sleeve or the bypass. As commented by others, a lot of it is going to come down to what your level of commitment, and your ability to change your lifestyle and deal with psychological issues. And you have to educate yourself. You can't drink a diet of only protein shakes forever. At some point, you have to learn how to eat real food in the real world, go to work, socialise and interact with food, people and life. If you haven't dealt with your "issues", you will have regain with either surgery.

It can be a tough decision, but I honestly feel that you can find success with either surgery.

I had the sleeve. My BMI is pretty high (66 was 73), my surgeon suggested the Sleeve due to my weight and previous medical issues (maybe a little less invasive). He also stated people with the Sleeve and RNY can lose about the same amount, just Sleevers might lose at a slower rate. I am 6 weeks out. I lost 36lbs before preop and 34lbs postop. I had minimum issues so far, I dealt with acid reflux a couple days after surgery and a UTI. But right now, no issues (fingers crossed) and I feel back to normal. Just from my OWN research, as far as weight loss forums, YouTube, FB groups, I think with RNY the heavier you are the more weight you drop, in comparison to the Sleeve.