I am considering having some type of gastric bypass. It has been in my mind for a number of years. About 5-6 years ago, I broached the subject with my PCP, who told me he did not think it necessary. But fast forward to my most recent appt with him, two weeks ago, and I broached it again, after first asking him what weight loss options I did have nowadays. I am up a few pounds this year, and probably am close to my highest weight ever, which is much higher than it should be for me. I am also about to turn 54, and have assorted medical conditions that are exacerbated by obesity, but would likely be ameliorated with significant weight loss. Doc has been bugging me to do appreciable exercise for years, but did not even bother to do so this month, and, truth be told, I am no longer physically able to do the sort of exercise that I did do, back in the 90s, which allowed me to lose 40 lbs then without any dietary changes (and even then, I was probably 50 lbs lighter than I am now, *when I began that exercise agenda). Doc did suggest dietary changes now, but, quite frankly, for a variety of reasons that are likely reasonably easy to glean. I see him every three months and he said we could talk about alternatives then, should no appreciable weight loss have occurred. It was then that I broached the bypass option again, and this time, he certainly did say that it would be a good potential choice, though he mentioned that there were two choices for it, one of which, the newer choice (slip?), being perhaps easier on the body surgery-wise. I left his office, and set to thinking, realizing almost immediately that this ostensibly radical surgical option may well be my only realistic choice for appreciable weight loss, and have essentially resolved to do as much research/ legit opinion seeking, between now and the next doc visit in Feb., and then, likely, tell him I would like to proceed. Any thoughts would be most appreciated, including, though not limited to, info wrt how long the recovery from either surgical choice would be, before one might be able to return to working. Thanks as always.
I have two friends who have had the surgery. One thing they seemed not to take fully into account beforehand is this. The real problem that makes so many of us overweight is a kind of compulsive eating. And removing that possibility leaves a big gap in the ability to cope with emotions. After all, if it were easy to stop the overeating, they would have done it already.
Anyway, one of them gained all the weight back over a period of about five years. The other one became an alcoholic, lost her job, and went on a downward spiral. She stopped communicating reliably with friends and I don't know what became of her at that point.
When I talk to folks, I hear a number of stories like this.
I think ongoing psychological support is, or should be, an important part of the mix.
I have been in therapy with an excellent, really truly exceptional, cognitive behavioral therapist for 5 years now. Do you think I should bring this up with him? He is not an MD, but maybe that does not matter?
I eat more than I should, but the problem wrt eating is not compulsive, but 1) my metabolism is much much slower than it used to be, which means, even though I eat less than I did 20 years ago, I burn off far fewer calories, and 2) I have very little money, which limits food choices (really, it does do that)....
Quote from: kaysixteen on November 28, 2021, 08:54:07 PM
I have been in therapy with an excellent, really truly exceptional, cognitive behavioral therapist for 5 years now. Do you think I should bring this up with him? He is not an MD, but maybe that does not matter?
I eat more than I should, but the problem wrt eating is not compulsive, but 1) my metabolism is much much slower than it used to be, which means, even though I eat less than I did 20 years ago, I burn off far fewer calories, and 2) I have very little money, which limits food choices (really, it does do that)....
1. Yes, of course discuss with your therapist.
2. Has the obesity been approached not as the disease, but as the symptom? Pituitary tumors and other causal issues can also lead to obesity as a side-effect. Has this been examined via MRI, T4/TSH/etc., CA-125 screens, etc.?
3. Bariatric surgery, as Hegemony correctly points out, is far from a cure-all. Its most appealing superficial quality is that it suggests the client need do nothing themselves, ever again, because the surgeon has done it all for them.
It's actually potentially dangerous, especially for those It's supposed to be designed to help, given the attendant breathing, heart, and circulatory issues usually besetting obese individuals.
If one survives the surgery without stroking out, going into respiratory distress, or becoming infected during or after the surgery itself--to say nothing of the potential for iatrogenic exposure to all the pleasant flavors of Covid now on offer--the day care plan and regimen of meds, food, liquids, and other treatment issues is fairly daunting.
4. And given the way Covid's going now, no-one in their right mind wants to book any elective surgeries for fear of tying up recovery beds, hospital personnel, and safety equipment.
In a year or so, if it's finally closer to being under control, revisit the question, maybe.
But talking the whole thing over with your counselor now sounds like the best plan yet, to me.
M.
I'm afraid your food choices will be much more restricted after the surgery. They will in fact be many of the same foods that you have trouble affording now. Plus there will be very restrictive eating conditions — only so much (a very small portion) at one time, and so on. It requires a lot of time and effort to manage. So that may be a contraindication.
My spouse is currently considering getting a gastric sleeve. She had a consult with the surgeon, who assigned her a number of tasks. These include 6 months of regular meetings with a nutritionist, 6 months of regular meetings with a GP, and 6 months of consistent CPAP usage. Seems that he said that she technically has only 1 comorbidity -- potential sleep apnea. He says that she does not weigh enough to consider her weight a comorbidity, and she also doesn't smoke or drink. The other factor is her epilepsy, which may or may not ultimately be a factor. The bottom line is that she'll need to prove there's a medical need for the procedure, otherwise the insurance won't cover the procedure and the surgeon won't perform it.
I'm sorry to hear that you are needing to consider surgery. It seems like many people find success with surgery, so it is certainly an option to consider. But it is a radical option, so I would like to put forth another radical option to consider that helped me.
About two years ago, I switched to a non-processed diet, focused mostly on plants, and was able to lose 25% of my body weight and keep it off. My diet is not expensive, as foods I eat on a daily basis include oatmeal, bananas, apples, vegetables, rice, potatoes, and beans. I did not exercise to lose weight and found it was fairly easy to drop the weight. The hardest part was committing to giving up foods that are "addictive" for me, like cheese, pizza, and oil, and to stop eating out at restaurants. If you're interested in learning more, there are a few movies on YouTube and other places that are a good place to start, like "What the Health", and online YouTubers that have lost the weight that way are also good, like Krocks in the Kitchen, VeggieNut, and ChefAJ. Things I like about eating this way are that it's really easy (I make a large batches of potatoes, veggies, rice, oatmeal, etc. and eat it throughout the week), I don't have to be perfect or track what I'm eating to succeed, and I get to eat until I'm full at meals. Understanding calorie density was perhaps the most helpful, and Jeff Novick has a great YouTube video about it that you can find. Anyway, that's just my experience and I wish more people would consider this kind of diet. It's been a game changer for me. Happy to share more if you are interested.
Wishing you the best of luck in your health and wellness journey.
My sisters-in-law both did this a few years ago. One has gained all the weight back and then some, and the other has stayed in the range that she ultimately hit after surgery. I think what others have said about emotional issues plays a big role here: Sue (who maintained) is a calm, collected person, who recognizes her issues and works on them. Tammy (who regained) is, well, not.
Thanks to all for the responses. Random responses:
1) AJ, irrespective of how *hard* it might, and indeed sadly probably would be, for me to actually follow this particular diet, it certainly does not actually sound like a particularly diabetic-friendly diet
2) I did not know that one needed to meet certain criteria to get this procedure (the sleeve thing, that's it, that is what my doc seemed to suggest would be better or safter for me). But I do have several of these comorbidities and my doc actually seemed to be encouraging, and indeed he seems to think it could more or less annihilate my diabetes, HBP, and even need for CPAP.
3) That said, as mamselle noted, and I apparently was underestimating, there are real dangers to the procedure, and there are, as was also noted here, some psychological aspects to this as well. I will certainly not only undertake significant personal research, but also make this a serious topic of discussion with my therapist.
I don't know anyone who had a gastric sleeve. However, I know two people who had gastric bypass surgery. Both subsequently struggled with alcoholism, which apparently is a common issue. My guess is that it has something to do with the way alcohol is absorbed in the digestive system, getting changed by the surgery.
I know two people who have had the gastric sleeve surgery because they were struggling with other obesity-related health concerns. They both did it over summer when they weren't teaching, so I don't know how long their recovery was. One who was struggling with depression before the surgery continues to struggle.
Quote from: kaysixteen on November 29, 2021, 09:58:38 PM
Thanks to all for the responses. Random responses:
1) AJ, irrespective of how *hard* it might, and indeed sadly probably would be, for me to actually follow this particular diet, it certainly does not actually sound like a particularly diabetic-friendly diet
While that would seem to be the prevailing opinion, there is a good amount of information out there to support otherwise. The non-profit website NutritionFacts.org is a good resource for info on dietary choices related to specific health conditions. Here's one video looking at diets for diabetes: https://nutritionfacts.org/video/the-best-diet-for-diabetes/ (https://nutritionfacts.org/video/the-best-diet-for-diabetes/)
Whenever I noticed that someone lost lots of weight it came down to two factors: Eating vegetarian meals and abstaining from soft drinks.
Hi Kay, I know two sisters who had the surgery at the same time; one lost dramatic amounts of weight, while the other one lost none at all. The successful sister felt that the hospital she went to had an excellent pre-surgery preparation program and an extensive and very helpful post-surgery support structure. In contrast, the unsuccessful sister got very little support or advice; she essentially did not change her eating habits, and over time, managed to stretch out the size of her stomach. Sadly, the successful sister has had a lot of stress in her life and she, too, has gained the weight back.
Another perspective, which might open up a path for you as a decision-making process, can be found in a blog-turned-memoir by Jennette Fulda, titled _Half-Assed: A Weight Loss Memoir_. Here is a link: https://www.amazon.com/Half-Assed-Weight-Loss-Memoir-Jennette-Fulda-ebook/dp/B004JN1CBA/ref=sr_1_1?keywords=fulda+weight+loss&qid=1638296038&s=digital-text&sr=1-1 . Fulda was extremely overweight and very young; the only options doctors gave her involved surgery, which she felt reluctant to have. However, she decided to start the process so that she would be eligible for the surgery, should she want it (her doctor had said she had to lose 50 llbs or so in order to have the surgery). She bought a treadmill and started eating a healthy diet (I think, though she doesn't really specify, she used the Palm Beach diet book).
When she had lost 50 pounds, she realized she didn't need surgery; she just needed to keep on as she had been going for the last few months and the weight would eventually come off, which it did. So you might research the surgery and learn about your post-surgical diet. Then, before making a final commitment, resolve to spend six months eating that diet. That will help you decide if you can indeed commit to that change in your eating habits; you might , like Fulda, lose enough weight during your six months of good eating that you realize you don't need the help of the surgery (which is designed to give you a head start on developing healthy eating habits, not designed to make you lose weight without thinking about it). Since having the surgery will necessitate a major change in your diet, why not make the change and see how you like it? You might find you don't need the surgery at all.
In addition, I wanted to make a similar point about your remark that you can't afford to eat better, healthier food. However, gastic bypass surgery *only* works if you change your diet! You have the help of a smaller stomach, but the doctors think of that as a jumpstart to get you going on a lifetime of healthy eating. And honestly: you can afford it. My friend is the wife of a farm laborer in a remote mid-Atlantic state. She had no trouble affording to eat healthy food. There is a big difference between the Healthy Food of Whole-Foods-bougie-foodies and the healthy diet that a cardiologist will give you (or weight-loss doc). You don't have to eat quinoa and wild-caught salmon! Generic rice and tuna in a can will work just as well.
Just to amuse everybody, here is a really hysterical song about the Whole Foods parking lot in LA (refrain: "It's gettin' real in the Whole Foods parking lot"): https://www.youtube.com/watch?v=2UFc1pr2yUU
Best of luck Kay! I know everybody is rooting for you!
Quote from: latico on November 30, 2021, 10:42:01 AM
In addition, I wanted to make a similar point about your remark that you can't afford to eat better, healthier food. However, gastic bypass surgery *only* works if you change your diet! You have the help of a smaller stomach, but the doctors think of that as a jumpstart to get you going on a lifetime of healthy eating. And honestly: you can afford it. My friend is the wife of a farm laborer in a remote mid-Atlantic state. She had no trouble affording to eat healthy food. There is a big difference between the Healthy Food of Whole-Foods-bougie-foodies and the healthy diet that a cardiologist will give you (or weight-loss doc). You don't have to eat quinoa and wild-caught salmon! Generic rice and tuna in a can will work just as well.
Yes, from what I understand there's just not any way to lose large amounts of weight over the long term that don't involve fundamental changes in diet. Surgery can only be a part of the solution. And fundamentally healthy eating, as opposed to eating a diet of upscale "health" foods, is not terribly expensive. I've eaten a basically healthy diet for a low cost for many years with foods found at an ordinary grocery store. No Bhutanese kumquats or other exotic "miracle" foods of the moment required. Just basic salad vegetables, staples like rice and potatoes, and lots of tap water to drink. Well, I eat lots of other things too, but those, along with some bread and fruits and milk, are the staples.
I particularly appreciate what Latico has to say.
Kay, what you might do is to get the food plan that you would be on if you had the surgery, and try it for six months. If you lose weight during that time and decide that merely staying on the food plan is sufficient, that will be a helpful non-invasive way forward. If you loathe the food plan and can't abide it, that will also be useful information, and suggest that the surgery is not for you.
I know that some people think, "Well, staying on the food plan is too hard normally, but after I have the surgery, I'll be forced to be on it, so that will make it easier." The problem is though that you're not actually forced to be on it; it's just that the weight-loss surgery will not be a permanent solution without sticking to the food plan. The surgery reduces the size of your stomach, but people can and do extend their stomachs again through eating off the food plan. So thwarting the whole thing is sadly entirely possible.
As for the number of people who become alcoholics after the surgery, I'm not persuaded that it's because they metabolize alcohol differently. After all, if they found themselves having trouble with alcohol, they could cut down or eliminate their drinking. My understanding is that they were using compulsive eating to handle emotions, and when that is no longer available, they move to compulsive drinking. So one would want to be very sure that one has a support system for handling emotions.
Hmmm... it seems obvious that there is a great deal more to learn about this type of surgery, and whether it would be appropriate for me, than I currently do know. That I can understand. What seems also, somehow, to be the case, is that my doctor, a graduate of his med school's class of 1981, did not seem to say anything like this stuff when I mentioned the idea to him, and I am wondering whether he knows these things, and if not, whom else to go to to get such data, objective and clear-headed?
A second opinion from an enterologist who specializes in the upper GI tract might be a place to start.
Time from degree isn't always a measure of capacity for a comprehensive work-up; most settings require CPE (continuing professional education, or however they're labeled now) credits, so they should be reading the JAMS, NEJAMS, etc., regularly and doing coursework to stay up-to-date for licensing, if nothing else.
That said, I still haven't heard any differential rule-outs based on looking at the issues through the other end of the kaleidoscope: what if the obesity is secondary to a pituitary or other related disease process?
Those possibilities should have been addressed at some point along the way, and continued to be options until something proves them impossible or almost absolutely unlikely.
It's important never to let the presenting issue take the lead in considerations of causality, because treating the symptom as the root disease won't lead to a resolution, just a merry-go-round of more symptoms.
You can end up playing Whack-a-mole with the symptoms while the root cause goes unchecked.
That may not be happening here, and it may have already been considered, in which case, fine, keep addressing the obesity as the main issue.
But if other options haven't been considered, they should be, and that's another reason to get a second opinion--but be diplomatic, you may still need your original MD on your side, too, and some people throw hissy fits over second opinions.
M.
Surgeons are typically most concerned with the actual procedure and its aftercare, rather than with the larger picture. For the medical stuff, I'd seek out a professional who looks at the bigger picture and has experience with people who've had the procedure done — perhaps a GP, perhaps a specialist. And I'd also seek out a therapist who specializes in psychological issues around this kind of thing, since seems clear that the psychological aspects of adhering to the eating plan and to developing other coping mechanisms are often the missing link in aftercare. Interview a number of therapists — say, 3-5 — as the field has its incompetents just like all other fields. Make sure you get someone with experience in this particular area.