I was not ready to stop medicating with food until I had worked through my depression with antidepressants and therapy and exited my terrible marriage. Try to get her to see a good therapist before she does anything else.

Wow, what a thread. I hadn't been back to read it since my last post back on page 2!

If you think WLS is mutilation, then don't get it; problem solved! I haven't seen ANYONE say that EVERYONE with a certain BMI and above should have it, just that it should be available if they so choose.

I was diagnosed with type 2 diabetes at age 25. If I hadn't been, I wouldn't have considered surgery for myself. That was my line of thinking, that I was "healthy" despite my weight. The problem is, how LONG would I stay healthy at that weight? Is it really so wrong for someone to have WLS as a preventive measure against all the risks of morbid obesity? Or do you have to wait until you already have a life-threatening diagnosis (other than morbid obesity, which is a diagnosis all by itself) that may be completely incurable before you decide to take more serious measures?

No, WLS is not right for everyone; in fact, there are some people who shouldn't have surgery (and then there are some who shouldn't but do anyway - it's not our job to police the entire community of individual patients). But having the option IS right. And making a fully informed decision (in any direction) is even, umm, righter :P

As for the DS, if anyone has DS-specific questions, I am happy to help. Though my DS was modified (not by choice), I take vitamin/mineral supplements 4 times a day due to the intestinal malabsorption. I had my surgery 2 years and 2 days ago, and I am now essentially diabetes-free (if I went to a new doc tomorrow without transferring my medical history, they would NOT diagnose me as diabetic - my fastings are in the high 70s to 80s, and my last 2 A1Cs were 4.8 and 4.9, and that's even without low-carbing) and insanely healthier and more prepared for a hopefully upcoming planned pregnancy than I would have been without the surgery I had.

Jill....very happy you came here!

I know Jill from another board where she is also well respected and informed.

You are really offensive and quite frankly rude. I am 10 yrs out from surgery and live this way of life day to day. I STILL DO MALABSORB FATS AND NUTRIENTS due to my shortened small intestine. Protein, calcium, and B Vitamin must be supplemented because of this. Also due to the stomach being reduced to a pouch there is less intrinsic factor also contributing to these factors. And excuse me according to my gastroenterologist my body did not create more villi. You should really not advise people on a subject you do not have the full facts on.

You will continue to malabsorb micronutrients (vitamins and minerals) forever because certain micronutrients can only be absorbed in certain parts of the small intestine. With the gastric bypass, the duodenum (first portion of the small intestine) is fully bypassed, plus, yes, the reduction of both intrinsic factor and gastric acid factor into the equation. However, it's true that additional villi will grow as your body tries to compensate for the bypassed intestine; additionally, the non-bypassed small intestine can also actually grow wider in diameter and longer, thereby increasing the interior surface area of the intestine used to absorb nutrients. This will never fully compensate for the malabsorption of micronutrients since, again, certain things can only be absorbed in certain parts of the intestine, so gaining additional absorption in the ileum, for example, won't help with absorption of micronutrients that are primarily absorbed in the duodenum. However, the additional villi and surface area will help to absorb more macronutrients (protein, fat, and carbs), which is why the caloric malabsorption lessens and even disappears over time after gastric bypass. This has been shown to happen not only in WLS patients who have intestinal bypass, but also in patients who have had portions of their intestines removed for other reasons (such as as a result of injury in an accident). If you'd like to learn more, you can include such search terms as "short gut" and "villous hypertrophy."

Of course, this is assuming a proximal bypass; the longer the bypass, the more likely some caloric malabasorption will be longer lasting or even permanent (as is more common with the DS).

Yikes!! I now understand what "War Zone" Means... the idea that we can Know what's right for someone else is horrifyingly arrogant..we each need to make our decisions based on the best info we have and our own circumstances...consulting those we trust and respect...experts that we trust...

I NEVER ask for medical advice here.....some practical assistance ..that is one of the best parts of this board..but medical advice is best made elsewhere.

I see people here who eat in ways that make me feel faint but, I
have no right to judge and roll my eyes at their choices...there is so much in this world I dont know...but I do know that I continue to learn what works for me.




....you know what they say abt opinions.......

I am 10 yrs out from my RNY and have studied my type of surgery and have discussed things with my gastro doc. The caloric malabsorption does not stop over time but can decrease a bit due to time and healing, pouch stretching etc. In no scientific rpt or according to my doc does the caloric malapsorption stop. In fact most studies reiterate that more in depth studies are needed to understand exactly what is going on.

http://www.ncbi.nlm.nih.gov/pmc/art...g00377-0034.pdf

The link you posted was for a jejuno-ileal bypass, which is not the same as the RNY. It's also from 1977. Here's one using rats from 2007 that concludes, "While RYGB is thought to cause weight loss in part via malabsorption, although this is transiently true (9), once the gut has adapted malabsorption is not observed."

http://ajpregu.physiology.org/content/293/4/R1474.full

Look, there's no point to arguing back and forth - whether you have a small percentage or no caloric malabsorption really doesn't make much difference (heck, a study has shown that even normal people who haven't had any surgery don't always absorb all the fat they eat). For every doctor you find saying one thing, I can find one saying the opposite. It's not an exact science due to the highly individual differences between human bodies, and if your procedure is more than 10 years old, it might even be slightly different from today's RNY. Even though I have a sleeve stomach instead of a pouch, I have about the amount of intestinal byass as a proximal RNY (I was unable to get a "normal" DS due to adhesions from a prior unrelated surgery) except that I still have a short amount of duodenum in my digestive tract, whereas yours is fully bypassed; I assume that, by now, I do not malabsorb any calories. Short of testing all dietary intake and excrement, there is no way to know for sure.

and what about the side effects from carrying this extra weight? Its going to catch up with the majority of people. Diabetes, cirrosis, exponentially higher risk of all kinds of cancer, lowered immune system from being overweight. There's more to it than just being "fat" - and if you think that just eating less is better - why don't YOU do it. You're not comfortable at your weight - if you were, you wouldn't be dieting and professing so much. What right do you have to decide what is right for one person over another? No one is having vanity surgery on an insurance company's dole. You are in fact obese. Obesity is a disease. You also have a severe case of denial. in 5 years when you're in for your double knee replacement, you'll be remembering the words you said.

I have a question for earlier posters that stated the sleeve is probably better than the lapband???

What was your starting BMI, and is the sleeve geared more toward people with a BMI 40 or higher?

My BMI is between 36-37, and the only surgical option for me (in the US) covered by insurance is the lapband. Im 5'10 and I weight 258 lbs. Im hoping that I can use the band as a tool but I figured I would ask for feedback. My surgery is scheduled for March and if I need to make a different choice now is the time I guess ....

Check with your insurance again. The guidelines in the US according to the NIH for ALL weight loss surgery procedures is a BMI of 40+ OR a BMI of 35+ with weight-related comorbidities (such as sleep apnea, type 2 diabetes, high cholesterol, etc.). If YOUR insurance is only approving the band for you, then that's specific to THAT policy, not all insurance in the US. I have friends who have had the DS (sleeve plus intestinal bypass) covered at a BMI of 35.

Sunny - my insurance would cover only the band, not the sleeve. This was about a year and a half ago. I did get the band - weighing in at 285 or so (5'8"). I'm currently at 207. I'm still losing, but I definitely have to work at it. I have seen people lose all of their excess weight with the band (tripletmom springs to mind), and others who have not lost a lot, or have regained.

Like many things, the band is a tool for me, and I need to actively manage it. I need to make good food choices, I need to be constantly vigilant, I need to weigh myself frequently, I need to track my calories or I won't just not lose, I will gain. I recognize that this tool is not a cure all, it has many downsides, and is not for everyone. For me, I am generally happy with my status, my situation, and my decision.

To call it life changing is not an understatement. And not just for the weightloss, but how it affects what you eat, when you eat, and how you eat.

Good luck with your decision.

-Casey

I hope you don't mind if I ask you a question about the above.

Did you know before having your procedure, just how much it would impact your life?

Thanks for saying how its effected you in your life.

Ah, good question Judy. And I'm not sure that I have a great answer.

I think that I knew the nuts and bolts of how I would be affected. I had spent quite a bit of time talking to my sister's college roommate who had done the lapband. I had spent quite a bit of time talking to my doctor and my surgeon and a therapist. I had spent some time checking things out on the web. I certainly felt at the time that I understood what I was doing.

But here's the big thing Judy - I was very concerned about the possibility that I would not be able to eat "normally", just in reduced amounts. (And, yes, I know that makes no sense.) And I talked this over with all of the people mentioned above. And they all assured me that I would be able to eat "normally". The reason that this is important to me is because I have a pair of 4 year olds that I so want to be able to eat healthfully, and it concerned me that we would no longer be able to have healthy family dinners together. I did not want them to see me with "disordered" eating patterns.

So, it turns out that my sister's college roommate has regained all or her weight and then some.

And, generally speaking, I do not eat what most people would call normally. There is a huge learning curve with the band where you have to learn what you can eat, how much you can eat, what are the soft cues, when will I throw up, etc. For example, I rarely eat chicken anymore, one of my pre-surgery favorites. I can eat canned chicken. Sometimes, I can eat rotisserie chicken if I am very, very careful to chew thoroughly and not eat too much. But otherwise, chicken is out.

There are times when my band is unusually tight, and, really, soft foods are the only things that work. There are times when my band is loose, and I can eat "normally". There are still times when I vomit. There are times when I feel self-concious when I am eating out with friends and I can only eat a very small amount. I have heatburn. I burp a lot (how attractive!)

Some of these things you have with any restricted diet. But some of these things alter the landscape in a big way. And I was definitely unprepared for that.

And, even having said all of this, (which I might come back and erase!), I'm still going to say that for ME, the band has been a good choice. Because, for ME, the bottom line is that something changed for me when I was pregnant and I was no longer able to control my weight, seemingly no matter how I ate. And, my weight was causing serious blood sugar issues and I have a pair of 4 year olds, so that had to be fixed.

Thanks being so honest!