BED....who to approach?

LOL. Yes. Get a surgery that lets you indulge in your mental illness with no weight consequences, that's clearly great advice about how to treat mental illness!

I'm sure your mental illness is not being able to read. I did say see a psychiatrist first.

BED was not added to the DSM until about 2013. It was not an option for us "old timers". However, if you have BED, why would you get a restriction only surgery? It seems almost foolish, and almost a recipe for failure.

When you get to 10+ years and have maintained a 300 lbs weight loss then we can talk ;0

I'm not sure why people like to claim VSG is restrictive only.

"When VSG was first introduced, it was deemed to be a purely restrictive procedure; however, this view has been transformed on the basis of clinical and experimental observations."

Albaugh, V. L., Flynn, C. R., Tamboli, R. A., & Abumrad, N. N. (2016). Recent advances in metabolic and bariatric surgery. F1000Research, 5, F1000 Faculty Rev-978. http://doi.org/10.12688/f1000research.7240.1

The reality is that a person that is prone to eat a significant amount calories (binge eating or otherwise) needs a significant amount of malabsorption or the ability to resist food. My contention is that the VSG alone does not provide enough protection from regain for a person that is prone to over eat. If it's working for you...good for you. However, if you are struggling with BED, my point was that even before BED had a name, we had a cure.

People that have the VSG and the RNY have to maintain a reduced calorie diet long term to be successful.

A surgery that allows you to binge eat without weight gain is not a cure for BED because weight gain is merely a symptom of BED.

Neither is medication. It's just a treatment

Yes. Treatment that helps to resolve the illness itself, not just the symptoms.

Obesity is caused by hormonal dysregulation rather than caloric surplus in some respects. Part of why the DS, or any surgery works, is thought to be these changes rather than the malabsorption alone. Any bowel resection or bypass, whether an RNY, DS, for ulcerative colitis, etc, has a profound metabolic shift that takes over. They developed an endoluminal barrier which actually causes the same effect as having a bypass, interestingly.

The DS tends to keep weight off because the effect is durable which is metabolic; it's not the malabsorption alone. While the malabsorption can help, it does not mean that you can eat more food, necessarily.

The problem is that if someone continues to binge you are in danger of jeopardizing the integrity of your anatomy with malabsorption, particularly if there are signs of malnutrition present. That is because our staple lines are stronger than the tissue around them. I've had surgeons tell me they operated on DS patients and the bowels just fell apart in their hands like wet tissue paper. These are super pro-DS surgeons, at that.

If someone is eating and they are not doing so in a healthy manner, almost always there are other unhealthy maladaptions or obfuscated pain and trauma that was not addressed. I have seen impulsivity in other areas, too...not just food. The behavior must always be addressed or there will not be true health across the spectrum.

and, surgery will never fix this...not ever. That is the sad reality may of us face.

The point of my post was not that people shouldn't treat mental health issues, but to say if you have a propensity to over eat (regardless of the reason) you should have a surgery that has a better chance of keeping the weight off.

As for malnutrition, I have my vits done annually- they are in perfect order. I am pretty religious about taking vitamins and making sure I eat enough protein. I've said it for years, I am better at taking a pill than dieting.

Scott

The problem is telling someone with an eating disorder that is potentially very dangerous post-WLS regardless of the procedure that they can eat more puts them at risk of causing serious harm to themselves. I believe your advice comes from a good place Scottie, but I do not think it is good advice for someone who thinks they may have an eating disorder.

My specialty tends to be clients who feel they are "failures." I've worked with DS patients who have significant regain - sometimes more than RNY and VSG peeps. Why? They never addressed the reason they eat. Surgery can never compensate for pathological behavior, and this thread is about an eating disorder, which represents the penultimate pathology regarding food.

The problem isn't the propensity for eating...it's what drives it. Being healthy means our perspective, mindset, and our intentions as well as our physical health. If the body is healthy and the mind suffers it does no good. Telling people with an eating disorder to get a surgery because they can eat more after admitting it's possible you may have one is dangerous. I almost ruptured my stomach during food binges yeaaaars before I had surgery. A DS won't stop that. Only mindfulness and therapy will stop it. Even without WLS, eating disorders are debilitating and can kill us.

I agree about diets, actually. Diets don't work, and never have. If diets worked then no one would get WLS. The fact is they do not. Pills always worked better for me too.

Thing is, that food is, absolutely, a pill. It's the ultimate drug. And, as with all drugs, the cure or the poison is in the choice of dose. Food is no different than a drug or any medical intervention. The only difference is that it's the one we take for granted the most, and that it's the easiest to shrug off.

In my recovery I don't just eat for weight loss but for the overall physiological benefits, lower inflammation, and pain reduction my choices give me. I have severe degenerative disk disease, need several joint replacements, and manage to function and remain busy. How? Because diet is, ultimately, the best medicine. Weight loss is a bonus to all that. No pill can replace good diet and the effects. Even with malabsorption, eating inflammation-prone foods still will cause damage that vitamins can't prevent.

What I am trying to say is that if you have a propensity to overeat, that must first be addressed, regardless of the fact that a DS can compensate for it - which a Hess DS absolutely can. The problem *is* the propensity to overeat is the pathology and the illness, not the obesity itself. Obesity is just a red herring. The true problem is what is driving people to eat themselves into the 300s, 400s, 500s, 600s.

Surgeons make this mistake. Nutritionists make this mistake. However, the reality is that we are not obese because we like to eat. Weighing several hundred pounds more than normal goes far beyond preference. Behavior drives it, almost always rooted in pain, and surgery is very good at masking that regardless of procedure.

Part of why I did not get a DS at 750 pounds, which I could have as I live in an area of the country where surgeons have done it thousands of times on very high BMI individuals more so than other colleagues (U of C is known for that), is that my propensity to eat was in full force. I did not address it. I also have an eating disorder and most WLS peeps do not necessarily.

Again, I am very pro-DS...I still regard it as the gold standard. No other surgery has, when looking at analyses, better results...period.

The problem is that it isn't the cure when you are referring to an eating disorder. It's treating a symptom, much like taking PPIs to fix GERD does not fix the issue but fixes the symptom, or like insulin for T2 diabetes doesn't fix the disease.

Pathology remains untreated though symptoms vanish, and where there is pathology, there is always risk.