Questions/concerns about the lifetime commitment...

[livvsmum 2,369]

I have to say that the fact that you've already committed to seeing a therapist for your food issues speaks volumes about your commitment to success. I started seeing a therapist at about 7 months post op and SO wish I would have sooner. It has made all the difference for me. The therapy is the one piece of this whole process that I think is overlooked, left out, or not stressed enough by many surgeon's programs. Sure, we all go for the "psych" eval, but let's be honest, that does not address any of the big-picture issues.

To speak to your concern on always watching, counting, planning, etc. You are right on both accounts. IF you stick to the program, it will cause you to think about your eating a lot. In a lot of cases, that's not a bad thing. I tracked everything religiously on myfitness pal for the first 2 years and I learned a ton by doing that. I also don't think I would have been as successful if I hadn't done that because it's so easy to lose track of carbs or calories if you're not watching.

But you're also correct that it can trigger eating disordered obsessive thoughts and pre-occupation with restricting food if that is something that you struggle with. For me, my eating disorder went from binge eating (pre surgery) to swinging the total opposite direction with extreme restriction (post-surgery). That is when I sought out therapy because it was scary.

I will say though, that yes, absolutely if you want to be successful count every gram of Protein, carbs, etc during that "actively losing" window. But after that, eat what is good for your body. You can ease up on the tracking a bit and follow the "general" guidelines of Protein first, veggies second, fruits for treat, very few carbs that process as sugar. Once you reach and maintain your goal, you're able to relax a bit, as long as you aren't relaxing by falling back into your own bad habits of the past.

You will navigate the journey for yourself and you will do what you need to do to be successful. Basically, you adjust to a new normal.

[Christinamo7 4,042]

Every bad habit we have is somehow serving us. we have to figure out how in order to end it. so, I did a lot of therapy work about 5 -6 years ago dealing with my over-eating issues. I thought. there - that's me sorted! now I can loose weight and keep it off.

not so much. I have never had a re-occurrence of the kind of food issues I had before (eating a whole small chocolate cake in a weekend - hiding it from the kids? can anyone relate?) however I spent the past years loosing and regaining the same 30 pounds. Thankfully the highest at 6 years ago, never got quite that high again.

Still. I don't think I would have a chance in hell of loosing significant weight and keeping it off without this tool. when I developed diabetes that was it for me. I am not going to spend the rest of my life battling that disease.

You have to have a real honest look at yourself and see what you think.

[kbVA 5]

This has been a very helpful thread! My mind is obsessed right now with all the unknowns and questions. I've just had my first initial consultation but I've been contemplating this for a long time. I think I've moved past my hang-ups of what eating will "look like" in the future - fear of being on this tiny, restrictive diet for eternity. I'm learning that the initial phases will be stricter and that in the losing stage I'll likely be strict with myself, but once I get to a weight I think I can maintain, life will feel more normal. Not normal as in "eat whatever the heck I want" again, but able to better control portions and control myself around certain foods. THAT is what I long for - a normal, healthy relationship with food. I'm hoping this will reset me back to a weight I was long, long ago so I can reset formally much better habits that I used to have and a body that will hopefully help me to do that instead of fighting against me all the dang time.

Now, for my next hang up - SURGERY. Why does the above that I mentioned^^^ involve cutting an organ up and having to operated on??? I've never had any operations (other than wisdom teeth:) and I'm freaking the freak out over what feels like a drastic step. I've looked into this fairly brand new procedure - endoscopic sleeve gastroplasty - where they mimic the sleeve and the effects last roughly a year, but it's non-permeant. I'm heavily swayed to the at idea, however it's entirely self pay and it's a LOT. Like around $15,000. It's still in the early stages of this method and if it was a whole lot less I'd probably be doing it to avoid my fear of the surgeon's knife and its permanence. I KNOW it's all laparoscopic and that I should think it's no big deal, but I can't get over that I do think it's a big deal. Despite my high weight, I have no comorbidities, I'm quite healthy (admittedly, that may not always last). If I had some health problems related to my weight, I'd be saying "get me under that knife - now!" but my latest hang ups revolve around getting 80% of a perfectly good organ removed just because I like all food (the good and the bad) way too much. Sigh. I'm a mess!

[Talaria 50]

Totally hear you--I'm 8 days post-op. About 5 days ago I woke up with some "buyer's remorse" and eventually just realized that either way, I'm not going to have "normal" eating habits. They can slowly kill me, or they can help me feel better and healthier. 8 days out, I'm glad I can say I chose the surgery.

Btw--this is one of the best posts I've read on here.

Sent from my iPhone using the BariatricPal App

Edited April 19, 2016 by Talaria

[theantichick 2,204]

First, thank you all so much for the support and feedback! When I stopped to re-read it before I hit post, I was concerned that it was going to be perceived as surgery bashing and I'd get a ton of negative feedback. But this is really my main concern, the ongoing changes to my life, and what my life will look like 10 years from now.

I'm a nurse, and underwent a massive knee reconstruction in 2008 which involved 4 months direct physical therapy and another 14 months rehab on my own at the gym. So I know the things to check on a physician, how to choose a physician, what kinds of complications are possible and what can be done to prevent some of them (not all, unfortunately, but life is a risk). The surgery itself and the post-op recovery don't scare me at all. The pre-op diet scares me more, because I know myself and that I'll really struggle through that part.

I also know that losing the weight is not optional for me at this point. I have 155 lbs of "excess body weight" by the official surgeon's calculation. The weight I ideally want to lose is actually about 125 lbs. I have sleep apnea and an auto-immune arthritis (psoriatic), as well as high cholesterol and borderline high blood pressure. My rheumatologist says the surgery would immediately change some of the hormone production that directly drives the inflammation with the psoriatic arthritis. Not that it will cure it, but it can definitely help the meds work better. I am so out of shape that only a few minutes of walking tops out my training heart rate. My therapist is trying to get me to embrace the "health at every size" concept, but I am not healthy. Nowhere close. While I'd love to be able to shop in "normal" clothes stores, the aesthetics are really not that concerning for me. I want to be healthy again, period. I want to go dancing and get back in a belly dance troupe and be able to do anything I want to (within the limits of the auto immune condition).

I also know that losing weight, whether with or without surgery, demands permanent lifestyle changes. Hence the work with the therapist.

I've been on diets off and on for over 30 years. Obviously that hasn't worked. The best I've ever been able to maintain was a 35 lb loss for about 2 years. (I only had about 45 to lose at that point). Which was great, I don't want to belittle it. But bottom line, it wasn't long term. I gained it back, plus another 100. I just want to make the best decision, and timing matters now because of the treatment plan for the auto-immune. If I were looking at this clinically on behalf of a patient, I'd recommend the surgery. My head's there. I just know how important of a decision it is, and need to know it in my gut as well.

Edited April 19, 2016 by theantichick

[VSGAnn2014 12,992]

I can tell you what my experience has been on the fronts you're concerned about.

FYI, I'm 20 months post-op, have lost 100 pounds, am maintaining at 135 pounds and currently averaging 1,800 calories/day and around 90-100 grams of Protein. I try to eat at least 5 healthy veggies / fruits a day. I prefer whole grains to processed ones. I drink a glass of wine OR scotch most days. In other words, if someone else were watching my daily menus I bet they would think I "eat normally" and probably "eat healthy."

Second, it seems like this imposes an unnatural relationship with food, forever. I mean, forever having to think about every bite, x many bites of Protein, x many bites of veggies, x many bites of carbs (if there's room)... in people who haven't had gastric surgery, this would be symptomatic of an eating disorder.

Uh -- that's not how I eat 20 months post-op. Yes, I spent the first 6-8-10 months being very disciplined about what I ate, when I ate, how I ate. And in doing so I built some new habits. And, badda boom! Now they're habits. I don't count bites or chews or anything like that now.

By working hard to build those new habits, I learned how to eat much more slowly, how to chew my food much better, how to recognize what satiety feels like, how to know when I'm approaching "too full" and to stop before I get there. Trust me, I had some awful bad habits pre-op. I bet you do, too. We can't change those bad habits without some serious attention to our behavior.

It's not persuasive to say to you, "Trust me, I don't have an eating disorder." But I don't have an eating disorder. What I have is a new lifestyle. I feel very relaxed in this new lifestyle. There's no anxiety about eating. There's no fear, anger, or other upsetting emotions about food. Isn't that what you want?

I mean, my current relationship with food isn't healthy (hence the therapist). But in trying to reach a balance and healthy place relating to food, do I want to permanently change my body in a way that requires unnatural eating to the other extreme?

Y'know -- on the front end it does sound *extreme* to remove 85% of your stomach. But on the back end where I am now, it just all feels normal. I just spent a week hanging with some good friends of mine -- all normal-sized and athletic people my own age. We were both eating at home and eating out, too. Some serious partying occurred, as well. What I notice in those settings is that, nearly two years post-op, I am now living the same kind of eating / exercise life they've been living for a long time. They watch what they eat. Read that again: They watch what they eat. Their watching is not obsessive, but it's attentive. I think there's a range of behaviors between obsessive and attentive, and it's intellectually lazy to equate the two end poles of that range. So don't do that.

I've read the studies about how losing a lot of weight through diet and exercise doesn't last long-term in the vast majority of cases. My reading of these studies indicates that it's because in order to maintain that weight loss, people have to spend large amounts of time and energy planning and preparing their food and exercise plans, and it's just too much to maintain long-term. It has to become the number 1 priority in their lives, and that's hard to maintain. It seems that the surgery imposes that same thing, the primary benefit seems to be that the cravings are substantially lowered for most.

Actually, the barrier to my maintaining past weight losses wasn't the planning -- it was that my plans were so often blown out of the Water because I'd never built any new eating habits beyond the "diet to lose weight" phase.

After you lose all your excess weight, after a year or so you can eat so much more than you could right after surgery. The first week after surgery I averaged probably 500 calories/day, all of it liquid. But over the last 20 months I have gone carefully from phase to phase to phase. I didn't go from Dieting one day to Struggling Not to Gain Weight the next day. (How I did all that is a big subject, and one I won't go into here, but it wouldn't surprise you how I did it.)

Yesterday, I ate 3 meals and 2 Snacks -- all real food. I do record most days my menus on My Fitness Pal (it takes me all of 5 minutes -- I'm a data hound). Yesterday I ate 1,805 calories, 103 grams of protein, 189 grams of carbs, 67 grams of fat, 23 grams of insoluble Fiber. Girl, that's how a real person who's eating healthy and maintaining her weight eats!

Oh, and yesterday morning I went for a hike up a small mountain with my sister and late yesterday afternoon I spread 20 bags of mulch in some flower beds. And I went shopping. I wasn't wearing my pedometer all the time, so don't know how many steps I got, but it was at least 10,000 I'm sure.

Am I obsessive? Or am I attentive? You decide. You can also read this post to your therapist and see what she thinks.

Last thought: You should not do this surgery unless and until you are really comfortable that it's the right choice for you. Don't let anyone here talk you into it, including me.

[KristenLe 5,979]

@@kbVA I wish I did the surgery before I started to have health complications due to being obese. That wasn't very long ago - it seems that all of a sudden - I have hypertension, hypothyroidism, sleep apnea, high triglycerides, multi-level disc deneneration (basically my neck and spine are a mess), asthma, joint pain and I'm sure before to long would have diabetes too. I eat fairly healthy (most of the time) - I just eat far too much in quantity. My weight has climbed to 289lbs and I realize I can't do this without WLS. I don't think a "temporary" surgery would help (me anyway) - I've tried temporary fixes in the form of diet pills (fen phen, meredia, xynecal) and diet programs (nutrisystem) and I just gained the weight back. I don't expect to lose all of my weight and maintain long enough not to fall back into my old habits within the one year the temporary surgery would last.

Whatever you decide - best of luck! We're hear to listen.

[theantichick 2,204]

FYI, I'm 20 months post-op, have lost 100 pounds, am maintaining at 135 pounds and currently averaging 1,800 calories/day and around 90-100 grams of Protein. I try to eat at least 5 healthy veggies / fruits a day. I prefer whole grains to processed ones. I drink a glass of wine OR scotch most days. In other words, if someone else were watching my daily menus I bet they would think I "eat normally" and probably "eat healthy."

Thank you, thank you, thank you. Too much excellence in your response to quote it all, but this is exactly the kind of thing I was hoping for. I have read so much about the post-op diet, and it feels like everyone is living post-op on some 600-800 calories and never eating carbs. That didn't seem realistic long-long-term, so I was hoping I was perceiving things a bit off.

I also love what you said about attentive vs. obsessive.

If it weren't for the hormone changes with the surgery, and what that means not only for cravings and overeating, but also the direct impact on my auto-immune condition, I don't think I'd want to do the surgery. I want to get to a place exactly like you describe... a normal healthy diet where I don't have to obsess about food and exercise, but eat mostly right and go and do the things I want to do.

[VSGAnn2014 12,992]

@@theantichick ...

You're so welcome.

You are such a smart person. Unless you already have some rough eating disorder like binge eating that has you by the throat and that you're trying to overcome (I don't suffer from that malady), I bet you could reason and practice and learn how to move permanently from unhealthy eating to attentive, controlled, mindful eating.

Another thing I've found to be true about the WLS experience is that it has become such a workable path -- a *yoga* if you will -- to move into much more mindful living in all areas of my life. As a long-time obese, high-achieving person, for decades and decades I'd put everyone else's needs ahead of mine. BTW, that is how you get straight As in many areas of life -- career, popularity, reputation. After all, if you drop everything to help others out when they need help, bosses do promote you and people do like you.

But living life that way (and enjoying the external reinforcement for being "nice") reinforces that everyone else's needs take a higher priority than our own. And, believe me, when you're that nice everyone knows your phone number!

Anyway, I'll shut up. This is your thread, not mine. I think you should drag up every objection you can think of against WLS to figure out whether it's YOUR best path. And I will also add that not everyone feels as positively about WLS as I do. Some people have NOT found it to be the grand solution they were hoping for.

[IncredibleShrinkingMan 437]

A lot of the language can seem very daunting, but 9 months out, let me tell you that my feelings are nothing but positive and I do not believe my life or my relationship with food is restricted or, as you say, "unnatural," in any way. No, I can't get the weekday large pizza special at Domino's and expect to get through much of it...any more than two slices in an hour, unless there were people with me. Yes, I barely know the word "appetizers" any more. And no, I don't consider Thanksgiving a competitive sport any longer. I'm fine with all of that. My brain had tricked me into thinking these were worthwhile endeavors, but I no longer think so, and I credit the sleeve to eradicating those mental cancers from which I suffered. That really does change forever. But at the same time, there isn't a food out there that I can't enjoy. 9 months out, I give very little thought to food, and I am settling into my desired general weight range, and hope to lose the rest in the next six months.

I think you also need to spend some time re-defining "natural" for yourself. What got us here in the first place wasn't the least bit natural. The food environment we live in hijacked our healthy brains and stomachs and made us think that huge heaps of fast food and refined carbs were the desirable norm. This is a return to normal, with some built in protections against a total backslide (which almost all of us presumably have experienced if we ever tried to lose weight "naturally" in the past). I feel like for the first time ever I have a very natural, amicable relationship with food, and one that gives us a fresh perspective on how horrible awry food and eating have gone in this country. Believe me, there are many societies on Earth today where a sleever would experience no restriction whatsoever...and that because that is the natural way of nourishing oneself.

[kbVA 5]

^{@@theantichick what you said: "I want to get to a place exactly like you describe... a normal healthy diet where I don't have to obsess about food and exercise, but eat mostly right and go and do the things I want to do." is also exactly what I'm looking for (and trying to push past these fears to achieve). I know and anticipate that I'll always have to be attentive towards my diet if I ever want to maintain any goals and not get back to this (250) again, but I'm hoping and assuming that with this surgery I can get the help to get a thinner body to do all that effort and work in.}

^{@@theantichick what you said: "I want to get to a place exactly like you describe... a normal healthy diet where I don't have to obsess about food and exercise, but eat mostly right and go and do the things I want to do." is also exactly what I'm looking for (and trying to push past these fears to achieve). I know and anticipate that I'll always have to be attentive towards my diet if I ever want to maintain any goals and not get back to this (250) again, but I'm hoping and assuming that with this surgery I can get the help to get a thinner body to do all that effort and work in.}

^{@@theantichick what you said: "I want to get to a place exactly like you describe... a normal healthy diet where I don't have to obsess about food and exercise, but eat mostly right and go and do the things I want to do." is also exactly what I'm looking for (and trying to push past these fears to achieve). I know and anticipate that I'll always have to be attentive towards my diet if I ever want to maintain any goals and not get back to this (250) again, but I'm hoping and assuming that with this surgery I can get the help to get a thinner body to do all that effort and work in.}

[OutsideMatchInside 10,166]

@@theantichick

Has your therapist had WLS? If not she doesn't have an idea what the lifetime commitment is.

Long term it isn't as dramatic as you think. You go through the stages in the beginning so you can learn to eat again. The surgery helps you with learning to eat again, by forcing you into basically being a baby learning over. If you actually follow your plan and do it right, you relearn to eat. You don't have to think about it, because it is a way of life.

@@VSGAnn2014 really hit it on the head. I am not as far out as her, only 9 months out, but I don't have to really think a lot about what I eat, it is a pretty natural thing because I have completely changed my attitude about food. Even when I go out to eat, it is easy to pick out what I can eat, because it is a natural thing.

[Babbs 14,681]

I can tell you what my experience has been on the fronts you're concerned about.

FYI, I'm 20 months post-op, have lost 100 pounds, am maintaining at 135 pounds and currently averaging 1,800 calories/day and around 90-100 grams of Protein. I try to eat at least 5 healthy veggies / fruits a day. I prefer whole grains to processed ones. I drink a glass of wine OR scotch most days. In other words, if someone else were watching my daily menus I bet they would think I "eat normally" and probably "eat healthy."

Second, it seems like this imposes an unnatural relationship with food, forever. I mean, forever having to think about every bite, x many bites of Protein, x many bites of veggies, x many bites of carbs (if there's room)... in people who haven't had gastric surgery, this would be symptomatic of an eating disorder.

Uh -- that's not how I eat 20 months post-op. Yes, I spent the first 6-8-10 months being very disciplined about what I ate, when I ate, how I ate. And in doing so I built some new habits. And, badda boom! Now they're habits. I don't count bites or chews or anything like that now.

By working hard to build those new habits, I learned how to eat much more slowly, how to chew my food much better, how to recognize what satiety feels like, how to know when I'm approaching "too full" and to stop before I get there. Trust me, I had some awful bad habits pre-op. I bet you do, too. We can't change those bad habits without some serious attention to our behavior.

It's not persuasive to say to you, "Trust me, I don't have an eating disorder." But I don't have an eating disorder. What I have is a new lifestyle. I feel very relaxed in this new lifestyle. There's no anxiety about eating. There's no fear, anger, or other upsetting emotions about food. Isn't that what you want?

>

I mean, my current relationship with food isn't healthy (hence the therapist). But in trying to reach a balance and healthy place relating to food, do I want to permanently change my body in a way that requires unnatural eating to the other extreme?

Y'know -- on the front end it does sound *extreme* to remove 85% of your stomach. But on the back end where I am now, it just all feels normal. I just spent a week hanging with some good friends of mine -- all normal-sized and athletic people my own age. We were both eating at home and eating out, too. Some serious partying occurred, as well. What I notice in those settings is that, nearly two years post-op, I am now living the same kind of eating / exercise life they've been living for a long time. They watch what they eat. Read that again: They watch what they eat. Their watching is not obsessive, but it's attentive. I think there's a range of behaviors between obsessive and attentive, and it's intellectually lazy to equate the two end poles of that range. So don't do that.

I've read the studies about how losing a lot of weight through diet and exercise doesn't last long-term in the vast majority of cases. My reading of these studies indicates that it's because in order to maintain that weight loss, people have to spend large amounts of time and energy planning and preparing their food and exercise plans, and it's just too much to maintain long-term. It has to become the number 1 priority in their lives, and that's hard to maintain. It seems that the surgery imposes that same thing, the primary benefit seems to be that the cravings are substantially lowered for most.

Actually, the barrier to my maintaining past weight losses wasn't the planning -- it was that my plans were so often blown out of the Water because I'd never built any new eating habits beyond the "diet to lose weight" phase.

After you lose all your excess weight, after a year or so you can eat so much more than you could right after surgery. The first week after surgery I averaged probably 500 calories/day, all of it liquid. But over the last 20 months I have gone carefully from phase to phase to phase. I didn't go from Dieting one day to Struggling Not to Gain Weight the next day. (How I did all that is a big subject, and one I won't go into here, but it wouldn't surprise you how I did it.)

Yesterday, I ate 3 meals and 2 Snacks -- all real food. I do record most days my menus on My Fitness Pal (it takes me all of 5 minutes -- I'm a data hound). Yesterday I ate 1,805 calories, 103 grams of protein, 189 grams of carbs, 67 grams of fat, 23 grams of insoluble Fiber. Girl, that's how a real person who's eating healthy and maintaining her weight eats!

Oh, and yesterday morning I went for a hike up a small mountain with my sister and late yesterday afternoon I spread 20 bags of mulch in some flower beds. And I went shopping. I wasn't wearing my pedometer all the time, so don't know how many steps I got, but it was at least 10,000 I'm sure.

Am I obsessive? Or am I attentive? You decide. You can also read this post to your therapist and see what she thinks.

Last thought: You should not do this surgery unless and until you are really comfortable that it's the right choice for you. Don't let anyone here talk you into it, including me.

@@VSGAnn2014

This post is damn near perfection

[Christinamo7 4,042]

I also know that losing the weight is not optional for me at this point. I have 155 lbs of "excess body weight" by the official surgeon's calculation. The weight I ideally want to lose is actually about 125 lbs. I have sleep apnea and an auto-immune arthritis (psoriatic), as well as high cholesterol and borderline high blood pressure. My rheumatologist says the surgery would immediately change some of the hormone production that directly drives the inflammation with the psoriatic arthritis. Not that it will cure it, but it can definitely help the meds work better. I am so out of shape that only a few minutes of walking tops out my training heart rate. My therapist is trying to get me to embrace the "health at every size" concept, but I am not healthy. Nowhere close. While I'd love to be able to shop in "normal" clothes stores, the aesthetics are really not that concerning for me. I want to be healthy again, period. I want to go dancing and get back in a belly dance troupe and be able to do anything I want to (within the limits of the auto immune condition).

I probably have a different auto immune disorder (they haven't done a biopsy needed to make sure. it's either that or something else scarier) and I will say I have personally had a 70-80% reduction in pain immediately after surgery. it is crazy good. I would hope the same for you. my bad days now are better than my good days were.

[OKCPirate 5,323]

@@theantichick - I watched every video I could find, especially from those who were not successful, and those who had problems. I faced the worst outcomes, and when I realized I could handle them, that's when I sent in my deposit.

This book was really helpful to me in prepping: http://www.amazon.com/The-Emotional-First-Aid-Kit/dp/0976852659

I am evangelist for this surgery, but I'm not a fanatic. It is a great tool, but for some, so is weight watchers. I just wish you great success and if you want to go down this path, we are here for you.