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-It is not an unreasonable position for her to keep, as the bypass does indeed provide very similar weightloss and regain results to the sleeve but at a somewhat higher cost in potential problems, limitations in future medical care and increased fussiness on supplements. The bypass is overall a very good procedure that is mature technology - it has been around as a WLS for some 40+ years, and its basis dates back some 140 years, so it is a well known quantity, both good and bad. Her concern about ulcers is well founded, and that is something that one lives with, or at least the threat of them, with the bypass as it is intrinsic to it. One may never experience one, and most don't, but everyone is living to avoid them - it is the basis of the "no NSAID" policy that is common in the bariatric world as one needs to avoid any medications that promote stomach irritation and NSAIDs are the most common class of drugs that we encounter (but there are others that one may encounter through life.) Occasionally someone will come through with an ulcer problem that defies resolution, and their main course of action it to reverse the bypass. This is rare, but it happens. Marginal ulcers are to the bypass what GERD is to the sleeve - you can't fool mother nature and there will always be potential consequences to fooling around with her. One needs to balance what one gets from a treatment against what might possibly occur on downside. Iron infusions are also a fairly common need after bypass, as it malabsorbs minerals in particular, and while some can get away with simple oral iron supplements, many can't and need periodic infusions. This is rare with a sleeve as there is no particular malabsorption. Another factor that weighs on some is the "plan B" factor - what does one do if things don't work as expected - complications, inadequate weight loss or regain? While we don't like to think in terms of getting revisions, they are sometimes necessary, and the bypass is difficult to revise if it doesn't work right; as noted above in the case of intransigent ulcers, the usual is to reverse the bypass and put you back where you started from, and likely still needing help in weight control. The sleeve, on the other hand, can readily be revised to the bypass if needed - typically for intransigent GERD problems - or to a duodenal switch for continuing weight problems. Again, not something we like to think about, but the options are there. The bypass also presents some additional limitations in future medical treatment, as it leave one with a blind remnant stomach and upper intestine, which can't easily be scoped endoscopically as with the natural GI system or with a sleeve. Again, something that may never come up, but likely will sometime in your future life. A further note, your surgeon is in good company, as my doc rarely does bypasses as well, though his preference leans toward the duodenal switch as his primary, with VSG as a second choice. He does, however, do a fair amount of business revising problematic bypasses to the duodenal switch, and will do the odd bypass when it is specifically indicated for a patient, but that is fairly rare.

You do have to take vitamins, supplements, and a B complex for the rest of your life on the sleeve, too, and you start with liquids (surgeons vary, some require clear liquids before you get thicker liquids), then on to purées and soft foods, and my surgeon recommends avoiding things like cruciferous vegetables (e.g., cabbage, broccoli, cauliflower, kale, Brussels sprouts...) until you are fully healed and know your own reactions. I don't think there's any such thing as a bariatric procedure with a simple post-op.

That's the weird thing, She has 23 years experience and is a surgeon of excellence in a MBSAQIP bariatric center. I don't want GERD and I don't want to have another surgery down the road. It annoys me a bit that the surgeons are like if this doesn't work out we'll change to a bypass later. Not everyone has the funds to keep getting surgeries.

Hi, Lesley! Nice to see someone else from Canberra! I did move there in 2019 and am seeing a GP to check blood levels. Everything is good, so I haven't needed to see a bariatric surgeon since I've been there. I left Australia for work in April 2021, theoretically for three months. Now I'm one of the thousands of people stuck outside the country because there are no flights, and I have no idea when I will be able to return. I'm very sorry you all are locked down. It must be a particularly difficult time to have surgery there!

Thanks everyone. Your comments have helped. I'm going to ask more questions and maybe contact the previous bariatric center I was working with before. I was really curious to see if anyone else had received the same feedback from their surgeon, like, perhaps opinions on the bypass were changing among the bariatric community. thanks again and have a great weekend everyone!

My wife had her RNY in 2019, I remember her pain was so intense that even clearing her throat would hurt her abdomen. Doing my research on how to minimize this type of discomfort beside taking your pain meds post surgery one can also have some relief by using a pillow or a brace to help you support the abdomen. Has anyone had experience with this and did it work for you? Any suggestion on a particular brand? And thank you in advance for all the replies this is a wonderful online community I am grateful for this forum it has really giving me hope and help me manage my questions and navigate thru my anxiety.

Hi BigSue, Thanks for responding. I actually started out at a different hospital and they seemed more likely to do both surgeries, the issue with them was that it took a long time to get them to give me their costs for the surgery and even with my insurance it was out of my price range. So I switched to another bariatric center that I could afford. the surgeon and the center have multiple awards for surgeries and she was voted best surgeon in my region, so I'm wondering is she just more experienced and knows its not worth the risks or too conservative? In any case, at this point I feel tied to this center since I've already spent a lot of time/money and am reluctant to start again. I really wish everyone would just list the costs up front.

Hello, I've just joined and I have a question I'm hoping someone can help me with. I am in a program for bariatric surgery to be scheduled later this year. I just met with the surgeon and was told she will only perform a sleeve, I would like a bypass. She says that she constantly has patients coming back from bypass needing iron infusions or having issues with ulcers and she thinks the sleeve gives the same benefit without the risks. Basically, she only does bypass on rare occasions, like with people who have acid reflux. Has anyone encountered this before? I thought I would be able to choose my surgery and after much debate I opted for the bypass. I'm 53, post menopause, 5-4, and 260. I would like this to be a one time surgery and not have to go back for additional one if needed. I'm also a sugar junkie and like that bypass would eliminate or limit that consumption for me. Thanks in advance for you responses.

the people above are correct. Most insurance companies cover it, but the employer can pick and choose which services it wants put in the policies it offers its employees. Some employers don't want to include bariatric surgery included in their policies because of the cost.

Thank you so much for this. I’ve been planning to try alternatives like cauliflower pizza and vegan burgers because I’ve ate it before and loved it. I just never knew anybody else whose had a sleeve or any bariatric surgery and I know the nurse they sent to my home does not know what she is talking about. I was never big on rice or pasta unless it was gnocchi. I reallly appreciate this

I have CIGNA, but they are just the coordinator (my employer self insures). The requirements they had were ridiculously easy: Letter from my PCP recommending me for surgery. New Patient Orientation / Post-Op Nutrition Education (combined into one) Surgeon Presentation ("This is what gastric bypass is... this is what sleeve gastrectomy is...") Psychological Clearance Attendance at one bariatric support group meeting About 20 pages of forms, quizzes, etc. I had to send in. That was it.

I haven’t done much research on this because I like whey protein anyways but the bariatric advantage rep was on Facebook live with the nurse practitioner from my office during the online support group meeting and she said that whey is the most easily absorbed and mentioned collagen as one that is less absorbable. When they checked my vitamins they also checked protein so I assume they will for you as well but if your protein is lower than expected the type of protein may be an issue. Just a heads up.

Though I have been following everyone's posts for the last 6 months, I did not want to subscribe until I finally got my surgery date! I got my surgery date! September 24th is the big day! The one thing I had not thought about purchasing until today was a new bariatric food journal that would specifically have a place to track my proteins, and waters. I have been keeping a basic food diary but I feel a new journal for post-surgery would be a great way to kick this off. I have been looking at different ones on Amazon but they don't give you a picture of what's inside the covers. Does anyone have a favorite food diary or food journal that's easy to use and they've found helpful? Sent from my moto g power using BariatricPal mobile app

Unbelievable. Cigna cannot determine whether weight loss surgery is covered or not under my insurance policy. On the phone, I have been told yes, it is covered only be told later that there is a a specific exclusion in my policy for weight loss surgery. I was ready to self pay. I saw the surgeon this week for an initial consult and tentatively scheduled surgery for the first week in November. BUT the bariatric coordinator just called - Cigna called her and said they thought WLS is covered under my policy. The bariatric coordinator let them know that Cigna said it is not covered when she verified my benefits. So the Cigna rep is "double checking" and will get back to her. I can't believe this! How difficult is it to determine whether I'm covered or not. Has anyone experienced this type of thing before? Also, if a miracle happens and I am covered, what kind of hoops will I have to jump through with Cigna? Any experiences with Cigna in this regard would be much appreciated. Thanks in advance!

I haven't (I'm not any psych meds), but I've been hanging out on bariatric forums for the last seven years, and many people are on them. They sometimes have to adjust your dosage, but that's about it..

Well I just found out about this forum so I saw this post and wanted to reply as I am older than a lot of people who have this surgery. Let me tell you that age is just a number. You can be young, have this surgery and be less successful then someone older. I think it depends on the individual. I was not overweight as a kid, and I weighed about 100lbs in high school. I started putting on the weight with each pregnancy and it got harder and harder to loose it as the years went by. Bad eating habits of course played a role, as well as genetics. My body killed my thyroid when I was pregnant with my son, and it just got harder after that to get the weight off. When menopause hit, I really started to gain. I had RNY surgery in Oct/2020 at age 61. I had high blood pressure, severe sleep apnea, sore hips, knees ankles, and feeling short of breath from just vacuuming so you get the picture. Could not walk 5 feet without having to sit down. Crazy awful. (I have asthma too) I have hypothyroidism, IBS, and was also border line diabetic. Yep...time to smarten up and take control of my health. I am 62 years old now and at 10 months post op. Best decision I have ever made and I wish I had done it years ago. I talked myself out of it every time, telling myself I can loose this on my own. Who was I kidding. LOL It was hard at first and I was not prepared for the mental side of it. I sat and cried the second day home from hospital as my brain was screaming at me, scolding me for what I had done. It wanted food, and I felt a lot of depression and remorse. I was not expecting that. It got better as time went on and as the weight started to drop, I felt much more in control, and very happy to see it go. Time to take care of me. I have hit a stall and have not lost any weight in 2 months, but I know this is normal and I am trying not to panic. I expected it would be more challenging to loose this weight because of my age. I do not exercise, but plan to start in the fall, I still have about 60lbs or more to go to reach my goal weight. No going back to my old habits, and If I do, I have this tool in place to help me. Any questions? just ask me. I am happy to share my experiences and happy to hear everyone's stories as well. BTW, You should check out Dr. Weiner's YouTube videos. He is a bariatric surgeon and has good sold advice on this whole process.

I was starving after surgery also. Moving towards real food helped - particularly the step from full liquids to purees. This is where I started to be able to eat some normal protein containing foods, like eggs and cottage cheese. (I really, really hated protein drinks until I discovered my protein powder latte.) After 1-1.5 months, when the amount I could eat also increased somewhat as the swelling went down, I went from starving to really full. Now I'm 18 months out and I still feel much reduced hunger. Personally, I think when people feel starving right after surgery, it is often because they aren't getting enough protein and their body has started to eat its muscles. I was reading a study the other day that says out of all the muscle mass you'll lose in the year after bariatric surgery (about 10-15 lbs on average), you lose half of that muscle mass in your first two months. That's almost certainly because people aren't getting enough protein at the very beginning because of the liquid diet/small amounts you can eat. Sure, it may be head hunger. But either way, I'd try increasing your protein first. Any time you feel hungry, start with whatever you can tolerate/is currently on your diet plan that contains protein.

I'm four years into my journey and like many here I too experience the same trials and tribulations of bariatric weight loss life. I'm a strong proponent of support groups as I had to form my own (with friends/family0 who have had WLS. It has helped me and I hope them immensely. Just by offering a tip on a method to help really makes all the difference in our success.

Stall and Loridee, out of necessity I had to form my own support group. Are there others that you know who have had the surgery that you can talk with? I found that just by talking and bouncing ideas around we all benefited. I told my surgeon that he should try to set up a way for his patients to exchange emails so we could network. Prior to covid he had two group meetings a month. He tried zoom meetings but they were not effective. So far he hasn't done it. I subscribe to Dr. Becky Gillespie on you tube. She doesn't give bariatric specific weight loss advice. Hers is geared more for us mere mortals and it's usually backed up with the science behind it. I find that fasting for 12 hrs a day helps me control my weight. I don't eat between 7PM - 7 AM. I'm also considering a longer fast but don't want to try until I'm absolutely sure that I can commit. One thing I've found out from not only my experience but with others, if you do not commit to a plan it will never work.

The truth is exercising only contributes to a maximum of 20% of the weight you have to lose. You’d have to walk 6km in an hour or run 8km in 45 mins to burn 360 calories (about two slices of pizza). Of course there’s lots of other benefits to building & maintaining your fitness. Making adjustments to your diet & reducing your calorie intake is the real key coupled with portion sizes to weight loss. If you consume fewer calories then your body needs to function you’ll lose weight. Work at reducing your sugar intake. Stop the candies for a month but avoid sugar rich alternatives. Then drop any cakes or biscuits. Look to fresh fruit for a sweet treat. Make other small changes to your food choices like @lizonaplane suggested. Again you don’t have to change everything at once. Swap out a couple of things at a time & give yourself time to get used to it. You’ll likely find it much easier to make & adopt small changes to your food choices. You may not see changes in the scale straight away but it will happen. Go back to tracking your food - calories & portion sizes. It’s easy to let these slip especially if you’re guessing or not being as vigilant. Check your protein & fluid intake & increase if needed. Did you have a therapist when you had your surgery? Maybe get back in contact with them or ask your bariatric team for a recommendation. The therapist may help you better manage your stress & what may be driving your cravings. You can get back on top of this. Good luck.

I suggest working with a bariatric therapist (see if your surgery center can recommend someone) because the cravings will not go away on their own, and if you had problems with binge eating before, it will hinder your progress, even if you lose weight in the beginning, you will start to regain. Good luck!

Yeah, my weight loss has basically been like yours; really stable at about a lb a month for about a year now. It seems like it's a good idea to make changes slowly and mostly try to make good eating habits we got used to right after surgery into a lifestyle. For me, I sought out bariatric surgery because I was pre-diabetic and had gotten to the point where I was absolutely starving all the time. It made it so hard to stick to a healthy diet over the long term. Taking that ravenous hunger away made it so much easier to make a permanent adjustment to my diet over a long enough time period where it really became habit. But I also was able to add in a bit more carbs daily and eat sugar once or twice a week, and still keep up this slow but steady pace. I enjoy food so much more now that I feel in control!

Personally, I've never had any problem with drinking before meals, even immediately after surgery. But I still find that it's a bad idea to drink much during and right after meals. A few sips is fine, but much more than that, and I'll feel some pain and/or faintness. For about 4-5 months after surgery, I would always feel a bit faint after eating and have to sit and rest a bit before doing much of anything. Now that feeling comes only occasionally, when my stomach has gotten too full. A couple of times that's happened, say, at a holiday meal, where there's a ton of foods and I want to try a bite of lots of things. But usually it happens when I drink too much fluid with/after a meal. When I eat at home, I simply don't serve myself a drink when I eat. But when I go out, they always bring a drink and if I haven't finished it before the meal comes, it's easy to forget and take a few drinks. Studies of gastric emptying show that when you drink water on an empty stomach, it empties from the stomach very quickly. But when you eat a meal, the stomach contents take 2-4 hours to fully leave the stomach. A liquid with a lot of calories (like a protein drink) empties a bit faster than a solid meal, but a liquid meal is closer to a solid meal than water. Even if drinking during/after meals doesn't cause you pain or discomfort, I'd recommend that you still do it. Both patients who have had bariatric surgery and obese patients who have not had surgery are more likely to empty their stomach too quickly (see the linked study). If your stomach empties too quickly, you start to feel hungry again more quickly. Drinking extra water can hurry this along. Doctors suspect that your stomach emptying too fast is actually one of the causes of obesity and/or the reason why some people don't have as much success with bariatric surgery in the long run. This is why different bariatric doctors all suggest not to drink with/after meals (though many differ about drinking before meals.) https://www.researchgate.net/publication/26774242_Scintigraphic_Evaluation_of_Gastric_Emptying_in_Obese_Patients_Submitted_to_Sleeve_Gastrectomy_Compared_to_Normal_Subjects

I am glad that it seems like it is getting better. I did find a paper talking about this kind of thing happening after bariatric surgery, so apparently you are NOT alone : https://pubmed.ncbi.nlm.nih.gov/32558689/ It actually seems like a fairly common problem, which I wish I had realized before I ever had surgery.

I'm four years into my surgery this month and here are the things that I've learned. At the beginning most will feel mixed emotions. Euphoric due to rapid weight loss, concern due to stalls and minor setbacks and trepidation due to looking at how others are doing and you feeling you're not doing enough. The one feeling we all have will be a renewed confidence in ourselves due to the fastest weight reduction you might have ever experienced. We attain our goal weight. We then transition into making wise food and lifestyle choices. No longer are we to eat the things that made us obese and unhealthy such as the three C's, Cookies, Cake and Candy. We will get more exercise. Maybe we park further from the building, maybe we join a gym, maybe we walk, run or work out. We are feeling great and we love our new selves. Next we work on maintaining the weight loss and our healthy lifestyle. One thing happens, we decide since we lost so much weight it couldn't hurt to visit our friends the three C's. If only for a short while and only in small amounts. Hey, why park so far? It's really cold/hot, I'll park closer. You're still feeling confident even if you gained only 10lbs of the 100 you lost. Hey, you're still down 90lbs. No problem, I can lose the 10lbs. I've lost far more than that after surgery. Then we realize, we are no longer weight loss super beings. We are just mere mortals who now have to work hard to lose the weight. Our bodies after time (usually after the one year mark) will not give us that rapid weight loss we once depended on. Here is when your determination and or lack of it will affect you for the rest of your life. We will all get back on a diet or healthier eating plan to lose the weight we gained. The majority will not succeed because it is not as easy it was when we first had surgery. Some will become complacent and throw up their hands and surrender. The weight will come back and the thoughts of a revision will come to our heads. Unfortunately, most insurance companies do not allow for a do over. For a few they will overcome and work on shedding those pounds. They will succeed due to a variety of reasons such as a good support group, using the honeymoon period wisely and really making better lifestyle choices or simply losing one pound at a time instead of trying to lose all of it at one time. Since my surgery four years ago I had five friends and family members undergo the surgery. We ALL gained back some of the weight. Some were able to lose it and regain their healthy lifestyle. Some never were able to lose the weight and went back into the habit of eating for gratification. This is what I did. I originally got down on myself. How did I after three years let myself gain 10 lbs. I vowed to get it off. My 1st week I lost 1/2 a pound. I was devastated, how could this be? The next week I gained a pound. Why? I needed help!! My regular group meetings were cancelled due to covid so I lost valuable support there. I decided to call my family and friends who had the surgery. I spent hours talking to everyone, I told them about my struggles and they told me about theirs. We all came away with a few good ideas of what to do. First don't look to lose the WHOLE amount in one shot. It won't happen and it will derail you from succeeding. Set a goal of 1-2lbs per week. Don't worry that some friends or family might be losing more. We aren't in competition with them. Look at the little things. One friend said she stopped putting Crystal light or Mio in her water. She only drank plain ice water. It seemed to help her jump start her weight loss. Another friend said he started taking the stairs instead of the elevator. He climbs seven flights at least once a day. Another told me her husband who did not have the surgery brought snacks home and that she would eat them. She purged her home of the unhealthy snacks as she did right after her surgery. I started to implement these and other ideas and I have lost 5lbs in five weeks. I'm at the half way point to getting back to my goal weight. We are not super humans we need help and we need encouragement in order to succeed. There are a few on here who have done a tremendous job on their own and they are to be commended and emulated. For me, I need and I will take all the help I can get. Everyday is a struggle to be healthy. I told my surgeon that all this is happening after only four years, how do people succeed at maintaining the weight loss? He said sadly, the majority won't.