Search the Community

A nutritionist/dietitian and a therapist are extremely helpful in a weight loss journey. The nutritionist/dietitian helps set you up with a diet plan and helps get you into better eating habits prior to surgery so it's not such a drastic change once you actually HAVE the surgery. The therapist helps you work through if you have disordered eating (such as binging) or if you're going through some other stuff in your life such as depression, stress, anxiety, etc (which are known to add to weight gain). Weight loss is never easy and one of the most difficult things is finding support in those you live with. You'll be on a special diet and it'll be easier on YOU if those you live with aren't bringing in the things you used to eat which would tempt to cheat on your diet. Try and talk it out with them and stress how important to you it is that they don't bring junk food into the house. Willpower is such a difficult thing. I admit, that if I hadn't developed a wheat allergy after surgery what would have ruined me is the junk food that my family brings into the house. Because of my wheat allergy, I can't eat that food. Nor can I get fast food (of which they eat a LOT). So the wheat allergy is a blessing. A sucky as hell blessing, but a blessing none the less lol (there is only a 3% chance of developing a wheat allergy or Celiac's Disease after your surgery. So chances are you'll be fine. My luck just sucks. Well, maybe not, because I really do consider the allergy a blessing in disguise as it keeps me on track and stops me from cheating as I, quite literally, have to keep track of every little thing I eat and the ingredients in what I put into my mouth).

I am having surgry The 29th of april. I had decided a long time ago not to tell anyone except husband and kids. However that changed sun. Had a family/friend reunion. I told everyone. Part because I am excited, but mostly because I was embarresed of my weight gain so I just wanted them to know I knew what they were thinking and I was doing something about it. Now I regret it.

So I decided weeks ago that 5/1 would be my quit date from tobacco! I completely forgot that one side effect of quitting tobacco is weight gain. So far today, I have been craving food!!! I’m only 2 weeks post op the Orbera. Do you think I’m setting myself up for failure? Maybe I should postpone my quit date do I do not have cravings...any thoughts, comments, or questions are appreciated! FYI...I use snuff.

I just had gastric sleeve surgery on Dec 17, 2015 and I the only ones who know are my husband, our twelve-year-old daughter, my mom and my best friend of 30 years. I went in to surgery weighing 279, and today, twelve days later, weigh 266. Post-surgery is going well. I'm feeling better and still on the bland, mostly liquid/pureed diet, and thankfully, haven't had any real issues with portion control and keeping things down. My husband, daughter and mom are 100% supportive. My best friend's reply to the surgery news, however, was that I was "lucky" to be having weight loss surgery. She's a petite gal, and when we were in college, was a size 4 (me, a size 14). At age 50 now, she's probably a size 10. So, I don't see her as ever having had much of a weight issue that a little diet and exercise can't fix. Me, I went from 135 lbs in college to a whopping 308 lbs before deciding to have surgery. Like many of you, I've struggled since puberty with weight gain and health issues and have battled my way through POCS, infertility, fibroid tumors, gerd, gout, sleep apnea, fibromyalgia, RA, anxiety, etc., and finally sought bariatric surgery for some relief from all of it. At present, I have chosen not to tell my extended family about my surgery. Even though no one on my side of the family has had to deal with obesity, I know they will be supportive because they've always been supportive of me and each other (and, if for nothing else, my four normal size brothers will stop feeling embarrassed about their "fat" sister.) But, I know based on past history, my in-laws and my husband's siblings won't be. Some of them are obese and miserable, so not being overweight anymore will definitely ruffle some feathers with both the skinny and not so skinny ones. Heck, my MIL was jealous that I got a new (used) car for Christmas. (Didn't matter that it's 9 yrs old and we desperately needed a decent second vehicle so my husband can get to work.) She couldn't even be happy about that!!! So, I'm not looking forward to a conversation about anything personal like my weight loss or appearance. Wish me luck new bariatric weight loss friends.... and please let me know how you've handled your friend/family struggles with this topic. I really could use some support and encouragement and specifically what effective responses you gave to others in handling your version of this problem. I know I'm in for a bumpy ride when the weight starts coming off and I can't hide that I had surgery! Thanks

I am on a pump have been for a year and have gained 50 pounds now 4 months into band process hoping to get rid of meds.I didn't know about weight gain before starting pump

Hi all. I am so happy to hear that others have had some weight gain immediately after surgery. I too was surprised to find I gained 6 pounds when I was only consumming about 500 calories each day in the form of clear liquids. I can see the swelling in my tummy so it must be there. I was banded on July 22, 08. I has been a fairly easy process so far. Good luck to all.

Losethemess, I became pregnant exactly one year from my lap-band surg. My husband and I were not exactly trying but feel very blessed at our new addition. I had lost 115 lbs. and still had 70 to lose. I too with my first baby gained a tremendous amount of weight and of course did not lose any of it plus gained an additional 40 on top of that after being diagnosed with Hodgkins Lymphoma in 2007 and had to endure chemo and radiation treatments and was told that the chemo may make me infertile. I did have injections of lupron to shut my ovaries down during that time to hopefully preserve my ovaries. My doctor did give me a weight gain limit of 15 lbs. because I am still overweight and I am glad she did I did not want to gain a whole lot of weight with this one.The Lap-band made it very easy to control myself during my pregnancy and my baby is doing great! Thanks blaze for the congrats. I am on my way to losing the rest of the weight I began to lose almost 2 yrs ago.

I have been required by my insurance to participate in a 3 month supervised weight loss plan prior to submitting a request for weight loss surgery. I weighed in on November 07, 2013 and I have to do my final weigh in on December 19, 2013 prior to my doctor submitting a claim to my insurance, blue cross blue shield federal plan. My question is this, I believe I have gained about 4 pounds since my last weigh in and the whole time I have been on the diet I have lost. I am guessing I did not do as good as I thought throught the holidays. Has anyone ever gained weight in the supervised diet with blue cross blue shield federal and got denied or approved. Any feedback would be greatly appreciated.

At one of the three seminars I attended at the beginning of this process, a nutritionist gave out information on a study that was done on successful weight-loss patients. I thought it was interesting to hear that one of the indicators for being successful is getting enough sleep at night, but she didn’t really explain why. This paragraph is about my sleep, you can skip this and go to the next one to hear about you. I’ve always had a lot of trouble sleeping; takes me a minimum of ½ hour to fall asleep, I have to use a sound machine because I’m such a light sleeper and I wake up during the night several times. Add to that, that I’ve had frequent migraines that usually wake me up in the wee hours of the morning, and I wasn’t getting enough sleep. After having a crippling migraine for three days one week I finally sought help and am now on a medication that has been a miracle for me…and one of the side effects is that you have deeper sleep. I’ve had a few episodes where I’ve woken in the night with the beginnings of a migraine, but then I’ve fallen back to sleep. That NEVER would have happened before. It doesn’t help me to fall asleep, and I wake up groggy, but I’m getting more hours of sleep, which is good. OK, here’s why it’s good. The Today Show featured a story today where Glamour Magazine looked at all the studies that showed a correlation between lack of sleep and weight gain. People who don’t get enough sleep on average eat 200 calories more per day. Glamour got women to change their sleep to at least 7.5 hours per night…and whataya know…they lost weight (they had more energy during the day to do more). When you don’t get enough sleep the body is under stress and craves carbs and fats as an energy source. When you get enough sleep (called sleep hygiene) the leptin (hormone that regulates how hungry you are) in the brain is kept in balance. Leptin goes down with sleep deprivation, which increases your appetite. If you Google ‘sleep deprivation and obesity’ you’ll find an avalanche of recent studies on this issue. The obesity epidemic has gone up at the same rate that average amount of sleep has gone down. So get your zzzz’s!!! Here’s the Today Show segment: http://www.msnbc.msn.com/id/21134540/vp/29098028#29098028

I'm booked... after a billion emails and questions to the office and to many people in this forum and another, I've booked my surgery date - June 22, 2010 - with Dr Armando Joya in Puerto Vallarta, Mexico. I've read through all of Weight Loss Surgery for Dummies (great book, but very gastric bypass-centric point of view) and have been reading pretty much every post that i can get time to go through on here. I think I'm ready. nervous as heck, but ready. lol I know this is the right decision for me, but it's so hard to be confident about it when not all of my family is supportive. I have one brother who is quite vocal about me making the wrong decision and nto really trying. I know he'll be there for me after it's over, but in the meantime, it leads to doubts... things like excess skin, weight gain after sleeving, and if I really have the fortitude to make this work. I assume nervousness and doubts are normal?

We have developed abnormal relationships with food. We eat to cope. We eat when we're bored, happy, sad. Food can be a lover, a friend. The biggest problem with this is that food works really well and really quickly in these situations and we gain weight. If we only ate when we were truly hungry we'd all be thin. We also train ourselves like dogs to be hungry all the time. This is not true hunger. This is phantom hunger. If we eat in the mini-van, in front of the computer or in our chair in front of the TV, what this does is that every time we are in the mini-van, in front of the computer or in our chair in front of the TV, we are HUNGRY. This is not true hunger. This is phantom hunger and we've gotten really good at it. A major help is to only eat at the table so that it is the only thing associated with food. If you go up to a dog and say, "wanna treat?" they will go absolutely bizerk because they associate this with food coming in. There are many terms for phantom hunger - emotional eating, mindless eating, non-hunger eating, etc. This is the hardest thing to solve. The keys are to recognize our triggers and to identify sources of deep-seated psychological pain and address them so the phantom hunger will go away. The best book I've seen on this is called "Shrink Yourself" by Dr. Gould. True hunger is a physiological NEED for food. It is patient. Any food will do. There is no associated guilt or shame. Phantom hunger is a DESIRE for food. It is impatient. There is a specific craving. ("If I don't get chocolate right now I will harm somebody" etc.) It is a reaction to a stimulus. It is associated with guilt or shame. The easy test to see if you suffer from phantom hunger is if you can't stop yourself. Phantom hunger is the most complicated aspect of weight gain and therefore the hardest part of successful weight loss. It comes from many different things in each one of us. We all have this. Skinny people have phantom hunger but they control it. A great example in Dr. Gould's book is an overweight woman whose life's dream was to get paid to sing. Unfortunately, in high school, a boyfriend made fun of her singing and this hurt her deeply emotionally. Every time this psychological pain came up, she ate. She struggled to lose weight. When Dr. Gould identified this and encouraged her to sing again, she finally agreed to sing at a friend's wedding and she received many positive accolades after. This led to a job as a music teacher in an elementary school - she was getting paid to sing. Guess what? She lost weight successfully. She solved the source of deep psychological pain and therefore eliminated the source of phantom hunger. Another example is women who were sexually abused as children. Food treats the pain and obesity is an outer protection against abuse. This is very difficult to deal with alone and typically requires the help of a professional to bring this to the surface, deal with it and treat the source of psychological pain and phantom hunger. You see similar situations in unhappy marriages and basically any source of real stress. The secret in all these things is to deal with the source of pain and also find non-food ways to cope with them. All this is easy to say. This is the most difficult aspect of weight loss. Finding a psychology professional that deals specifically with weight loss can be helpful to tipping the scale in your favor. An interesting test in Dr. Gould's book is to ask yourself who you are jealous of and why. He sees many patients who can't pinpoint their source of psychological pain so he asks them who they are jealous of. This is how he identified the source of pain in his singing patient when she told him she was jealous of a friend who was paid to sing. This is a tiny amount of information on a very complex topic. You can do the nutrition and fitness stuff perfectly and still not lose weight if there are issues in the brain stuff category. Ask yourself if you suffer from phantom hunger and if you have difficulty stopping yourself. Consider working with an expert or reading Dr. Gould's book. Positive self-talk is another important topic in this discipline and I go into detail on this and more on YouTube. Search Watkins Weight Loss Class. I hope this is helpful. Weight loss surgery makes all this stuff much easier but it is still important to be smart in the disciplines of Nutrition, Fitness and Brain Stuff. I wish you all the greatest success in your weight loss journey. Remember the importance of buying yourself a really nice present when you reach your goal. Brad Watkins MD

I don't know what's up with me but I am totally wired. Last night I was fully awake until 9 AM this morning and I fell asleep til about noon. It's 2 AM right now and I'm just not going down, I'm sort of puttering and putting on moisturizer and I can not sleep. I am a pretty terrible insomniac but ever since surgery I've been sleeping at night and waking up in the morning at least. It used to be so bad that I would give up on sleeping at all for a couple days just to make myself tired enough to go down and stay down. I have herbs. Passionflower, hops, valerian, skullcap, etc. I have unisom but diphen causes weight gain doncha know. I have Ambien I can't really take yet ( and I never do because that stuff scares the crap out of me). None of the OTC/herbals really work all that well. I have no Ativan and decided to cool it on that stuff when I ran out last month. ( Actually that is a functional untruth. In reality the doctor at my clinic threw me out the last time I asked for more and threatened me with a drug panel) I'm still in the healing phase and I know I need to rest. I'm not doing it though. Are ya'll sleeping and if not what are you doing for it?

I've been having lots of issues with my weight loss the last two weeks....I've been using dailyplate, exercising, and limiting my carbs. I was only eating between 500 and 700 calories, realized was probably in starvation mode so I upped my calories to 1000-1100, started my period, had a 7 pound Water weight gain and now I've been drinking water like crazy trying to get rid of the extra weight fast. Well my period is over and so I decided to weigh myself last night. Before my period I was at -24...then I stepped on the scale...-31.5...I ran into the living room and excitedly told my dh. Then I thought...I will weigh myself again before putting my jammies on...I will probably weigh a pound less......... I pulled out the scale an stepped on it...My scale had lied...my digital scale that has NEVER read wrong...had....I was up 7 pounds still. How could this be?? I cried and cried...I thought everything was going well since my fill except for the low calories, which I had just changed days ago. Was my water weigh going to go away... I just don't understand! I certainly ton't want to go down to my second fill appointment with a weight gain on the 1st. So now I'm just disgusted and second guessing myself. The scale thing...I may have had it off center of where I usually have it, but I weighed myself twice and our home is only 5 years old so it would not be because the floor is uneven... Should I up my water intake again? Take water pills? Exercise moring and night? I'm just disgusted. I make great food choices and have been right on track with healtheir foods and such. This water weight gain is really bringing me down again. This is my second period since surgery and I lost the other water weight relatively fast after my period. I really need to get out of this Funk I'm in.... Any ideas.... I'll have my 2 month bandiversary on Friday!

It depends. Are you going to let the numbers on the scale dictate how the rest of your day goes? Are you going to be able to deal with stalls and even weight gain if you weigh daily? If you think that's not going to bother you, by all means weigh daily. If it is a problem for you, stay off the scale and weigh weekly, bi monthly or even monthly if you feel that will work best for you. I weigh once a week, Monday morning no fail. Even weekly still can be annoying when you're in a longer stall

Hi all!!! I was sleeved on 6/10 and recently began ursodiol 300mg twice a day. Although I shouldn't since I'm still in the early stages and fluctuating, I weigh myself usually everyday...my first weigh in after the medication I fluctuated 3lbs up..did anyone else notice if their gallbladder meds changed their weight or slowed the progress of their weight loss? A few people have expressed bloating and weight gain while others have said it helps to aid in weight loss as your gallbladder can breakdown cholesterol etc. perhaps my weight is attributed to the fact that I had about 680 cals compared to my average of 400-500. Thanks all!!! -Mike

I am scheduled for surgery on 10-21 and now weigh 219 and am 5"9 I get it all the time but I have a bad history of weight gain and loss and would like to be at 150 or 160 and just stay. I am hoping my band will help me MAINTAIN!

Well, as the title says I'm about 21 months out and now starting to gain. I got down to 143 (my goal was 130, but I was comfortable in the 140s). I'm now back up to 155. Over the past year, I've also developed a bruising issue and have multiple bruises on my arms and legs, mostly on the left side; random but moderate/severe aches & pains; brain fog; severe fatigue, and other idiopathic symptoms. I have a physical scheduled for mid-June, but I'm wondering if any of these things are common after surgery. As for my weight gain, nothing has really changed. I still eat very clean, limit myself to two low-sugar/low-calorie alcoholic beverages a week, and really try to take care of myself. With the aches, pains & fatigue, I'm finding it difficult to keep up with working out, but to be honest, I probably wasn't working out as much as I should be anyway. Mostly walking & biking. I'm also at the age where hormones are likely changing (I'll be 50 in two months). Any idea what might be going on or how to restart the weight loss? Thanks.

Hey West Houston folks. I was banded 8-2-06 by Dr. Spivak who was wonderful. I am 65 pounds down with about 20 to go and I feel fantastic. Went from a sendentary lifestyle to exercising 3-5 times per week. Little to no hunger pains, little weight gain and easy to lose. Go for it!

Here is an academic overview of the various bariatric procedures with a bit of excess 'science stuff' thrown in. No opinion. No bias. Published 2012 by the UK Royal College of Physicians. If anyone requires further clarification to the sources contained (hopefully its been copied successfully), please see the reference list at the end. This will provide you (licensing permitting) with a link to those original source documents so you can do your own further research/analysis. Any questions or queries, please do not hesitate to ask. Revs x Overview of bariatric surgery for the physician Keng Ngee Hng, Specialty registrar in gastroenterology1⇓ and Yeng S Ang, Consultant gastroenterologist and honorary lecturer2 + Author Affiliations 1Salford Royal NHS Foundation Trust 2Faculty of Medicine, University of Manchester, Oxford Road, Manchester Address for correspondence: Dr KN Hng, 4 Fern Close, Shevington, Wigan WN6 8BL. Email:keng_ngee@hotmail.com Abstract The worldwide pandemic of obesity carries alarming health and socioeconomic implications. Bariatric surgery is currently the only effective treatment for severe obesity. It is safe, with mortality comparable to that of cholecystectomy, and effective in producing substantial and sustainable weight loss, along with high rates of resolution of associated comorbidities, including type 2 diabetes. For this reason, indications for bariatric surgery are being widened. In addition to volume restriction and malabsorption, bariatric surgery brings about neurohormonal changes that affect satiety and glucose homeostasis. Increased understanding of these mechanisms will help realise therapeutic benefits by pharmacological means. Bariatric surgery improves long-term mortality but can cause long-term nutritional deficiencies. The safety of pregnancy after bariatric surgery is still being elucidated. Introduction Obesity is a worldwide pandemic,1–4 with the number of obese children and adolescents increasing alarmingly.5 This has serious health and socioeconomic implications due to the attendant increase in related comorbidities.1,2,4,6 Obesity causes type 2 diabetes, hypertension, dyslipidaemia, cardiovascular disease, obstructive sleep apnoea, obesity hypoventilation syndrome, cancer, steatohepatitis, gastro-oesophageal reflux, gallstones, pseudotumour cerebri, osteoarthritis, infertility and urinary incontinence.1–6 Severe obesity reduces life expectancy by 5–20 years.1 Diet, exercise and drug treatments for severe obesity have been disappointing.1–3,5–12 At the present time, bariatric surgery is the only treatment that reliably produces substantial and sustainable weight loss.1–7,9,13 It is indicated in people with BMI >40 kg/m2 or with BMI >35 kg/m2 in the presence of significant comorbidity.3,5,7,14 Bariatric surgery is cost effective,3,6,15 achieving weight loss, as well as improvement or resolution of associated comorbidities.1,2,5,6,9,15,16 In the past decade, the development of centres of excellence,5,6laparoscopic techniques,2,5,6 improved safety profiles2,6,9 and better documentation of clinical effectiveness2,6,15 have fuelled an increase in the number of procedures performed. Types of surgery Bariatric surgical procedures are traditionally classified as restrictive, malabsorptive or combined according to their mechanism of action. The procedures most commonly performed are laparoscopic adjustable gastric banding and roux-en-y gastric bypass.3,13 Sleeve gastrectomy is increasingly performed.2,6,7 Biliopancreatic diversion and biliopancreatic diversion with duodenal switch are much more complex and performed infrequently.2,5,17,22 Other historical procedures are no longer in common use. In addition to restriction and malabsorption, recent evidence suggests that neurohormonal changes are an important effect of bariatric surgery.2,6,7,17,18 Bariatric surgery is only part of the management of severe obesity. Careful patient selection and preparation are extremely important, as are long-term compliance with diet, nutritional supplementation and follow up.2,5,6,19 Laparoscopic adjustable gastric banding2 A purely restrictive procedure, laparoscopic adjustable gastric banding (LABG) is the least invasive procedure, is completely reversible and has the lowest mortality.19 A silicone inflatable band is placed around the stomach cardia immediately below the gastrooesophageal junction (Fig 1). This is connected to a subcutaneous port that is used for band adjustment.5,6 The band compresses the cardia to generate a sense of satiety and reduced appetite, which is thought to be mediated via vagal afferents.2 Roux-en-Y gastric bypass (RYGB) is a combined procedure that is also performed laparoscopically. A 20–30-ml gastric pouch connected to the jejunum forms the Roux limb (Fig 2). The disconnected duodenal limb is anastomosed 75–150 cm along the Roux limb, forming a Y configuration. The distal stomach, duodenum and part of the proximal jejunum are thus bypassed.5–7,20 Despite the traditional classification of the this procedure, malabsorption is not significant with the standard RYGB surgery.7 In an extended gastric bypass, the Roux limb is lengthened to increase the malabsorptive component.6,20 In sleeve gastrectomy, 60–80% of the stomach is removed along the greater curvature to leave a restricting ‘sleeve’ of stomach along the lesser curve (Fig 3).5,20,21 Originally the first step of the biliopancreatic diversion with duodenal switch (see below), sleeve gastrectomy has evolved into a staging procedure for super obese or high-risk patients.2,5–7,20 It is also increasingly used as a standalone procedure.2,6,7 Biliopancreatic diversion (BPD) and biliopancreatic diversion with duodenal switch (BPD/DS) are malabsorptive operations that result in bypass of most of the small intestine. With BPD/DS, a sleeve gastrectomy is performed, leaving the pylorus intact. The duodenum is then disconnected and the stomach anastomosed to the distal small bowel (the ‘duodenal switch’), creating a short alimentary limb. The long biliopancreatic limb is then anastomosed to the ileum 75–100 cm proximal to the ileocaecal valve, so digestion and absorption occurs only in the short common channel.5,6,20 With BPD, a partial gastrectomy leaves a 400 ml gastric pouch and the common channel is shortened to just 50 cm.5 Safety profile and complications Bariatric surgery is safe.2,5,6,9,22–24 High-volume centres of excellence deliver bariatric surgery with inhospital mortality of 0.14% and 90-day mortality of 0.35%, which is comparable to that for cholecystectomy.6 Acute complications, including haemorrhage, obstruction, anastomotic leak, wound infection, cardiac arrhythmias, pulmonary emboli, respiratory failure and rhabdomyolysis, occur in 5–10% of patients.5,6,9,10,25 Long-term complications include internal hernias, anastomotic stenoses, marginal ulceration, fistulae, diarrhoea, dumping syndrome, gallstones, emotional disorders and nutritional deficiencies.5,6,13,15,20,25–27 Patients with LAGB can experience port problems, stomal obstruction, band slippage/erosion, pouch dilation, gastro-oesophageal reflux and oesophageal dilation.5,13,19,25 Malnutrition is a concern with BPD with or without DS.1,17 Long-term risks for sleeve gastrectomy are unknown.5 The Longitudinal Assessment of Bariatric Surgery22 reported overall 30-day mortality of 0.3% for 4,610 patients having LAGB or RYGB for the first time, with 4.3% of patients having a major adverse outcome within 30 days. This was most frequent among patients having open RYGB (7.8%). A meta-analysis involving 85,048 patients reported a total 30-day mortality of 0.28% and a two-year mortality of a further 0.35%.24 The most complex malabsorptive procedures had the highest perioperative mortality at 1.11%. Mortality for gastric banding is between one in 2,000 and one in 5,700.2 Effects on weight, comorbidities and long-term mortality After RYGB, patients lose 60–70% of their excess weight over two years, and this is largely durable.1,2,6,9,15,16,28 Weight loss is dependent on long-term compliance with dietary recommendations.2,5,6 Sugary, energy-dense foods and drinks can ‘bypass the bypass’. After gastric banding, patients lose about 50% (range 39%–59%) of their excess weight at a slower rate, often continuing into the fifth year.1,2,5,6,9,19 Regular band adjustment is necessary.16 The Swedish Obese Subjects (SOS) study reported a reoperation or conversion rate of 31% for gastric banding and 17% for gastric bypass among patients followed for ≥10 years, excluding operations for postoperative complications.16 However, at the centre in Melbourne, only about 10% of patients after LAGB need some revisional procedure, including band replacement, in the following 10 years.2 Biliopancreatic diversion with or without DS produces excess weight loss of 70.1%9sleeve gastrectomy produces initial excess weight loss of 55%, but this may not be durable.2 Bariatric surgery also produces significant improvement in obesity-related comorbidities, with the most remarkable effect being resolution of type 2 diabetes (T2DM). A meta-analysis encompassing 22,094 patients reported complete remission of T2DM in 76.8% of patients,9 and a registry from the UK with data on 8,710 patients reported resolution of T2DM in 85.5% of patients.29 Major improvement often occurs within days after RYGB, before significant weight loss is achieved.5–7,17,18 After LAGB, improvement in T2DM occurs more slowly as a result of weight loss.2,7,19 Combined or malabsorptive procedures produce greater improvement than purely restrictive procedures.1,2,5,9,18 Diabetes less than three years in duration, no insulin requirement, milder obesity with BMI <40 kg/m2 and weight loss ≥10% predict complete resolution of T2DM.18,19 Bariatric surgery is now advocated by some for the treatment of T2DM in patients with BMI <35 kg/m2.4,7,30,31 Bariatic surgery effectively treats all other associated comorbidities: from steatohepatitis and pseudotumour cerebri to urinary incontinence.1–3,5,6,15 Meta-analysis showed that hyperlipidaemia improved in ≥70% of patients, hypertension resolved in 61.7% (and resolved or improved in 78.5%) and obstructive sleep apnoea resolved in 83.6%.9 At five years, the risk of cardiovascular disease had decreased by 72%.3 The incidence of cancer also reduced markedly,6,15,16 as did the risk of developing new comorbid conditions.15 Long-term efficacy is well documented.5,6,28 At follow up after 10 years, the Swedish Obese Subjects (SOS) study showed a 29% reduction in adjusted all-cause mortality, primarily because of decreases in cancer and myocardial infarction.16A retrospective cohort study of 7,925 patients after RYGB reported a 40% reduction in all-cause mortality during mean follow up of 7.1 years.23 Specific mortality decreased by 56% for coronary artery disease, by 92% for diabetes and by 60% for cancer. A large observational study, in which the vast majority of patients had undergone RYGB, reported an 89% risk reduction in five-year mortality.15 Energy homeostasis and hormonal changes Weight loss after bariatric surgery is not explained by volume restriction and malabsorption alone.17 Indeed malabsorption is estimated to account for only 5% of the weight loss following standard RYGB.17 Bariatric surgery causes significant changes in the neurohormonal profile, which contributes to sustained weight loss through changes in appetite, satiety, food preferences and eating patterns and explains the remarkable effect on T2DM.2,5–7,17,18 The hypothalamus32 Hormonal signals provide information about energy status to the hypothalamus. Adipokines are secreted by adipose tissue and enterokines by the gut. Incretins are enterokines that stimulate release of insulin after food intake.18 Two hypothalamic circuits influence food intake, and both contribute to acquisition and storage of nutrient energy. The homeostatic circuit increases appetite and locomotion in response to energy shortage. The hedonic circuit is engaged at stable weight plateaus in association with increases in body fat. It heightens finickiness to taste of food. Obese animals overeat palatable food but undereat bland foods and lose weight. In our current obesogenic environment, the hedonic circuit facilitates the seeking of energy-dense foods uncoupled from energy status. Enterokines Ghrelin,33 which is mostly synthesised in the stomach, is a potent appetite stimulator involved in hunger and meal initiation. Circulating levels are inversely proportional to BMI and respond to changes in body weight. Ghrelin enhances gut motility and speeds gastric emptying.17 It promotes lipid accumulation and weight gain, favouring glucose utilisation. It also inhibits insulin secretion and impairs glucose tolerance.18 Levels of ghrelin reported after bariatric surgery have been variable, which may be due to differences in surgical techniques and research methods.7,18Overall, the trend is for a decrease in ghrelin levels after RYGB and an increase after gastric banding.7,17 Sleeve gastrectomy, which removes most of the ghrelin-producing stomach, reduces levels of ghrelin. Peptide YY (PYY)34 is secreted postprandially by L cells in the pancreas, small intestine and colon. It suppresses appetite and promotes satiety via signalling actions in the brain. It also delays gastric emptying (the ileal brake) and enhances insulin sensitivity.7 Secretion of PYY generally corresponds to the energy ingested, although it may vary depending on the macronutrient content.17Interestingly, levels also correlate positively with exercise intensity, with resulting decreases in food intake. Glucagon-like peptide 1 (GLP-1) is co-secreted postprandially with PYY in the distal intestine.17 A powerful incretin, GLP-1 potentiates glucose-stimulated insulin secretion, enhances β-cell growth and survival, inhibits glucagon release and enhances all steps of insulin biosynthesis.7,17 It also slows gastric emptying to produce greater gastric distension and helps regulate appetite and body weight.7,17 Obese individuals have lower levels of PYY and GLP-1, and levels are decreased further in patients with diabetes.5,17,18 Two hypotheses exist to explain the hormonal and metabolic effects of the RYGB: the hindgut hypothesis the foregut exclusion theory. The hindgut hypothesis postulates that after RYGB and malabsorptive procedures, rapid nutrient delivery to the distal gut L cells and their increased exposure to incompletely digested nutrients lead to an early and exaggerated PYY and GLP-1 response, contributing to early satiety, reduced meal size and early resolution of T2DM.7,17,18 Ileal transposition studies provide strong evidence for this. Interposition of an ileal segment into the proximal gut in rodents produced exaggerated PYY, GLP-1 and enteroglucagon responses, reduced food intake, weight loss, improved insulin sensitivity and overall improved glucose homeostasis.7 The foregut exclusion theory proposes that exclusion of the duodenum and proximal jejunum after RYGB is the mechanism that mediates the effects of bariatric surgery.7,18 However, duodenal–jejunal bypass experiments in rats supporting this theory are compounded by the accompanying pyloric disruption that results in accelerated gastric emptying and rapid nutrient delivery to the hindgut.7 The endoluminal duodenal–jejunal sleeve also accelerates gastric emptying by abolishing duodenal osmoreceptor control of pyloric contraction.7 This 60 cm-long sleeve prevents nutrient contact with the duodenum and proximal jejunum, while biliary and pancreatic secretions flow outside the sleeve, delaying digestion.35 A possible mediator of the foregut exclusion theory is the gastric inhibitory polypeptide or glucose-dependent insulinotropic polypeptide (GIP), which is secreted by K cells in the duodenum in response to nutrient absorption.18,39,40 In addition to its incretin action, GIP promotes lipogenesis,41 with GIP receptor knockout mice protected against diet-induced obesity and insulin resistance,39 while antagonism of the GIP receptor improves glucose tolerance and insulin sensitivity and partially corrects pancreatic islet hypertrophy and β-cell hyperplasia.40 Levels of GIP are suppressed after malabsorptive procedures.18,41 Adipokines Adiponectin17,36,37 is synthesised primarily in adipose tissue, with levels inversely correlated with BMI. It is an important insulin sensitiser, and hypoadiponectinaemia causes insulin resistance and T2DM. Adiponectin also possesses antiatherogenic, anti-inflammatory and cardioprotective properties and may act centrally to modulate food intake and energy expenditure. Weight loss following bariatic surgery increases levels of adiponectin. Leptin38,32 is secreted by adipose tissue and regulates body weight via its action on the hypothalamus. It increases nocturnally to stimulate lipolysis but also increases postprandially to induce anorexia. In addition, leptin plays an important role in glucose homeostasis. Levels of leptin are proportional to body fat, with starvation or energy shortage activating the homeostatic mechanism in the hypothalamus to restore energy balance. However, leptin resistance develops in obesity. Weight loss from bariatic surgery reduces leptin levels.17 Many other enterokines and adipokines exist, some of which may also play a part in producing and sustaining weight loss or diabetes remission after bariatric surgery.17,18 Understanding the mechanisms of action of bariatric surgery will help realise therapeutic benefits by pharmacological means.6,7,19 Nutritional deficiencies Nutritional deficiency is common after bariatric surgery and the risk increases from LAGB through SG and RYGB to BPD with or without DS.20,26,31 The problem is heightened by the fact that micronutrient deficiencies are already highly prevalent in obese patients before surgery.21 After surgery, patients are at particular risk of deficiencies in Vitamins B1, B12, C, A and D and folic acid, as well as Iron, Calcium and Protein.20,26 Lifelong prophylactic supplementation is often necessary, and regular monitoring is essential.26 Investigation of clinical syndromes resulting from malnutrition can be challenging. Anaemia20,27 After bariatric surgery, patients are prone to iron deficiency because of intestinal bypass, pouch hypoacidity and intolerance of red meat. Obesity creates a state of chronic inflammation that can contribute to anaemia. Anaemia can also be caused by deficiencies in folate, Vitamin B12, vitamin E (haemolytic anaemia), copper (anaemia and neutropenia), Vitamin A and zinc. In refractory anaemia, gastrointestinal blood loss must be considered. Bleeding in the excluded stomach, duodenum or biliopancreatic limb is problematic as the usual endoscopic access route is no longer available. Neurological problems6,20 Neurological symptoms can result from deficiencies in thiamine, vitamin B12, niacin, vitamin E and copper or from hypocalcaemia secondary to Vitamin D deficiency. Clinical syndromes includes Wernicke's encephalopathy, peripheral neuropathy, dry beriberi, neuropsychiatric beriberi, pellagra, ataxia, spasticity, myelopathy, muscle weakness, posterior column signs and ptosis. Oedema6,20 Patients with oedema may have underlying heart failure, which can also be due to wet beriberi (thiamine deficiency) or selenium deficiency. Hypoalbuminaemia may be caused by liver cirrhosis secondary to steatohepatitis; severe protein/calorie malnutrition; kwashiorkor; and diarrhoea secondary to bacterial overgrowth, malabsorption of bile salts and niacin deficiency. Eye, skin and hair problems20 Vitamin A deficiency causes difficulties with nocturnal vision and reduced visual acuity. Vitamin E deficiency can cause retinopathy. Thiamine deficiency can present with blurred or double vision. Dry skin, pruritus and rash can be caused by deficiencies in vitamin A, niacin, riboflavin, zinc and essential fatty acids. Hair changes can be due to zinc deficiency or protein malnutrition. Pregnancy after bariatric surgery About half of patients undergoing bariatric surgery are women of childbearing age,8 which introduces specific concerns. Obesity is strongly associated with infertility8 and increases the risk of obstetric complications.8 Yet the effects of rapid weight loss and potential malnutrition in pregnant patients are of concern. Bariatric surgery improves fertility42,43 and reduces the incidence of obesity-related complications such as gestational hypertension, gestational diabetes, pre-eclampsia and foetal macrosomia when compared with obese controls. The effect on premature delivery, miscarriage, intrauterine growth retardation, low birth weight and neural tube defects and the need for caesarean section are unclear.8,43 Maternal surgical weight loss reduces the prevalence of obesity and cardiometabolic risk factors in offspring until the adolescent years.42 Pregnancy seems to have little effect on the surgically induced weight loss.8 Patients are generally advised to delay pregnancy until after the period of maximal weight loss (12–18 months).8 Extra vigilance in preconception, antenatal and obstetric care is required. Conclusion In summary, bariatric surgery is a safe and effective treatment for severe obesity and its associated comorbidities. It is particularly effective in the treatment of T2DM. Neurohormonal changes that affect appetite, satiety, glucose homeostasis and long-term energy balance contribute to its long-term efficacy. Two hypotheses exist to explain how hormonal changes produce these effects, and both may contribute. Patient adherence to postsurgical aspects of management is very important. Pregnancy after bariatric surgery brings additional considerations. Finally, the indications for bariatric surgery are being widened. Acknowledgements Dr Keng Ngee Hng is a specialty registrar in gastroenterology and has previously submitted part of this work for her Master of Science in gastroenterology (Salford University). Dr Yeng S Ang is the educational supervisor for Dr Hng and has refined the ideas, concepts and layout of the previous work. Recent updates are also included within this paper. © 2012 Royal College of Physicians

Hi Jacksbanster, I was banded back in 2004 and weight loss was great. I went from 322 pounds to 140 pounds. In 2010 my band seem to stop working and i started to gain weight (plus I stopped following the bandster rules) but that is because again I didn't feel I had the control the band gave me originally. Anyway, after gaining 60 pounds I was fed up and decided to investigate if others where experiencing the same thing with the band and if there were other options out there for me to look into. So I did a lot of reading and research and found out about the plication surgery. So I met with my Lap Band doctor and he told me more about this new investigational surgery called Plication. Fast forward, I had the surgery Dec 8th 2011. The surgery was a success, recovery was a breeze, the liquid diet was hard, but I got through it. My first post op visit I had lost 8 pounds. Then I got walking pneumonia and had to go on prednisone - this made me ravenously hungry and of course I regained all the weight I had lost back. I was so disappointed and frustrated that I wanted to die. But my doctor told me that prednisone is know for weight gain and I'll get back on track soon. So fast forward, my next appointment with him I had only lost 4 pounds which did not make me happy because before I had lost 8 and now I was starting all over and at a slower pace. It is now Feb 16th 2012 and I've not gotten on the scale because I don't feel like I've lost any weight. All my clothing fits the same and I just don't see any change and I've not weighed myself since my last fill. I've had two fills since my plication surgery and I'm still hungry (more than) I thought I would be with the band and the plication. This is a different experience than when I had the lap band surgery, the lap band surgery had the weight come off very quickly. I didn't even have to think about dieting I just wasn't hungry. With this surgery (albeit it is a revision of the previous band, new band with more capacity, and the plication) I'm not as pleased as I had expected. With all that said I think my expectations need to be adjusted. I wonder if people who have had the band and have had some type of complication with it (slippage, erosion, etc) it the pouch that is above the stomach is premanently stretched out of shape. I don't have the answer I just know that the experience is not the same. I'm having to really monitor what I eat and exercise everyday. So I eat around 900 to 1000 calories a day, and I exercise on the stairmaster for an hour/ or I go for a jog. I know that I need to incorporate some weight training but I'll just have to get to it when I can. As for your questions above: How was your recovery? Recovery was great. The first couple of days there was a little pain but after that it was a breeze. How soon did you go back to work? Surgery was on a Thursday I went back to work on the following Wednesday. Do you follow a low carb diet? I followed the liquid diet they put me on for about 4 weeks. Since then I've tried everything - right now I'm basically eatting lean cuisines or smart ones. But I think I'm going to try a one week Medi fast - we will see. Right now I'm so hungry between meals I doubt if I can pull that one off. Have you had to have any fills in your band? Yes I've had 2 fills since my surgery and they don't seem to have made that much of a difference. The doctors, are being cautious because they don't want me to get too tight and have another band slippage.. I understand that but in the meantime I wish I had more restriction. How is your hunger level? Higher than I thought it would be. But if I try to stay on an eat every 4 to 5 hour schedule I do okay. How much can you eat before you feel "full" If I allowed myself I could eat a lot. The think is I count every calorie that goes into my mouth. I use www.fatsecret.com they have an incredible food database - almost everything you can put into your mouth in in their database, So that helps. I hope that my story has helped you and I will keep you informed on my progress - I hope that you will do the same. Regards, Willowsdoweep

Thank you both. I spoke to a relative regarding the bruising - he's a retired oncologist and hematologist. He thinks it's likely a vitamin K deficiency, but also suggested bloodwork, which I fully intend to request during my physical. He also asked if I take Ibuprofen on a regular basis (which I do due to the aches & pains) and he said that could cause it as well. Hoping that's all it is. As for the brain fog, memory loss, and mood swings, I totally agree that it could be hormones. My biggest concern though is the weight gain. I've worked so hard to get where I am...I got on the scale this morning and I'm up another .5#. I just want to cry.

AL- I am already feeling some hesitation in responding to your comment, but I feel that there should be some clarification on a few things. So obviously if we are waiting for approval then we have seen our surgeons, done psych evals, etc. Those seem to be the most basic requirements for everyone that I have spoken with. With that said, we (or at least I) know that the lap band is not a magic wand that waves the fat away. Honestly, if it was I wouldn't have thought about and researched it for over 2 years before making a decision. Secondly, I feel like there will always be cravings and head hunger and all the triggers that caused the weight gain everyday. But you know what I have really found from all of the people on here is that the lap band is a tool to help you so that you are not running into battle without a weapon. While the throwing up and being uncomfortable may not seem to be a good reason for you to avoid cravings, it is for me. When I do have unbearable cravings I will vent here, just like we are now. Thank you for your input and response, but I guess I didn't appreciate the negativity you brought with it.

Hello to all, I am a 57yr. old Mom of 5 children and live in Upstate NY. I am in the very beginning stages of my lap band journey. I have been to the info. seminare and nutrition consult. My PCP has recommended the band to me, as I have been struggling for quite some time with weight gain problems. I weigh 227 and am 5'3. I found this site and am hoping to get some input from others who may be about my age and how the band has worked for them. Needless to say, I am scared! BUT, I still have 3 children at home and my youngest is 12yr's old. Many of my family members are not supportive of the band and my husband is "on the fence" but supportive about what ever will help me get healthy. So, questions~~~~~ What is life like after the band? Is it difficult to adjust to foods? Does it really have a high percentage of slippage? and I guess the big question is ~~~~ If you had the chance to choose again, would you opt for the weight watchers plan or have the band? I am just trying to get started on my journey. I hope I hear from some of you folk's I have not met anyone that has had the band!! Thanks so much!! ( I'm going to have to figure out how to navigate this site, I am not too cyber space oriented)

Congratulations for making your decision on changing you life in a healthy manner. I'm also sorry you have those who are not supportive of your decision. I read it and hear it alot from those on this website and people I personally know who have had the lapband. All I can say is chalk it up to ignorance, jealousy, fear & care for us, and who knows what else. Hopefully you've researched your surgeon and staff and have found the right mix for you. You will also learn so much here on LBT. I'm sorry I found this after my surgery but better late then never. I'm still learning from everyone on here on a daily basis. My husband & I had the surgery earlier this year and we've had nothing but support from loved ones, co-workers, clients, etc. And if someone thinks differently about our choice of "taking the easy way out", that's their opinion as they're entitled to it. I'm 57 and at the stage of my life that I can't worry what people think about me. I still have a good 25 lbs to lose and feel so much energy and confidence then I have in the past years of putting on a good 60+ lbs and not being able to walk up or down the stairs without holding on to the railing, enjoying gardening, and just getting out of my car to food shop was a problem with my knees and back. At this point I can do it all and then some! Have there been compromises along the way, absolutely. Like any other addiction, I'm learning to change people {moi} places and things that caused my weight gain. In the beginning it was an everyday challenge and right up there in my conscious mind, As time goes on, with the help of the lapband being a tool, it's helped us to be just a part of our everyday life and reminding us to make better choices. So far so good. I wish you the best on your journey. Hopefully, as time goes on, your loved ones will see you made the right choice and change their minds. If you need support, we're all here for you on LBT 24-7.

Pam, you've discovered the one thing that makes being banded so different from anything and everything we've tried in the past. So many people considering banding want to know why this might work where everything else has failed. Well--this is it! It works because it doesn't go away!! Of course we have to change our habits, and of course it can be hard sometimes. But this little band of silicone is our tool to help us stay on course, or get back on course when necessary. I've done what you describe several times. Changing our lives to the extent necessary to put morbid obesity behind us forever is not something that can be done overnight. Our bodies and minds NEED to take "breaks" once in a while, think about something else for a few days/weeks/months, get used to the new reality and internalize it completely. If we continually think we're on a "program" then occasional lapses in vigilance only lead to a sense of failure. I've worked hard to just BE smaller, eat less and more healthfully, and not treat my banded life as being one of constant dieting. The band is there when we're ready to refocus. Lapses don't lead to weight gain and disappointment and failure anymore!! :)