P-Diddy

So I've found out my employer covers Bariatric Surgery for weight loss and I have been considering the surgery for some time. I had recently decided that I was interested in the Gastric Sleeve as I didn't want to take vitamins and was overall scared of the intestinal re-routing of the Bypass. The specific program with my employer is a pilot program and only one surgical center in the US is allowed, luckily for me it was only 200 mi away since we're nationwide that isn't the case for a lot of employees. After attending my initial consultation I was met with some resistance over wanting the gastric sleeve. The wife of the surgeon who is also a family medicine doctor said that Gastric Sleeve surgeries are ineffective for people with my BMI (hovering near 60) and that if I was going to have surgery I should consider a surgery thats more likely to achieve the results I want. I've been leaning towards their advice and am now considering the Gastric Bypass more heavily. My reservations are thus: Currently I feel like the biggest impediment to my natural weight loss is a simple lack of energy. I can put together months of working out or even diet and lose weight. I won't bore you all more with that sentiment because I feel you've all been there. The gastric sleeve was more resonable to me because I feel if I could get under 300 lbs my activity would increase significantly. I'm no stranger to the gym as is and feel very comfortable weight training and exercising in the gym. Just by being under 300 lbs I would likely be meeting strength goals that are common among athletes (squating 1.3 times your weight, etc). So I feel like my weight loss would go fairly well sub-300 with any method. My questions: I've looked on the forums and have seen numerous people with lots of weight loss with the gastric sleeve. I'm worried that the Doctor could be right and that a gastric sleeve would be ineffective. My initial reaction to the doctor was that she was being a bit negative. She said that at my BMI it would be unlikely I'd be in the upper percentages of weight loss (60%+) with the gastric sleeve because I have so much weight to lose. My reaction was that this was faulty logic and that a person with a high BMI would likely lose more weight than someone with a BMI closer to 40 for instance as the closer you get to goal the harder it is to lose. Is gastric sleeve effective for people with High BMI's nearing 60+? (I've googled the hell out of this trust me. Does anyone know of a place that has demographic data so that I could get a picture of statistical groups that include my age and gender? Do men have better, worse, or equal success as women? What about different age ranges? Do younger people have better success than older people. (Older and younger is relative) We'll say sub 45 and above 45. But more importantly an age group that quantifies me in it. I want the surgery to go well, I want to be successful and I don't want to deal with a lot of complications. Does anyone have any advice or insight to help me reason this out?

Thanks Bryan I appreciate your input. You're almost my exact demographic and oddly enough you started your consultation almost exactly two years prior to mine. Small world!

I suspect in spirit that was what she was saying but in context she was comparing the sleeve vs the bypass and suggesting that I won't get satisfactory results with the sleeve because of my weight she just used weird logic to come to that conclusion I'm sure I'd lose less weight with the sleeve than the bypass. Which like you say it might be that she was suggesting if I were lighter I would be more likely to get sub-200. It sounded like she was trying to sell me on the bypass is all. She quoted some other figures that didn't make sense to me and didn't seem to know how many calories were in a gram of fat so its possible that shes just sticking to the script. It's been a very weird experience going to that surgical center to say the least. Appt 2 is Monday, I'm not sure what is in store for me. I had to have a cardiologist appt and when I went to the cardiologist he rolled his eyes and said that "The computer misread your ekg...it says you had a heart attack but I can tell from your ekg thats not the case...sometimes the computer just makes an error...". Which was comforting I didn't know I was tasked with seeing the cardiologist because it said I had a heart attack...that would have been weird. They scheduled an echo because of a congenital heart defect I had when I was a baby but the cardiologist suggested that as long as nothing showed up on the Echo that he'd clear me. I've started being ketogenic and dieting a little to start to get down lower before surgery. I would love to be sub 350 going in to surgery. We'll see how it goes but I appreciate your optimism and also feel optimistic about my chances.

Further proof that I'm barking up the right tree. That the statistical model we're presented doesn't really give any information about my demographic in a meaningful way. This only leads me to believe my instincts are right. I fail to see how suggesting that women who aren't my age aren't good models of my outcome is some how equal to needing a "PRECISE" demographic. It doesn't need to be "PRECISE" i.e. males in their mid-thirties with X amount of body fat etc...more so I was just interested in the very least that the models be male and I'd like to see them at my starting BMI. But strawman away!

I appreciate you posting but quit reading when you started to give tips to fail. Thanks but not interested in how to cheat. I'm sure I'll figure out things as I go along, no need to pre-emptively start reworking the laws to accomodate my current behaviors before I even have surgery. I see everyone says that...but...statistically I'm going to lose @ least 50% of my excess weight. That isn't a gamble to me. But for someone to try and quote a small genetic study by Harvard as proof of some genetic quality that determines outcome and suggest that its all in the wind does sound like gambling to me. I don't feel like I'm not in control of the whole thing I just can't get any solid answers. I posted in the guys only section hoping for a demographic that better matched my own. Everyone is not created equal in terms of outcomes and I wasn't trying to mix myself up with people not in my demographic. Because I simply don't believe that their experiences are a good representation of what I'll likely experience. I don't expect that a woman who is post-menopausal (sorry if that offends anyone) is an accurate model for what a man in his thirties should expect from surgery. That doesn't mean that women have nothing to offer in terms of support, only that I think this question is better fielded by people who more closely match who I am.

Mostly I just want to feel like I'm not gambling.

Than the bypass vs sleeve argument is moot. The Dr. should simply let the patients choose. Congrats! But thats what I want to know. What predictive factors do you have, and how would we know there are or aren't any? We're constantly being tasked with listening to our doctors. We have to simply listen to them. No doctors ever disagree...nothing is ever pseudo-scientific for them...etc. Of course Doctors ARE wrong all the time, of course personal bias DOES become a factor in someones recommending one surgery over the other. I was given an 80% of excess weight lost with a bypass vs 50% of excess weight lost with a sleeve. Why if I look at other websites do they say up to 70% of weight lost for the Sleeve? Why do some people here quote 60%? I've seen other studies simply quote a BMI reduction number. Why isn't there better information? If I lost 50% of excess weight I'd be right around 280. That would be great! Everything would be soooooo much easier. But if the surgery itself doesn't help why is everyone on this forum able to lose any weight and why is there an expected % of excess weight lost? If super obese are just food addicts and they can't lose weight...how do they lose weight? I'm confident based on my previous attempts at weight loss that weight loss would be rapid. At 1500 calories per day I lose currently 6 to 8 lbs a week. Given the numbers I've seen on the forum I'd lose probably another pound or 2 per week based on the restrictive diet. The fact that I'm a man seems to be a benefit as well as most of the people I see on these forums so far that have issues are women. I just wish there was some statistical data that could be seen that WLS patients could use to make decisions. Instead of relying on strangers less interested in your results than you are to be as up to date as possible on the numbers.

Well, I agree, and thats why I wish medicine had demographics for us to look at. I think clearly its the case that a person with a higher BMI would be MORE likely to lose more weight than a person with a lower BMI. Mostly because of Basal Metabolic Rate. A person who weighs more has a higher metabolic rate than a person with a lower weight (all other things equal). Thats why I was dubious when she said "People with high bmi's don't lose as much weight as people with low bmi's" that contradicts what I know about BMR. Given that I lose a lot of weight anytime I diet, which has been too numerous times to count, I think its safe to assume I'll also lose weight rapidly with any surgery. Thats what I think too! I think that if I can get through say 80 lbs or so by next summer (surgery wouldn't be til fall). Not only would I have a significant gain in energy but also the introduction of summer and wanting to be more active and simply having more opportunities to be active socially it will only continue to spurn on quality weight loss. I've given it some thought and I've settled on two factors. A. If there is some genetic ailment or physical condition that limits my weight loss like one of the responders was discussing then it seems logical to have the Sleeve. If I don't lose weight I don't lose weight but I don't have a lifetime of malabsorption problems and thousands more in medical costs for potential problems. B. If I lose in the upper percentages like many of you have (go you!) than I'll just be that more happy that I chose sleeve than bypass. Thanks for everyones input. I'm leaning more towards the Sleeve again.

It does help. Its a valid point. But you're also terrifying me. God forbid I end up getting a bypass and I have to deal with malabsorption the rest of my life for nothing. Don't you think if I can lose weight rapidly say for a few months when restricting my diet that this is a good indicator that I'll probably continue to do so when I've undergone surgery? This topic seems to be a many headed hydra. You answer one question and introduce more. I appreciate your input. I'll have to take these things and unpack them and see what other people think about them.

Thats alarming as I do have Hypothyroidism. But when I diet I lose weight rapidly. For instance I tried to do meal prep and lost nearly 20 lbs in a month. Wouldn't Hypothyroidism restrict my weight loss now TOO if it was going to be an indicator for gastric bypass? I found the article interesting. While its interesting it has no practical use. I can't test for these chormosomal markers @ Walgreens.