I'm scheduled for sleeve surgery in three days, and I'm experiencing serious cold feet. I'm a 44-year-old male, 5'9" tall, weighing 270 pounds. I've struggled with yo-yo dieting for over 21 years, with my highest weight being 280 pounds and my lowest 198 pounds. I've had success with intermittent fasting and restricted calorie intake, but I've regained the weight. I suffer from mild sleep apnea, which causes heavy snoring and comes with its challenges. Thankfully, I don't have any other health problems, and I take medication that contributes to weight gain, though I doubt they'd make me fatter the 270 pounds than I am now; they just make it harder to lose weight. I'm feeling uncertain about the necessity of the surgery since I'm not extremely heavy and overall healthy. I'm also worried about only being able to eat small quantities in one sitting, and the idea of changing my body scares me.

Yet Im also excited to get this option available

Edited February 18, 20242 yr by Joe Brown

Hi Joe! My surgery is in 4 days. I am 5'6" and at my highest weight, I was 250 pounds, which gave me a BMI of 40.3. Since starting the nutrition program and pre-op liquid diet, I am down to 228 pounds, so a BMI of 36.8. I have high blood pressure, prediabetes, and high cholesterol. Like you, I've dieted countless times. In fact, I was enrolled in the nonsurgical program at my hospital for 7 years, starting when I was 42.

I found it relatively easy to lose up to about 15% of my total body weight, around 40 lbs, by counting calories, exercising religiously, and not letting my guard down for a minute. After that, I would stall. Then the weight would creep back up. My doctor would prescribe meds (including Wegovy for a while, but it's too expensive for longterm use for me), and I'd lose 10 pounds. Then I would stall, followed by regain. Or the nutritionist would suggest a new approach, and I would lose a few pounds again, followed by regain. A little more each time. After 7 years of trying, I was back to my highest weight ever. I feel like I wasted a whole lot of time with nothing to show for it.

And now I'm nearly 50. My blood pressure, blood sugar, and cholesterol all have gotten worse. My feet hurt. My joints ache. I feel older than I am, and I don't want to be old before my time. I know from reading the latest studies in weight loss science that my chance of long term success in reaching and maintaining a healthy weight without the metabolic reset of bariatric surgery is around 5%.

I'm fortunate because I've seen my brother go through sleeve surgery 15 years ago. He lost a huge amount of weight (about half his body weight) and though he has regained a fair amount of that, it's nowhere near where he used to be. His appetite is now what I would call the smaller side of normal. Nobody looks at him having dinner and would guess he had surgery. So I know that the most drastic parts of this (like a liquid diet!) are phases you have to get through to get somewhere better.

I feel nervous, too. I've never had surgery. I worry about complications. I'm hardly ever sick, so I sometimes think what if I'm trading decent health for problems? But realistically, problems are in my future. I've seen it in countless family members. The writing is on the wall. And the surgery is very safe. So for me, the risk is worth it. I've tried on my own long enough to know it isn't going to happen for me without this. And a BMI of 40 might not be as big as some people, but it's big enough to rob me of good health in my future.

I really hope this helps at least give you some things to think about to help you make your decision. Wishing you all the best!

Nerves & feeling anxious before surgery isn’t unusual. You are doing something that requires many changes to you physically, psychologically & emotionally. And you don’t have any experience with any of it.

I didn’t have any co morbidities at all before my surgery but I knew they would be in my future simply because I was obese. Being generally in good health bedside surgery puts you in a stronger place for your surgery & recovery so a plus.

The very small portions are only in the beginning during the staged return to eating. As you progress you are able to eat more until you are eating what is a recommended & appropriate serving size. Not those large servings that are two, three or more times we been acclimatised to think of as normal but the portion size we should be eating. Doesn’t mean you won’t ever eat your favourite foods ever again either. In time you work out how much you can eat of that food & how often. Or you may make changes to the ingredients or the cooking method to make it a healthier & more nutritious choice.

We talk about having to do the head work while we are losing. This is the most important step. Working out the why, what, when you eat & changing your relationship with food. Reflecting on what drives you to eat & the food choices you make so you can mange those cravings & work out a way of eating for the future that is sustainable, doesn’t restrict or limit you & allows you to enjoy your life as you want. This is the difference between the surgery and every other diet I’ve been on (& I was almost 54 when I had the surgery & had been on a lot of diets). I’ve never been able to lose weight & maintain it for any length of time like I have after the surgery. Yes, I work on it every day but it doesn’t mean I don’t or can’t enjoy my life or miss out on anything. A lot of it is routine & I look at it as not being on a continuous diet (so many negative connotations) but this is just my way of eating. Like how people who have food allergies or may be vegan or vegetarian eat & the food choices they make.

Ensure you have access to a supportive therapist you can call on if needed & a helpful dietician who listens. This isn’t something you can really do completely on your own.

Best decision I ever made.

All the best whatever you choose to do.

Thank you very much for your reply it will help me decide

I can really only share what the experience has been like for me, and the positives that have come into my life. I was in a very similar spot as you, both mentally and physically. The doubts and fear doubled, trebled, quadrupled to an infinity even as I was being rolled into the OR for surgery.

I am now six months and two weeks post-op. I can pop off for a 2 mile run if I feel like it. A 10 mile hike. A long yoga session. I am signed up for getting an open-water SCUBA certification. My cholesterol is normal for the first time in my adult life. My mental health has improved. I've also enjoying seeing my physical transformation.

Attaining a high level of fitness remains a strong motivation for me. But eating small portions, managing supplements, timing my water intake, and tracking food? It has gotten easier and easier. I truly wish you well on your journey, no matter which path you decide to take.

Thank you very much all this helps

I read online that after surgery even long term it will take 10-15 minutes to eat 2 tablespoons and eat extremely slowly chowing until all food is equivalent to mash potatoes thickness before swallowing is this true signing up my life for this??

Hi Joe, I am almost 8 weeks post surgery. While I can't speak for everyone, I did not experience this.

Yes, you have to chew your food well (if it needs chewing), but it is not as onerous as it seems. Sure, the first time I had solid food I made sure that it was well chewed and I ate it slowly to make sure it was not going to present a problem. I've done that with every new food I've tried. But it has NEVER taken me 10-15 minutes to eat 2 tablespoons of food. In fact, I have to make sure I don't eat too fast!

It is like drinking water after surgery... at first you struggle to take a sip at a time. Then you notice you are taking bigger sips and then a large swallow. I can drink 8 oz of water in a couple of swallows now.

I know that thought of the changes this surgery may bring to your life can be scary, but does it really matter if when you are past the initial stages of the process it takes you 15 minutes longer to eat your dinner than it did prior to surgery? That you can't get your money's worth at an all you can eat buffet?

If you look at the surveys of people who have had WLS, their most common regret is that they didn't have the surgery sooner.

BTW - I'd always been a "healthy" fat person until I wasn't. I can't count the number of times I lost a little weight only to gain it back; Weight Watchers should have been giving me frequent flyer rates. Today, I went under 300 lbs. for the first time in 19 years and I'm 35 lbs away from being a weight I haven't seen since 1984. Yeah... I'm good with it all!

Thank you very much

Im now only 262 lost 10 pounds lately and i feel maybe this whole thing is not really for me i need to diet … and that these surgeries are for very heavy ppl that have basically no chance with diet

An the other hand i want to be 200 pounds and ive had a hard time maintaining that I snore heavily and buy a lot of food out and on general want to stop being crazy about running after food im seriously confused surgery in three days feel like cancelling

10 hours ago, Joe Brown said:

I read online that after surgery even long term it will take 10-15 minutes to eat 2 tablespoons and eat extremely slowly chowing until all food is equivalent to mash potatoes thickness before swallowing is this true signing up my life for this??

For life? Not true at all.

Stage two of the post op return to eating is purée. It usually is weeks 3 & 4 so two weeks only in the first month. The staged return to eating (usually a two week cycle of liquids, purée, soft then solid foods) is to protect & support your healing tummy. It takes about 8 weeks to fully heal. Some surgeons recommend chewing well before swallowing to help during this time too to ensure nothing too coarse or fibrous is swallowed that could impact your healing. It also makes you stop & think about your eating. I wasn’t told to do that. A couple of weeks on the solid food stage (probably early start of month 3) I was eating chicken thighs, steak, lamb chops, pork loin, etc.

Yes we are advised to eat slowly. It takes a good 20 odd minutes for the message to get through that you’re full. If you eat quickly you’ll easily eat too much & be over full. It’s about being mindful when eating too. Putting your cutlery down between bites & really thinking about if you need the next bite yet or just want it is a good habit to get into. It’s actually a good practice for everyone not just bariatric patients. So many people just shovel in spoonful after spoonful of food in their mouths & before they know it they’ve eaten copious amounts of food & are groaning & uncomfortable because they are overfull.

Something to be aware of is eating too much, too fast or food that is too coarse or fibrous can result in the foamies. Thick foamy saliva rises to protect your oesophagus & to help you bring up the excess food or food that is causing a blockage. I still have the foamies at times. I think my oesophagus is more sensitive. Char grilled meats & vegetables & sometimes fibrous vegetables can cause me grief. But I feel fine once I’ve bought up the offending thing, I feel fine. Last time I had an episode it was because I hadn’t trimmed my sugar snap peas well & there was string left dangling & it irritated me. Most people rarely experience it & not in the long term.

There’s lots of misinformation & scary horror stories online many not based on any truth or vey little or posted to drive likes (the scarier the story the more clicks). Go to reputable medical sites & forums like this one. Generally a good idea to avoid social media too. Highly recommend the you tube videos of Dr Matt Weiner (A pound of Cure) & Dr John Pilcher. Straight forward, practical information, clearly explained.

15 hours ago, Joe Brown said:

Thank you very much

Im now only 262 lost 10 pounds lately and i feel maybe this whole thing is not really for me i need to diet … and that these surgeries are for very heavy ppl that have basically no chance with diet

You're 100 pounds overweight with a BMI of 38.7 (with 20-25 being normal).

Only 20% of people can lose even 10% of their body weight and keep it off for more than 5 years through diet and lifestyle alone. You're looking to lose about 25% of your body weight, at which point you will still be borderline obese (29.5 BMI).

You might consider asking yourself, how much more overweight would you have to be to see yourself as "very heavy"? And how much worse would the odds need to be for you to think you have no chance with diet?

Im 5’1. Weighed 195 day of surgery. My bmi was right at 35. I was what one might call a “smaller” heavy person- but my frame was not built to carry that weight. My joints hurt, was struggling with high A1C1 and starting to have trouble sleeping, etc. It was time- and most people wouldn’t have even considered surgery— but it was the best decision for me. The yo-yo dieting and struggles were not working. The surgery gave me my life back. My advice— Think through your whys- and dont let fear of change keep you from moving forward— whatever you choose.

Thank you all for taking the time to respond. I very much appreciate it