Thoughts on if I picked the best surgery option?

After research on my own, I decided against even considering the lap band.  I gave some thought to the sleeve, but decided against it due to lower success rates and not giving the major benefits of malabsorbtion.  That left me with the RNY and the DS.

After talking to my surgeon, Dr. Jawad here in Florida, I decided to go with the RNY.  I'm still about a month away, so I could change that.  I don't know if it's just because of cold feet, or just finally engaging in this wealth of information, but I thought I'd put it out there to get some opinions on the two surgeries.

I'm athletic and ac tive, and that's irrespective of my size.  For my size, I'm VERY athletic and active.  That's one of the reasons the doctor recommended the RNY over the DS.

So...thoughts?

I am 9 weeks out from having RNY and I LOVE it, best thing I have ever done for myself!

Being athletic and active despite obesity is exactly why I chose the DS.  Obviously my level of activity was doing nothing to help me lose weight.  I chose the DS to kick my metabolism in the ass, and it did so beautifully.  11 years later, I'm still delighted.

I had RNY, and couldn't be happier.

I have no idea what being athletic and active has to do with choice of surgeries. Neither RNY or DS will have an effect on that. There are a lot of other factors that will have some impact on your choice.

As Grim mentioned, I have no idea what being athletic and active would have to do with the choice between RNY and DS, but I am pretty active and I had RNY about 4-1/2 months ago. I am super happy with the results, and I can certainly be as active as I want to be. This was the best decision I have ever made! By the way, mine was a revision from the lapband. You made a great decision by not having that procedure!!!! Good luck and keep us posted!

i had RNY and am happy with it. in retrospect i would have gone with DS because it has the best rates of weight loss. 

that said, both are good options and both will require you to work for maintenance. its great that you're active, but keeping your weight off will depend on your food choices. 

Only time will tell .... Both surgeries have their good and bad points.  

I was verybfit athletic before RNY..and I was able to maintain a good muscle mass maximizing my proteins. 

Not much regular exercise. The diet is really what helps to lose weight - fat. Exercise can be counterproductive as it may cause much more drastic blood sugar fluctuation, and appetite increase.   Recently I added exercise because I lost too much and I am trying to get more appetite.  

Being fit can help with muscles and bones.... Even when I did not exercised regularly- I was always active, walking a lot, taking steps, stairs, every time there was an option. ...and when I noticed that I was getting less fit. I added regular planned exercises. 

When do I  know when I am getting less fit? Fast walking 3 flights of stairs in high heels made me tired... Lol..

Due to my BMI pre-op, if I was going to do a malabsorption procedure I would do the DS.  

But I opted for the sleeve because I didn't want the malabsorption AND it has great success rates.  

One factor to consider is that fact that the malabsorption lessons over time.  In the end you are left with restriction, however you will always malabsorb vitamins so you have to remain vigilant no matter how much you malabsorb.

Also keep in mind that the malabsorption of both the RNY and DS is mainly fats and protein, so if you are a big carb eater than either of those surgeries (or any other surgery) will help with that.  Simple carbs will always be absorbed 100% no matter what surgery you have.

In the end for me what has helped me is restriction.  I had a very malabsorptive procedure in 2002 and yet still managed to regain 100 lbs because I couldn't stop eating junk.  I had little restriction and could basically eat the same amount after surgery as before, plus even with restriction you can drink a lot of calories and graze all day and sabotage that.

Malabsorption is helpful if you concentrate on low carb, high protein eating.  Even without WLS a low carb diet is shown to promote weight loss.  The trick is giving up the refined carbs.  Having WLS gives you a tool to help you be satisfied with less food.  Period.  It is not a magic procedure that allows you to eat what you want, when you want, as much as you want, and still lose weight.

So you are looking for a tool.  I don't have statistics handy but I have heard that after about 5 years the maintenance numbers are pretty close for both the sleeve and the RNY.  The DS has the best stats for maintenance but also the biggest risk of issues due to not being diligent with vitamins and lab work.  And many people, no matter how enthusiastic they start out, tend to become lax over the years with follow up.  That is why, in my opinion, surgeons are favoring surgeries like the sleeve over malabsortive procedures.  Less risk for the patient and less liability for them.

It all comes down to being able to follow the rules.  When it came time for my revision I opted to have as little malabsorption as possible due to the issues I was having.  I could not think of one medical advantage of having malabsorption other than being able to eat more.  Malabsorption does not increase the metabolism, it just allows you to eat more calories because they all aren't being absorbed.  Restriction allows you to eat less food, thus taking in fewer calories.  At the end of the day it is all about eating (and absorbing) fewer calories.  

There is no set it and forget it WLS.  I guess the sleeve is the closest but there are still vitamin issues even with the sleeve.  It all comes down to how ready you are to make changes and which surgery will help you best make those changes.

I agreed to having a RNY because I had confidence in it having been performed the most and the longest of all WLS.  Even though I don't really have a textbook RNY, I am glad I have it. What I really have is a RNY pouch with my intestines configured more like a DS except a longer common channel, 200cc.  Even with that I have to be very diligent with supplements.  I have labs drawn every 3 to 6 months and take vitamins in response to the results.  If I see anything trending downwards I increase the dose.  I have been doing really good in that department and my levels have been hanging steadily in the upper range of normal so I have things pretty set and it's my new normal, swallowing handfuls of pills daily.  It really isn't a big deal at this time in my life but it would be if I didn't keep a close eye on things.  I have to watch my Ferritin levels closely and have iron infusions as needed if it gets too low.  I also have to watch my bones as I had osteoporosis, now reversed due to Reclast infusions.

What I am trying to say is that there is a lot of lifelong upkeep with WLS and I learned the hard way what happens if you let up on it.

With all that said when people ask me about WLS I usually recommend the least invasive as possible depending on your needs.  If my daughter wanted WLS I would probably direct them to the sleeve because that has the least amount of consequences of non compliance.  If they had Diabetes I would encourage them to look into the DS because that has the highest rate of remission after WLS.

In the end it is between you and your surgeon as to what is best for you.  I would not take the advice of strangers on the internet other than to take into account their experiences in how they would relate to my situation.

I would also do a lot of self honesty about my ability to follow the rules regarding supplements and follow up, including the cost.  It can get pretty spendy and you have to take into account that things in the future could change, insurance can change, situations can change.  I recently read about a person who wound up incarcerated and developed issues because they could not get what they needed to stay healthy. 

Also, a lot of self honesty about your eating and what changes need to be made, perhaps counseling or support groups to help with any food addiction issues.

There is a lot to consider, not just for the present but the future.  Because WLS is forever.  It's not like Weigh****chers or Jenny Craig, where you can just stop doing it when you are no longer motivated.  You have to stay consistent for the rest of your life, and you have to find a way to stay motivated.  Your body will no longer be the same as it was and it will always need to be treated differently. Some people have had WLS and then moved on to where they no longer even remembered they had WLS.  Until something happens to remind them, usually declining health.  I read about those things nearly every day because I am committed to daily contact with WLS support groups by reading OH and contributing when I can.

Good luck to you.  I hope I haven't overwhelmed you.  You have come to a good place to do your research and I am sure you will make the best choice for your own situation.