Who is a "good" candidate vs. a "bad" candidate for surgery?

[InfiniteButterfly 438]

bikrchk--On the note of nutrition, has anyone found (post op especially) V-8 drinks helpful? Noticing that I don't tend to get a lot of vegetables normally, I have tried to drink one or two of these a day (and have my daughter do the same) to get some valuable nutrients. I would think, being liquid, that these might also be easily consumed post surgery.

this would be one to ask your NUT. There's little to no Protein in V8, so I don't think it would necessarily be appropriate at the start. After that? I don't know. It's not one of the foods/beverages listed on any of my paperwork ASIDE from the pre-surgery liquid diet (I was allowed 1 cup per day) It would definitely not be appropriate during the clear liquid phase, and I know my stomach couldn't have handled it during full liquids either

[InfiniteButterfly 438]

@Nothingupmysleeve:

Honestly I don't know how this misunderstanding occurred. Either he doesn't want me to get the surgery for personal reasons, or he didn't listen to me, or he doesn't think I'm telling the truth. I normally get along well with this guy, but he wrote the following things in the psych letter that aren't favorable to approval:

“She showed up to the interview drinking a Starbucks non fat iced mocha with cream”

(I do this occasionally, and this was one of those days. And it wasn't cream, it was light whipped cream, but whatever)

“She drinks iced tea and sees nothing wrong with this”

(I told him I drink unsweetened iced tea as much as possible, it helps me hydrate and get my Water intake. I don't know why he missed the unsweetened part)

“This provider is concerned she may not have sufficient understanding of good nutrition and meal planning to help her maintain a lower weight after surgery”

“…..this will be a very difficult adjustment for her”

“….she has only recently made some changes necessary for success after the surgery”

(Not sure why he put down these things. I have told him that I've been on some kind of diet and exercise for many years, the most recently being Weight Watchers from 2012 to now; I studied nutrition, bought special foods and logged everything. I lost 30 lbs. with great struggle but due to hunger and busy schedule gained it all back. The way he writes it's like I've never tried anything.)

The Starbucks is something you would not be able to have post-surgery. Definitely not immediately, and with the amount of sugar in even the non-fat varieties, it's definitely a very, very occasional treat (if even that. I used to LOVE non-fat, no-whip green tea frappucinos pre-surgery. I took one look at the sugars post-surgery and said goodbye forever)

The iced tea, I would assume is more down to the caffeine than the sweetened/unsweetened part. Some doctors are very, very picky about caffeine consumption (I was very lucky that mine is an "as tolerated", but he still wants me drinking no more than a cup of coffee worth in a day at the present).

But these are things that a nutritionist would go over with you during your WLS journey, and the bariatric team during your weigh-ins. I thought I knew a lot about nutrition and weight loss too...before I started learning that the post-WLS mindset isn't the same as following a diet. It's a full-out lifestyle change.

If you feel the assessment to be unfair, the by all means seek a second opinion (your WLS office should have psychiatrists that they work with. I know my office has one person they use in particular, who deals exclusively with WLS patients both pre and post-surgery. I know I've continued seeing her and a lot of the other patients opt to as well. She's as useful of a tool as the WLS itself )

And honestly, if your goal post-surgery is to follow Weight Watchers? I don't know that it's nutritionally sound for a bariatric patient. You would need to discuss that with a nutrition counselor (I know from when I tried Weight Watchers that there was a helluva lot of food that I couldn't possibly eat post-surgery or likely ever)

[moonlitestarbrite 902]

these are all good questions for your nutritionist.

as for Protein, for an adult, 2 things are important... lots of Water and dont go over 100 grams a day.

i think the psych was likely right, but since you havent done your nutritional counseling, how are you supposed to know? go get your nutritional counseling and then another psych eval. i think you might have put the cart before the horse.

[Skywalker 170]

@InfiniteButterfly:

The Starbucks is something you would not be able to have post-surgery. Definitely not immediately, and with the amount of sugar in even the non-fat varieties, it's definitely a very, very occasional treat (if even that. I used to LOVE non-fat, no-whip green tea frappucinos pre-surgery. I took one look at the sugars post-surgery and said goodbye forever)

When you say you don't have Starbucks, etc. anymore, is that because you just don't want it, or is it forbidden for some reason? I've read conflicting things on the sleeve/WLS, but I'm learning all I can. Some people discuss head hunger, while others state that it biologically altered what they actually can eat and/or crave from that point on.

And honestly, if your goal post-surgery is to follow Weight Watchers? I don't know that it's nutritionally sound for a bariatric patient. You would need to discuss that with a nutrition counselor (I know from when I tried Weight Watchers that there was a helluva lot of food that I couldn't possibly eat post-surgery or likely ever)

I'm not really sure what the "right" answer is for a psych consult, all I can say is that I'm not a lazy WLS candidate. I've done a lot of things in my life, up to and including being an athlete, and I've never been non-compliant with medical advice. I don't, by any means, plan to eat small amounts of unhealthy foods until my stomach expands to its original size, because I've seen WLS people do that and think it's such a waste. I want to get thin again and stay healthy.

@Moonlitestarbright:

since you havent done your nutritional counseling, how are you supposed to know? go get your nutritional counseling and then another psych eval. i think you might have put the cart before the horse.

Right....how would I know? I'm not non-compliant and I'm not post op (yet); I'll follow whatever diet plan the doctor deems appropriate, because I want to heal and look good and keep it off for the rest of my life. Perhaps you were right that I put the cart before the horse. I don't believe I'm a bad candidate for surgery, because I've molded my diet to a lot of different things before and adhered to them (Weight Watchers, South Beach, etc.). The hunger, at least on Weight Watchers, is what is currently getting me to surpass the points I'm allotted, so I thought stomach reduction and getting the hunger hormone cut out would be especially helpful.

Edited June 18, 2014 by Skywalker

[gomekast 559]

these are all good questions for your nutritionist.

as for Protein, for an adult, 2 things are important... lots of Water and dont go over 100 grams a day.

Don't go over 100 grams of Protein a day?! Many programs have their patients hit goals over 100g per day. That's not something anyone here should be advising anyone else on. Only a Dr/dietician/bariatric nurse should be handing out that sort of advice.

[InfiniteButterfly 438]

I honestly think a meeting with a nutrition counselor will be your best bet. For me, Starbucks is something I am choosing to not have going forward because it's a HUGE amount of sugar in a relatively small drink, and frankly, I have better uses for the small amount of calories I'm allowed. Maybe when I'm further out (I'm only 5 weeks post-op right now, so I have about 500 calories I'm working with daily, and I'm not going to put 200 calories and 21 g sugar from one drink into me) It's about making smart choices and the best decisions possible for my new lifestyle.

And yes, my tastes have changed dramatically. I couldn't eat a popsicle with 10g sugar in it (I tried a lick when I ran out of SF, and even though 10g sugar is a low amount, the sweet was overwhelmingly horrid)

I'm not saying that I won't someday in the future decide I can't live without a non-fat no whip unsweetened green tea frappucino...but it would be an extremely rare treat.

Honestly, I was never asked what my diet plans were at my psych evaluation. We talked more about why the surgery was important to me and what I hoped to accomplish with it (and my answers were mostly health-based, because I have co-morbidities, I've spent my entire life overweight and I want to be healthy.)

But you won't necessarily know a lot of these things until you begin with your bariatric team and attend NUT counseling. I had one solo meeting (prior to ever talking to my psych) and two group sessions to discuss food plans for post-surgery.

[Pookeyism 1,143]

I know that the surgery will shrink your stomach size, and not do anything to one's metabolism or mind.

Did you mean to ord this sentence this way? This might be what the doctor is talking about - the weight loss surgery will change EVERYTHING, more or less.

The surgery is often found to be a culprit of affecting your metabolism, although there is increasing evidence this doe not have to be the case. It WILL affect your mind, in so many ways it is difficult to even give a good list, things I can think of off the top:

You will no longer be able to have food be your support system.

food can no longer dictate a social life.

You will have to resolve or at least come to peace with your old body image.

You will have to be mindful of possible transfer addictions, now that you cannot eat all you used to, or what you used to.

You have to be prepared for when the "honeymoon" period is over, and the smaller you is not so novel.

You will create reactions that are not always positive, or perhaps are very positive but far from how you used to be treated.

You have to forgive yourself for where you were before you lost the weight.

Talk to your doc, ask for insight to what was said, and ask for assistance in resolving the situation. Good luck.

PS - I can provide suggestions for reading that go in depth to about the WLS journey.

Edited June 18, 2014 by Pookeyism

[Fluffnomore 1,235]

I can only tell you my experience, and my husband's with our psych/readiness evals. I was approved initially; he was not.

I believe that he went in with the attitude that he just needs a smaller stomach and the rest will fall into place. In addition, he was very honest and up-front about some of his less helpful behaviors (night eating, etc.) and it was a red flag to them.

I was able to go in and say honestly that I was exercising and that I had a strong grasp of what the post-op eating requirements were. That I saw it as a tool but not the answer. I was approved immediately. I have another friend who has similar issues to my husband's but didn't tell them everything. She was approved.

I can see that walking in with a mocha (light cream or not) would probably be like waving a red flag, because of the sugar content. I get that this might not be an every day thing for you, but if the main point of the appointment was to get you approved, then this is on par with walking in and eating an ice cream. Not fair, but it is about 30 grams of sugar in one drink. There's actually only about half that amount of sugar in a serving of vanilla ice cream. Would you know this? No, of course not. But if you look at it through that lens, then you've inadvertently allowed him to form an impression of your readiness.

We're NOT all ready for the surgery when the surgery hits, else we wouldn't have any posts about how hard the pre- and post-op diets are. And I am certainly not saying that you can't or won't be successful. But I do think that if you can pull in someone else to write this evaluation and do your homework ahead of time, you won't have as much to worry about. The good news is that I doubt anyone will submit your chart to insurance with that letter included. So there's that.

[BigGirlPanties 957]

@Skywalker I think you've heard "plenty"...I just want to say that going to the psych that your surgeon recommends would probably be the best thing for you...

As far as Premier Protein... that is the Protein that you can possibly, get for free from InsureNutrition.com...so many of us use it... they also may provide you with free Vitamins and a wonderful scar cream

When you are on this program of eating, you don't need any other...so you won't need Weight Watchers, etc...the surgeon should be giving you a list of items you can and cannot have and you take it from there.

recipes are EVERYWHERE for Bariatics...cookbooks, websites (like this one) and the blog that most of us love for recipes is The World According to Eggface...

Good luck...I'm sure it will turn around soon

[CowgirlJane 14,259]

My opinion the factors that make someone a "poor candidate" for WLS are things like:

-unwillingness to listen and adopt surgeon/NUT eating plan, including the liquid, soft foods etc transition

-know it all attitude - like I don't need to drink no stinking Protein drinks. My cousins ex wife's boyfriend lost weight just fine without it... so what do these "so called" experts know anyway?

-over dependance on food for emotional comfort and reasons and lack of willingness to get help to face and work toward changes

-lack of willingness to break away from unhealthy habits suck as soda, eating too fast, eating junky/carby food etc. I have seen on these forums a number of people who really don't accept this major shift.

-mental health issues so severe that a person won't be able to handle the emotional rollercoaster that can happen post op/massive weight loss

-secret thoughts (or maybe not so secret) that this is just another diet with a beginning and an end. No, it is not a diet, it is a complete change to your body and should come with a significant lifestyle change. If you don't buy into that early, your chances of successful maintenance aren't so hot.

-unrealistic expectations like how you will look, or how thin you will be, how long it will take or whatever. The goal should be weight loss to get you in the ballpark of a healthy weight. We are all individuals and if you think you are guaranteed to look like a super model after 6 months... well... you are in for a surprise

I personally think that it is the job of the surgeon and NUT to teach you how to get enough Protein in for example, it is YOUR job to do your very best to comply. Protein Drinks aren't my favorite food either BUT my life is alot better having them daily and not ice cream.

That psych eval missed the point, in my opinion. It isn't about you being educated on how to eat post op, it is about you being really really ready to make the changes to be successful, with their guidance and with the tool of the WLS to help you.

[BeagleLover 1,020]

The person that did the report *may* have just seen the Starbucks drink, made his mind up, didn't want to bother listening and had a report to write. Did you decide whether or not you are going to get another psych report?

[Skywalker 170]

Did you mean to ord this sentence this way? This might be what the doctor is talking about - the weight loss surgery will change EVERYTHING, more or less.

Yes, I believe I did, but I think there may have been more than one way to read that. The way I meant it was--getting this surgery will not take away anyone's eating disorder. This is what I have studied and been told by people who got WLS. Whatever was going on in their mind prior to the surgery--they still have to work on that. Do you disagree with this?

Yes if you have reading suggestions I'll take them, thanks.

Edited June 19, 2014 by Skywalker

[Skywalker 170]

I was able to go in and say honestly that I was exercising and that I had a strong grasp of what the post-op eating requirements were. That I saw it as a tool but not the answer. I was approved immediately. I have another friend who has similar issues to my husband's but didn't tell them everything. She was approved.

I can see that walking in with a mocha (light cream or not) would probably be like waving a red flag, because of the sugar content. I get that this might not be an every day thing for you, but if the main point of the appointment was to get you approved, then this is on par with walking in and eating an ice cream. Not fair, but it is about 30 grams of sugar in one drink. There's actually only about half that amount of sugar in a serving of vanilla ice cream. Would you know this? No, of course not. But if you look at it through that lens, then you've inadvertently allowed him to form an impression of your readiness.

We're NOT all ready for the surgery when the surgery hits, else we wouldn't have any posts about how hard the pre- and post-op diets are. And I am certainly not saying that you can't or won't be successful. But I do think that if you can pull in someone else to write this evaluation and do your homework ahead of time, you won't have as much to worry about. The good news is that I doubt anyone will submit your chart to insurance with that letter included. So there's that.

All really good advice, thanks. The Starbucks wasn't a daily thing, and it was an honest mistake, because I don't have it a lot, but I see now why I definitely shouldn't have brought it in with me--in a way, I was "performing" for him to achieve a desired result, and I didn't really pass the test. In fact, I'm pre-op now, and I can't think of the last time I had a Starbucks. I came to the conclusion (without dieting) in the last couple months that I would rather grab an Egg McMuffin on the way to work because it fills me up and the protein/heat makes me feel better than the morning Starbucks sweetness, which makes me hungry about an hour later.

The weird thing now is, I submitted this letter to my bariatric surgeon's office, and even though I thought the psych eval was a tepid piece of crap, she thinks it's just fine. She said she's never seen a patient get denied with a "guarded" rating for a psych eval. Regardless, I pushed her for the list her office has of psychiatrists, and think I'm going to follow that route. The insurance approval that's at stake is worth $17,000, so I don't want to give them any excuse to deny.

[Skywalker 170]

@CowgirlJane: All very good points, and I like the scenarios you ran through for people with the wrong mindsets. There are a couple people I used to work with, and they both had bariatric surgery. One is still keeping the weight off, and the other isn't. I had lunch with the successful one (she'd banded) the other month to pick her brain and see what it is all about. She says she still has some demons and daily choices to make, but overall she's so much better and healthier. FYI she looks great in pictures, too. The other lady, who appears to me to be really heavy, apparently did the whole thing where she ate whatever she wanted and went back to her original size.

[Skywalker 170]

The person that did the report *may* have just seen the Starbucks drink, made his mind up, didn't want to bother listening and had a report to write. Did you decide whether or not you are going to get another psych report?

Possibly. I'm not trying to start a shitstorm here (so apologies in advance to any religious people), but the counselor I saw is Mormon, and they inherently disapprove of alcohol and caffeine anyway. In addition to this, one of his relatives had the surgery and gained all of the weight back because she kept eating crap. So I don't know if any of this played a role in his negative review.

I'm a disabled veteran, and he also mentioned in the psych report that I had a rating for major depressive disorder, and I kind of don't like that being out there that way. Not that it's anything to be ashamed of, exactly, but it is my personal business and really doesn't keep me from being productive and living life (I still go to work and work hard, and I still have a 3.8 GPA at college). The irony here is that my massive weight is a large part of my self esteem issues and contributes to any unhappiness I have in a major way, so denying me the surgery wouldn't be doing my health any favors.