Talk me out of having a "luxury" mini gastric bypass (long)

In My Humble Opinion
1

I’m seriously thinking of having a mini gastric bypass done (MGP). An MGB is a from of weight loss surgery, and usually results in the patient losing about 70% of their excess weight and a much better overall health. I found a surgeon willing to do the surgery. The surgery will cost about 5000 USD, incuding tests before and after. Luckily, I have saved up money and will be able to pay for the surgery out of pocket, so I won’t have to deal with insurance companies.

I want this surgery very much. I have read up well on the subject (found a wonderful book on Amazon).
So why do I want to hear opinions that tell me not to do it? Because I am what you might think of as a border case. I’m morbidly obese, but otherwise healthy. And I wonder, is losing weight worth the (small) risk of surgery and complications, and the diet limitations for the rest of my life?

I’m morbidly obese allright. Two months ago, I weighed 233 pounds at 5 ft 7 inches, so a BMI of 37, which counts as morbidly obese with greatly increased health risk. With a BMI above 40, insurance companies generally pay for surgery. But I’m otherwise healthy and fit enough. And since I started taking antidepressants a month ago, I lost about 10 pounds without much effort. I’ve always been fit and physically active, and now I’ve also found an exercise routine that works for me and that I will keep doing, even if I have surgery.

So why don’t I just keep on trying to lose the weight this way? Why do something as drastic as surgery?
Because I’m fairly sure I will lose a few more pounds, but then it will taper off. Then I will still be obese, but no longer be eligible for surgery. So then I’m really stuck. Because I have never, ever been able to diet. Not even for a day. I quite often eat less for weeks at a time, but I can’t really diet.
Besides, statistics paint a bleak picture of the success of the “put down the fork and exercize”-method. The long term success is less then 5 %. Surgery, on the other hand, has a success rate of over 90 %.
So, I think, the most likely scenario then is that I will put myself through years of yoyo-ing and beating myself up every time I gain weight again. That is not effective, that is some sort of moral crusade that I can do without. Surgery as an alternative sounds a hell of a lot better. It would amount to going through an unpleasant experience once, and then be done with it. The surgery will make me sick if I eat too much, for the rest of my life. And that fits me, that sort of short-term rewards and punishments works well with how I’m wired. I also don’t mind eating less: I will probably enjoy food more that way. But I don’t want to diet, I don’t want to wage a conscious moral battle of wills with myself everytime I put a morsel of food in my mouth.
I know that surgery is still thought of as the easy way out, and there’s a lot of disdain for it. After reading up on it, I don’t see it that way. It seems to work, and that is what I’m interested in.

So Dopers, is there anything I’m overlooking here? What would you do if you were me? What were your reasons to choose surgery, or to choose some other option?

If there’s anything you want to ask, go ahead.

2

Having had 100% medically necessary surgery, I can’t contemplate having surgery for an issue that could conceivably be resolved any other way, except as an absolute last resort. The pain and recovery just wouldn’t be worth it to me.

Why don’t you just keep doing what you’re doing for as long as it continues to work, and then if it doesn’t work anymore, reconsider the issue?

3

I won’t talk you out of it. I had an R-N-Y 4 years ago, lost 130 lbs at the time and I’m still 100 lbs down. Best thing I ever did for myself. There are a few downers to it I’ll admit, but for me they’re trivial compared to the benefits.

So long as you’re doing this for medical necessity and not vanity, go for it. I have to ask, 233 lbs at 5’ 7"? that’s got to be a typo. I’m currently at 245 at 5’ 10" AFTER losing the weight.

4

I’ll chime in as someone who had the full go gastric bypass almost a decade ago and tell you two downsides:

One, it doesn’t always work. Didn’t for me. In the end, while it made me ‘full’, I have a terrible psychological relationship with food, and I’d still eat anyway. Nine years later, I’m heavier than I was then.

Two, the side effects of the surgery can be real buggery. My digestive system is seriously screwed up, and every year or so there’s another side-effect that shows up, and another broad list of foods I can no longer eat, or precautions I must take -while- eating.

The bypass always -sounds- like a good idea, and if it works for you, it works. Just realize you’re going in for something big (no matter how much of a ‘mini’ it sounds like) and it might only change your life in ways you’d rather it not.

5

No, that is correct, and that is why I’m describing myself as a “border case” . I’m a woman, while you’re a guy, right? And bear in mind that in the Netherlands, obesity is less epidemic then it is in the USA. About one third of women here is obese, but generally less extreme then in the US. Still, at the company where I work, there are 700 completely average Dutch employees, and at 233 lbs, I’m one of the 15 most obese women. But mostly I hate not being able to kneel down, always have to walk around with that 35 kg backback, and always have to wonder if I will fit in chairs. Here are two recent unflattering pictures of me.

6

How much serious effort have you put into losing weight the old fashioned way? It would be extremely irresponsible to subject yourself to major surgery if you haven’t tried other options first. Most people of your weight could lose 40 pounds in six months with fairly minor lifestyle changes.

7

My fault. I thought you were of dude persuasion…

8

My old roommate had that done several years ago and I got to watch her go through all of that first hand. I’m heavier than you are and it is something I won’t consider at this point for several reasons.

  1. You are not able to absorb the right amounts of vitamins and minerals and have to give yourself daily/weekly injections.

  2. When my roommate did it she lost a lot of weight, yeah, but she is still fat. She got down to 175 lbs which was a big difference for her but I am not going through surgery, daily injections, and constant digestive issues to end up still being fat.

  3. I’m actually in really good health except the weight issue. As I get older that may change and then the surgery might seem like a better option but until then I will stick with the diet and workout options that keep failing and hope that one of these times it sticks.

  4. I am extremely worried how it would impact me in my old age. This surgery hasn’t been around long enough to see the long term (30-40 years down the line) effects on people and that worries me a bit.

9

What does your regular MD think about it? Go with that.

In the meantime, try the high-protein/low carb diet for six months. I can lose 40 pounds easy. Now, the high-protein/low carb diet is very hard to stay on (like almost all diets) = so after that try exercising and eating sensibly. I have found that exercise and eating sensibly loses weight very very slowly, but it is very good for keeping the weight off you have lost through another diet.

10

In the US you aren’t considered morbidly obese until BMI=40, FWIW. And that is with us adjusting the definition of obesity to include more people about 10-15 years ago.

One reason not to rush into that is that your depression might have contributed to your weight gain. Addressing that problem might get your weight back to a much more manageable level and make exercise easier to get motivated for.

11

A lot, and none. I have read many books on nutrition and diets. I have visited a dietician for about 10 times. It is extremely hard for me to diet. It demands a kind of discipline I just don’t have. Saying I shoudl have it when I don’t, is not realistic. Besides, the two times I have dieted for about a week, I lost 4 pounds and regained about 15.

As for non-invasive weight loss surgery, I had an intragastric balloon. I had it for 5 months. I lost 6 pounds. Not worth it.

As for exercise, I do that. I’m fairly fit, and bike and walk everywhere. There’s not much to be gained there.

One other question friedo, How is it irresposible? Irresponsible to whom?

12

I would give myself at least a year after starting the antidepressants before even considering any other drastic change to your body.

Give them a chance to work. They may work better than the surgery in the long run anyway for losing the weight and keeping it off.

13

DrDeth, I told my MD I wanted to do this, and she was neutral about it, neither encouraged nor discouraged it. She did agree my argument made sense that the “classic method” has such a low long term result; just five out of 100 people stay at their goal weight. She just didn’t have an alternative solution to offer.

Dieting doesn’t work for me, and I already exercise.

pbbth, those are good points. However, the risk of being obese for years *are *well documented. Obesity just makes it harder to stay healthy in old age.
Did your roommate had to have injections, or did she just have to take a supplement? And did she have a gastric bypass, or a duodenal switch? My doc told me I would only have to take a daily multivitamin, which is no big deal because I take those already.

And “major surgery”? A laparoscopic mini gastric bypass (which is a more simple version of the Roux en Y gastric bypass) is a 30 to 130 minute operation.My cesarian lasted longer, and that had me up and walking stairs again in five days.

14

For all those with a wait and see advice: so, suppose I lose another twenty pounds. That will leave me still obese, but, not obese enough to qualify for surgery. Then I’m really stuck. I strongly feel it is now or never.

15

You just recently started on anti-depressants, right? I would give them some time to kick in and work before deciding on something as drastic as weight loss surgery. You might find that when you aren’t so depressed that you’re more motivated to take better care of your health. I know that’s what worked for me.

Right after my second son was born, I realized that I needed to tweak my meds. Then I decided that I was tired of being overweight, and that I would focus on eating smaller portions of healthier food and doing more walking. A year later, I’ve lost 30 pounds with almost no effort. I didn’t put myself on a diet, I didn’t drastically change my eating habits. I decided to eat slightly less and much better. We don’t keep junk food or sweets in the house, so it’s not even an option. I don’t eat to capacity all the time. I indulge when I want to, and don’t beat myself up about it.

Do you have a therapist you can talk to?

16

For those of you who had surgery: what are the “digestive issues” you mention? How bad are they? The studies say that about 10 percent of people had diarhea, but that was resolved 3 months post-op.

17

It seems extreme and perhaps premature to me. If those are recent photos, you’re pretty (full stop, and also) young. OTOH, being young and otherwise fit and healthy makes your recovery likely easier and faster than the typical GB candidate.

18

Well said, that is how it is for most of us. But when you see it written down like that, isn’t it… frustrating? Ineffective? Is that how you want to spend years of your life? I came to the same conclusion you wrote here, and I just didn’t think it was good enough.

A strange thing it is about the willpower. Pain for a couple days or weeks doesn’t bother me at all; but I have absolutely no willpower when it comes to forcing myself to do something minor that doesn’t come naturally.

19

When you say “diet”, have you just tried “diets”, or have you tried changing the way you eat in a permanent way?

20

don’t mind me, thanks for the compiment. I’m 42 though, which appears to be a common age for women opting for surgery. The easier recovery is something I’ve kept in mind when I read the stats about complications, and I figured (perhaps incorrectly) that they were less likely to affect me.