Obesity surgery (ottoluv)

I lost my mom due to heart failure. I always thought the excess weight would eventually catch up to her.  She was about 500l bs.  The last two years of her life she really tried to lose some weight.  I think she lost about 50lbs.  But that has to be frustrating...I mean 50 lbs seems like nothing when u weigh 500lbs.  I wish she would have had the surgery. 

I think she lost about 50lbs.  But that has to be frustrating...I mean 50 lbs seems like nothing when u weigh 500lbs.

That's exactly it. When I was 15, I lost 80 pounds. I still weighed 220 pounds. And after those 80 pounds, I went down ONE clothing size...from a 24 to a 22, a 20 if that particular thing ran big. It's disheartening when you can lose that much weight and have it just barely change your physical apperance. Eventually, it just seems completely hopeless and you give up...at least I did.

I get to see lots of people that are post surgery.  Both kinds.  At first they are miserable than after a few months they are happy and feeling better.  After a few more months I don't even recognize them.  Most or all the health problems they had pre-op are gone.  I think in the long run it would be less costly on the insurance company's if the morbidly obese had the surgery.  I think maybe it's not excepted yet is because (I think) it's elective surgery.  Not like fixing a heart value.  But then in the long run it's really like helping the heart isn't it?  I wouldn't be offended if my Doc said I needed to lose weight or if I was obese that there was a surgery out there to help me and my long term health.

So, here's this Jane Q. Public's uneducated view! (Please nobody take offensive, it's a very uneducated view.)

To me, who knows nothing about it really, it seems like a bad idea in most cases. This is coming from me watch my step-mother grow from 5'2", 120 lbs. or so, to certainly well over 200. This after having a heart attack and quitting smoking. She now can't walk properly, let alone for any distance, and is constantly having digestive "distress" of various sorts. When she took a trip to Spain last year she only left the hotel room once, to give you an idea of how bad it is. Despite all this, she does nothing to improve her health. She is constantly on "diets" of various strange sorts, which she only adheres to when she thinks people are looking. She buys "fat free" desserts only to eat 5 helpings of them at a time (out of sight). She makes a big point of telling people she doesn't eat breakfast or lunch, only to eat about 3 times as much dinner as I ever do (and I eat a LOT). She does "exercises," which consist of her locking herself in her room to watch TV and maybe do a couple of stretches. She won't see a doctor and she won't see a psychiatrist - she refuses to admit there is a problem, let alone do anything about it. She will, however, constantly criticize other people for their dietary indiscretion.

So, because she's the only clinically obese person I know personally, this is the picture in the back of my mind whenever I hear the words "fat" or "obese." So do I think people like her should have surgery? No, I think they should have forced psychiatric care to help them deal with whatever the underlying issues are instead of turning to surgery first. To me, because it is so invasive, surgery should be used as a last resort, not as the first thing you try. Besides, it seems like surgery isn't going to the root of the problem, and instead is serving more as a "band-aid" to fix the symptoms instead of the problem itself.

So it seems like my prejudices are based on ignorance of the procedure and the types of people who elect to have it. However, I'm sure I'm not the only ignorant person in the world with an obese person in my life whom I don't particularly like, so hopefully laying my prejudices out in the open will help you better understand the great hordes of unwashed masses out there who understand neither obesity nor obesity surgery... like me. ;)

From how you've described it, it actually sounds like a Godsend for those who need it. I hope it's as helpful as you make it sound! 

I just met my brother's mother in law at their wedding a few weeks ago.  She had the gastic bypass surgery.  But, couldn't stop eating.  She ended up in the hospital and having to have another surgery to fix the damage she did.  She still can't stop eating.  She's got all the symptoms of an eating disorder now.  She knows she's not supposed to eat certain things or certain amounts of foods.  She does anyway, then vomits. 

And, she's only lost about 40 lbs or so, she's still big.

I think as long as they are sure the person is mentally OK for it it's a life saver sometimes.

Thanks again guys for posting, Brittany a few things I wanted to mention to you in particular since you seem intersted in actually having the procedure. As for bringing it up with your doctor, I think this is a real concern. It is a really specialized area and I do think that many clinicians don't know much about it. I also think that many people don't think of obesity as a medical problem, but a mental disorder which isn't the case. I think the best way to approach this is read what you can on the internet and just say, "I'm intersted in this procedure and here is why.....". Mention the health benefits and that you are worried about how obesity will effect you in the future. If your doctor is not receptive or ridicules you or you percieve that he/she is, you can go elsewhere until you get the discussion you would like. From your prior descriptions of your health problems, I would say you probably suffer from metabolic syndrome and would be greatly helped by this surgery. As for how you eat in the future, you can only have small meals, definately bigger then a teaspoon at a time, but not much bigger then 8 ounces at a time. Many social things revolve around eating and the thought of not being able to "eat" normally really distresses some people. Most of the patients I have encountered have very supportive families and friends that are really positive about everything so that helps. The key to eating successfully after this surgery is chewing everything very, very well. In addition, I think another important point is to be brutally honest with yourself. Really sit down and assess what you eat on a daily basis and what exercise you do. Most people are suprised with how much they actually eat when we do this. It's not a mystery, calories in greater then calories out you gain. This is especially important if you are to consider the band. If you are what we call a "sweet" eater, the bad can be cheated where the bypass can't. "volume" eaters do better with the band. It's a big decision for anyone to make and it takes a lot of careful consideration. I am encouraged that many people who have posted don't have the negative view I thought they would.

 

I had a coworker who was considering this surgery. She ended up not doing it and did a liquid diet instead, but has no put back on about 20 pounds of the 80 pounds she lost. The problem is that she can’t have a “normal diet” without gaining weight after doing this liquid.

 

She regrets NOT having the surgery (that WAS covered by insurance) and is now too “thin” for the minimum requirements. I often wonder how she would have fared had she done the surgery (but our old boss talked her out of it…)

 

The good news is that her diabetes problems went away with the majority of the weight she has lost… so hopefully she can at least keep that in check.

 

Kel- did you know that my hospital has what is suppose to be known as ‘a very good” bariatrics program?   Maybe you can look into what they are doing if you are looking for what other places in southern Cal are doing in this area? Just a thought…

I think surgery is too extreme in 98% of cases. If those people can change their lifestyles AFTER surgery, why can't they do it BEFORE surgery, and avoid surgery altogether? It's just BS..

I'm overweight, come from a mostly overweight family, a few of my family members are obese, though I would only call my cousin-in-law "morbidly" obese. If ANYone in my family started considering surgery, I would smack them and tell them to put down the chips and cookies and get up off the couch.

Most overweight/obese people say they've tried "everything", but obviously they haven't. I'm fat because I eat crap and don't move. That's the truth. It's too much trouble to go grocery shopping regularly and spend an hour a day exercising. I don't know why that's true for me, it's the stupidest thing I've ever said, but them's the facts. If I stopped eating crap, added some vegetables to my diet, and spent an hour on my stationary bike every night, I'd be skinny in no time. I lost 40 pounds last year, and it really wasn't that hard, but it took effort. I stopped putting forth that effort and gained 20 back. There's no big bad reason for that, it's just my laziness.

One of my sisters goes on the Atkins diet practically every other month. She loses some weight, but as soon as she goes off, she gains that weight back PLUS some. She is obese now, and still thinks the Atkins diet is a good way to lose weight. And "if she could just..." whatever, she'd be fine. But she can't. It's impossible to eat all the cheese and sausage you want one week, and then next week suddenly switch to eating healthy foods to maintain your weight. But she can't see that, so she does this yo-yo-dieting and just gets bigger and bigger.. If she ever mentions something about surgery, I'll smack her upside the head.

I'm sick of people acting like their fatness isn't their fault, because in 98% of cases, it IS their own fault, and in those cases, I think surgery is stupid (now..when you get up into 500, 600, 700 pounds and facing death because of it, it becomes necessary).

Okay, so I'm judgemental, maybe ignorant..but yeah, that's my opinion.

Now chelsea your reaction is what I'm used to hearing. I think it is a problem and a lot of obese people don't take ownership of how they effect their weight, but.....it really is genetic in a vast majority of cases. Not genetic like i said in I eat saltines and work out six hours a day and am still 300 pounds, but genetic in that they don't feel full and feel more hungary then others. The reason that the surgery is better (in the case of the bypass known as LRYGB) is that it is malabsorbtive as well as restrictive. You can't mimic that with a strict diet. I think the important thing to remember is that these people have significant life shortening medical problems. Regardless of how you feel about their self control, they don't deserve to die from them IMO. They can't loose the weight frequently because their body is telling them different things then mine is. My body says I'm full where their body tells them they are starving. Cedars is a COE in obesity surgery, one of the few in california so I see people who understand the surgery. It just seems to me that on the media that it is portrayed as a failure if someone gets it or that one should be embarased.

 Like the episode of "Scrubs"? (You're a surgeon, surely you must watch Scrubs )

ottoluv

Not genetic like i said in I eat saltines and work out six hours a day and am still 300 pounds, but genetic in that they don't feel full and feel more hungary then others.

Interesting... I eat a lot, but I don't think it has anything to do with genetics. I think I've forgotten what "full" but not "stuffed" feels like. When I'm just "full", I still think I need to eat. I don't feel satisfied until I'm stuffed. But I'm pretty sure that for me, that's learned and not genetic. But obviously people are different.

I don't think someone who gets surgery is a failure, or they should be embarassed, I just think it's awfully extreme for someone who isn't hugely morbidly obese. I do think eating can become an addiction just like cigarettes or alcohol, but we don't go around taking out most of someone's lungs so they can't smoke, or sewing their mouth shut so they can't drink, KWIM?

Maybe there should be widespread rehabs for obesity.

I am overweight (have had a heart attack and am diabetic).  I have a negative opinion  of the surgery because i feel it's taking the "easy" way out - i'll let "someone else" fix it for me, because i lack the will power to do it myself.  I know i "should" lose weight.  Could I do it?  I don't know.   But not one of my physicians (primary care, endocronologist or cardiologist) has actually said "lose weight" - and if they don't say it to me they don't say it to others.   I think if one Dr. said i want you to lose ten pounds by the time you come back in three months, i'd do it.  I know i have to take responsibility for myself, but i guess i think I'm not "that" overweight or they'd say something - but i know i am.  I don't eat horrible things (we eat out almost every meal), just a lot.

chelsea_b

But I'm pretty sure that for me, that's learned and not genetic. But obviously people are different.

I think this gets overlooked A LOT....familial inherited eating patterns...it's not "in the genes" so much as "in the house". Kids are told "clean your plate"...boys are rewarded for having HEALTHY appetites...I've caught myself doing it to my own son! It is something that is real and completely within one's power to un learn if one wants to.

My DH was raised to eat EVERYTHING on his plate...even if he is full....even if he didn't like it. That to me...is not a healthy way to teach kids to be. Now he has relearned that leaving things is okay...and he often says he "could eat more but I won't". I was NEVER allowed to snack but with my metabolism I am ALWAYS hungry. Consequentially I snack ALL THE TIME now...in addition to regular meals. My "full" lasts only a few hours...then I am hungry again. I rebelled to an extent against my familial training...I eat what I want when I want...perhaps others do to...but absent my same metabolism...they get big.

If you are studying families with obesity I really think it's impossible to say it's genetic and not in some part...familial/envrionmental.

 

This is probably totally obvious, but I think the most important issue with negative perceptions of the surgery is that once a person gets "too big" (or "too skinny";), they are seen as public property, are assumed to lack the ability to make good choices and hypercriticized for making bad ones.  We talk about larger people as if they don't exist and everyone becomes an expert because regulating weight is something most people have some experience with, at least in theory - we ignore medical evidence, psychology and emotional factors and frame the issue as solely one of individual choice, more specifically bad vs. good choice.   Bad choice = getting fat.   Good choice = dieting.  It's as if obese people have made a "choice" that so drastically violates social norms that they have to repent by losing weight the "hard" way.   Surgery is seen as lazy, the easy way out, an incorrect choice that obese people are undeserving of because in general obese people are seen and treated as lacking self-determination and bodily integrity.   That stigma is extremely hard to work through.

Weight is such a touchy subject for so many. No one is happy, and it really plays on self esteem. I personally am not "fat" but I have put on extra that I want and can't seem to lose. However that is my issue. I have a friend at work who had to have both her knees replaced, her knees were bad from years of obesity. Post surgically she was still having issues and was frustrated that her knees would fail again, she had gastric bypass surgery. At first it scared me. She dropped in my opinion quickly. Her skin and color seemed "off", but now after another year has passed she looks AWESOME. She no longer walks with a cane either. I did worry because I had heard the bad stories, but I think she did it right. I also knew of a man who had a weight issue who rode horses. He wanted to be thinner. I do not know his history. I do know he had his mouth wired shut, and gastric bypass. He did not lose 'much' weight. As I said I do not know his history there could have been underlying factors (other than just will power).