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I personally would be concerned but it's also a really serious issue to be very overweight. I was concerned and I know I was not the largest person my surgeon had operated on. I was just nervous for the surgery. You might consider getting a second opinion or seeing if there's a surgeon who specializes in larger patients, but there might not be someone in your area. The other thing I would suggest is to lose as much weight as possible before the surgery because that is the best way to put yourself in good shape for the surgery. Whatever you decide, please keep us posted. I'm rooting for you!!

I'm on Week 3 post-op. I lost 9 kg the first two weeks, then gained about 2 kg this week. I was feeling frustrated but the comments here were really helpful. Let's hang in there and wait it out...

it's a more powerful surgery than the VSG or RNY. You're likely to take more weight off, and it's likely going to be easier to maintain your loss long term (although you'll certainly find people who've had VSG or RNY who've taken off all their excess weight and managed to maintain it). But your odds are better with the DS. My insurance doesn't cover DS, just RNY and VSG, otherwise I would have considered it given my starting weight. Although I ended up losing all my weight with my RNY anyway, so I'm good. DS does come with more potential complications than either the VSG or the RNY, so there's a trade off. But as with the other two, you'll find a lot of people who've never had complications at all with it. If you have a history of GERD, I'd still go with the RNY, since DS has a sleeved stomach (in fact, the VSG used to be phase 1 of the traditional DS surgery, back when it was often done in two phases. A lot of people ended up losing a substantial part of weight with just the sleeved stomach and really didn't need phase 2 - the intestinal part. So eventually VSG ended up being offered as a standalone surgery). So you still have the potential of worsened GERD (or new-to-you GERD) if you go with a DS, but then 70% of VSG/DS people don't develop GERD issues at all, so there's that... tough decisions. I'm still very happy with my RNY - but I would have at least considered DS if my insurance covered it.

should i be concerned that my doctor told me i will be her biggest patient have a perform weight loss surgery on

@Arabesque I have the same question about why am I still on pureeds! I am STARVING all the time! Even my surgeon's diet guide says soft foods start approximately 5 weeks after surgery. The surgeon scolded me on Facebook and said at 7 weeks out I should only be eating 3 tbsps of pureed food. I think the plan has changed or something happened to make the surgeon change the method, but the diet guide was never updated. It could be so that people lose more weight more quickly. I ditched the support group, it's not a requirement. I have started testing the water with soft foods. I've been doing some tough workouts in the mornings, and I feel like I need an egg every now and then, lol (soft boiled or poached of course!). Thank you to everyone who responded! I feel less like a failure hearing from all of you! And I really appreciate all the thoughtful input. Sent from my SM-N976V using BariatricPal mobile app

I haven’t touched a protein shake since my two weeks of post surgical liquids finished. I lost all my weight plus more, met all my protein goals & got all the nutrition I needed through the food I ate, even stopped vitamins just after I reached goal. My plan was always to get the nutrition I needed through what I ate not through supplements. I’m a question asker too. Plus I do a lot of my own research - love me some googling. I think your questions were very sensible. Can’t say the same for the responses from what you said though. Sheesh!! Do you have to be your surgeon’s support group? And why does he have you still on purées? That seems to be taking it too far at 7 weeks unless there are other health considerations at play of course. Though I’m a stick to your plan person, I think you could slowly start to add real food sources of protein & other nutrients to your diet. Maybe don't jump to a steak tomorrow but move to soft food for a week or so. Check with your nutritionalist, make sensible nutrient dense healthy food choices & then tell your surgeon when you see them. You’re doing well with your loss so far. Congratulations.

The most compelling reason for the DS, particularly the "classic" or "traditional" BPD/DS (as distinct from the SIPS/SADI/Loop DS, which is a different procedure with its own, albeit similar tradeoffs,) is much better regain resistance than the other mainstream procedures like the RNY or VSG. It's hard to say where the SIPS fits into that spectrum as it is still a relatively new procedure, but I would expect it to be somewhere between the RNY and BPD/DS. The RNY is a mildly or minimally malabsorptive procedure; the caloric malabsorption dissipates after a year or two as the body adjusts to it so metabolically it winds up being similar to the VSG long term, This is why some doctors will classify the RNY as essentially only a restrictive procedure. However, the nutritional malabsorption is a long term thing that you need to accommodate. The DS malabsorption is a long term feature, so it continues working to help you maintain your weight over the long haul. With the RNY, as with the VSG, that is much more up to you. It is much more common for people with the RNY or VSG to have substantial regain problems than it is with the BPD/DS. I went with the basic VSG as I had lost around a third of my excess weight with diet and lifestyle changes (that we should all do anyway....) I went through when my wife had her BPD/DS and kept that off for several years before deciding to go with the VSG (which wasn't commonly done before) to complete the job - I didn't feel that I needed the extra power of the DS to maintain the loss longer term, and wasn't comfortable going the the RNY as it really doesn't do markedly more than the VSG, but "costs" about as much as the DS when it comes to long term compromises - the extra fussiness over supplements, etc. Further, it has additional long term potential problems with medication and medical treatment limitations that the DS and VSG don't have.. The simpler was the better option for my needs. If one has substantial metabolic problems (including diabetes) or a history of yoyo dieting, the DS is a better choice.

Even just four weeks out, the weight loss is so amazing that I put aside the yearning. And honestly, a lot of what I gorged on before doesn't appeal to me anymore. All the sweets just look terrible to me now.

I actually bought a few bariatric books when making my decision. I’m reading Weight Loss Surgery for Dummies right now. Losing weight and keeping it off is definitely in our head. The surgery is only a tool. If we don’t follow the expected guidelines that come with the surgery then we set ourselves up for failure. Those books are perfect to help us on our journey to become healthier. Thank you.

I got some interesting pictures of my insides today. Reason for Multidisciplinary Case Review: lap adjustable gastric band by Dr. Johnson on 6/6/2011. Had emergent fluid removal from band with dr. Svendsen on 9/10/21. She had been experiencing severe reflux, regurgitation, choking at night, night time cough, vomiting nearly everyday and abdominal pain after eating, Some of the symptoms have resolved after the fluid removal. She continues to have heartburn and epigastric pain. A comprehensive review of imaging and relevant past medical history occurred. Upper GI Series (9/8/2021): Gastric band located below the diaphragm with widening phi angle measuring 66 degrees. The proximal pouch has migrated into the chest consistent with a hiatal hernia. There is dilatation of the distal esophagus and esophageal dysmotility Upper GI Endoscopy (10/6/21): - Tortuous esophagus. - Normal esophageal mucosa. Biopsied. - Z-line irregular, 38 cm from the incisors. - 2 cm hiatal hernia. - Gastric band slipped 2-3 cms distally. - Body and antral gastritis. Biopsied. - Multiple duodenal polyps. Biopsied. biopsy Results (10/7/21): A) DUODENUM, POLYPS, BIOPSY: 1. Gastric (fundic) heterotopia 2. Normal background duodenum; negative for celiac disease 3. Negative for dysplasia and malignancy STOMACH, ANTRUM, BIOPSY: 1. Normal gastric antral mucosa 2. Negative for Helicobacter C) ESOPHAGUS, DISTAL, BIOPSY: 1. Normal esophageal squamous mucosa 2. Negative for reflux changes and eosinophilic esophagitis 3. Negative for columnar mucosa Staff present from ANW, UTD, MCY & Shakopee Weight Management including Surgeons, Advance Practice Clinicians, Bariatric Nurse Clinicians, Registered Dietitians, Psychologists She has completed her preoperative evaluation and has been judged to be a good candidate for surgery. Plan: A Laparoscopic conversion of adjustable gastric band to roux-en-y Gastric Bypass and hiatal hernia repair would be an excellent choice to meet her goals for weight loss and comorbidity resolution. The plan is to proceed with scheduling for surgery.

Hang on a tick, I'm stuck on something here. Let me see if I have the facts correct: 1. Your dietitian thinks you're not losing weight fast enough. 2. You have lost 25.5 kg (56 pounds) in 7.5 weeks. 3. Your dietitian refuses to give you guidelines for what or how to eat beyond 60 g of protein and 2 L of water. 4. You're still on shakes at 7.5 weeks out from surgery. I think it is high time you tell the dietitian to shape up or ship out. There are plenty of dietitians out there who don't require their clients to be mind-readers. And who understand how bariatric patients lose weight. I mean, is this dietitian brand new off the wagon from dietitian school? You should be extremely satisfied. Most bariatric patients lose 7-11 kg (15-25 lbs) in the first month and then about 5 kg (11 lbs) a month thereafter, with several stalls that can last a few weeks. Expecting you to AVERAGE 2 kg a week when you have lost 25.5 in 7.5 weeks means that you could be stalled for 3-4 weeks and lose not a single gram and still come out okay. Expecting you to lose 2 kg EVERY SINGLE WEEK is—and I said what I said—daft. If you are stalled, try increasing your calories by about 100 a day for a week to see if that breaks the log jam. Even just 15g of peanut butter or something along those lines could do it. 100 cal a day times 7 days is not enough to make you gain weight.

My surgeon pushes more for the DS or SADI-S/Loop DS if the patient has a BMI of 50+. I was originally wanting the Gastric Bypass but my surgeon told me that statically I wouldn't get under 200 pounds if I chose the Gastric Bypass as I'm disabled and can't exercise much at all so I was really having to rely upon statistics. According to my surgeons statistics the lowest weight I would have gotten to with the statistical average of Gastric Bypass was 206 pounds, while the DS was 184 pounds (which I've surpassed that statistic by 8 pounds). In the end, the decision on what surgery you decide is YOURS. Not your surgeons. YOURS. I chose the SADI-S/Loop DS because my insurance doesn't cover revisions and my ultimate goal was 180 pounds (which I've surpassed by 4 pounds) and I didn't think I'd be able to get there with the Gastric Bypass. The downside to the surgery I chose is more vitamins and more protein, but you get used it. I haven't really had any issues other than that I developed a wheat allergy, but you can develop that with any of the surgeries with malabsorption which INCLUDES the Gastric Bypass (it's only a 3% chance, but my luck is crap). So really, just weigh the pro's and con's and choose whichever surgery that you are most comfortable with.

I have not had lap band but I have had two prior bariatric surgeries that failed. I am now going to have RNY Gastric Bypass revision at age 73. I have learned a lot since I started on this path 6 months ago. Good for you for moving forward toward a healthy weight. However, I'm concerned that you have not learned how to eat differently yet. Consider the possibility that you are a sugar/food addict. If you are, Keto is not the answer for you. You need to change your habits entirely. I strongly recommend some reading for you. Choose at least one book from each of these groups. Finally, conclude with Success Habits of Weight Loss Patients. Get started now. Apparently you have already had the surgery, so there is no time to be lost.

Revision is not that uncommon according to my surgeon. My surgeon's office pushes for patients to choose a surgery that will help them lose the most weight they can because they have people coming back for revisions due to choosing a less aggressive surgery the first time or weight regain because they feel that people don't factor that in. They have no problems with doing revisions, but warn that sometimes you won't lose as much as your first surgery or if you do then you'll lose it a lot slower. And, revision also relies very much upon insurance approval if you can't afford it out of pocket so they always advise people to check what their insurance allows before deciding on a final surgery. Originally, I was looking into Gastric Bypass, but my surgeon pushed for me to have the DS or SADI-S because of me being super morbidly obese with a BMI of over 50. My insurance wouldn't have approved of a revision if I didn't like where my weight settled so I ended up going with my doctor's advice. So when it comes to revision I understand that it very much depends upon the insurance. Some will only approve a revision if you develop complications such as GERD, while others will allow it if you've had significant weight regain and can't lose. So it's really just dependent upon what your insurance allows. If it does allow a revision then it comes down to what you want. A revision to Gastric Bypass or the Duodenal Switch (for reference the first part of the DS is the gastric sleeve. Also, there is the SADI-S version which has a longer intestinal length then the original DS, but you'd have to find a surgeon who even does the DS or SADI-S as not every surgeon does). I hope that your insurance will cover your revision and if it doesn't then I hope you find a place that is affordable for out of pocket costs. Sorry that your surgeon was so unhelpful and I hope you have better luck with the next one!

Hang in there! I gained and lost the same few pounds a few times in the first few weeks. Look at trends, not just the weight over a few days. Everyone here is right; there are lots of reasons for an increase at one time point - including constipation especially right after surgery and if you're dehydrated, your tissues hold on to more fluid. Just follow the plan and the weight will come off!

I had the gastric sleeve surgery in February of 2018. I lost 100lbs and was feeling wonderful. I got pregnant with my son in June of 2019 and gained about 55lbs and cannot for the life of me lose the weight. I reached out to my surgeon as at the time of my surgery he told me to "get the sleeve because it is more safe if I plan on getting pregnant" and if I wasn't happy with the results after my pregnancy I could "always come back and get bypass". Well I reached out to my surgeon after about a year of me doing multiple failed diets and said I wanted to make an appointment for a revision surgery. My surgeon then responded with "You have the tool you need to work it". That was that, I feel very discouraged however, am looking into a different surgeon in another town. I guess my real question here is: Has anyone else had to deal had a hard time being approved for revision?? Did your surgeons frown upon it? Is it possible they will turn me down for surgery because I previously had the sleeve already? If you made it this far, thank you for reading my rant!

Today is five weeks exactly, and I am down 21 lbs. Last week was weird; for some reason, I gained a few lbs, and then within six days, I started dropping an lb a day. My dietician would like me to stay between 80-100g of carbs, which I was reluctant about reading other revision experiences, but I am happy to say that I am still losing at 80g daily. I can eat many things without issue, but only if I eat them in small portions. Pooping is weird... It smells, often loose, and I have had some oily moments (TMI), but it is definitely diet-related. I have noticed that I have gas early in the morning and have to poop first thing, so that is something to keep in mind if you are considering revising to SADI.

I believe all of us should know the "why" of things WLS. Most people don't want to know why, they just want a list of what to eat when, then get stuck when their life doesn't easily sync with the plan. Knowing "why" let's you understand how to make adjustments that aren't obvious but are still following the plan. Keep it up. I stopped going to (in person) support after the third meeting and left the online portion about the same time. The main topic was how to cheat, and the second was women stuff. Not my cup of tea. I never did protein drinks except when I was binge running and then it was more for the running than my plan. Even on puree I was at my appropriate protein level by about week 3-4. For RNY patients there is always the question of how much protein are we NOT absorbing because of our surgery. So popping in a protein drink can ensure enough is being absorbed. Or, like @catwoman7who have a specific need. My RNY had a small bypass so I don't malabsorb much. My doc was four square against protein drinks, he wanted us learning to eat correctly from the very beginning. My sense, though, is generally they are a meal replacement for the crash diet many surgeon's put their patients on so that they will lose weight faster. Keep on thinking and learning. Tek

Different people, different ideas. Take what info you deem useful for YOU and leave the rest. Personally, i give kudos to you for questioning and researching and educating yourself. Too many people follow heaps of advice given to them because they believe these people surely must know better. Sometimes they may, sometimes they may not. For what its worth, i stopped drinking protein shakes around the time I reached goal. Since then, I’ve probably reached my protein goal (60g a day..NOTE: i am on the the small side: 5’2”, 115.9 lbs this morning, and exercise regularly) with just regular food maybe 75% of the time. Im 3 years out now, have been maintaining my current weight (+/- 5lbs) for over 2 years; every single one of my labs have come back satisfactorily (last one in April, my next one is end of this month); my body fat percentage in April was 19% (so i have zero issues regarding muscle mass) ; and I feel fab. Do you, boo. You’re doing great.

Your surgery weight was higher than mine and you had your surgery almost a week later, yet your current weight is lower than mine! If it helps, you're making more progress than me, and my surgeon's office is happy with where I am. It's crazy how different expectations are; my nutritionist said that anything over 8 lbs a month is on track. Stalls are normal along the way and I think it's really difficult to expect to lose 4 pounds a week every single week. Great work so far!

I am a person who always wants to know the "why" behind a rule (unfortunately!). So, as I've slowly been progressing through my surgeon's plan (still on pureeds for two more weeks, and I'm 7 weeks out), I've started wondering if we will always have to drink protein shakes. I hate them, they taste gross, and the ingredients list is like 5 paragraphs long full of things I can't even say - besides that, they're full of carbs and often high calorie. And if we do have to always drink them, why? Why can't we meet our protein goals through eating real food? For example, an egg and a morningstar breakfast sausage patty is 16 grams of protein and 150 calories. The protein shake I drink is almost 300 calories (bariatric advantage with PB2 over a plant based milk). Also, bone broth, cottage cheese, greek yogurt, tuna are all high protein, low calorie options that taste way better than protein shakes. If a person is able to meet protein goals and still stay around 600 calories a day during weight loss phase, why the shakes? (I don't know if that's feasible, I haven't tried it - I am still drinking the nasty protein). So, I posted the question to the online support group my surgeon keeps on Facebook. I asked if a person can meet their daily protein goal through real food, are protein shakes still required. Man! You would have thought I asked if I could eat a full meat lovers pizza from Papa John's! People launched on me, accused me of eating too much food, told me if I wanted to lose weight and maintain it I HAD to drink protein shakes for life. Then the surgeon came on and publicly shamed me, said I was way off track and wasn't following the plan. What bomb did I set off??? And nobody ever explained WHY the shakes are required??? The previous time before this when I asked a question, almost the same thing happened. I asked if I could drink the Unjury ready made shakes instead of the powder because they taste so much better. People berated me, and told me the ready made shakes were not good for me. Then the surgeon chimed in and said the ready made were not as good because they are protein caseinate instead of whey isolate. Um, the packaging clearly says the Unjury brand is whey protein isolate. So now why are they bad for me? The next day, my surgeon posted a long post about people having this surgery and not taking it seriously. I can't help but think it was in response to my question about protein shakes. I didn't even have Facebook, I deleted it in 2016 when things started to get so nasty online. I only started using it again to join my surgeon's group. I cancelled following the page. I was really ticked off at the responses. I'm so angry I don't even want to continue with my surgeon's office. AND, by the way, I am not way off track, I've lost 41 lbs. in these last 7 weeks, and I'm really happy with that. Started at 235, now 194 (and have been losing about 1 lb a day for the last few days). I know I'm being a baby, I think I just needed to vent. I do like my surgeon when we meet one on one for appointments. Facebook is evil. Sent from my SM-N976V using BariatricPal mobile app

I'm a guy. Everything your husband fears about surgery is true. Something COULD happen. You COULD change. You COULD find a better guy. He's seen the same WLS horror stories as you. He's had associates at work tell him all the things that he fears happened to a friend of a friend and it was horrible. Another true thing: WLS makes good relationships better and bad relationships worse. By having surgery you are changing the status quo in all your relationships. Relationships will necessarily change as you change when eventually a new status quo is established. Again, some relationships will be better, others worse, and others may not change much at all. So, you have a lot of talking to do. Talk to your husband about his fears and reassure him that nothing extremely bad will happen, that you will not change in any important way. That you love him and have no intention of leaving him. You will have to have this discussion every time his fear (and insecurity) come up because you love him. Tell him of all the things you can do with him when you lose weight. Express all the reasons you are having WLS and how those will impact him in a positive way. Open and honest, again and again. Then you will have to do similar in other relationships whether you tell them about surgery or not, because they have eyes and will notice you losing weight. We all get insecure about change sometimes when we perceive or imagine changes. We all have buttons. This may seem unfair and perhaps it is. But it's how loving, caring, giving relationships work. If you don't care about the relationship you don't need to take the time. "I'm doing this. Get on board or..." works if you don't care about the fallout. Your choice. Good luck, Tek

Given this, I wouldn't worry that you are not losing much. That 27 lbs is where you lost the water weight that most people lose in the "shrink the liver" diet. That's when you see those amounts like 10-12 pounds. The fact that you were able to lose 27 lbs shows you're gonna do just fine!

Have I misunderstood? You've lost 56lb in about two months or just a little under that? I think what you've lost is great. Some professionals or those who deem themselves to be seem to set some unrealistic expectations. Were you happy with your weight loss up to the point in time your dietician told you otherwise? 10kms a day is quite a lot. I assume you are followng your post op guidelines for calories, volumes of food, types of food etc? Protein intake? Liquid intake? And hopefully consuming sufficient to sustain 10kms a day. If so and your are averaging a reasonable weight loss you are doing great. Editied to add: You mention you stopped losing weight? How long since you've lost some weight on the scale? Stalls are not uncommon, most of everyone who has WLS has a stall or more than one, even in the first few weeks.

Hi Peeps, I had my Gastric bypass (RnY) on Aug 17. My stats are as follows. SW: 302 lbs Height: 169 cm. CW: 246 lbs. Total lost: 56 lbs Exercise: Walking 10km daily However, I'm feeling I'm not losing fast enough, my dietitian thinks I should be losing about 4 lbs a week. I'm worried that I'm going to ruin this. Any tips on how to lose faster. Would really appreciate the help. Thank you.