SpartanMaker

I forgot, I also wanted to comment on this. I too thought that logically this made a lot of sense and thus sleeve must somehow be better because it kept the pylorus in the food canal. The more I thought about it, the more I realized I couldn't actually articulate why i was so worried about this? Millions of bypassers live normal lives, thus surely it can't be as big a deal as I thought? What I always found odd is that most people feel the sleeve is "less invasive". In sleeve, part of your stomach is permanently removed from your body. In bypass, noting is removed, all the parts are still there, just rearranged a bit. Not sure about you, but permanently removing things sounds pretty invasive to me?

Thank you Alex for sharing this! Now let's see how the US insurance industry responds...

A chose bypass due to GERD, but I also had some reservations around dumping and medications. Medication-wise, the reality is over time, a lot of the medications you take may end up going away. Especially if they are for conditions like high blood pressure or diabetes that are often reversed with weight loss. Personally, I was really worried about NSAIDS, because I have a number of physical issues that have had me on prescription NSAIDS for over 35 years now. My surgeon agreed that even with bypass, I could keep taking them as long as I continued to take a PPI to limit the risk of ulcers. I'm also hopeful that as I get closer to goal, I may be able to give them up entirely. For the rest of my meds (if you include supplements, I take over 30 different pills a day), no mention has ever been made about me needing to adjust the dosage in any way. Honestly, I think the whole "malabsorption" thing for bypass may be a bit overblown? As far as I'm aware, the only ones where you might run into a problem are extended release versions of medications. For most of those, there are non extended release alternatives. If you have specific medication concerns, my suggestion would be to talk with your bariatric team. They can best advise you if bypass would be an issue for you with that medication. As far as dumping is concerned, dumping is far from guaranteed with bypass. I have not experienced it and many others here have not either. Plus, we've had first hand reports that even some sleevers have end up with dumping syndrome. Certainly it's much more likely with bypass, but I'm not sure I'd worry about this too much. If you do end up with that issue, it can certainly help you stay on plan and may help you do better in the long run by controlling your intake of things you probably shouldn't be eating anyway.

It sounds to me like you've already identified some things you know you could change. I'm a big believer in making lots of small, but sustainable changes, rather than huge diet "resets". By that I mean, maybe for the next couple of weeks, you simply make sure you stop at only one glass of wine at night. Then maybe it's cutting the wine down to every other day, or maybe limiting yourself to 1 or 2 bags of chips a week. Try and make just one small change every 2-3 weeks until each small change becomes the new normal for you. Only then, add in another change. I think most people try to drastically change everything all at once and that rarely works. Again, I think you know what you need to do to get back on track, the trick is taking it step-by-step and turning the "bad" habits into good ones.

So I'm curious if others have this same thing going on... I was talking to my wife about body image the other day and she mentioned that she seems to have 2 different internal body images of herself. I realized I have the same. I basically have one image of myself when I was much younger and very fit. I think most of the time, this is my "default" image. I am sometimes shocked when I see myself in a mirror or in photos, because I'm a lot older and fatter. But here's the kicker: There's also a body image I have of myself that's actually of me at my heaviest. I notice this one mostly in picking out clothing and being surprised it will fit. This seems so odd to be that I have both of these conflicting images internalized and sometimes I think of myself as one and sometimes the other depending on the circumstances. Anyone else experience this?

Wow, that's got to be so disappointing, but you seem to have the right mindset about it! Kudos also to that doctor. For him to decide not to move forward meant he cared more about your health and safety than his ego. While not really the same, my unusual anatomy did cause my surgeon some extra work. Simply put, my intestines are routed differently than most people, so she had to put in a lot of extra work to locate some on the anatomical markers they use to properly measure the roux limb for the bypass. Apparently it made my surgery take about an hour and a half more than usual. Thankfully she is one of the most experienced bariatric surgeons around.

It might be giving up caffeine and carbonated drinks? I went from drinking lots of caffeinated sodas and energy drinks every day to being carbonation and caffeine-free basically overnight. I now have zero desire to have carbonated or caffeinated drinks at all and I feel a lot better for having given them up.

This is a good point. Especially if you are someone that has non-alcohol related fatty liver disease (NAFLD), or especially the more severe form non-alcohol related steatohepatitis (NASH), regular drinking probably isn't in your best interest. A lot of obese people end up with NAFLD/NASH since obesity is the leading cause. Depending on the severity of your disease progression, you may have caused sufficient damage to your liver that frequent drinking on top of that could put you on a one way path to cirrosis, liver cancer, and/or liver failure. Now that said, one drink or even a few now and again isn't going to cause severe disease. Also, weight loss often can completely reverse NAFLD, so if you didn't actually damage your liver permanently, this may not be a factor. I totally get those that say alcohol is a poison and don't understand why anyone would purposely poison themselves. Objectively though, ALL of us are here because we purposely poisoned ourselves with food. I'm in no position to judge anyone that chooses to drink. (By the way, my main hobby pre-surgery was winemaking, so stopping drinking was an even bigger challenge for me. I had to give up not only nightly glass of wine, but my main hobby.) In the end, I think we're all grown-ups and everyone needs to decide for themselves what's right. Just know the risks and decide for yourself if the risks are worth it to you.

This is a fantastic point! The surgery is just a tool, and plenty of people have surgery and fail. Those that are successful have made fundamental changes to the way they eat. OP: either way, if you want to be successful with or without surgery, you'll need to change your relationship with food. For you at your low BMI, that may be enough even without surgery.

I tried both Ozempic and Saxenda (both GLP-1 agonists), pre-op and they do work for some, but at least for me, neither was the miracle drug some claim them to be. The idea is they curb hunger, but hunger is not why I was obese, so overall these had little impact on me. They are also quite expensive (~$1,200 a month sans insurance coverage), so depending on your budget it may be cost prohibitive. As I understand it, this class of drugs have also become trendy among the wealthy that don't really need them, but can afford the monthly cost to help them stay slim. As a result, there are significant shortages right now.

It's not uncommon that bariatric programs warn people not to drink alcohol post-op. Some, like your team seem to take a "never again" approach, while some say avoid it for a specific length of time, such as the first year. As I understand it, here are the biggest concerns those programs have: The biggest concern by far is that there is an increased risk of developing Alcohol Use Disorder. As @Starwarsandcupcakes mentioned, some research suggest that susceptible patients transfer disordered eating onto alcohol. Some studies have even found that the incidence is as high as 20% of bariatric surgery patients. The second concern is that alcohol affects our altered biology differently. Honestly this is worse for gastric bypass patients, but sleeve patients still have have issues with getting drunk much faster, on much less alcohol. Further, it can take a lot longer to metabolize the alcohol you do consume, meaning you'll stay drunk longer. Bottom line, it's really easy to overdo things and end up completely drunk on a lot less booze than before. There is also the concern that this is wasted calories that provide no nutritional benefit and can slow your weight loss. Obviously for those in maintenance, this doesn't really matter, but for those still losing, it might be a concern for some.

Thanks for this advice, I'll have to ask! I also REALLY need to know if I can shorten the time between pills. It's such a chore for me because I'm talking about 30 pills a day right now. Having to wait 10 minutes in between makes this really hard.

Now if you'd eaten the whole slice I would have been a bit concerned (mostly about where you put it all), but just the toppings? Eh, no big deal. Especially if it didn't hurt you later. Don't make it a habit and I think everything will be fine. I'm generally in the 600-800 range too, but have found some days it's more like 500 and some days more like 900. It all works out in the end. I think part of that is just our bodies telling us we need more food sometimes?

Don't even talk to me about chicken! I was so grossed out by "chicken salad" during purees, I have not touched any chicken since. On reflection, it wasn't just that I was grossed out, but it also "sat really heavy" in my stomach. It made me feel gross and felt like it took forever to digest.

For clarity, the 65 pounds lost is from when I started working with the bariatric program. I actually lost about 50 of that pre-op. I'm only 1 month post op at this time and lost 16 pounds in month one. I'll definitely keep everyone updated. I suspect as I get closer to goal both of these images will still be there, but hopefully the "fat me" one will fade over time!

Most insurance won't pay since typically they use a BMI of 35 with comorbidities, or 40 with no comorbidities as their cut-off. If you're self pay, there should be more options open to you. I do think a lot of those tend to use a BMI of 30 as their cut off, but I'm no expert there. Your best option might be to talk to a few different clinics about what they can do for you.

Hear, hear! By the way, anyone that says this is the "easy way out" is, well, an idiot.

I hear you! I always put it in the perspective of what things were like for me pre-surgery. At that point, if I saw a 5-8 pound drop in a month I would have been ecstatic!

I basically lived off beans & legumes during puree stage. The pureed meat thing just didn't work for me, so refried beans, lentil soups, etc. with added unflavored protein powder was my go-to food.

I had been thinking the same. Mostly I'm just doing my thing, trying to figure out how to live with all the changes I'm experiencing. My challenges lately: I'm still not regular, with my guts bouncing between one extreme and another. I'd really like to find the right balance, but haven't found it quite yet. I'm struggling with water more now that I have to not drink 30 mins before and after a meal. If I take ~30 minutes to eat, than means I'm not drinking for and hour and a half per meal, or roughly 4.5 hours out of the day with 3 meals a day. Add in a snack to hit my protein goals (which I often have to do), and we're at 6 hours sans liquids. Some days I do okay, but I find once I get behind, it's almost impossible to catch back up. I'm still struggling to slow down my eating and chew better. I knew this would be a problem for me and it is. Thankfully it's not been too big an issue as my pouch seems to be surviving me not doing this quite as well as I'm supposed to. I'm trying to understand what both being hungry and being satisfied feels like with limited success. About all I can tell at this point is no pain and some pain. Some foods seem "different" than before. Because I'm never really actually hungry, I sometimes either don't eat at all, or don't eat very much, just because I don't like what I'm eating. I have the alternate issue sometimes as well. When I actually find I enjoy something, I find I can eat more than i thought and more than my team says I should be able to. (See previous bullets about trying to understand fullness). I'm not concerned, but on occasion I have found myself pushing the limits of this capability and paying the price afterward. Enough for now. What about everyone else? What's working or not for you right now?

20 pounds seems excessive, especially considering where you started. I lost 16 pounds the first month and was quite thrilled with that! I'm also a guy and starting from a lot heavier weight than you. I think the only people losing 20+ pounds in a month are a lot heavier.

There's actually a whole host of things they look at, but I think it can be summed up by saying they are evaluating if you are ready for bariatric surgery. They look to see if you have a history or tendency toward addictive behavior, if you are a suicide risk, if they think you will be able to be compliant with your program, if you actually mentally understand what's being proposed and why, if you have any other mental disorders that might cause issues, etc.

Can you please provide references for this? Everything I've seen or read in the scientific literature suggests that RMR testing by direct calorimetry is considered the gold standard for determining calories burned. Indirect calorimetry may be slightly less accurate, but is still far and away better than anything else available to us. Where things get "fuzzy", is that we are not always at rest, so just knowing your RMR is not enough. This is where activity level estimates or heart-rate based calorie estimators like fitbits try to make up the difference. These will obviously be less accurate, but are certainly better than a wild guess or deciding based on something much less accurate like height and weight charts.

Exactly this. There are unfortunately no standards at all when it comes to pre and post bariatric surgery diets. I found this incredibly frustrating early on as it makes it seem like it's not science, but guess work. On reflection, I suspect it has more to do with how long a particular program has been doing bariatric surgery and the experiences of their patients over that time. Most teams probably only update their plans rarely. Some may still be clinging to recommendations that were more common a long time ago. Also, some doctors are just more conservative than others. Anyway, whatever the reason, every bariatric program is free to design their own plans. Some are very strict, and some not so much. When I asked my team about this, I was specifically told to ignore what other programs were doing. They designed their plan around the outcomes that work for them. In terms of conflicting advice between your written plan and what you were told, I agree it's best to ask. I had this happen a few times, but I always asked about it and was given a reason why they wanted me to deviate. For example, at my 2 week post-op visit, I was told I could progress faster than the written plan. This was specifically done for me because I was healing well and had no nausea.

None here at all, including spicy heat. My wife and I really love flavorful dishes, so we cook a lot of Indian, Chinese, Japanese, Taiwanese, Vietnamese, Mexican, Peruvian, etc. dishes and I've had no issues with anything so far.