What's ahead for us - please read!

I found this information on one of my friend's profiles and I wanted to share it with you today! As many of us are entering our 8 month I think these are some things we may need reminding of. Sort of a reality check - at least it was for me, and I hope it is helpful for some of you as well. I hope you all take this as good information, and not a downer -- it's not supposed to be, but more, like I said, a reality check so that we don't set ourselves up. I know that I cringe to think of regaining any of the pounds that I am working so hard to take off, but it's a fact, and I need to remember that so I don't become hysterical when it happens! So here 'ya go! "This article touches base on a LOT of FACTS about weight loss surgery that I think some either are NOT aware of, or choose not to believe. WEIGHT LOSS SURGERY is NOT 'the' PERMANENT FIX! It scares me to think 170K people had this surgery last year and 10's of thousands probably 'think' its a quick and permanent fix. That's not the case - long term is totally and completely up to YOU and the choices you make. ALL the surgery does is give us the immediate opportunity to lose weight fast and start over. What we do with that second chance is completely up to us. Total and complete credit or blame is OURS for the taking and it will forever be our long term battle in life. This article touches base on a lot of fallacies floating around out there on the weight loss buzz line and it puts it into a factual perspective." "Choosing the KNIFE!" By Sally Squires Tuesday, March 7, 2006; HE01 "Today" show weatherman Al Roker and singer Carnie Wilson are likely to have a lot more company in the once-exclusive ranks of those who have had weight-loss surgery. A recent Medicare decision expands coverage for gastric bypass and other weight-loss surgery to people with a body mass index of 35 or greater -- about 60 pounds or more overweight -- who also have at least one weight-related medical problem, such as diabetes, sleep apnea or heart disease. In 2005, about 170,000 people in the United States had weight-loss surgery, according to the American Society of Bariatric Surgery (ASBS). Medicare paid for 6,000 of those procedures. Ninety percent of those operations were performed on people younger than 66, who are disabled by their weight and other medical problems, according to the federal Centers for Medicare and Medicaid Services (CMS). Since private insurers generally follow Medicare's lead, weight-loss surgery is expected to increase significantly throughout the country. But experts caution that surgery is not a cure for obesity. "It's a tool designed to help you help yourself, not a free ride," says surgeon Harvey Sugerman, past president of ASBS and professor emeritus at Virginia Commonwealth University. Some worry that the expanded coverage sends the wrong message, since medical treatment for obesity is limited at best. "Insurance companies won't cover the medical care of obesity treatment, but they're willing to pay for surgical intervention," notes Arthur Frank, director of the George Washington University Weight Management Program. "That's outrageous. It drives people into surgery . . . and may create the wrong incentives." Here are some of the caveats to keep in mind about gastric bypass and other weight-loss surgery, which has a mortality risk of about 0.5 percent to 2 percent, about the same as a hip or knee replacement. Surgery only gives a jump start. The procedures promote weight loss in two ways: either by diverting food from the stomach to a lower part of the digestive tract where nutrients can't be absorbed, or by reducing stomach size so that less food can be consumed at a given time. Overeating after surgery can result in vomiting or in "dumping," a condition that lasts about 30 minutes and is characterized by lightheadedness, nausea, flushing and sometimes diarrhea. "But you can always beat the system by drinking milk shakes or eating ice cream," says Frank, who notes that the same healthy habits prescribed for weight loss -- eating less and moving more -- are still required after surgery. That may be particularly challenging since people who become morbidly obese usually have difficulty controlling what they eat and often don't exercise. "Lots of people go into this with unrealistic expectations that the surgery will take care of it all and this will be it," says Ronna Saunders, director of the Center for Behavioral Change in Richmond, who counsels people after weight-loss surgery and screens them before it. Plan on taking vitamin and mineral supplements for life. Weight-loss surgery alters the digestive tract so that enough key vitamins and minerals can't be absorbed from food alone. After surgery, "all menstruating women need iron supplements," Sugerman says. "All patients need vitamin B12daily by mouth or monthly by injection." Also required: a daily multivitamin and at least 500 milligrams of calcium per day. Expect to regain some of the weight lost initially. During the first two years after surgery, an average of 60 percent of excess pounds are lost, which can improve the patient's health by treating such conditions as type 2 diabetes, high blood pressure, sleep apnea and ease joint pain. But those who undergo weight-loss surgery almost never achieve an ideal body weight and still remain slightly obese or at least overweight. "If they started off with a body mass index of 60, they may get to a body mass index of 35," Sugerman says. "They're not going to get to a BMI of 30 or 25." The weight also creeps back, as Roker has found. He shed more than 100 pounds after surgery in 2002, but in January of this year began a diet on the show to lose 20 of the pounds he's regained. He's said that a back problem and a hectic business travel schedule have contributed to his added pounds. "Typically you'll get three to five years of benefit in terms of weight loss," Frank notes. "But the weight almost invariably adds back." Prepare to pay . Even if you have health insurance, it may not pick up much of the tab. Weight-loss surgery averages $20,000, plus the cost of follow-up care. Private insurers take their cue from CMS, which allows $10,000 for hospital costs, plus up to $1,700 for the surgeon. Medicare picks up 80 percent of the surgeon's cost; the patient pays 20 percent. Follow-up medical, psychological, diet and exercise treatment are extra and can run thousands of dollars more and generally is not covered by insurance or Medicare. Find additional help. The often large and fairly rapid weight loss following surgery "requires physical and emotional adjustment," notes clinical psychologist Melissa Kalarchian, who studies people who have undergone weight-loss surgery at the Western Psychiatric Institute and Clinic in Pittsburgh. Spouses may also need some assistance. A recent University of Tennessee study examined spouses of 63 people who underwent weight-loss surgery. They found that 75 percent of spouses who were obese gained weight in the year after surgery -- perhaps because they ate food no longer eaten by their mates -- as did 38 percent who were not obese. The team suggests counseling to prevent weight gain and that very obese spouses be considered candidates for bariatric surgery themselves. Medical treatments have not proven effective for severe obesity. "Nothing about the surgical procedures will cure the disease," notes Frank. "It's the very uncommon patient who will sustain the weight loss. But if you can get five years of benefit out of it, that's pretty good."

Donna, Thanks so much for posting this information. IMHO, anyone who diligently researches this surgery, meets with their surgeon for open discussion, attends a pre-surgery seminar, and/or attends support group meetings probably has all of this information. I know that I had all of this information pre-surgery, but have not looked over it like I should. One of the reasons I enjoy our web-support group so much is because of the variety of reminders I receive from everyone. Like I said before, thanks for posting this...I needed the reminder that this surgery is not the solution, it is the catalyst for my new lifestyle and is assisting in my weight loss! ~~em

Hi Em, yup, heard it, been there, got the tee shirt, but it's good to, as you say is to remind us of some of the things we've heard! donna

Wow!!! And thank you Donna for sharing. Your timing is perfect. Goal is within sight and the reality of the long term commitment is sinking in. Daily exercise has GOT to be a part of my new life. I know this is going to be the key for long term success. Making good food choices daily is a given. You're right on in reminding us all. Thank you. Sydney 244/147/140

Hi Sydney, this was good timing for me as well. Not that I think it's going to be easy for the rest of my life, but just a reminder that the playing field is level and I need to do some work as I go through this process!! donna

Hi Donna you know what we had to go thruogh just to get this surgery It was not an easy task. We have to continue keeping your eyes on the prize because if you give in to those demons you will get lost. I know that I watch what I do and eat every day. Judith N

yup - I do indeed know what we had to go through!! It was so good seeing you on Monday and having our little lunch! I enjoyed that Judy. donna

It's a good reminder to be vigilant and do what we need to do, but (and yes, I know - I'm nitpicking) it does contain some factual errors. First of all, not *ALL* WLS patients need B12. That is specific only the RNY. People who have had the Lap Band do not malabsorb at all, and people who have had the DS do not malabsorb B12. Also - 500mg of Calcium? Get real! A woman who has NEVER had surgery needs more than 500mg of Calcium. We should be taking 1500-2000 mg of Calcium. Secondly, there is nothing in the medical research that indicates you CAN'T reach goal if you start with a BMI of 60+. You are MORE LIKELY to reach a normal BMI if you start lower but starting BMI is not a guarantee of success of failure. Third - overeating is not what causes dumping. They actually do not KNOW precisely what causes it, but it is related to specific foods - not volume. Someone who dumps on fruit is not going to dump eating the same amount of tuna. And lastly - surgical treatment is the ONLY successful treatment of obesity for the morbidly obese. Diet and exercise are only successful for 5% of the obese population. These facts were stated by the National Institute of Health in relation to Weight Loss Surgery.

As with all information that we receive, from all types of media, this of course needs to not be considered as the gospel! I would hope that we all have had enough education on our surgery to pick out, as you did, the inconsistencies. However, I think the overall message is a good one. I know there is disagreement even amongst the medical community on different types of vitamins to take, what to eat, when to eat it, how long our 'honeymoon' period is, etc. I was told to eat mashed potatoes after about 2 weeks, for others that is a big no no.

Good post, thanks for sharing. It's kind of scary tho. The weight loss is really slowing down, I wonder if I'm ever going to get to the century club. I've also been worried because I'm afraid once I hit 100 lost it will stop. I'm also worried because I really don't eat much, still can't eat meat so I'm only averaging 500 calories a day. This can't go on forever, I'm going to have to start eating more but if I can't lose weight now???? Okay, I'm gonna stop worrying (I drive my poor hubby nuts) and get ready to go home... Micha (aka autumn's mom)