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I think you will be okay if you have lost weight you are probably shrinking your liver. It just depends on how big it was to begin with I imagine. The smaller it is the safer your surgery will be though so definitely don’t do it again. The more important thing I would be asking myself is if you can do the post op diet without cheating. No judgement here if you can’t but you really need to be certain you are prepared for it because one little cheat post op and you can seriously hurt yourself. If you aren’t ready there is no shame in that. Only you know if you are really ready for the post ip changes. If not, Perhaps a bariatric therapist can help you explore why you are “cheating”.

I have to do IV iron infusions because I can't take iron pills. I found that it did help with my energy and at the time my hair was actually falling out a bit, so the infusions help (this was before bariatric surgery). I can't imagine you should be taking a multivitamin with iron if you are getting iron infusions, but that's something to ask your doctor.

Sounds yummy. If you can make it with spray pam instead of oil or butter it would be even better for you. Maybe a little cinnamon and sweetener. i like to make s’mores in banana boats. I use sugar free choc chips and almonds or pecans instead of graham crackers so the only bad thing really is the marshmallows. It’s still higher calories and not necessarily for weight loss phase but for maintenance for me it’s a healthy-ish alternative to s’mores Have you considered a bariatric therapist to try to get to the root of the head hunger. A lot of people swear that this has helped them tremendously.

My ex's uncle had this. Usually it's stumbled upon accidentally during an emergent surgery situation. Which is what happened with his uncle. He had emergency appendectomy probably about 50 years ago and the surgeons were just dumbfounded when they opened his abdomen. So of course this has nothing to do with weight loss surgery, but my advice would be if you live close to a university that teaches medicine, and has a bariatric center, reach out to them. They would LOVE to get their scalpels on you, lol. Sorry, bad joke. But yeah, they love hard cases, and atypical cases. They publish papers on these cases. You're in North Carolina. How close are you to Wake Forest, they have a bariatric center https://www.wakehealth.edu/treatment/b/bariatric-surgery I wish you the best! Keep us updated!

A chose bypass due to GERD, but I also had some reservations around dumping and medications. Medication-wise, the reality is over time, a lot of the medications you take may end up going away. Especially if they are for conditions like high blood pressure or diabetes that are often reversed with weight loss. Personally, I was really worried about NSAIDS, because I have a number of physical issues that have had me on prescription NSAIDS for over 35 years now. My surgeon agreed that even with bypass, I could keep taking them as long as I continued to take a PPI to limit the risk of ulcers. I'm also hopeful that as I get closer to goal, I may be able to give them up entirely. For the rest of my meds (if you include supplements, I take over 30 different pills a day), no mention has ever been made about me needing to adjust the dosage in any way. Honestly, I think the whole "malabsorption" thing for bypass may be a bit overblown? As far as I'm aware, the only ones where you might run into a problem are extended release versions of medications. For most of those, there are non extended release alternatives. If you have specific medication concerns, my suggestion would be to talk with your bariatric team. They can best advise you if bypass would be an issue for you with that medication. As far as dumping is concerned, dumping is far from guaranteed with bypass. I have not experienced it and many others here have not either. Plus, we've had first hand reports that even some sleevers have end up with dumping syndrome. Certainly it's much more likely with bypass, but I'm not sure I'd worry about this too much. If you do end up with that issue, it can certainly help you stay on plan and may help you do better in the long run by controlling your intake of things you probably shouldn't be eating anyway.

I went down to 200lbs the day of surgery, I'm 3 weeks out & have lost 15lbs. I read a passage in my bariatric handbook that basically said, 'Your metabolic rate is higher when you weigh more, meaning you lose more doing less. Weighing less will slow that down. Essentially, the surgery will help you when losing weight is at its hardest.' Aka, this will help us lose those stubborn last pounds! Its very encouraging for me

Medical Groups Replace Outdated Consensus Statement that Overly Restricts Access to Modern-Day Weight-Loss Surgery NEWBERRY, FL – Oct. 21, 2022 – Two of the world’s leading authorities on bariatric and metabolic surgery have issued new evidence-based clinical guidelines that among a slew of recommendations expand patient eligibility for weight-loss surgery and endorse metabolic surgery for patients with type 2 diabetes beginning at a body mass index (BMI) of 30, a measure of body fat based on a person’s height and weight and one of several important screening criteria for surgery. The ASMBS/IFSO Guidelines on Indications for Metabolic and Bariatric Surgery – 2022, published online today in the journals, Surgery for Obesity and Related Diseases (SOARD) and Obesity Surgery, are meant to replace a consensus statement developed by National Institutes of Health (NIH) more than 30 years ago that set standards most insurers and doctors still rely upon to make decisions about who should get weight-loss surgery, what kind they should get, and when they should get it. The American Society for Metabolic and Bariatric Surgery (ASMBS) is the largest group of bariatric surgeons and integrated health professionals in the United States and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) represents 72 national associations and societies throughout the world. "The 1991 NIH Consensus Statement on Bariatric Surgery served a valuable purpose for a time, but after more than three decades and hundreds of high-quality studies, including randomized clinical trials, it no longer reflects best practices and lacks relevance to today’s modern-day procedures and population of patients," said Teresa LaMasters, MD, President, ASMBS. “It’s time for a change in thinking and in practice for the sake of patients. It is long overdue.” In the 1991 consensus statement, bariatric surgery was confined to patients with a BMI of at least 40 or a BMI of 35 or more and at least one obesity-related condition such as hypertension or heart disease. There were no references to metabolic surgery for diabetes or references to the emerging laparoscopic techniques and procedures that would become mainstay and make weight-loss surgery as safe or safer than common operations including gallbladder surgery, appendectomy, and knee replacement. The statement also recommended against surgery in children and adolescents even with BMIs over 40 because it had not been sufficiently studied. New Patient Selection Standards — Times Have Changed The ASMBS/IFSO Guidelines now recommend metabolic and bariatric surgery for individuals with a BMI of 35 or more “regardless of presence, absence, or severity of obesity-related conditions” and that it be considered for people with a BMI 30-34.9 and metabolic disease and in “appropriately selected children and adolescents.” But even without metabolic disease, the guidelines say weight-loss surgery should be considered starting at BMI 30 for people who do not achieve substantial or durable weight loss or obesity disease-related improvement using nonsurgical methods. It was also recommended that obesity definitions using standard BMI thresholds be adjusted by population and that Asian individuals consider weight-loss surgery beginning at BMI 27.5. Higher Levels of Safety and Effectiveness for Modern-Day Weight-Loss Surgery The new guidelines further state “metabolic and bariatric surgery is currently the most effective evidence-based treatment for obesity across all BMI classes” and that “studies with long-term follow up, published in the decades following the 1991 NIH Consensus Statement, have consistently demonstrated that metabolic and bariatric surgery produces superior weight loss outcomes compared with non-operative treatments.” It is also noted that multiple studies have shown significant improvement of metabolic disease and a decrease in overall mortality after surgery and that “older surgical operations have been replaced with safer and more effective operations.” Two laparoscopic procedures, sleeve gastrectomy and Roux-en-Y Gastric Bypass (RYGB), now account for about 90% of all operations performed worldwide. Roughly 1 to 2% of the world’s eligible patient population get weight-loss surgery in any given year. Experts say the overly restrictive consensus statement from 1991 has contributed to the limited use of such a proven safe and effective treatment. Globally, more than 650 million adults had obesity in 2016, which is about 13% of the world’s adult population. CDC reports over 42% of Americans have obesity, the highest rate ever in the U.S. “The ASMBS/IFSO Guidelines provide an important reset when it comes to the treatment of obesity,” said Scott Shikora, MD, President, IFSO. “Insurers, policy makers, healthcare providers, and patients should pay close attention and work to remove the barriers and outdated thinking that prevent access to one of the safest, effective and most studied operations in medicine.” The ASMBS/IFSO Guidelines are just the latest in a series of new recommendations from medical groups calling for expanded use of metabolic surgery. In 2016, 45 professional societies, including the American Diabetes Association (ADA), issued a joint statement that metabolic surgery should be considered for patients with type 2 diabetes and a BMI 30.0–34.9 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. This recommendation is also included in the ADA’s “Standards of Medical Care in Diabetes – 2022.” About IFSO The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) is a Federation composed of national associations of bariatric surgeons and Integrated Health professionals. Currently, there are 72 official member societies of IFSO, as well as individual members from countries that thus far have not formed a national association. IFSO is a scientific organization that brings together surgeons and integrated health professionals, such as nurse, practitioners, dieticians, nutritionists, psychologists, internists and anesthesiologists, involved in the treatment of patients with obesity. About ASMBS The ASMBS is the largest organization for bariatric surgeons in the United States. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of severe obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for patients with severe obesity. For more information, visit www.asmbs.org.

I listened to this female-centric podcast during my walk today, which somewhat addresses this temporary cognitive dissonance following bariatric procedures: https://drmariza.com/435-most-effective-way-to-transform-your-self-image/. It's on Apple Podcasts. The guest speaker has lost a lot of weight, in addition to making other significant changes in her life. She suggests you change your environment (e.g., the contents of your bookcase), your personal style, etc., to allow the external match the internal. Kinda interesting, but OP is male so his mileage may vary.

Wow, that's got to be so disappointing, but you seem to have the right mindset about it! Kudos also to that doctor. For him to decide not to move forward meant he cared more about your health and safety than his ego. While not really the same, my unusual anatomy did cause my surgeon some extra work. Simply put, my intestines are routed differently than most people, so she had to put in a lot of extra work to locate some on the anatomical markers they use to properly measure the roux limb for the bypass. Apparently it made my surgery take about an hour and a half more than usual. Thankfully she is one of the most experienced bariatric surgeons around.

I had VSG at HospitalBC and they also do plastic surgery, specializing in post-weight loss stuff. I'm not familiar with that side of their work, I just know that many patients return for plastics. I did have a wonderful experience there for my bariatric surgery though,

HI all, My sister is planning on having the gastric sleeve procedure done in Mexico in a few months. I am going to go with her and I am considering liposuction. Basically, surgery buddies, but different procedures. I know a lot of bariatric patients end up needing some surgery for loose skin, etc. But I'm not sure which practices provide both. Does anybody have any experience with a bariatric place in Mexico that also provides plastic surgery? Thanks, Kelly

Adding to what SpartanMaker mentioned above, the other major concern with alcohol use post op is that it is a liver toxin (physiology here, no moral judgement) and that our livers already tend to be in poor shape owing to our obesity (hence the "liver shrinking" pre op diets that some programs put their patients through) and then the liver is further taxed by its role in metabolizing all of that fat that we are rapidly losing. The last thing that it needs is the added stress of metabolizing alcohol. Surgeons vary on how much this point bothers them, largely depending upon their experience with such things (and maybe their own alcohol tolerance?) Our surgeon also moonlights as a biliopancreatic (liver, pancreas) transplant surgeon, and the last thing he will tolerate is one of his bariatric patients coming back onto his transplant table.

Also, the written instructions are sometimes just boilerplate, created for general cases, and sometimes not even bariatrics, and sometimes they just go obsolete and haven't been updated, so certainly go with what instructions you get personally from your doctor or RD (and sometimes even that will vary.) The post op discharge instructions given to you by the hospital can be some of the most generic (often written more by lawyers than be doctors....) and can conflict with what your doctor will tell you - go with the doctor's instructions. Sometimes the guidebook given to you by the bariatric program may be a bit out of date - I have seen some be told by their doctors to advance to the next stage now, even though that may be a week or so in advance of what the book said, with the doc telling them that "we have learned that the patients are doing better by going a bit faster, and we'll change the book next time we print some..." Again, go with what the doctor tells you.

It's not uncommon that bariatric programs warn people not to drink alcohol post-op. Some, like your team seem to take a "never again" approach, while some say avoid it for a specific length of time, such as the first year. As I understand it, here are the biggest concerns those programs have: The biggest concern by far is that there is an increased risk of developing Alcohol Use Disorder. As @Starwarsandcupcakes mentioned, some research suggest that susceptible patients transfer disordered eating onto alcohol. Some studies have even found that the incidence is as high as 20% of bariatric surgery patients. The second concern is that alcohol affects our altered biology differently. Honestly this is worse for gastric bypass patients, but sleeve patients still have have issues with getting drunk much faster, on much less alcohol. Further, it can take a lot longer to metabolize the alcohol you do consume, meaning you'll stay drunk longer. Bottom line, it's really easy to overdo things and end up completely drunk on a lot less booze than before. There is also the concern that this is wasted calories that provide no nutritional benefit and can slow your weight loss. Obviously for those in maintenance, this doesn't really matter, but for those still losing, it might be a concern for some.

If I were you I would consider trying the nutritionist and bariatric therapist first. Those two things are often a huge part of why the surgery is successful and they very well could just be enough to get you there without surgery. I understand that you have tried everything and can’t lose and I get it that you need to do something. I was lower BMI as well (35). But, I had the sleeve a year and a half ago and I still didn’t get to my dream weight. This surgery is a great option for many people but it is still major surgery. Post surgery you cannot take NSAIDS for pain and you may struggle with constipation plus have to take vitamins all for the rest of your life. These are all things that you can live with and of course if you still can’t lose the weight they may be things you have to live with but I wish someone had told me to give it one last try with the nutritionist and therapy before I committed to all this. I may still be exactly where I am by now but at least I wouldn’t have to wonder if I could’ve done it on my own. Having said that, ask your doctors of course because you do have medical issues that I did not have and maybe losing the weight asap is really important and the surgery is definitely a faster way to lose it. Also, IF your insurance will cover you can kill two birds with one stone if you get the process started while trying to lose. For many insurance companies you have to do 6 months of physician managed weight loss attempt anyways so you can do all that while you see if the nutritionist can help and maybe even talk to a bariatric therapist to see if you have any disordered eating behaviors that they can help you with. In terms of getting the surgery if that’s what you choose you may have to wait until you get to a BMI of 30 to qualify, BUT. If you haven’t been measured in a while your height may be shorter than you think because we shrink as we age and your BMI will be higher than you think. (BMI goes up almost an entire point just because of one inch). Also, I would still call around because I believe anything under 35 you will have to be self pay so maybe with your medical issues they would consider doing it just under 30. I’m pretty sure it’s up to the doctor.

For clarity, the 65 pounds lost is from when I started working with the bariatric program. I actually lost about 50 of that pre-op. I'm only 1 month post op at this time and lost 16 pounds in month one. I'll definitely keep everyone updated. I suspect as I get closer to goal both of these images will still be there, but hopefully the "fat me" one will fade over time!

First of all, congratulations. In terms of your thread title, I would suggest that you feel like you're all over the place because you essentially are! This procedure is significant, and it results in significant changes to our bodies. I know that I felt very similar in the first weeks post-op. It is excellent that you're getting your fluids. Lots of people struggle with this at first (I did my first few days) and it sounds like you're keeping up. Likewise regarding your pain and moving around. These all sound like you're doing pretty darn good. Like you, I little-to-no taste or desire for sweet things post-op. In fact, I wanted more savory things, and they sat better. I drank a lot of broth in the first few days post-op. I finally settled on the Premier Protein Cafe Latte flavor (yes, it does have caffeine, and some providers/programs don't allow that, but it was the only one I could choke-down at first). To me, it seemed to be the least sweet of all the other ones I tasted. The program I am in has a reduced protein goal for the first month post-op, so it is a little easier to get close, but they told me to focus on the fluid first, protein second, doing the best you could. When I started taking the bariatric vitamins, my nutritionist recommended the Bariatric Fusion chewable ones. They made me sick the first day I took them. Day two of them was no better - epic nausea - so I stopped. I checked in with nutrition, and they suggested Bariatric Fusion one-a-day capsules. I started taking them at about the 3 week mark and they sat/sit fine. You may want to check with your provider to see if that is an okay choice for you. As time went on, I was able to tolerate different flavors of the Premier Protein without issue. As an example, I start the morning with a serving of the Chocolate powder mixed in 8 ounces of unsweetened almond milk. The almond milk seems to reduce the overall sweetness, at least to me.

I bought some great bariatric cook books that have meal plans for each phase. They at least help get the creative juices flowing when I’m feeling bored with what I’m eating or drinking:) Two of my favorites are Bariatric Meal Prep made easy by Kristin Willard and the Complete Bariatric Cookbook and Meal Plan by Megan Moore. Also I have found following Bariatric dieticians on social media as well as people in the WLS community often have great ideas! These are just what seems to work for me:) best of luck!

There's actually a whole host of things they look at, but I think it can be summed up by saying they are evaluating if you are ready for bariatric surgery. They look to see if you have a history or tendency toward addictive behavior, if you are a suicide risk, if they think you will be able to be compliant with your program, if you actually mentally understand what's being proposed and why, if you have any other mental disorders that might cause issues, etc.

Exactly this. There are unfortunately no standards at all when it comes to pre and post bariatric surgery diets. I found this incredibly frustrating early on as it makes it seem like it's not science, but guess work. On reflection, I suspect it has more to do with how long a particular program has been doing bariatric surgery and the experiences of their patients over that time. Most teams probably only update their plans rarely. Some may still be clinging to recommendations that were more common a long time ago. Also, some doctors are just more conservative than others. Anyway, whatever the reason, every bariatric program is free to design their own plans. Some are very strict, and some not so much. When I asked my team about this, I was specifically told to ignore what other programs were doing. They designed their plan around the outcomes that work for them. In terms of conflicting advice between your written plan and what you were told, I agree it's best to ask. I had this happen a few times, but I always asked about it and was given a reason why they wanted me to deviate. For example, at my 2 week post-op visit, I was told I could progress faster than the written plan. This was specifically done for me because I was healing well and had no nausea.

Bariatric surgery is a major step, so I don't blame you for being scared. I just wanted to reach out and validate your feelings. I was scared, too, which is why I chose a non-surgical option (Endoscopic Sleeve Gastroplasty). It is not yet covered by insurance so it is not as popular, but in my experience thus far and per the medical literature it is safe & effective. Maybe ESG is something to keep in mind for later, if you still need a "tool" in the form of a sleeve. But I would wait until your weight stabilizes after the meds, exercise, and new healthy eating habits are established. FWIW, I do not think your PCP is fat phobic. Obesity is a serious health risk, the older and the bigger you get. No one sees this more than a diligent PCP. Mine is 100% in favor of my new tool because she is the one who has been prescribing all my meds for hypertension and pre-diabetes, referring me to specialists, etc. I am just glad you went to see an endocrinologist and found a medical reason for your obesity. In case no one else has said it lately, great job!! Even with new meds, losing that much weight is an accomplishment. I agree with the other suggestions here re: strength training and all. Best wishes to you.

I know Prescot well! I used to live in Manchester and did a lot of work with an arts organisation in Preston. It’s possible to get bariatric surgery on the NHS, but the waiting list is years long. So I’ve gone private! My surgeon recommended the RNY as the sleeve can make reflux worse, and that’s something I already struggle with. Surgery is on Monday 😅

I also take the bariatric pal brand, but berry flavor and they are delicious!

Hello, I had found out about my HH during my WLS pre-op process. They saw it in the scope. I had severe GERD for YEARS and never heard of a HH (on 2 prescriptions plus TUMS), my doctor never even looked into WHY I may have acid reflux so bad. I didn't even know it was a thing, he did say my weight doesn't help it though. Anyway, long story short. Major damage to my esophagus and a huge HH. My bariatric surgeon fixed everything during my WLS. I had bypass, I have ZERO regrets and only wish I had done it sooner. My GERD is completely cured, off all GERD medications and have eaten just about everything I would have before surgery as far as "trigger foods". Otherwise I only had slightly high blood pressure and now it is always low, sometimes even too low. So again, ZERO REGRETS! Good luck on your journey!

it's hard to say. I would lose weight on 1500 calories (albeit slowly), but some people would gain. I've been in maintenance for several years (and have been hanging out on bariatric boards for about eight years). I know people who can maintain on 2000 calories, and others who can only eat 1200. You can always experiment with different calorie ranges and see at what point you lose, at what point you maintain, and at what point you start gaining. That's really the only way to do it other than the RMR test that someone above mentioned. at any rate, 1500 calories isn't that much. Some people do gain on that, but then, you're pretty tall so I'm guessing you'd either maintain or lose on that much. also, the closer you get to a normal BMI, the slower weight loss becomes. That's just a fact. 1200 calories is super low, unless you're short or have an incredibly low metabolism. Most people can't really sustain that forever. Personally, I'd give up the ghost on that one. As I said, even 1500 is pretty low for most people....sustainable, but low. I wouldn't worry about it unless you're gaining on that. for the record, I can maintain on 1500-1700 calories. If I'm doing some heavy exercise, I can go up to 1800 or so - maybe even higher.