I had a roux-en-y in December 2002. I was just over the borderline for the surgery with a BMI of 41. The reason I did it was that I looked into all the methods, compared the statistics, and surgery simply has the best chance of working in the long run. With diet and exercise only–5% keep it off. With surgery (and diet and exercise, because any surgeon will tell you you need all three), about 80% keep the weight off. There is also the advantage that with surgery the weight loss is quicker. Jerk-offs will try to tell you it’s the “easy way out”. Bullshit. It’s not easy-- it’s painful at first, and for the rest of your life, you must keep up a regimen of vitamin supplements, especially B12 in the case of roux-en-y, because you can no longer absorb it from food. What it is, is the most EFFECTIVE way currently to keep weight off.
For me, in some ways the surgery “didn’t work”. I didn’t lose a lot of weight (only 40 pounds) and I have gained it back since my pregnancy. (This may have something to do with being hypothyroid, as I was diagnosed with that a few weeks ago. But it remains to be seen how getting treated for thyroid will affect things.) Even so… my diabetes is much better. Even when I had gotten down to a lower weight through diet & exercise alone, my blood sugars were never under very good control. My hA1c was barely in acceptable range (right below 8) and my daily readings were quite high. Now, even though I’ve been at this weight before-- my diabetes is completely under control. My hA1c has been near 5 throught out my whole pregnancy and ever since. My daily readings are nearly always within ADA goals. I don’t know if this is how it works for everyone, but this is my personal experience. Although FWIW, an endocrinologist told me a few years back that some doctors are starting to see Type II diabetes as a surgically curable disease. My other co-morbidities are better, as well. My asthma is completely controlled-- I haven’t used my rescue inhaler in months, and I’m not taking any other asthma medication. Lower back pain hasn’t recurred in a while. The only thing that still bothers me is carpal tunnel, and that is related to the hypothyroid (it was going to the doctor for the carpal tunnel that revealed the thyroid condition, but looking back, I’ve had symptoms for years.) The surgery didn’t make me thin, but it did improve my health-- which is actually the point of the surgery. You have the surgery to improve your health, not to look better. Also, most surgeons won’t do the surgery unless there are “co-morbidities”-- serious conditions that will be improved by losing weight. (Like diabetes, asthma, lower back pain, sleep apnea, etc.) Some insurance companies will pay for it right off, like mine did, because they’ve realized that it saves them money in the long run. Others will make you jump through hoops for years before they will pay (like Kaiser). Others won’t pay at all.
I had laparoscopic surgery and spent three days in the hospital. My surgeon made me take classes before surgery on how to eat after the surgery and what vitamins to take. If you eat to much, it can be extremely painful, especially if you get the horrible “dumping syndrome”. After a while, I was able to go back to “normal” eating. (You aren’t supposed to eat and drink at the same time, as you can eat more than you should this way. I struggle with this more than anything else, because I always want to have some tea, water or diet soda while I am eating.) My husband has had this surgery as well, although a long time ago. He still can’t really eat normal portions. It’s just a difference in our surgeon’s philosophy (his surgeon made his “pouch” much smaller than mine) and how it heals. And he’s still heavier than me, despite the fact he eats a fraction of what I do, and is more active. He does feel that without the surgery, he’d be much, much heavier, or probably dead by now.
What they’ve recently discovered is that the surgery tricks your body into feeling that your stomach has been full a lot. (It used to be thought it worked mainly by calorie restriction, but now it seems this is only a small part of it.) Your body then doesn’t put out the hormones that cause a powerful urge to eat. Back in the caveman days, when food was scarce and difficult to get, having a hormone mechanism that motivated you to get out they and slay something or dig up some roots before you got too thin and weak was definitely an evolutionary advantage. Today, when food is much more calorie dense and doesn’t require nearly any expenditure of energy to get, it doesn’t work so well. They think now that this is why diets fail so often. Your body responds to dieting (therefore not being full) by putting out this hormone. If you resist your hunger, your body just cranks out more and more, until you crack. They also think in some people this mechanism is defective, and the body pumps out this hormone all the time even when the stomach has been full a lot. In the future, I think as we gain better understanding of how these hormones work, there will be non-surgical treatments that will do essentially the same thing as the surgery. For now, though, surgery is the most effective thing.
I knew someone who had a lap band surgery, and I think my husband and I have a much better quality of life than she did. After a while, we both were able to learn what works and avoid dumping and vomiting for the most part, while my lap band friend still was vomiting several times a day years after the surgery.
I don’t remember where exactly I found the thing about how surgery is thought now to work. I’ll continue to research when I have a chance. Here are some articles about recent hunger hormone findings:
http://www.msnbc.msn.com/id/5323305/
http://news.bbc.co.uk/1/hi/health/3889185.stm
This article is kind of along the lines of what I’m talking about above, but I know what I read had much more detail:
http://www.drmirkin.com/nutrition/2514.html
