Pre-op doubts

[Barrr 4]

I am a 50-year-old man who struggled with my weight most of my life, starting with being an overweight kid. No diet or exercise program produced tangible, good results. At my annual physical in March I weighed in at 405 pounds. I take no meds, and up to this point, my most serious health issue has been sleep apnea that I was trying to handle with CPAP (mostly unsuccessfully). Given my alarmingly high weight, my doctor recommended that I look into the bariatric surgery option.

I eagerly started the process, looking at it as a once-in-a-lifetime chance for getting back to normal body weight and gaining a quality of life I have not enjoyed for a long time.

The bariatric program I joined requires that patients lose 10% of their weight before even being scheduled for surgery. Insurance also requires at least 3 months of engagement with a managed weight loss program. I was determined that despite my past struggles with diets, I will do whatever it takes to make the cut.

I met with the program's nutritionist and had a very nice discussion with her. Then I went home, and threw out the materials she gave me (calorie counting book, etc), and ignored all her directions and advice. I dove into reading and research and started implementing a diet largely based on Matthew Weiner's A Pound of Cure vegetable-focused program. I had immediate success, losing 20 lbs in the first month (guaranteed, a lot of that may have been Water weight held onto by insulin). I kept reading and experimenting, incorporating advice from Sten Ekberg (Master Your Health), Eric Berg, Dave Asprey (Bulletproof Diet), Jason Fung (fasting strategies), and many others.

At this point, I am three months into my pre-op personally directed diet. I have

• lost a total of 70 pounds
• have a current weight loss rate of 1 lb / day
• feeling great
• COMPLETE resolution of my sleep apnea issues
• 120/80 blood pressure (was somewhat high at the beginning of the program)
• went from a size 4XL to wearing 2XL (depending on cut of clothing)
• 48 inch waist to 42 inch waist
• not counting calories
• no hunger or craving issues

I am just starting to discover the research (a recent Nobel Prize-winning one) regarding Autophagy and its related health benefits brought about by intermittent fasting, and many other possibilities.

Next week I am scheduled to meet with the bariatric program's PA, do my weigh-in, and (pending insurance approval) schedule the surgery.

I am torn and in doubt.

The last few months have been some of the most exhilarating experiences in my life. Gaining control of my body and my overall health in the way I have done in such a short period of time is amazing.

The bariatric surgery option, which just a short while ago seemed like a Holy Grail lifesaver to me, seems full of pitfalls and restrictions on the methods I can do to manage my body weight and health. I was looking forward to trying out possibilities with time-restricted eating, and using longer fasts (triggering autophagy) to eliminate loose, hanging skin that might come about otherwise with significant weight loss.

On the other hand, I still weigh 335 pounds and am nowhere near my goal of a healthy 200. What if my weight loss stalls out well short of that goal?

The sensible answer might be to simply wait, see what happens, and re-engage with the program if it seems necessary to keep pushing past a stall point.

However, for reasons I do not want to detail, I might not have this option after this year. Under these circumstances, if this was your only chance to move ahead with a Gastric Sleeve operation, would you do it? Any other thoughts?

Your help is greatly appreciated.

[Tomo 1,191]

If there is one common phrase that I have heard through all these years from WLS patients... It is "I wish I did it sooner." I echo that as well. I really wish I did it in my 20s except skip the lap band surgery because although I lost a ton of weight, it caused me years of esophagus problems. I would have gone straight to the sleeve or gastric bypass. So I think so. You have a wonderful and great start. Far better than most. You are on track and that is so admirable. Cheers to you, and good luck either way you decide.

[Arabesque 7,193]

Congrats on what you have achieved so far. Fantastic.

I’m very glad I did the surgery. Like a lot of us, I’d tried many, many diets over the years. The two things they had in common was that if they worked I’d lose some weight & then put it on again (start gaining again a couple of weeks later). With the surgery I’ve been able to maintain my weight for about a year. I know I’m a newbie when it comes to maintaining but it’s been pretty astounding that I’ve been able to do for this long so far.

The surgery afforded me the opportunity to reassess how I ate, what I ate & why I ate & I’m way more mindful of these now. The physicality of the surgery also helps me to keep to smaller portion sizes & the restriction reminds me very quickly if I eat too fast or too much. It also boosted my metabolism which I had killed through decades of not eating in an attempt to maintain my weight.

I did quite a bit of reading too & worked out a way of eating that works for me. I wanted to ensure the changes I made to how I ate (I don’t like using the word diet much - too negative) was practical, sustainable & didn’t compromise how I wanted to live & enjoy my life.

The surgery doesn’t stop me going out to restaurants, socialising with friends & family, etc. I don’t miss out on events. Honestly, my long term sensitivity to spice & chilli is much more restrictive on what & where I can eat than the surgery.

Personally, I chose the sleeve because it altered my digestive system the least & had fewer possible restrictions & requirements (less chance of dumping, less absorption issues, etc.).

Life has the unfortunate habit of throwing a heaping pile of crap at us at times, so we don’t know where we will be in 5 years. But even if in 5 years, you’ve settled at the average weight loss of 65% of the weight you had to lose, that’s still better than where you are now. You’ll be healthier, eating better & enjoying life more. That’s my thinking anyway.

Good luck whatever you decide to do.

[Aviate310 7]

I am like you and always battled weight. My wife did WLS and had a huge success. I too was able to lose 100 lbs on my own in my late 20s. I was always skeptical of WLS since I had done it on my own. One lingering fact that convinced me was even though I could lose it, the weight always came back plus. From what I learned through my wife is this program will help make the life style changes you need that did not happen on your own. You are on the right path and have hope I am too. I have surgery 10/13 and I am determined to make it stick. By the way I am 60 and still want the change. Stick with the program and I hope you find sucess with WLS.

Edited September 23, 2021 by Aviate310

[waterwoman 179]

It seems like you think you will lose the joy of being in control of your body if you have the surgery. For me, RNY was another tool to help me be in control of my eating.

[Queen ApisM 427]

I'm only 5 weeks out from surgery, and I am already wishing I had done this sooner. Obviously will have to reassess this in the future as time progresses.

I think many of us on this board are very experienced at losing weight - sometimes massive amounts. The issue is we are also pros at gaining it back, usually with extra lbs tacked on top of what we originally lost. The long term success rates for people losing large amounts of weight and keeping it off without surgery are low - I can't recall the percentage but I think less than 5%. Biologically, there are a lot of factors that make it extremely difficult (but not impossible) to be have long term success the "normal" way of losing.

Surgery isn't guaranteed to keep it off, but it is a tool that helps make it more likely - both in terms of the way it changes your eating but also the changes it can cause biologically that we have no control over.

This isn't to say you should get the surgery, but more to suggest perhaps discussing these issues with the bariatric PA and doing you own research to arm you with all the data around what might get you were you want to be permanently. It's a very personal decision and you have to be ready to do it or else it won't be successful.

[GreenTealael 25,277]

11 hours ago, Barrr said:

I am a 50-year-old man who struggled with my weight most of my life, starting with being an overweight kid. No diet or exercise program produced tangible, good results. At my annual physical in March I weighed in at 405 pounds. I take no meds, and up to this point, my most serious health issue has been sleep apnea that I was trying to handle with CPAP (mostly unsuccessfully). Given my alarmingly high weight, my doctor recommended that I look into the bariatric surgery option.

I eagerly started the process, looking at it as a once-in-a-lifetime chance for getting back to normal body weight and gaining a quality of life I have not enjoyed for a long time.

The bariatric program I joined requires that patients lose 10% of their weight before even being scheduled for surgery. Insurance also requires at least 3 months of engagement with a managed weight loss program. I was determined that despite my past struggles with diets, I will do whatever it takes to make the cut.

I met with the program's nutritionist and had a very nice discussion with her. Then I went home, and threw out the materials she gave me (calorie counting book, etc), and ignored all her directions and advice. I dove into reading and research and started implementing a diet largely based on Matthew Weiner's A Pound of Cure vegetable-focused program. I had immediate success, losing 20 lbs in the first month (guaranteed, a lot of that may have been Water weight held onto by insulin). I kept reading and experimenting, incorporating advice from Sten Ekberg (Master Your Health), Eric Berg, Dave Asprey (Bulletproof Diet), Jason Fung (fasting strategies), and many others.

At this point, I am three months into my pre-op personally directed diet. I have

• lost a total of 70 pounds
• have a current weight loss rate of 1 lb / day
• feeling great
• COMPLETE resolution of my sleep apnea issues
• 120/80 blood pressure (was somewhat high at the beginning of the program)
• went from a size 4XL to wearing 2XL (depending on cut of clothing)
• 48 inch waist to 42 inch waist
• not counting calories
• no hunger or craving issues

I am just starting to discover the research (a recent Nobel Prize-winning one) regarding Autophagy and its related health benefits brought about by intermittent fasting, and many other possibilities.

Next week I am scheduled to meet with the bariatric program's PA, do my weigh-in, and (pending insurance approval) schedule the surgery.

I am torn and in doubt.

The last few months have been some of the most exhilarating experiences in my life. Gaining control of my body and my overall health in the way I have done in such a short period of time is amazing.

The bariatric surgery option, which just a short while ago seemed like a Holy Grail lifesaver to me, seems full of pitfalls and restrictions on the methods I can do to manage my body weight and health. I was looking forward to trying out possibilities with time-restricted eating, and using longer fasts (triggering autophagy) to eliminate loose, hanging skin that might come about otherwise with significant weight loss.

On the other hand, I still weigh 335 pounds and am nowhere near my goal of a healthy 200. What if my weight loss stalls out well short of that goal?

The sensible answer might be to simply wait, see what happens, and re-engage with the program if it seems necessary to keep pushing past a stall point.

However, for reasons I do not want to detail, I might not have this option after this year. Under these circumstances, if this was your only chance to move ahead with a Gastric Sleeve operation, would you do it? Any other thoughts?

Your help is greatly appreciated.

In Dr. Wiener’s latest videos (I still watch him 3+ yrs out from WLS) he discusses who he believes would benefit most from WLS (obesity since childhood, genetic obesity- other family members who are obese, people with good diets, etc.)

Surprisingly, he also believes that WLS not for everyone. With so much seemingly conflicting information available, having doubts are natural especially when you are seeing results without WLS.

A couple of questions I would ask myself if I was in your position are:

Was losing the weight this way relatively hard or easy?

Could I really stick to these changes for the next 5-10 yrs?

What are my contingency plans if diet/lifestyle changes are not enough?

Do I fall into the good candidate for WLS category?

Should I pass up this opportunity even though it may not come again?

Good Luck !

Edited September 23, 2021 by GreenTealael

[catwoman7 11,210]

I started out at 373 lbs. I am in my 60s (had surgery 6+ years ago while still in my 50s). I was overweight my whole life, and morbidly (and for a few years, super morbidly) obese since my 30s. I tried program after program after program. On my more successful attempts, I'd lose 50-60 lbs (and on my less successful, 10-20 lbs), keep it off for awhile, and then the weight would come piling back on. Happened over and over and over again. I finally got to the point where I realized this wasn't working for me. I had over 200 lbs to lose, and I couldn't even lose 50 and keep it off for more than a couple of months.

The truth is, fewer than 5% of people can lose a lot of weight and keep it off. I proved to myself that I was not one of those lucky 5%. It could be that you are - I don't know. But weight loss surgery was the only thing that actually "worked" for me. My efforts paid off. I lost over 200 lbs. I've gained back 20 of it over the intervening years, but a 10-20 lb rebound is common after hitting your lowest weight. I've managed to stay there (after stabilizing at 20 lbs above my lowest weight) for a few years now.

I'm not saying to do it or not do it. If you're one of the people who can successfully lose a ton of weight and keep it off (and there are a few people out there who CAN), then you're very fortunate and may not need to do this. But I couldn't. I finally decided to go through with the surgery. and I'm so very glad I did. I should have done this YEARS ago!

[Barrr 4]

Thank you so much for the many constructive and helpful responses. To clarify my worries, here it is distilling them to two points of greatest concern:

1. Ability to incorporate good fats into a post-gastric-sleeve diet
   The foundation of my current diet (that I would be happy to keep for the rest of my life) consists of lots of vegetables, moderate amounts of high-quality Protein, and the inclusion of a good amount of healthy fats (avocado, EVOO, butter, animal fats from pastured, organically raised animals).
   This is supposed to help the body adapt to regularly burning fat (whether from the diet or from our own fat stores), and to much more easily reach satiety and control hunger, in addition to the various documented nutritional benefits of these fats.
   
   I read over and over again about directives to keep post-bariatric diets very low fat for the rest of the life of the patient. Also various posts from patients about not being able to tolerate fats and struggling with digestive issues. How much of a problem is this universally (realizing and respecting that everyone's body, digestive system, and hormonal balance are different)?
   
2. Ability to do fasting and support periodic zero-protein day(s)
   I have started to incorporate time-restricted eating (16/8) with great success and starting on my first 36-hour fast over the weekend. I have not only had great results on the scale, but starting to see amazing physiologic benefits outside of simply lowering my body weight. I definitely would want to have the ability to have a longer (3 day?) fast once in a while to trigger autophagy and reap some of the other benefits related to insulin and metabolic issues.
   
   I realize that for a period following surgery I would have to be adhering to the physician-prescribed diet aimed to maximize healing and avoid complications. But what is the situation six months or a year down the line? Can I incorporate fasting then, or am I eternally tethered to a 70g-minimum-per-day protein intake that I cannot violate without risking my health?

Your help and insight are appreciated!

[GreenTealael 25,277]

5 minutes ago, Barrr said:

Thank you so much for the many constructive and helpful responses. To clarify my worries, here it is distilling them to two points of greatest concern:

1. Ability to incorporate good fats into a post-gastric-sleeve diet
   The foundation of my current diet (that I would be happy to keep for the rest of my life) consists of lots of vegetables, moderate amounts of high-quality Protein, and the inclusion of a good amount of healthy fats (avocado, EVOO, butter, animal fats from pastured, organically raised animals).
   This is supposed to help the body adapt to regularly burning fat (whether from the diet or from our own fat stores), and to much more easily reach satiety and control hunger, in addition to the various documented nutritional benefits of these fats.
   
   I read over and over again about directives to keep post-bariatric diets very low fat for the rest of the life of the patient. Also various posts from patients about not being able to tolerate fats and struggling with digestive issues. How much of a problem is this universally (realizing and respecting that everyone's body, digestive system, and hormonal balance are different)?
2. Ability to do fasting and support periodic zero-protein day(s)
   I have started to incorporate time-restricted eating (16/8) with great success and starting on my first 36-hour fast over the weekend. I have not only had great results on the scale, but starting to see amazing physiologic benefits outside of simply lowering my body weight. I definitely would want to have the ability to have a longer (3 day?) fast once in a while to trigger autophagy and reap some of the other benefits related to insulin and metabolic issues.
   
   I realize that for a period following surgery I would have to be adhering to the physician-prescribed diet aimed to maximize healing and avoid complications. But what is the situation six months or a year down the line? Can I incorporate fasting then, or am I eternally tethered to a 70g-minimum-per-day Protein intake that I cannot violate without risking my health?

Your help and insight are appreciated!

I’ve done both with absolutely no issues.

[Tony B - NJ 642]

I think the theme here is that most of the people on here are for the surgery or they would not be on here with few exceptions. The reality is that many of us have lost a ton of weight before but end up bringing it right back on board. The sleeve is the tool many of us find is going to be there to keep us honest and help us keep the weight off. You cannot just unconsciously eat anyway and go and gain it back. If you eat and stretch out your sleeve, you are going to know it is happening and make a conscious choice to eat and screw it up for yourself.

[Tomo 1,191]

One can fast and incorporate good fats with no problem. Many VSG patients are on the Keto diet and/or intermittent fasting. Surgeons each have their own philosophy about diet after WLS and they vary drastically. The one I like the best is Dr. Duc Vuong (Ultimate Gastric Sleeve Success). I also love his YouTube channel. I'm currently reading Dr. Weiner's (Pound of Cure) so I can't remark on that one yet but others have but so far, it's really enlightening.

https://www.amazon.com/Ultimate-Gastric-Sleeve-Success-Practical/dp/0615830447

[Arabesque 7,193]

I am an advocate of finding the food choices & way of eating that works for you.There isn’t just one totally correct way to eat eat. It may be vegetarian or meat focussed or Aitken or vegan or Keto, intermittent fasting or frequent eating, etc. or include aspects of a number of eating styles. The only thing you can trust will work for everyone is Portion Control - eat more than you need you’ll gain weight.

Once you get to maintenance you can really embrace your new way of eating but you could start to incorporate aspects while losing as long as you’re still meeting your plan’s requirements & expectations. Have regular conversations with your nutritionalist & surgeon to discuss what you could start introducing & when. Your regular blood work will influence their advice & recommendations.

You may (or may not) have to make adjustments to your weight loss plan & future eating style because of your personal physiological needs. Some may be pre existing, some may arise because of the surgery or be discovered as a result of all the additional medical tests & monitoring.

I’ve never been great with too fatty or too oily food. I was low fat while losing but added some more good fats from goal. I was low carb while losing too & then added some whole & multi grains carbs. Since my sleeve, rice, bread & Pasta sit like lumps in my tummy so I still don’t eat them. Protein has become even more important to me since I had my gall removed 4 months ago as I don’t absorb it properly anymore. I’m a carnivore but include vegetarian meals occasionally. 40+yrs of fasting & skipping meals killed my metabolism. I feed my much faster metabolism now - 3 meals & 3 or 4 Snacks a day. These things influenced how I chose to eat now & it’s been working for me.

Your enthusiasm for researching & adopting a new way of eating & making the changes to take the best advantage of your surgery is fantastic. I hope it motivates others starting the process too. Good luck.

[ShoppGirl 4,739]

I am six months out and I already incorporate healthy fats like avocado and nuts/ nut butters in moderation. As far as fasting goes and days with no Protein the sleeve will not prohibit you from doing that. If anything it would make it easier because of less appetite. The surgeon may or not be on Board with it but I can’t imagine it has anything to do with the surgery, just personal preference of whether that is a healthy practice. I am pretty sure they would tell a non WLS patient the same things about the importance of protein. If that makes sense. If I were you I would at least meet with the surgeon or NP and ask them these questions though.

[SleeverSk 635]

On 9/23/2021 at 12:20 PM, Barrr said:

I am a 50-year-old man who struggled with my weight most of my life, starting with being an overweight kid. No diet or exercise program produced tangible, good results. At my annual physical in March I weighed in at 405 pounds. I take no meds, and up to this point, my most serious health issue has been sleep apnea that I was trying to handle with CPAP (mostly unsuccessfully). Given my alarmingly high weight, my doctor recommended that I look into the bariatric surgery option.

I eagerly started the process, looking at it as a once-in-a-lifetime chance for getting back to normal body weight and gaining a quality of life I have not enjoyed for a long time.

The bariatric program I joined requires that patients lose 10% of their weight before even being scheduled for surgery. Insurance also requires at least 3 months of engagement with a managed weight loss program. I was determined that despite my past struggles with diets, I will do whatever it takes to make the cut.

I met with the program's nutritionist and had a very nice discussion with her. Then I went home, and threw out the materials she gave me (calorie counting book, etc), and ignored all her directions and advice. I dove into reading and research and started implementing a diet largely based on Matthew Weiner's A Pound of Cure vegetable-focused program. I had immediate success, losing 20 lbs in the first month (guaranteed, a lot of that may have been Water weight held onto by insulin). I kept reading and experimenting, incorporating advice from Sten Ekberg (Master Your Health), Eric Berg, Dave Asprey (Bulletproof Diet), Jason Fung (fasting strategies), and many others.

At this point, I am three months into my pre-op personally directed diet. I have

• lost a total of 70 pounds
• have a current weight loss rate of 1 lb / day
• feeling great
• COMPLETE resolution of my sleep apnea issues
• 120/80 blood pressure (was somewhat high at the beginning of the program)
• went from a size 4XL to wearing 2XL (depending on cut of clothing)
• 48 inch waist to 42 inch waist
• not counting calories
• no hunger or craving issues

I am just starting to discover the research (a recent Nobel Prize-winning one) regarding Autophagy and its related health benefits brought about by intermittent fasting, and many other possibilities.

Next week I am scheduled to meet with the bariatric program's PA, do my weigh-in, and (pending insurance approval) schedule the surgery.

I am torn and in doubt.

The last few months have been some of the most exhilarating experiences in my life. Gaining control of my body and my overall health in the way I have done in such a short period of time is amazing.

The bariatric surgery option, which just a short while ago seemed like a Holy Grail lifesaver to me, seems full of pitfalls and restrictions on the methods I can do to manage my body weight and health. I was looking forward to trying out possibilities with time-restricted eating, and using longer fasts (triggering autophagy) to eliminate loose, hanging skin that might come about otherwise with significant weight loss.

On the other hand, I still weigh 335 pounds and am nowhere near my goal of a healthy 200. What if my weight loss stalls out well short of that goal?

The sensible answer might be to simply wait, see what happens, and re-engage with the program if it seems necessary to keep pushing past a stall point.

However, for reasons I do not want to detail, I might not have this option after this year. Under these circumstances, if this was your only chance to move ahead with a Gastric Sleeve operation, would you do it? Any other thoughts?

Your help is greatly appreciated.

I am 10 weeks post op and regret it deeply. If you are loosing weight on your own stick with it. Once the surgery has been done there is no going back. I firmly believe unless people have serious life threatening illness this should not be done. I want my stomach back !! I am struggling physically and most of all mentally. I would happily take back the weight I have lost to be normal again and loose the weight the conventional way