RNY....is it the safest choice for...

I am not prejudiced against lightweights at all. I have no issue with anyone who has a BMI of 35 or over getting WLS, even without co-morbids. Under a BMI of 35, I don't think it has been proven through any reputable studies that the risks are worth the rewards. This woman, presuming she lost 17 lbs on the pre-op diet as reported by the OP, would have still have had a BMI of 32.3 at her very highest weight. 

In other words, the facts don't support the contention that she met the NIH guidelines. It seems to be that either the OP has the information wrong, or the doctor has presented misinformation to get her approved. 

In Europe the BMI requirement is 30 and over, so I'm sure they have the stats to support the efficacy and safety of WLS for lower BMI patients; especially since they've been performing WLS longer than U.S. surgeons.  I would also guess that the lower the bmi, the less surgical risk and the higher the possibility of 100% EWL.

 

 I'd be interested to see those studies. If the data is there that the benefits support the risks, I can certainly see the usefulness. I can particularly see it for a patient who has a history of being MO, such as your situation. My concern is that these procedures are not without risk. I think obviously, the line has to be drawn somewhere.

I have a friend who told me, in all seriousness, that she wishes she could get the DS to lose 20 lbs she hasn't been able to get rid of through dieting. She sees it as a quick fix. I am afraid that there are certain unethical doctors out there who would perform these risky surgeries on patients like her, who truly could be trading in 20-40 lbs for a world of problems.

Yes, there was recent study of BMI 30 - 35 patients in Europe who got the sleeve and they all had 100% EWL.

I think the US has its head up its ass on this one. A person with a BMI of 30 is *obese*. They aren't going to be helped with diet & exercise, not most of them, not in the long run.

Heck, I used to be "only" 50 lb. overweight myself. I did WW, I did JC, I did Atkins. All it got me was 100 lb. overweight. And in the meantime I went from no health problems to having high BP, plantar fasciitis and GERD.

I have no prejudice towards light weights.....I simply am concerned for this woman.
I also know many people who have fought like crazy trying to get approval and they have been turned down for not meeting guidlines.  Many with multiple co-morbidities.

I merely question if a malabsorption procedure is really the right way to go.....ultimately, it is her and her surgeons decision.  I simply wanted to get a feel for how others felt about the situation....I have the stats correct....she is 5'6" and her current weight is 183....her weight at consult was 200.

Missy

Hmm, I do think something sounds a bit off.  It can be really hard to tell what someone weighs so if she claims she only needs to lose 50, she might actually be 80-100 pounds overweight.  If she really is only 50 pounds overweight, I hope they do a verrrrrry proximal RNY on her.

There are some bariatric surgeons who are doing trials of WLS in smaller patients (I think the U of Minnesota is doing RNYs on people with BMIs as low as 30 if they have diabetes) but I don't think Medicare would have caught up to that yet.

If she was approved, then her BMI is at least 35. The reason that's the cutoff in the US is that studies have shown that people with 50 lb. or more to lose have little to no chance to take it off and maintain that loss in the long run.

If someone has uncontrolled high blood pressure and sleep apnea, their risk of dying is much higher than if they don't. Why should they be made to suffer ill health until they have 100 or 200 or 300 pounds to lose? That's medical malpractice IMO.

Anyway, how much weight you are going to lose depends on many factors, not just starting weight. It's not like everyone who gets RnY is going to lose at least 100 pounds no matter what. Once she gets to her goal weight, it's going to take her the same amount of calories to maintain as it would if she started with a BMI of 60. So, if someone with a higher BMI isn't going to lose too much weight, why should she?

I always find it interesting that many people on OH have experienced all kinds of horrible size discrimination, but nobody talks about how we have our own form of reverse discrimination in the WLS world.  Our measure of whether someone needs surgery is still based on how they look as opposed to the medical issues they face due to the extra weight. 

The day I had lap band surgery I weighed 196 lbs. thanks to an 8-lb. loss from the pre-op diet, so I had 50-60 pounds to lose.  People were constantly questioning my decision to have surgery.  All they saw is what was on the outside, but what they didn't see is my malignant hypertension and renal disease.  I was just 30 years old when I had a stroke and my BP reading that day was 251/132; I shouldn't even be here right now.  That was when I seriously began trying to lose weight on my own -- Weigh****chers, Nutrisystem, Atkins; you name it, I did it.  I was always able to lose a significant amount of weight, but of course it always came back and my BP was still out of control.  So when the opportunity for WLS came along, I took it because I knew what was going on with my body and I knew I needed a more drastic solution than yo-yo dieting.  

Unfortunately, my band was removed last year due to slippage, GERD and other issues, but before it was removed my BP meds were cut in half and I felt more energy than I'd felt in years.  I've been without my band for almost a year and I've now gained  back all the weight and then some.  I also have horrible leg and back pain due to the extra weight.  I know people who are much heavier who don't experience the mobility issues I experience daily.  How much one weighs has nothing to do with how their body handles extra weight; we're all very different.  

I've decided to revise to the DS, so now I'm going into surgery with 92 lbs. to lose.  I assume people in the WLS world will find this "acceptable."  My only regret is that I didn't get the revision when I had only 50-60 lbs to lose; it'd have made things much easier for both myself  and my surgeon.