Yay or Nay: Weight loss before surgery for better success

[Globetrecker 5]

I met with my surgeon this week to schedule my surgery (yay!) I have a BMI of 44 and am 263, and would like to lose 100 lbs. I asked him about how to be successful at this and he said some interesting things that surprised me. Namely:

1) Generally, BMI will go down about 10-12 points but not much more. (That would still leave me overweight! I want to get to a healthy BMI!)

2) People who lose weight before surgery (whether liquid diets, low cal, low carb) don't always lose as much after surgery.

I was surprised because I thought that the more weight I lost beforehand would be better. I've seen lots of people on here who lost weight on their pre-surgery diet and did fantastic post-op with their weight loss. What has been your experience? Would love to hear the positive benefits of losing weight pre-surgery.

[BigSue 1,320]

It makes sense that people who lose weight before surgery lose less weight after surgery -- simply because they have less to lose if they've already lost some! But I certainly wouldn't take that as a recommendation not to lose weight before surgery.

I lost about 70 pounds in the 5 months before my surgery. My highest recorded weight was ~340 pounds and I was ~270 the day of surgery. I'm ~150 now (so I've lost ~120 pounds after surgery). So let's say I hadn't lost any weight before surgery and went into surgery at 340 pounds. Maybe I would have lost 150 pounds by now instead of only 120. That would put me at 190 pounds. So I am glad I got a head start on my weight loss before surgery.

Keep in mind that the heavier you are, the easier it is to lose each pound. At 340 pounds, it was not difficult for me to lose 10 pounds. At 150 pounds, losing 10 pounds is a major challenge. If you wait until after surgery to start losing weight, your results will be more dramatic because that "easy" weight will be melting off in the beginning. I suppose that could be a benefit because the early post-op stages can be rough and the quick weight loss can keep you motivated. But you will still eventually reach a point where the weight loss slows down. It will just be later than it would be if you lost some of the weight before surgery.

In addition to getting a head start on weight loss, I think it was good for me to lose weight before surgery because I started getting into some healthier habits before surgery. I think it's extremely important to log everything you eat (I use MyFitnessPal, but there are other apps that do the same thing), and I've been doing that since 5 months before my surgery. By the time I had surgery, it was already a habit. I had also started to make healthier food choices before surgery, which made it easier to eat healthy foods when I transitioned to solid foods after surgery (also easier to avoid high-fat, high-sugar foods that could cause dumping syndrome after surgery, since I had already reduced my intake of that stuff before surgery).

By the way, the lower your weight before surgery, the lower your maintenance weight is likely to be (and the sooner you'll get there), so I'd consider that to be a pretty good argument for losing weight before surgery.

[summerset 5,261]

I didn't lose any weight before surgery. Started out at BMI 46, now it's 23 since a whole while (no plastics so far).

Would BMI be lower if I had lost weight before surgery? Who knows. Can't go back in time to give it a try, right?

[Globetrecker 5]

2 hours ago, BigSue said:

It makes sense that people who lose weight before surgery lose less weight after surgery -- simply because they have less to lose if they've already lost some! But I certainly wouldn't take that as a recommendation not to lose weight before surgery.

I lost about 70 pounds in the 5 months before my surgery. My highest recorded weight was ~340 pounds and I was ~270 the day of surgery. I'm ~150 now (so I've lost ~120 pounds after surgery). So let's say I hadn't lost any weight before surgery and went into surgery at 340 pounds. Maybe I would have lost 150 pounds by now instead of only 120. That would put me at 190 pounds. So I am glad I got a head start on my weight loss before surgery.

This is incredible success! My surgeon said most people don't make the kind of weight loss, and with my weight he said I could expect to lose 75 pounds and 100 was unrealistic. Yet YOU did it and many, many other people have too! I wonder what makes the 100 pound mark so unattainable in his eyes? If you did it and so many others have, I can too (right?)

Edited April 30, 2021 by Globetrecker

[Globetrecker 5]

2 hours ago, summerset said:

I didn't lose any weight before surgery. Started out at BMI 46, now it's 23 since a whole while (no plastics so far).

Would BMI be lower if I had lost weight before surgery? Who knows. Can't go back in time to give it a try, right?

You're close to my starting BMI and 23 is incredible. What did you do to make a loss *double* what my surgeon is saying is average?

[ShoppGirl 3,341]

One “pro” for losing some before surgery is that you lose it slower so less loose skin from that weight.

[blackcatsandbaddecisions 844]

I lost about 60 lbs before surgery, and I’ve lost almost 70 in the 5.5 months since surgery. Still actively losing. I’m sure my weight loss would have been faster if I’d not lost the weight presurg , but I’d also be heavier and I don’t care for that idea at all. I’m sitting at a 30 BMI right now, I was a 48. My goal weight is 48 lbs lower than I am currently and my doctor thinks that’s totally reasonable and doable. That means that total loss will be almost 175 lbs.

I think that there’s an amount of weight loss that’s certain, and after a point post op then it’s behavior that gets you to continue losing, so it’s not a sure thing anymore. Maybe he’s being conservative and assuming that you won’t keep going. I personally feel motivated by the people I see on this forum who did keep going and got to goal, even though it was a long way away.

[TinDE 83]

55 minutes ago, ShoppGirl said:

One “pro” for losing some before surgery is that you lose it slower so less loose skin from that weight.

My nutritionist just told me the same thing last week.

[ms.sss 14,634]

I didn't lose any weight before surgery (well, except for 11 lbs during my 2 week pre-op liquid diet...does that count?)

I had a BMI of 43 at the beginning of my pre-op diet. I'm BMI 20 today.

[GreenTealael 24,850]

I didn’t lose any significant weight prior to surgery and was a BMI of 44 . Currently I’m a BMI of 27 (I tend to fluctuate between 26-28)

[ms.sss 14,634]

4 hours ago, BigSue said:

By the way, the lower your weight before surgery, the lower your maintenance weight is likely to be

Ok, this caught my attention...do you happen to know the reasoning for this?

[The Greater Fool 1,937]

1 hour ago, ms.sss said:

Ok, this caught my attention...do you happen to know the reasoning for this?

I think it comes down to statistics. I haven't researched statistics in the last 15 years, but it used to be 'weight at surgery' vs 'low weight post-op' vs 'ending weight' (at a specific point, like 2, 3 or 5 years post-op.

So, it's really easy to say "hey, if you have a lower weight at surgery, then all the following numbers, on average, are lower. Thus, I think it ultimately is playing games with statistics.

But, regardless, statistics are great for evaluating odds, but sucky on what will happen with the individual.

Lies, damned lies, and statistics.

Edited April 30, 2021 by The Greater Fool

[BigSue 1,320]

1 hour ago, The Greater Fool said:

I think it comes down to statistics. I haven't researched statistics in the last 15 years, but it used to be 'weight at surgery' vs 'low weight post-op' vs 'ending weight' (at a specific point, like 2, 3 or 5 years post-op.

So, it's really easy to say "hey, if you have a lower weight at surgery, then all the following numbers, on average, are lower. Thus, I think it ultimately is playing games with statistics.

But, regardless, statistics are great for evaluating odds, but sucky on what will happen with the individual.

Lies, damned lies, and statistics.

Yes, that's what I meant -- just based on math/statistics. Expected weight loss from surgery is typically expressed in terms of percent of excess weight loss, and the lower your starting weight, the lower your end weight will be after losing X% of excess weight. If I started at 340 pounds and lost 70% of my excess weight (140 pounds), I would end up at 200 pounds. If I started at 270 pounds and lost 70% of my excess weight (91 pounds), I would end up at 179 pounds.

[Arabesque 6,444]

The stats show the average weight lost at about the 3 year mark (maybe 5yr I can’t remember) is 60-65% of the weight you have to lose to put you in the healthy BMI range. This is likely the weight loss number your doctor advised you would likely lose but you can aim to lose more or less. Do people lose more than the 60-65%? Yep. Some of us do. Do some lose less? Yep, some do. Do some maintain the lower weight they reach? Yep, some do. Do some put weight back on in the years after surgery? Yep, some do. That’s the reality.

For some, a weight in the healthy BMI range is not sustainable. It may be because of lifestyle i.e. an inability to sustain a lower calorie intake & increased activity level to maintain at the lower weight. There’s nothing wrong with that. You have to be able to live your life. Or it could just be them - a weight their body is happy at & is easy to maintain.

I wonder if your doctor’s comment re people who lose a lot pre surgery, lose less after surgery is really about how fast you lose & how long it takes for you to reach your goal. Generally, the more you have to lose the faster you lose to begin. Therefore, if you lose a lot of weight pre surgery, you likely won’t lose as quickly at first as you would if you hadn’t lost much before your surgery. The rate of your loss slows as you get closer to your goal weight. This is because your calorie intake & energy output is closer to what is needed to maintain at that weight.

We’re all different. No one can predict exactly what you will lose or maintain at, they can only suggest what might happen based upon statistics & experience. Good luck with your surgery.

PS. I lost about 5kg in the two & a bit weeks pre surgery. I reached my goal in 6 months then lost 13kgs more at my lowest. I waiver at around 49kgs now.

Edited May 1, 2021 by Arabesque

[lizonaplane 1,604]

My doctor also said I could expect to lose only about 70lbs with surgery. Since I started off at 280, that would put me at 210!! I've already lost 27 and my surgery won't be for a few months yet due to insurance hoops. I'm still working on losing weight because 1) I want to practice the healthy habits I will need after surgery, 2) any weight I lose now is weight I don't have to lose after surgery, and 3) surgery is easier on your body (and easier for the surgeon) when you weigh less. I'm hoping to lose more than the "average".

I just recently had a huge success: I went on vacation with my parents and we ate out 3 meals a day and I didn't gain any weight. I shared meals with my mom at many meals and we exercised A LOT - hiking, walking, and swimming most days. Usually when I go on vacation I would gain 5-10 pounds in a week! It was really hard but totally worth it. And of course, the day after I got home, my cousin had a pizza party, but even though I was exhausted, I had only one piece of pizza and filled up on salad and veggies (I did have a bit of dessert; I'm not perfect!). If I was throwing "food funerals," like some people, I could be gaining weight which would put me farther from goal...