NickelChip

So, I'm not an expert, but I've been doing a lot of reading and watching videos from reliable medical professionals (like the one I shared above, and the videos from Dr. Matthew Weiner in Tucson). I've also had friends and family members with both bands and sleeve surgery, and seen all of the ones with bands eventually fail, while the sleeves have had at least moderate success. Full disclosure: I'm scheduled for a bypass in December. The most important thing about all of this is it's not your fault. It's not about getting your head right, it's about getting the right tools. And the band is just not a good longterm tool for almost everyone. The biggest difference between the band and the sleeve or bypass is that while the band relies on restricting your eating, the sleeve and bypass both change your metabolism. It's not just about capacity, it's about a fundamental shift in how your hormones communicate with your body. Do you still have to have good nutrition, and be mindful, and work on your life issues that influence how you eat, and all that good stuff? Definitely. But choosing a metabolic surgery (sleeve or bypass) totally shifts the playing field in a way the band didn't. I think it was one of the videos from Dr. Weiner where he said it was like getting a second chance to draw a new card from the genetic lottery. Good luck with your meeting with your doctor, and just remember, this isn't your fault. It's not because you're not strong enough, or good enough, or any of that nonsense people like to say. It's because you got dealt a crap hand in the gene department that makes it really hard for you to manage your weight, way harder than for a lot of people, and it's okay to use every tool available to make it easier.

If you haven't already watched this, I highly recommend this video from Dr. John Pilcher, (and pretty much all his other informative videos). He's a bariatric surgeon in San Antonio and does an amazing job of explaining medical information in a really understandable way:

I got the same, and I'm curious how they compare, if you don't mind sharing. I'll see if I can scan mine and share it, too. Edited to add: this quoted the wrong post for some reason! I was trying to reply to @SpacePossumSupreme!

There are definitely other brands of 100% whey protein isolate available. I mean, it does sound like they want you to buy from them, but I would compare the price to make sure they aren't marking it up. My doctor's office just gave us a list of brands to consider, plus a few requirements for fat and sugar content. They were more concerned with us finding flavors we liked, which you can't always do with a single brand option. Then again, my doctor also doesn't require more than 48 hours of a liquid diet and doesn't do the puree stage, just soft, well-cooked foods you can chew down to mush. So they're all different. Which leads me to believe many of the "rules" are more like "preferences."

I think either way is fine, but my suggestion is just don't substitute artificial sweeteners to do it. Take it at whatever pace you need to be able to handle it and adjust your tastes for the long term. If that means cutting back on the sugar in your coffee over many months, that's fine. Better to go from two spoons down to one and then to half a spoon of sugar slowly than to start using an artificial sweetener and never kick that habit. For me, I made the decision to eliminate several things from my diet before taking a few weeks to either eat up or throw away the things I didn't want to have in my house anymore. The key has been not allowing it back in once it was gone. I am also pre-op. I started the process in July with a surgery date in late December. I happened to find the book Pound of Cure by Dr. Matthew Weiner and it's absolutely been the best nutrition book I've ever purchased (and I've purchased many). Full disclosure, I did not do the 2 week reset portion of the program, but I did start out by increasing my veg and eliminating the stuff that was easiest for me to do right away. After that, there have been certain stages that I took faster and certain ones I've done slower. But overall, in my opinion, it's an excellent guide for what your healthy diet "should" be most of the time. Higher on veg and plant protein, lower on animal products, mostly free from the vast majority of processed carbs, sugars, and artificial crap. If you're looking for guidance, his books and videos are super informative and rooted in science, not fads.

Yes, for several years. She's the one who suggested getting the surgery.

A lot of things played into it, but honestly, it was when the doctor asked me if I would be interested in it. For background, I'm turning 50 next year, so yes, that milestone is in my head as part of it. My younger brother had VSG 15 years ago, and ever since then, I wished I could do it because he had such a great outcome. But at the time my BMI was 34, so I didn't qualify, even with high blood pressure. As my weight increased, my doctor referred me to the hospital's weight loss center. They started me on a non-surgical program, and it worked a bit for a while. And then it didn't, and I gained everything back plus some. I even tried Wegovy for a while, but I could never get it long enough to see if it would work because of the shortages, plus the discounts dried up and the out of pocket was crazy. But this past summer, my weight peaked at the highest it had ever been, tied with the day I left the hospital after delivering my second child. My BMI had reached 40. My body ached, my feet ached. I was bloated all the time. Nothing fit. My heart kept doing a worrying fluttery thing. I had to increase my blood pressure medication. With the pandemic, I had stopped going to the weight management center. My doctor told me to go back. This time, they asked if I would be interested in considering surgery, and I jumped at the chance. It was like the second the question was asked, I knew it was time. If they'd asked earlier, I probably would've done it then. But for such a long time I didn't qualify, and then I probably did but everyone seemed to think I should still keep trying on my own. When I found out my out of pocket costs would only be around $3k, I nearly fainted. I assumed it would be so expensive. My brother was self-pay and it was 10k. Instead, it's the same as two months of Wegovy! Now I'm just counting the weeks until my Dec 27th surgery date.

You make some really good points about needing to be a little selfish. I think of all the people in my life who need things a certain way, and how I go out of my way to accommodate. Oh, you go to bed really early, or you must eat dinner at 3pm, or you only like Italian food, or can't meet up at that time because you need to workout? Okay, I can be flexible! I'm turning 50 this coming year and it's only in the past few years I feel like I've started to learn to advocate for my own needs. And it's definitely a learning curve. It's so hard to remember that just because you could be flexible doesn't mean you always have to be. As for relatives and food, my strongest childhood memory is probably my very obese grandma, who seemingly passed down 100% of her genes to me (thanks, Grandma!), saying within the span of two breaths: "You know, you're going to be overweight like me and you have to be so careful with what you eat...want more Polish sausage?" I mean, bless her heart, she lived to 92 and was sharp and reasonably active until the last year or two, so if she passed that gene along to me, I'll take it. But you can't tell a person one minute that they have to eat healthy and the next minute present them with an entire family-size Tupperware filled with grapes as a snack because "grapes are healthy." Which I would eat all of even if I didn't want them so as not to hurt her feelings. Meanwhile, my mom was rail thin and always going on some sort of "eat grapefruit for a week and melt the fat off" women's magazine fad diet my whole childhood. Yikes. Family can do a number on you. And you're right, all that stuff will still be there to deal with emotionally even after the surgery...

I know in the US, our requirements for insurance to cover the surgery (if you have insurance that does) is generally a BMI of 35 with co-morbidities (blood pressure, diabetes, etc), or 40 without. I've had similar struggles to yours, weight gain starting in my 20s blamed on thyroid. With diet and exercise I could lose a few pounds, but never enough. I hovered in the 190s until my late 20s, 210s in my 30s, climbing to 225+ in my 40s. I went to my weight management center that was connected with my hospital network for 6 years starting at age 43 and started with nutrition and lifestyle changes, followed by medical interventions (Contrave, Saxenda, Wegovy when you could get it). I never got below 204, and that was with a strict 1200-1500 calorie diet that I tracked religiously and 10k or more steps daily for a year (I never missed a single day!). As soon as I relaxed even a little, the weight came back with a vengeance. This summer, I hit 251 and also have hypertension and prediabetes (A1c of 5.9) . That was when my weight management doctor (an endocrinologist) finally asked if I wanted to talk to the team on the surgical side. I'm awaiting insurance approval now. It should be covered though I have no idea about out of pocket expenses. I don't really care at this point. I'll make it work. If you are considering paying out of pocket and concerned at all about going to Mexico (although my brother went that route many years ago and it was fine), I did see a self pay option here: https://www.poundofcureweightloss.com/bariatric-surgery-cost/ I know it's frustrating, and if there's one thing I wish, it's that I had dealt with this when I was turning 40 instead of 50. Wishing you luck!

What a transformation!!! You look great and you must feel so much better.

Okay, so the weight loss looks great, but can I just say that your hair wins the day! I absolutely love the new style! And are those lavender highlights? It looks fabulous!

That sounds about average to me. I've met with a few different nutritionists on and off for several years as I was in the non-surgical side of my hospital's program for about 6 years before my doctor recommended starting to pursue surgery this past summer. This time around for the surgery prep meeting, I discussed my eating habits, asked a few questions, and we went over the stages of eating after surgery plus supplements, etc. But honestly, if they get the sense you understand how to eat healthily and there aren't any specific issues to go over, that's about it. Mine was about 45 minutes.

I was hoping for November but it looks like my date won't be until December 27. Wishing all the November peeps good luck!

I imagine price might have something to do with the reason your doctor is starting with this one. I've never taken it, but I looked up the price and it's very affordable, like under $10 at some pharmacies. If this works for you, affording it long term will be a breeze. The newer GLP-1 drugs might sound so much better in terms of effectiveness, but at over $1k a month, I'd be praying for something else to work!

It's funny because I have a friend who is naturally very thin, bordering on underweight, and she is always cold. We were out walking on a horribly hot and humid day this summer where everyone else on the street was in tank tops and shorts and looking ready to die, and she had on a light denim jacket. I almost wouldn't have believed she could feel cold, but her hands were like ice to the touch. I have to say I wouldn't mind this side effect because I hate the heat. If it makes summers more bearable, I'll take it. (Of course, I say that now, before the onset of what they're all saying is going to be an epic New England winter.)

Good luck tomorrow. So happy for you and I love your good attitude!

What about adding a higher calorie shake like the Ensure Complete Nutrition, which has 350 calories in a 10 oz serving? It's generally considered too high in calories for using if you're trying to lose weight, but if you had three of those per day, you'd be getting 1050 calories and 90g protein right there before even having soft foods. You should be able to manage that amount capacity-wise with no problem. They have 8g fat and 15g added sugar, which might cause some risk of dumping, but I would think it would be worth a try. It seems like you'll need to hit about 1400 calories per day minimum to stop losing weight, whereas in the early days the guidelines you get from the doctor that are intended for weight loss may put you well under 1000.

So, post-op he is definitely not advocating for a pound of veggies per day, at least no time soon. That goal is for a person who has not had surgery or is years out and has regained a pretty standard appetite. What he does suggest for bariatric patients is that for that honeymoon period of the first year or so, you focus on protein first. But as time goes on and your hunger returns and you have more capacity to add foods, you should increase the veggies you eat while keeping your protein and starch servings small by comparison. He likes to say veggies should be the star of your meal. In other words, instead of going from 3 oz of chicken to 6 oz so you can feel more full, you would eat your usual 3 oz of chicken and fill up the rest of the way on healthy veggies (but only to your personal capacity, whatever that is). Same with snacks. If you get hungry and need a snack, make it a healthy one with veggies instead of a junk food snack. From what I gather, the strategy is one that really helps to combat that weight gain in later years when it becomes a little too easy to eat a lot more like you used to (the way that got us all into trouble to begin with!)

1. Less aching in my feet and joints 2. Being able to walk faster and longer 3. No more blood pressure meds (hopefully!) 4. Healthy lab work and no more prediabetes 5. Shopping in a store and not having to think "they probably don't have it in my size" or "that won't look good on me."

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My advice is not to think in terms of "being on a diet" but in terms of "what does healthy eating look like." I know at least for myself, I've spent so many years counting calories or doing fad diets, and I'm burnt out on the tracking and the counting, and feeling deprived and waiting for it to be "over." What I've started doing instead is focusing on what healthy eating really looks like and trying to choose mostly the good things and eliminating the bad things. For example, I've started having a smoothie every morning with 2 oz spinach, plain Greek yogurt, unsweetened almond milk, frozen fruit, chia, flax, and hemp seeds, and protein powder. I know that everything in it is great for fueling my body and I feel good about drinking it. At lunch, I have a massive salad. Like, I bought a serving bowl and I fill it to the top with spring mix, spinach, shredded carrots, cucumbers, tomatoes, cabbage, beets, and mushrooms. I put about 3oz chick peas and black beans on it, and 2-3 oz lean deli meat, plus a Tbsp each of pumpkin seeds, sunflower seeds, and sliced almonds. I top it with a freshly squeezed lemon and Tuscan seasoning blend instead of dressing. I'll be honest, the thing is so filling I barely have room for dinner. I do eat dinner, but it's light and mostly protein and veg. Since I've started doing that and gotten all the snacks out of the house (no more buying pretzels, crackers, and other easy carbs or sweets) and only allowing myself fruit or nuts for a snack, I haven't really felt hungry at all, and I haven't been craving junk like I used to. I've also cut back on caffeine and stopped drinking diet sodas. I started making these changes in July and I'm down almost 15lbs without having to write down everything I do, because it's mostly the same every day. For me, this is something I can keep up long term as long as I am mindful of what I allow myself to bring into the house. Give yourself time, you can do it!

Did they test you for Graves' disease? I assume they ran thyroid tests, but I have a number of people in my life who have had Graves' and the inability to keep weight on despite eating constantly is a top symptom.

The story behind the 2000 calorie per day number is kind of interesting. It's to make it easy for food labels. The USDA wanted to be able to give nutrient information for comparison between foods, so they surveyed lots of Americans in the 1990s to see how many calories they ate per day and got a range of 1600-3000. But putting a range of nutrition values on a food label is messy and confusing. They decided on 2000 because it makes the math easy. But 2000 is actually too high for most adults not to gain weight, which might be why almost 70% of Americans are overweight or obese!

If you are at 1000 calories now, 1500 would be an additional 50% of calories. If you look at it like that, it's a lot more than what you're eating now! It's like going to work and getting a 50% raise! You just have to make sure you choose wisely how to spend those extra calories. I'm on the other end of things, waiting for surgery and working on improving my nutrition in the meantime. Honestly, one of the biggest things that has helped me in the past few months has been following the advice in Dr. Weiner's A Pound of Cure book. I had gotten into some really bad habits, like white toast for breakfast and a sandwich with lots of cheese and mayo for lunch, and I was constantly hungry and snacking on pretzels and other simple carbs, or candy (my biggest weakness). I hardly ever got much protein or veg and fruit. In July, after my doctor recommended surgery, I bought the Pound of Cure book and made the decision to incorporate a pound of veggies every day into my diet, and to follow the other guidelines as I was able. I stopped buying the junk food and reduced my dairy and wheat intake significantly, plus eliminated all artificial sweeteners and most added sugars. Now I have a smoothie in the morning that has just under 400 calories and 40g of protein in it, and gives me 2-3oz of spinach. At lunch, I make a salad that is around 450 calories with 30g of protein and literally weighs more than a pound of veg, beans, and seeds. I usually add a couple ounces of smoked salmon or turkey breast, but I've been skipping the dressing in favor of lemon juice and a spice blend. I usually have around a 400 calorie dinner that is mostly protein plus 4oz or more of veg, and I'll have some fruit or nuts if I need a snack. This stuff is so much more filling than my pieces of toast with butter or my sandwich ever was that I find I'm really not that hungry much of the time. In fact, I feel like I'm eating way more, and I'm not craving snacks the way I did, yet I'm rarely above 1500 calories on a regular day. So if you choose wisely, you will be amazed at the volume of food you can consume for under 1500 calories. I know I've been really surprised by it, and I've managed to lose around 15 pounds in 2 months without really feeling deprived. I know for me the biggest risk would be to fall back into the old habits, so I'm trying to keep things as simple as I can to make it less likely. But not feeling hungry all the time really makes a difference.