I can haz weight loss surgery?

http://ask.metafilter.com/99422/Im-so-sick-of-being-fat#1446832 and my response then: My father weighed about 450 pounds at his peak, and even at 6'4, this meant he was VERY large. Seatbelt-extender-on-the-plane large. He literally did try everything, from Jenny Craig to exercise routines, to prescription pills to other options. Nothing worked. So he researched, fastidiously, in his way, and determined that he'd like to go for the http://en.wikipedia.org/wiki/Duodenal_switch form of weight-loss surgery. Prior to his surgery, he had very high blood pressure, had just been diagnosed as a type II diabetic, had a chronic potassium deficiency that had led him paralyzed and close to death several times and had severe back pain, amongst a few other issues. Blue Cross/Blue Shield of Arizona was not covering DS, only RnY. They cited lack of a sufficient body of work showing the efficacy of the surgery and willing surgeons. My father put together an 85-page briefing on the surgery and before it went to arbitration, a BCBS VP for Arizona called to thank him personally and to let him know he'd be the first DS surgery and that they'd begin covering it. The surgery went very well. He lost over 250 pounds and is now down to 200-205 pounds. It's three+ years later. Initially, there were giant swaths of food he just couldn't touch. Dairy was nightmare, certain meats he had to be very careful about, and after the initial surgery, he could only eat about three tablespoons and he'd be full. This is a DRAMATIC LIFESTYLE SWITCH for anyone who is EVER used to sitting down and eating a meal. Your force of habit makes you want to continue eating to the point you normally eat to be "full" or "overfull." When you do this after weight-loss surgery, you get very sick and nothing fun comes of this. With DS specifically, and others, I'm sure, you also no longer process fats properly. This means that no one will want to be in a 20-mile radius of the bathroom when you're done using it. He could naturally write this better than I, but the lifestyle changes are significant. And you still require some semblance of discipline. Surprisingly, my dad now eats almost everything he ate before the surgery, and he eats regular meal quantities. I'm sure his stomach has re-stretched to a normal size, but DS features a malabsorption approach in addition to capacity, which causes a good chunk of your meal to bypass absorption entirely, without the pesky http://en.wikipedia.org/wiki/Dumping_syndrome RnY patients sometimes have. So he hasn't regained ANY weight. And I've seen him do some things that I question, but alas, it's been over three years and the malabsorption component does him well. If you met him on the street, you'd have no clue he used to be 450 pounds. His face is thin, and he has a relatively thin build. 6'4 at about 205 lbs, looks about normal, if not a bit thin. Without his shirt, it's a bit different—you can tell there's extra skin there; he hasn't had any skin reconstructive surgery yet, since that's a bit involved and about the only person who might care would be my mother. Regardless, there's a bunch of excess skin that doesn't just go away. On the flip side, what was once an annual trip to the emergency room for one epic failing of his body or another is no longer. His diabetes is completely cured, he no longer requires beta-blockers for his blood pressure and his potassium rates are normal. His heart is in good condition and I swear to you, I'm absolutely convinced that the surgery saved his life. (After the sixth or seventh trip to the ER in as many years, you start preparing for the news that he's just going to die. He came so close several of those times, especially with the potassium and blood sugar—his blood sugar was 600 once.) He's happier, healthier and infinitely more self-confident. You're a bit on the lighter side; but just a bit. You can probably find a doctor who will perform the surgery, but the insurance question comes up based on your provider and your plan. For my dad, who was paying $1,200 a month for HIS OWN policy with no other family on it, and visiting the ER at $15,000 a pop at least once a year, it was a bargain for BCBS to pay the $25,000 for the surgery and never have him in again. It's a huge lifestyle change. Look up "bariatric surgery" since that's the technical term and you'll find plenty of support groups, etc. (My dad's surgeon ran a support group as well, which he found very helpful.) Remember that the different types of surgery are dire to varying degrees and also have varying degrees of bounceback. Do your research. Do a LOT of it. Understand what they're doing to your insides and why things are supposed to work the way they are. When you work to understand the core components and the underlying principles, you can make considerably better decisions from a more educated standpoint, instead of just hoping the first and second opinions you hear are right. My dad had some side effects, but frankly, nothing as dire as "your hair will fall out" or anything. Your mileage may very will vary. But there are definitely things to do and NOT do to help mitigate those issues. If you're suffering from any other comorbidities, and frankly, having an old injury that still hurts you will only hurt less the less weight you have to truck around, the surgery is of significant more concern to you. Finally, all surgeries carry significant risks with them. I think there's a flat-out 2% chance of dying during the surgery. The risk levels vary wildly based on your weight going into the surgery because of additional complications, naturally. You'll want to find a surgeon you trust and whom you can vet externally; this is very much something that leaves a lot of room for error, as all surgeries do. This can change your life, but you may be in for a bit of an uphill climb. I think my dad would be the very very first to tell you that it's absolutely, 100% worth it. In fact, he'd go so far as to insist he wouldn't have progressed as far at his corporate job now if he hadn't lost the weight before the opportunity opened up—weight perceptions when you're as large as he was play directly into "how much longer is this guy going to be with us," and frankly, the answer was "probably not very." I no longer worry that the next time my mom calls me, it'll be because it's finally happened. In fact, I don't worry about it at all. And I used to. All the time. Because he cheated death too many times. The surgery saved his life, which sounds dire, but it's absolutely the case. And it changed it immeasurably for the better. Skinny folk don't necessarily understand the plight of the overweight. "Put down the fork" isn't enough, even when we so desperately want it to be. (Yes, I'm a bit overweight, but I've put in enough psychological stopgaps to ensure to the best of my ability I don't pass a certain weight.) It's hard and it makes life harder. It's one of the few areas where people don't feel bad being judgmental because, to them, it's OUR choice. Not like race, or sexual orientation. No, we *choose* to be fat. But we don't. God knows we don't. You owe it to yourself to look into this in a very serious manner. You need to do the research, you need to involve yourself actively, and you need to treat it with the weight this decision has and not just hope and pray that those around you will direct you correctly. You make your own luck in a lot of ways and educating yourself completely on this is doable and needs to be done. If you're interested more in the DS, or my father's surgeon, MefiMail or Gmail me. And good luck, whichever path you choose!

I had a gastric bypass several years ago. It likely saved my life, so I've never regretted it. Also, no real long-term complications, but YMMV. Having said that: 1. It's real surgery, and real surgery involves real risk. I would not have considered it myself it I did not honestly believe I had exhausted every other option. 2. For the surgery to be effective, you have to commit to several lifestyle changes. Frankly, reading your question, it looks to me like you've already lined up all of your excuses for failure. (Ie, "Exercise is too hard." "I do most of the cooking.") I mean this in the kindest possible way, since I've been there myself. I believe that the main reason for the success of my surgery was that I had already put the diet and exercise plans in place long before the operation. I had already lost over a hundred pounds before I turned to surgery. The surgery was truly the last resort to get that last 80 or so off after a prolonged plateau. While group therapy was a good idea, I might suggest getting some personal counseling in this area, to help you discover if your emotionally prepared for this. It really helped me. 3. Your concerns about vomiting, dumping, etc, are legitimate, but I will offer my own experience: in eight years, I've never had a single instance of any of these symptoms. 4. Yes, after the surgery I lost most of my interest in eating. And thank goodness for that! In my old life, I couldn't finish one meal without planning the next one. Afterwards, I discovered that I could eat a small, reasonable meal, and be perfectly content with it without feeling the least bit deprived. For me, freedom from the food addiction alone was enough the justify the surgery. In the end, it's your decision. If you are actually experiencing major health problems because of your weight, then surgery may be a reasonable option. Best of luck, regardless of what choice you make.

Also you say you rarely feel rested on 10 hours of sleep? You might have sleep apnea. I suggest getting a sleep study done ASAP. Sleep apnea puts a huge strain on your body and studies have shown that it makes it difficult to lose weight. Which makes the apnea worse. Which makes it difficult to lose weight. Obesity and sleep apena is a miserable cycle - and both can kill you.

I have had quite a few friends have this surgery. From what I have seen complications are common. One friend almost died from the procedure. All of them have had to radically change their lifestyles. I don't think anyone regretted the surgery but none of them has the lifestyle you presently have. One of my friends who has had it exercises quite a lot and told me she is the only one of her friends who has had it who has actually kept off the weight. I think you really need to take a hard look at your life in total. Your schedule is killing you and the surgery is not going to change that. Making time to find an exercise you can enjoy, building up your muscle mass and your metabolism and being able to have healthy meals is something you would have to do whether or not you have the surgery. From what I observe from the people I know I would consider the surgery a last resort.

Reduction in caloric intake or type of food intake did not seem to break the plateaus if this is truly the case, a gastric bypass will do nothing for you, as all it does is forcibly restrict your caloric intake. rather than going through a drastic, irreversible and potentially fatal body modification procedure, have you thought about trying a really strict diet and exercise regimen, with a scale and log books and so on? one that you maintain come hell or high water, regardless of social outings, what your wife is eating, how hectic your schedule is, etc? a really fit guy i used to know once gave me some really good advice, when i was bitching about not having enough time to exercise in college: "you have to make the time." in other words, losing weight has to be important enough to you to trump the income that comes from your second job, or whatever else is sucking away the time or effort. otherwise it'll fail. this is why people usually talk about "lifestyle changes" - it might be worth it to re-evaluate your time commitments in light of how you feel about your weight, and make some hard choices about what's important to you.

My only experience with the surgery is knowing two people who had it and are doing well, one person who put the weight back on quickly. I know working too hard and stress, though, and I know being a big dork of a foodie. So, I'm sorry, but I can't imagine how the surgery would be a good solution for you at this point. You are unable/unwilling to make time for exercise, you have previously not had much success sticking to diets, you work incredibly demanding hours and put yourself under a lot of stress, you don't feel that you get enough rest, and you sincerely enjoy food. You're proposing major surgery that requires you to make a lifetime commitment to all the things that you haven't been able to do so far, and takes away what, from your post, may be the only indulgence you allow yourself. Please consider rethinking what you're doing to your body and mind by working like this before you consider surgery.

I am very sorry you face this situation. Although I have no direct experience with bariatric surgery, I can describe how your post reads to a neutral third party. It seems as if you are seeking an excuse or a solution that would allow you to maintain your present lifestyle. As everyone has said, you will have to change your lifestyle in a major way to lose weight, or to even become a candidate for some kinds of bariatric surgery. At the same time, from your post you sound like you have a really valuable asset-- the ability to analyze pros and cons. You can put your problem-solving talents to use with this problem too. Prioritize what matters most to you: exercise or work; limiting food or adding exercise; eating the same or different foods with your wife; acquiring wealth NOW or learning to maintain healthful living, and so on. Do that and you may able to see where to begin--surgery, food intake reduction, or gentle exercise. Obviously your physician should be part of that decision-making process. One thing I shared with you was a dislike of exercise. At the end of week 2, I began to actually feel better after a workout. After that I began to look forward to the gym. If I missed a session I felt gross. (I also started a regimen during basketball playoffs so I could watch games on the machines.) It may take you longer to get to that point. But once you do, it's the best feeling in the world.

My aunt had gastric bypass surgery. She said it was hard at first because they put you on a liquid diet. This lasts for a few months. Not everyone has problems digesting foods after the surgery. She never had any problems keeping food down so while she is nowhere near as big as she was, she has gained back some of the weight she lost the first year, but honestly she looks better. She lost so much weight the first year she looked malnourished. Today she is very active and is glad she can pretty much still eat whatever she wants, but sh knows her limits and does not overindulge. She runs around with her grand kids and is frankly like the Energizer bunny. She was never like that when we were growing up. She says she would have the surgery again because it really did change her life and outlook on life really. She's so much happier than I've ever seen her and her self esteem is through the roof. She had the surgery when she was maybe 52 or 53 and she's 58 or 59 now. She was in the hospital for a good 3 weeks after the surgery (she had no complications) so you'll have to factor that time off of your busy 3 job schedule. She went through Kaiser. My mom was about 100 lbs overweight at 5 feet tall and she just decided to start cutting her portion sizes in half one day. After about 2 years she's easily half the size she was and feels much better. She uses dessert plates to portion out her meals and always takes half her dish home if she goes out. She never stuffs herself and hardly eats any sweets. She does not drink soda. She has never exercised in her life. So she's an example that it can be done without the surgery, even without exercise, if you have tremendous willpower to eat as little as possible without starving yourself. She's also been doing Weight Watchers for the past 6 months which has taught her about good nutrition and gives her a support outlet. I know you came up with it being a "2.5 hour trip" to go exercise but all you have to do is step outside your door and start walking and the pounds will melt off. Start slow and only when you think your body can take it then think about going to the gym. Definitely hire a trainer. Walking is plenty good enough to start. Moving is the key to see and feel a difference. Your legs and feet will hurt at first but they will hurt forever if you do nothing. I promise after a month you will be looking forward to taking a walking, you'll be able to breathe better and you'll hurt less. GOOD LUCK!! YOU CAN DO IT!!!

You're looking for another excuse not to do something about your weight/health. I have no idea if the surgery is the absolute right thing or not for you. But it's a last resort scenario. Your third job right now should be your health. Not a pipe dream for the future -- your body and happiness and comfort ARE your future. Put the other thing on the side and make it your duty, your job, your obligation, to getting healthier in the way that YOU know how to do. Everything else is a distraction. Walking fast or up hills is hard? There's your exercise. With an iPod and some great podcasts or a book on tape. Or join a team. Or make a competition with your wife. You don't need 2+ hours a day. Walk fast for 45 minutes before work. Walk for another 20 after dinner. Keep a food diary EVERY single day. Talk to your doctor. Join one of those 2.0 fitness sites like gyminee. I bet after 3 months you'll start to see some changes. Good luck -- I think you're wanting folks here to shy you away from the surgery for a reason. Because you know that the consequences of that might not be worth not trying other things first. Not just "trying" but DOING. You can do it!