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Generally, the sleeve will be less fussy than the malabsorbing procedures when it comes to supplement requirements, however, they will all have some initial requirements for the first few weeks or months as you need some additional nutrition since you won't be eating much for a while. Shakes are a part of it, for a variable amount of time, as that's the only way other than real food to get our needed protein. Over time, there will be little that you can't eat with a sleeve -which is good and bad. Good in that you can, in principle, be able to get all of your nutrition from food if you are so inclined (most aren't, which is why they still need to supplement some.) Bad in that you can still eat junk that goes against your weight maintenance goals. Some people need supplements, even with no WLS at all, simply because that is how their body works. Some programs impose the same supplement regimen on their sleeve patients as they do for their bypass patients, not out of necessity for the sleeve but for their own (the practice's) convenience. Periodic lab checks will tell you what you personally need to stay healthy. Are you having your WLS done here in the States, or in MX? The mini bypass is rarely done here in the US and is rarely covered by insurance and AFAIK has not been endorsed by the ASMBS as an approved, mainstream procedure. I would do some further research as to why this is before proceeding. The mini is done in MX, primarily as a cheaper alternative to the RNY, and is also more commonly done in some other countries. Here in the States, I would shy away from it for the same reason that I wouldn't own a French car (irrespective whatever merits they may have) as they haven't been sold here for decades and finding parts and service is a PITA. Likewise, should you have problems with a mini sometime down the road, finding someone who knows how to treat it can be a problem; if you have a sleeve or RNY, any bariatric practice at any hospital will know what you have and how to treat it.

-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.

I am close to you in age- I am 49. I also think I look a lot better with clothing ON than OFF right now so pictures can be deceiving. There is much to be said for a good pair of leggings and a good bra! My stomach, butt, triceps and inner thighs are my current problem areas. They have some loose skin but I accept it is part of the process. I think my Biceps actually look the best , I think they respond well to working out. I am taking a collagen supplement daily - in hopes that it will help maintain some elasticity with my skin. I have noticed my complexion is a lot better since adding the collagen. Hard to say if it is helping with elasticity since I had to take a month off from the gym since my gall bladder surgery. As my weight loss slows down now, I am going to get back to the gym this weekend and really going to focus on workouts with the goal of tightening up/toning as much as possible. Starting to research body recomposition - building muscle and losing more fat. This will also help with increasing BMR for maintenance. I am going to continue to reassess things as time goes by. I always thought I would never want plastic surgery but I may change my mind and get the Mommy makeover in a year or 2. My boobs are flat and saggy now and they are the only part of my body I am unhappy with right now. My stomach has some loose skin but it still feels better than it did at 264 lbs. From what I understand genetics, age and prior weight all play into loose skin. I am working on giving myself grace and accepting my imperfections and working to continue to improve as much as I can. Advice Welcome....

I hear you loud and clear. My weight loss is already starting to slow down. I am hoping that I have a good foundation now for the continued journey. I would like to continue to lose more but it seems it is going to be slow and harder to do as I get closer to goal. Just going to take it day by day meal by meal. Any advice is always welcome!

I think yours makes more sense to me than mine did lol. I had a clear liquid diet, all clear fruit juices unlimited. Therefore, lots of carbs. I followed it, lost weight but the jury is still out to why my surgeon preferred that diet. Everything turned out fine in the end. Surgery was fast and successful. But as cellbell said low carb is what shrinks the liver is what I have always read.

KSW22 I am sorry to hear you can not do your revision surgery and am wondering if you have ever looked into keto/low carb? I had the roux en y in dec 2004 and lost 100 lbs, but than got almost back up to my original weight. Two years ago i found keto and Dr. Ken Berry (u tube him). I had success with losing about 70 lbs, but last year when covid hit I got off track and am now getting ready to start over. It is the closest thing to what i should have done after my 1st surgery, if I had only known than what I know now. look into it and if you have questions feel free to ask.

We’ll done!!! My SW and GW numbers are almost identical to yours. I’m 5’4” and 54 years old. I’m impressed at how fit and toned your body is, and I am hopeful that I might not have any issues with extra skin. Did you do anything special—apart from exercising, weights, and so on—to ward off problems with extra skin? My biceps are a concern for me. I would really like to avoid cosmetic surgery to remove extra skin. I appreciate any guidance you might be able to offer me. And again, congratulations on your great success!

Misconceptions abound. My often cited one is looking at a person who is poor and obese. People will say look at that person complaining about not having money but probably wasted their money on food. The misconception is, poor people have poor food choices. Their diet consists of cheap over processed carb based foods. Eating these on a consistent basis will eventually lead to obesity. These poor food choices are direct marketed, readily available, easy to consume and cheaply priced. I too was a victim of this until I started to eat better quality food to maintain my weight loss. I don't know how many times I had to explain this to people who have no clue about food nutrition. I can't blame them, until my WLS I didn't know as well.

Looking good. Now, in the coming months the most difficult part of the journey will be upon you. The maintenance of your weight loss and the continuance of your good health. Many before you have experienced the overwhelming joy and gratitude of such a rapid weight loss. It is such a great experience and due to surgery attainable. In time our bodies start to revert back to some sense of normalcy and the battle to keep the weight off will be a daily struggle. You're doing everything right and all is going to plan, best of luck on your life's battle with weight loss.

If your wanting to track your moods and things along with your calories and intake you could just use the notepad app in your phone. I use it to track my weight. I record it daily but on surgery date each month I delete all but that day so I can see the downward trend month to month.

I grew as a chubby kid but once I entered school, I was kept in sports my whole life so being skinny was my normal life. It wasn't until I was diagnosed with PCOS at the age of 22. I was at 150 pounds. A tad bit overweight but hey, I was a university kid who would party, drink and eat junk all the time. What was I expecting? it's what us, uni kids do... right? PCOS never tempered with my life so why care. It wasn't until I was 24 when the weight became my biggest nightmare. It was as if it came with vengeance, full force. This is when everything 'clicked' for me. I would always do crash diets, starve, Intermediate fasting, juicing... you name it, I've tried it. NOTHING WORKED. I would diet with no weight loss. AND TRUST ME... I CALORIE COUNTED EVERY GRAIN OF RICE OR OUNCE. I would go to the gym religiously for 2 hours at a time...I would weigh myself every morning in hopes I finally lost a pound. This developed an unhealthy addiction and I ended up with an eating disorder. I would give up on dieting and binge eat thousands of calories at a time. I would feel guilty, mentally, emotionally, and psychically. I would vomit and start over. I missed the "skinny" me desperately to the point I jeopardized my body, my mind and killed my metabolism due to my eating disorder. I was sitting at my heaviest at 210. For some, this weight isn't much but keep in mind- I didn't feel like myself anymore. I wasn't happy. I would drink myself to sleep. I would cry because I felt that I could have done better with taking care of my body, But Instead, I tortured my body thinking I was doing the "right thing." Scared and lost, I turned to my last resort and to fix my alcohol addiction and health around with the VSG. I am now 1 month post op and down to 169. I hope to get down to 110 like I used to be. But honestly, I just want to be happy again. This time. HEALTHY, regardless of the weight. People think that only thin people have eating disorders but, oh boy are they wrong. I am still learning how to deal with my new tummy. But What I keep in mind is, that this surgery is a tool. Not a 'miracle' surgery. I still need to eat healthy to get the results. And I aim to do so.

Unfortunately the glorious & heady weight loss of the pre & immediately post surgery days doesn’t last. Think of this time as the kickstart. Around month 3+/- when your weight loss starts to slow is when reality begins to set in again. You’re eating solid foods, there are more foods you can eat, your portions are getting larger & you’re consuming more calories. Just stay your course. It’s not a race. You’ll reach your goal in your time which is the right time for you. You can’t control factors like gender, age, metabolic rate, weight loss history, etc. which influence how much & the rate at which you’ll lose. Remember the axioms: the more you have to lose the faster you’ll lose to begin & the closer to your goal the more slowly you’ll lose.

I kept very closely to the plan I was given & the recommendations from my dietician & surgeon. They knew what they’re talking about. Your plan would advise when you can start to try to include certain foods in your diet as your tummy can’t digest some things to begin - too coarse, too fibrous, too dense, too rich, etc. When you’re able to eat solid foods again it’s not a free for all. You need to be careful not to stress & strain your tummy & digestion. It will be sensitive & as you’re discovering may not tolerate some things you used to enjoy. (It does improve but it takes time.) We’re advised to avoid nutrient poor pasta, rice & bread because they tend to swell in your tiny tummy & fill you up so you’re unable to eat the protein & other nutrients you really need. Remember you physically are only able to eat small portions if anything. There are pretty good alternatives about. A lot of people swear by a ricotta bake which reminds people of pizza or in time you could try pizza made with a cauliflower rice or a shredded chicken base. Try zucchini noodles instead of pasta. You will be able to eat salads in a little while. Some people will say they ate bread, rice, pasta, etc. without issue at some point while they were losing. Some successfully with careful portion control incorporate these things & foods like pizza occasionally in maintenance. Personally, I decided that the weight loses phase was the perfect opportunity to change the way I ate & what I ate & I still stay away from lots of foods - I realised they were danger foods for me. But ultimately, it’s your decision. You have to do what works for you. Good luck.

I fortunately just missed the 400 club, but am 6' 3" with a HW of 382 on 7/3/19, but thought I would "weigh in" on this topic. SW 309 5/18/20 for VSG CW 216 15 months after surgery. I hit my goal weight of 220 about 7 months post op and have maintained in a ~10lb range (213-222). Taking in about 2000 calories daily and doing well. When I start creeping up, I lower to 1800 or so until I get back down. Working so far, still tracking every day, hydrating, exercising, focus on my macros. I've scheduled a tummy tuck in late September to deal with the loose skin. Excited, but nervous about that.

Glad you are hanging in there! Keep working at it! I’ve been slow in my weightloss too, but still losing, and I’m very thankful for that! I am 15 lbs. from my goal, so I know it will still take awhile, but if I don’t lose another pound I am thankful for what I have lost and hope it continues. The dr. Told me at my 7 month visit that he was very pleased and said I shouldn’t want to lose much more because if I get sick I still have some weight to help. My goal is 135 or 130, I go back and forth about which one, and I’m presently at 145. I was 209 when I started, and it’s now been 9 mos. I started out the first few weeks losing 5 lbs at a week but that only lasted a couple weeks and suddenly I was down only 1-1-1/2 lbs. a week, and it has stayed that way ever since. But I fell a lot better than I did for the first couple months. I was always sooo tired. I have a lot more energy now and I can walk much better. I’m so very thankful I had this operation.

I found out today that I approved and my surgery date is Sept 15. It’s so surreal. I wanted it for years.But didn’t pursue it and when I finally did my insurance at the time didn’t cover any type of weight loss. It’s been 18 years of waiting. When I was 23 I had Kaiser but thought the 6 mos of classes was too long 🤦‍♀️🙄. I look at cute outfits that I never even glanced at before and think “wow I will be able to wear that” I’m in shock. I’m nervous about the actual surgery as well. Ahhh my emotions are all over the place.

I lost weight faster on the pre op diet but I was a lower starting BMI. I lost 14 in two weeks pre op then 10 in my first month post op and less each month from there. But again I was lower starting BMI so I am a slow loser.

Firstly, Congrats!!! 31 pounds is a great victory! It is very normal to experience a stall at that stage. Anywhere from week 2-week 6, most people experience their first stall. By re-evaluating, I wouldn't decrease your calories since I am sure you are eating less than 500-600 calories a day. Move around, up your protein and water. Stalls can last anywhere from a week to a month (from what I read.) but keep in mind, majority of us experience them and they are a pain in the ass to break. Don't feel discouraged as your body is still healing and trying to catch up to your rapid weight loss. Give this time to stay off the scale and focus on your intakes in terms of water and protein. I focus on 80g of protein (with collagen peptide powder and fiber powder) 64 ounces of water (I despise water with a passion ugh) and my calories are anywhere from 500-600 a day as recommended by my NUT. Good luck.

1. My program had me do liquids for 2 weeks pre-surgery and I think it was 10 days post surgery. I think I lost 7 lbs presurgically during liquid phase and 13 lbs in the liquid phase post surgically for a total of 20. That is going to be different for everyone depending on your starting weight etc. 2. A lot of weight is lost during the liquid phase but it is also done for proper preparation and healing of your stomach. I personally think the choices you make once you can begin eating solid food is the most important because this is where you are making the choices/changes that will hopefully change your habits for the long term lifestyle change. I also think the liquid phases are not real life- you have a list with very specific things you can/cannot eat. Once you are on solid food you have recommendations to follow and must choose to avoid the things that contribute to weight gain. I did however keep some of the tricks from the liquid phase (sugar free popsicles, sf jello, broth, protein drinks/shakes to fight hunger. Pre-op I lost 29 lbs from my first surgery consult until day of surgery. (27.3% of the weight lost) Post-op I lost 13 lbs during the liquid phase after surgery (12.3% of the weight lost) 64 of my 106 lbs has been lost during the soft/solid phase. (60.4% of the weight lost) 3. I personally had no brain fog or weakness/fatigue after surgery. I actually felt very enrgized after surgery. I made sure to get some carbohydrates as permitted by my program in my liquid phase (G2 instead of Gatorade zero to add some carbs). Some of the fatigue/fog can be related to anesthesia. Luckily I recover well from anesthesia, but not sure that is something that can be controlled. I had to take 4 weeks off work because I do heavy lifting at work. I really think that time off was beneficial because that is when I developed a new routine of walking 2 times daily and really had nothing else to distract me from making changes to my eating habits, searched for recipes, had time to shop for all the food I needed, and was able to have reduced stress for 4 weeks. I highly recommend if you can afford to take a few weeks off work to do so in order to get organized/develop new habits/heal properly. 't. 4. Advice- listen to your surgeon/program and follow the program. I know some people say that exercise is not important, but I really feel that my activity/exercise level is what has contributed greatly to my current weight loss. I also believe there is research indicating that those that exercise regularly have better long term success than those that don't. Exercise is a good way to get away from the kitchen when you are hungry as well as burning calories and improving overall health. I also learned to roast vegetables which has made a huge difference in my food choices. I used to rarely eat vegetables. I now usually roast green beans, zucchini, carrots, sweet potatoes, onions etc with my protein (chicken, pork, beef, fish). Learn to read food labels- it now takes me longer to shop because I read the food labels before buying something. Also have found a lot of things at Aldi's that are good choices for my new lifestyle. Keep seeking support via this group and/or other groups. This is also something that contributes to long term success. Good Luck on your journey!

Hello everyone! I had my gastric sleeve and (unexpected) hiatal hernia repair on August 12th. Post op hasn't been fun. I should be on purees this week, but I can't swallow much. Just water, broth, and gatorade. I'm praying things will get better. I can now wear my wedding ring. So I'm definitely losing weight.

@Hop_Scotch that's the kind of thing I was thinking, make sure I stay in deficit and keep losing weight without being on the liver shrinking diet. Currently 117kg, aiming for 75kg @FutureSylph and @catwoman7amazing, thank you for the info on the less restrictive/post op guidelines. I'm feeling like I'm floundering. I'd done so much set up for my pre-op and ready for liquids post-op and expecting to have a dietitian and guidance coming out of the surgery that having a "follow the bouncing ball" type diet for a week or two is definitely the way to go right now. @Maribelle76 I'm trying really hard not to flip out and eat all the things! The problem is that after a week on the pre-op diet when I told my body I was about to eat all the thing again my body said no. I'm not a teary person, but I keep bursting into tears and just want to have a tantrum. But I figure post-op I'm going to have to have some serious willpower, so I may as well start exercising that as well as my body pre-op Honestly I just want to get a different dietitian that has a bit of empathy and is responsive to a stressful situation. But I can't do much about the Covid outbreak and the surgery postponement. So I'll keep a handle on the things I can control and try to let the stuff I can't control roll by.

I use the free version of My Fitness Pal. It tells you all your macros. I'm almost 3 yrs post op and still track my food to make sure I get my protein in. The other stuff I don't really care about. The free version even has a bar code scanner in case you need to use that and it has a pretty big database of food products. I find it just as easy to use as the Weight Watchers tracking tool that I've used for many years.

What matters is what your policy with the insurance company covers, not the company in general. For example, for years my insurance company covered weight management services and surgery in many policies. However, policies negotiated between my employer and the insurance company specifically excluded it. Therefore, even if a doctor affiliated with the insurance company recommended surgery, it would not be covered for me. Seeing how you are already getting conflicting information, I would make sure you get everything in writing going forward.

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!

there are usually fairly large drops the first month or two, but then it slows down quite a bit. More like what you'd expect on a regular diet. After the first month, I lost about 8-12 lbs a month until maybe month 7 or 8, then I dropped down to about five pounds a month, and after the first year, it really slowed down to a crawl - a couple of pounds a month. I finally stopped losing at around 20 months out. of course, some of this depends on your starting weight, age, gender, genetics, metabolic rate, etc - but it does seem to be the general pattern, at least...