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Low BMI obesity gastric sleeve option



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Hello. I am 44y old male and I am seriously considering SG. I am 5’7 and around 195 lb. I know this is not too obese -I am in fact BMI 31- and normally bariatric surgery should not be an option. Yet, after extensive literature reading I believe it is a good option. I have high blood pressure , high cholesterol and early non alcoholic fatty liver disease. Moreover , I have been always struggling with weight issues since I was a teenager, alternating times of physical activity and good diet habits -and a relative healthy weight as a result - with bad periods of overeating and sedentary behavior. All in all, the aggregated tendency is adding up weight on the long run.

My wife is highly critical of this decision, blaming me for taking the “easy way” instead of modifying my eating / physical habits. I’ve tried to explain her several times the apparent inconsistency of deeply wanting to get rid of my weight problem with the fact that it is nevertheless not easy at all. She’s naturally skinny and cannot grasp how fat/obese people relate with food.

I’d love to hear from those on a similar situation. I believe it is the right step to do, but I want to hear open, sincere opinion -so not just for reaffirming my choice but rather to have well grounded , unbiased, facts for a well informed decision.

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first of all, surgery isn’t easy. it’s permanently changes your life; what you can eat, how you can eat.. and it’s not always in ways that you would choose.

you have to modify your eating habits if you have surgery for the rest of your life if you want to have any success. it sounds like you may need that more than surgery. 31 is not a high bmi, so fine tuning what you do eat and finding a healthier moderation may be just the ticket.

work with a nutritionalist. even if you wanted surgery, you need to do it anyway. you might find that after modifying your diet you won’t need surgery and can be healthier!

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I hate that "it's taking the easy way out" line. There's nothing easy about this. Plus, why in the world would that even matter? It's like some people think if we use a tool like surgery, we didn't pay our "penance" for being fat.

"Nope, sorry, you're not worthy of being healthy, because you cheated your way to health. Do it the right way or not at all"

Really?

I sympathize with the position you're in as my wife was and still is very anti weight-loss surgery. Her line was always why would you permanently alter your anatomy when it's possible to do this without making so drastic a change? My response is I never had a problem losing weight, what I always struggled with was maintaining. After way too many yo-yo diets, I needed to do something else. Dieting alone was not working for me. I needed a better tool.

That's what it is, by the way, a tool. The analogy I like to use is that WLS is like a shovel. I know that sounds odd, but bear with me...

I've dug quite a number of holes on my property to plant trees. Most of those trees will be here longer than I will, but It's still worth it to plant them. I suppose technically I could have tried to dig those holes with my hands but wow, that would have been a challenge and I'm not sure I would have been able to finish the job.

With a shovel, it became doable. The shovel still was a lot of work, but it made an almost impossible job, possible. No one thinks using a shovel is "cheating", we just think of it as a better tool.

At the end of the day, the risk of early death for me was extremely high with cardiac issues, diabetes, liver and kidney problems, etc. I began to feel that I was living on borrowed time. WLS for me was life-changing and life saving. It immediately reversed my diabetes and high-blood pressure. I used the tool because I had reached the point where all I saw in front of me was an early death.

For what it's worth, it would also seem that the medical community takes your side here based on the available medical evidence:

https://www.bariatricpal.com/topic/442260-after-30-years-new-guidelines-for-weight-loss-surgery/

Best of luck whatever you decide.

Edited by SpartanMaker

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UHG! I wish I knew what to say to help other than you just have to do what's best for you at the end of the day.

Is your wife obese? Maybe she just doesn't get the struggle?

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The surgery is a tool, just like using a washing machine or a calculator. It makes it easier, yes but you still have to put in the work. And the tool fades when your hunger comes back so keeping the weight off is just as hard as any maintenance plan I have ever been on with one exception IF you took the time to make real changes to your diet and habits you know what to do to keep it off this time.

Having said that, this is a major surgery with real changes to you body. Many of us have chronic constipation to deal with, most of us have to take Vitamins forever and I believe all of us are told to avoid NSAIDS forever (which kinda sucks when you get a headache or throw your back out and drs won’t give you pain meds for these things). These are not major things, no but evidence that this does change your body forever.

The nutritionist and the bariatric therapists are two huge components to the surgery that make it successful. If you have not tried those two things you may want to consider trying those first before committing to major surgery. I had a low-ish BMI and I had the sleeve (35). I wish I had tried those things first so that I would know I absolutely had to take this extreme option. I may very well be exactly where I am but at least I would know I truly did try everything first. But ask your doctor because you have real medical issues that I did not have and maybe losing it fast is imperative. The surgery will definitely help you to lose it faster that diet alone.

Best of luck in whatever you choose. And just keep talking to your wife. My husband is also someone who has always been fit and doesn’t totally get it either. He is at least supportive but he is first to admit he doesn’t understand. I once told him when he was thirsty to try not to drink anything for hours and he will have some clue what it’s like to try to ignore hunger. Not the best analogy I know but it was the best I could think of. I also recommend taking her with you to your doctor visits if/when you do decide to have surgery or while you are trying to decide. They can help explain things to her.

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1 hour ago, SpartanMaker said:

I hate that "it's taking the easy way out" line. There's nothing easy about this. Plus, why in the world would that even matter? It's like some people think if we use a tool like surgery, we didn't pay our "penance" for being fat.

"Nope, sorry, you're not worthy of being healthy, because you cheated your way to health. Do it the right way or not at all"

Really?

I sympathize with the position you're in as my wife was and still is very anti weight-loss surgery. Her line was always why would you permanently alter your anatomy when it's possible to do this without making so drastic a change? My response is I never had a problem losing weight, what I always struggled with was maintaining. After way too many yo-yo diets, I needed to do something else. Dieting alone was not working for me. I needed a better tool.

That's what it is, by the way, a tool. The analogy I like to use is that WLS is like a shovel. I know that sounds odd, but bear with me...

I've dug quite a number of holes on my property to plant trees. Most of those trees will be here longer than I will, but It's still worth it to plant them. I suppose technically I could have tried to dig those holes with my hands but wow, that would have been a challenge and I'm not sure I would have been able to finish the job.

With a shovel, it became doable. The shovel still was a lot of work, but it made an almost impossible job, possible. No one thinks using a shovel is "cheating", we just think of it as a better tool.

At the end of the day, the risk of early death for me was extremely high with cardiac issues, diabetes, liver and kidney problems, etc. I began to feel that I was living on borrowed time. WLS for me was life-changing and life saving. It immediately reversed my diabetes and high-blood pressure. I used the tool because I had reached the point where all I saw in front of me was an early death.

For what it's worth, it would also seem that the medical community takes your side here based on the available medical evidence:

https://www.bariatricpal.com/topic/442260-after-30-years-new-guidelines-for-weight-loss-surgery/

Best of luck whatever you decide.

Thanks so much for your advice and words. And the metaphors are really great.

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3 hours ago, William Weston said:

Hello. I am 44y old male and I am seriously considering SG. I am 5’7 and around 195 lb. I know this is not too obese -I am in fact BMI 31- and normally bariatric surgery should not be an option. Yet, after extensive literature reading I believe it is a good option. I have high blood pressure , high cholesterol and early non alcoholic fatty liver disease. Moreover , I have been always struggling with weight issues since I was a teenager, alternating times of physical activity and good diet habits -and a relative healthy weight as a result - with bad periods of overeating and sedentary behavior. All in all, the aggregated tendency is adding up weight on the long run.

My wife is highly critical of this decision, blaming me for taking the “easy way” instead of modifying my eating / physical habits. I’ve tried to explain her several times the apparent inconsistency of deeply wanting to get rid of my weight problem with the fact that it is nevertheless not easy at all. She’s naturally skinny and cannot grasp how fat/obese people relate with food.

I’d love to hear from those on a similar situation. I believe it is the right step to do, but I want to hear open, sincere opinion -so not just for reaffirming my choice but rather to have well grounded , unbiased, facts for a well informed decision.

I, too, was a low-BMI patient. But, my BMI was just high enough that with my comorbidities, my insurance would cover the surgery.

Like me, you are one step away from metabolic syndrome: diabetes, high cholesterol and high blood pressure. I have diabetes and high cholesterol.

Only 5% of people who lose weight using "just diet and exercise" will have kept that weight off over a 5 year period. With bariatric surgery, the number jumps to 90%.

I would set up the consultation with the surgeon and make your wife come with you to the appointment. The surgeon will explain to her the science of obesity and how it's not as simple as she thinks.

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At 44? Well-my husband was 5'7" so I can "see" you. I understand you wanting to do that, but I really do think you are awfully young. You probably come home in the afternoon and sit in front of the TV, like most of us as we grow older. I know I do it. The truth? I think a little modification in what you eat and more exercise. I know it is not what you wanted to hear, but you asked for the truth. But it is nice to know that that is there, if you really need it. 😉

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17 minutes ago, oldandtired said:

At 44? Well-my husband was 5'7" so I can "see" you. I understand you wanting to do that, but I really do think you are awfully young. You probably come home in the afternoon and sit in front of the TV, like most of us as we grow older. I know I do it. The truth? I think a little modification in what you eat and more exercise. I know it is not what you wanted to hear, but you asked for the truth. But it is nice to know that that is there, if you really need it. 😉

Hmm, I look at it completely the other way around. How I wish I'd done this when I was 44, or even better 34, instead of waiting to my late 50's.

I think of all the opportunities to enjoy life I passed up on because I was too fat. How many opportunities to do things as a family did I pass up on because I was to heavy to do them. How many times did I stay home instead of go out because of my weight.

I also think of the fact that I lived decades in pain that probably could have been avoided had I been healthier when I was younger. How many of the 15 plus surgeries that I've had could have been avoided? How many of the conditions like diabetes, coronary artery disease and congestive heart failure could I have avoided entirely had I done this decades ago?

I think of the fact that I now see the same patterns of disordered eating showing up in my grown children and have to wonder if I'd addressed this obesity disease when I was younger, could I have modeled healthy living for them and perhaps have broken the cycle? I have to wonder if now it's too late for them to see me making health changes and make their own changes as a result.

So yes, how I wish I'd done this while I was "awfully young".

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I got my surgery done at 200lbs because of thyroid & PCOS issues. Since you have certain conditions, it can get approved! & I don't regret it one bit.

Also, my family thought it was a waste & an easy way out until I sat them down & went over ALL the lifestyle changes I've had to make pre & post op. They eat rather healthy & even they admit they couldn't do it bc of all the work that goes into it. People think you get it done & you deflate like a balloon. But nope, hard work still wins in this case. Maybe you can sit your wife down & go over everything, she may understand!

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I had a BMI of 31 at 44 years of age - also BMIs from 23 - 35 in the years around 44. I also lost lots of weight 'successfully' but was completely unable to maintain it *ever*. I just put it all back on and more besides, until my BMI finally went over 40 and I knew I couldn't live that life any more.

I wish I had been able to have my surgery when I was younger (and yes, if possible when I wasn't as obese) because it would have been a lower risk procedure for me.

Absolutely nothing wrong with doing your research and meeting a surgeon to see what information they can give you. There are risks, but there are also risks if you stay overweight (or get more overweight) over the next few years. You need to get as much information as possible so you can work out what's right for you.

Best of luck.

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As SpartanMaker pointed out, the medical criteria recommendations have changed. The original article is here: https://www.soard.org/article/S1550-7289(22)00641-4/fulltext. Depending on the specifics of your metabolic disease, you might qualify in the near future. If you are of Asian descent, BMI ≥25 suggests clinical obesity, and individuals with BMI ≥27.5 could soon be offered surgery as well.

But it may take some time before the insurance companies adopt these recommendations. In the meantime, you will likely have to pay out of pocket. If you are willing to pay cash, you should look at other options first. My starting BMI was also <35, so I would not have qualified even if I wanted surgery. I opted for less invasive ESG (endoscopic sleeve gastroplasty -- do look it up on Google, Instagram, YouTube, etc.). It is still pretty drastic, but it is far less risky, effective, and with quick recovery.

I have had people ask me "Why?" in that tone (you know the one!) because I did not look fat, I carried it well. I did it for many of the health reasons the ASMBS cites in that article, and which you mention regarding your own health. Bottom line...I want to live! I want to be around to play with my grandchildren someday. I am only 50, but I could see the writing on the wall (or rather, the life expectancy charts...). Maybe if you phrase it that way to your wife, she will appreciate that you are doing this for your family. And if you choose a less risky procedure, she may get on board.

Best of luck to you!

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Sounds like you had made your decision up. If you feel that this will improve your health. Go for it.
on the other hand. I hope you have a solid relationship with your spouse. This WILL change your whole dynamic. For the better or worse. Good luck

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On 10/25/2022 at 1:00 PM, SpartanMaker said:

Hmm, I look at it completely the other way around. How I wish I'd done this when I was 44, or even better 34, instead of waiting to my late 50's.

I think of all the opportunities to enjoy life I passed up on because I was too fat. How many opportunities to do things as a family did I pass up on because I was to heavy to do them. How many times did I stay home instead of go out because of my weight.

I also think of the fact that I lived decades in pain that probably could have been avoided had I been healthier when I was younger. How many of the 15 plus surgeries that I've had could have been avoided? How many of the conditions like diabetes, coronary artery disease and congestive heart failure could I have avoided entirely had I done this decades ago?

I think of the fact that I now see the same patterns of disordered eating showing up in my grown children and have to wonder if I'd addressed this obesity disease when I was younger, could I have modeled healthy living for them and perhaps have broken the cycle? I have to wonder if now it's too late for them to see me making health changes and make their own changes as a result.

So yes, how I wish I'd done this while I was "awfully young".

Wow, hon-

He asked for what we thought. That was what I thought. And yes, he is younger than my youngest child. So he is "awfully young." Once again it is a personal opinion. I personally lost 50 pounds when I was 50, on willpower alone, but could not do it (although I tried) as I grew older. So, January of 2022, when I was 68, I had WLS.

I'll say it again. He wanted an opinion-don't trash me for mine.

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Unfortunately, you still need the change in lifestyle/diet habits to make this work long term. I like to think of the sleeve/RNY as being a "do over" rather than a total fix, because it will indeed help get the weight off, and usually faster, than going alone, but there is still the tendency to gain again over time, as one can still "eat around" the surgery. The DS (duodenal switch) is better in the regain resistance area, but that is even greater overkill for a low BMI patient. I decided on the sleeve after my wife had here (much needed) DS and I had lost 50 or so lb of my excess weight, and kept it off for 5-6 years, but couldn't sustainably lose the next 100 that I needed to lose. So I had much of the habit part taken care of ahead of time, and it worked well, though it still takes work to keep it off - most of us long timers have been through periods of gain that we have had to lose again. Regain tends to be slower than without the WLS, but the bias is still there. So, you may well be in this same boat again in 5-10 years.

In short, the sleeve will help you with the part that you already can do fairly well - lose when needed - but is only soso on helping you with the part that you struggle with - keeping it off. That's a consideration when trying to match the "personality" of the surgery with your own personality.

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