6 months pre-op WL effect eventual possible total WL?

[greenchilegoddess 14]

Hi everyone,

I'm brand new to all of this, and had my initial consult on February 5th. Obviously things were online because of covid, and I hadn't weighed myself in a long time because I used to do that at the gym. In my paperwork I wrote 340 (estimated) but when my home scale arrived I found out I was 370, considerably heavier than I used to be. My problem with weight loss has usually been keeping it off, not getting it off - I've gained and lost 50-65 pounds more than once. Since I weighed in then I'm now at 356. In my head I think well, gastric sleeve patients will lose up to 70% EBW on average, and if I can get down to 300ish by August, that 70% EBW loss will be based on my surgery day weight, not my consult weight. Is that true? Is there a big advantage to losing before the surgery in terms of potential final weight outcomes? Or is my "set point" my set point and there's nothing I can do about it, even if I get down lower on surgery day.

I'm so used to hitting a wall after 65-75 pounds and feeling like my body won't budge no matter how little I eat. I'm freaking myself out that if I lose that now in the 6 months before surgery, nothing will happen or I will barely lose weight or I will already be in "starvation mode" and it won't work.

Thanks for your help!

[catwoman7 11,212]

you pretty much just wrote my story. i started at 373. That 70% is just an average. People fall on either side of that. Some people lose way less than that, some way more.

lose all the weight you can before surgery. I started at 373. The morning I rolled into surgery, I weighed 316. My lowest weight was 138 (most of us gain 10-20 lbs after hitting our lowest weight - and I, of course, did too - but that's OK - I look better now at 150ish than I did at 138). So I lost 100% of my excess weight.

anyway, not sure it matters if the 70% is from your starting weight or your surgery day weight, since that's just an average and you could lose more or less than that - or even a LOT more or less than that - depending on how committed you. I was VERY committed. I almost never went off my program until I hit maintenance. I never wanted to be overweight again.

[catwoman7 11,212]

11 minutes ago, catwoman7 said:

you pretty much just wrote my story. i started at 373. That 70% is just an average. People fall on either side of that. Some people lose way less than that, some way more.

lose all the weight you can before surgery. I started at 373. The morning I rolled into surgery, I weighed 316. My lowest weight was 138 (most of us gain 10-20 lbs after hitting our lowest weight - and I, of course, did too - but that's OK - I look better now at 150ish than I did at 138). So I lost 100% of my excess weight.

anyway, not sure it matters if the 70% is from your starting weight or your surgery day weight, since that's just an average and you could lose more or less than that - or even a LOT more or less than that - depending on how committed you. I was VERY committed. I almost never went off my program until I hit maintenance. I never wanted to be overweight again.

p.S . you'll likely drop quite a bit the first month or two - but after that, it slows down quite a bit. Months 2-6 I lost about 10 lbs a month - after that, maybe 5-8 lbs a month. So it's not as quick as most people expect (esp if you've watched "My 600 lb Life" - those people lose fast because they start out way heavier than the average WLS patient). So whatever you lose beforehand you won't have to worry about after. I does get harder to lose the further out you get from surgery. So yea - lose some of it now if at all possible. Then it's G-O-N-E!

P.P.S. the surgery seems to "reset" the set point. Mine seems to be about 158 these days because I have to really struggle to keep it under that My body seems to float up there if I stop paying attention for too long. Also, your comment about "starvation mode" and the surgery not working. "Starvation mode" is controversial - not everyone believes it happens. And the surgery WILL work as long as you stick to your eating plan and follow all the rules.

Edited February 21, 2021 by catwoman7

[greenchilegoddess 14]

Just now, catwoman7 said:

p.S . you'll likely drop quite a bit the first month or two - but after that, it slows down quite a bit. Months 2-6 I lost about 10 lbs a month - after that, maybe 5-8 lbs a month. So it's not as quick as most people expect (esp if you've watched "My 600 lb Life" - those people lose fast because they start out way heavier than the average WLS patient). So whatever you lose beforehand you won't have to worry about after. I does get harder to lose the further out you get from surgery. So yea - lose some of it now if at all possible. Then it's G-O-N-E!

Thank you so much for such a thoughtful and detailed response! I'm also just an inch taller than you so we are very similar! I think I'm used to dropping a lot of weight the first month of a diet bc of "water weight" and then having things slow down, and sort of assumed that might be what the first month of post op is like (or might not be like if I already lost 70lbs).

I also noticed you got gastric bypass in 2015. Do you mind me asking why you chose that over the sleeve? I originally went in wanting the bypass because of my terror of just hitting a wall and not losing after a certain point. My surgeon was open to it but suggested the sleeve since I'm young (28 at surgery time) and don't have GERD, so I've been leaning that way now. I just still have that nagging desire to do the thing that will give me the best shot at losing the most weight long term, and the malabsorbtive part of bypass is appealing for that reason.

Also, I totally understand if that's too personal or involved! Happy to talk in DMs or not at all. You've been super helpful!

[catwoman7 11,212]

6 minutes ago, greenchilegoddess said:

I also noticed you got gastric bypass in 2015. Do you mind me asking why you chose that over the sleeve? I originally went in wanting the bypass because of my terror of just hitting a wall and not losing after a certain point. My surgeon was open to it but suggested the sleeve since I'm young (28 at surgery time) and don't have GERD, so I've been leaning that way now. I just still have that nagging desire to do the thing that will give me the best shot at losing the most weight long term, and the malabsorbtive part of bypass is appealing for that reason.

Also, I totally understand if that's too personal or involved! Happy to talk in DMs or not at all. You've been super helpful!

a couple of reasons - 1) I had GERD, and sleeve will often make that worse (although not always - and for a few people, their GERD actually improves). But there's about a 30% chance of it getting worse, and I didn't want to risk it. Bypass will often improve, if not outright cure, GERD.

2) when i had surgery in 2015, the sleeve was still kind of a new thing (at least as a standalone procedure. The duodenal switch (DS) surgery has been around for a long time, and that is a sleeve stomach combined with a largely-bypassed small intestine). But as a standalone surgery, sleeve was still pretty new in 2015. It's now taken the place of the lap band as the non-RNY option, and in fact I think it's more popular than the RNY now. But I was reluctant to go that direction because of it's new-ness at the time. I was afraid of it becoming "lapband 2". But....it's been around long enough at this point and his proven itself, so that wouldn't really be a concern of mine if I was having to make the decision today.

3) I wanted the malabsorption piece because I thought it would make it a bit easier to get all the weight off - although my surgeon did assure me that the difference between final weight of sleeve patients and bypass patients was pretty negligible, and that success is due more to commitment than it is to type of surgery.

I would still choose the bypass today because of my GERD history, but if it weren't for that, I'm not sure. I've been super happy with my bypass, though.

[catwoman7 11,212]

also, you're right - the big drop the first month is mostly Water weight, so if you lose a lot of weight before surgery, your water weight will be long gone, so you won't notice a big drop. Still, I lost 16 lbs the first month - and my water weight was definitely long gone...

[Jaelzion 1,127]

1 hour ago, greenchilegoddess said:

Thank you so much for such a thoughtful and detailed response! I'm also just an inch taller than you so we are very similar! I think I'm used to dropping a lot of weight the first month of a diet bc of "water weight" and then having things slow down, and sort of assumed that might be what the first month of post op is like (or might not be like if I already lost 70lbs).

I also noticed you got gastric bypass in 2015. Do you mind me asking why you chose that over the sleeve? I originally went in wanting the bypass because of my terror of just hitting a wall and not losing after a certain point. My surgeon was open to it but suggested the sleeve since I'm young (28 at surgery time) and don't have GERD, so I've been leaning that way now. I just still have that nagging desire to do the thing that will give me the best shot at losing the most weight long term, and the malabsorbtive part of bypass is appealing for that reason.

Also, I totally understand if that's too personal or involved! Happy to talk in DMs or not at all. You've been super helpful!

Hi there,

I felt just like you, I really wanted the bypass because my reading had told me that bypass patients on average lose more weight and keep it off longer. So I was super disappointed when it turned out that there was a medical reason why I couldn't have the bypass (at least not safely). But I went forward with the sleeve and it all worked out for the best. The surgery has been very effective for me and I lost a lot more than that 70% average of excess body weight you read about. I lost it all. I know learning how to maintain it crucial, so that's what I'm focused on now. The best way to eat for long-term maintenance. So @catwoman7 is absolutely right. That 70% average is not a hard cap on how much you can lose with the sleeve. It's just an average based on outcomes they have tracked. I'd suggest you talk it out with your surgeon and get all the pros and cons to help you make your decision. Kind regards. 🤗

Edited February 22, 2021 by Jaelzion

[NovaLuna 710]

I was 389 pounds when I started my journey so I had a LOT of weight to lose. On top of that I'm also partially disabled due to two back injuries so I can't exercise beyond walking and right now even that is limited due to some other health issues, so for me I looked at the average percentage to make my choice because I knew I was pretty much relying on the average due to not being able to exercise much. Diet I can do, exercise not so much...

VSG average is 50-70% loss of excess weight

Gastric Bypass is 50-80% loss of excess weight

Duodenal Switch/ Loop DS is 80-100% loss of excess weight

So I went with the Loop DS. I chose it because it's the second most aggressive surgery (Traditional DS is #1) and chose the Loop DS because it's the new and improved version of the DS with the improvement being slightly more small intestines so less chance of diarrhea issues... (instead you have the occasional Constipation issue lol).

You can always lose more than the average. The average includes those that don't follow diet guidelines and don't lose much alongside those who lose way more than the average. The more weight you lose before surgery the better. I lost 68 pound myself during my six month program. I was 321 on my surgery day. I'm almost 13 months post op now and down to 197 (I haven't been under 200 pounds since I was 13... 20 years ago. I just got into ONEderland last week and I still want to cry because it doesn't seem real sometimes).

The choice of surgery is a very personal thing. It's something that you have to live with so it's a choice that you have to make for yourself. If you are most comfortable with the VSG, then go for it! I wish you the best in your journey!

Edited February 22, 2021 by NovaLuna
spelling error

[greenchilegoddess 14]

Oh wow, a lot to think about here (and talk at my surgeon about, if I get to see him again any time soon). I don't think my doctor would even consider DS (it's not on his practice website) and I'm financially limited to his practice because I'm on university health insurance. That still leaves the RNY/VSG issue but hearing from you both helped. It's also really great to be reminded that the average is just the average and does include people who are noncompliant, so a sleeve isn't a hard limit on my success. Here's hoping I end this journey with 100% excessive weight loss. I know I shouldn't focus on that, but I haven't been a normal weight ever in my life and I want a chance at it.

I just wanted to also say thank you to all three of you. I wasn't expecting so much kindness and so many time intensive responses, and I'm truly blown away. I'm keeping this a secret from all but one friend for now, and knowing I can come here and talk/think through these things is so reassuring.

Have a great week everyone ❤️

[blackcatsandbaddecisions 851]

I’ve always said I’m great at losing weight, but I’m better at gaining it back. I lost almost 60 lbs before surgery, and I’m down almost 45 in the three months after. I tried to find out exactly what you’re asking- should I use 339 as my “start” or 281 when I use those fancy online calculators? I never found an answer.

I finally decided that it doesn’t matter. Those numbers are averages and that’s not what I’m going to do. I have control over what I eat and how I live and I’ll use my tool to get to 100%.

In the end I’m so grateful to my past self for losing weight prior to surgery. It gets harder the further out you get post surgery so make the most of the time you have. Every pound lost now is a pound you don’t have to lose later. It will also make the preop diet and the post surgery life less of a shock. I felt very well prepared because of changes I’d made in the months prior.