New Here, seriously considering surgery

Hi I'm Sarah. I am 32 years old. I am seriously considering weight loss surgery. I weigh around 360 right now and have been at least 350 for probably 10 years. The ONLY time i've been sucessful with weight loss was when i was pregnant with my now 3 year old daughter, it took me 5 years to get pregnant with her and I was terrified of losing her so i did exactly what i was supposed to as far as eating and such. After she was born i had gotten down to 325ish but quickly gained it all back. I've tried just about every diet out there and just never get past the initial success, i never can seem to keep the momentum going and make a total lifestyle change. I have not yet chosen a doctor or made an appointment but i think i might have found one i will call next week. So here I am looking around the site for information and stories.

Well youve come to the right place.  These boards are filled with information and advice if thats what your seeking. Hello by the way Im Kelley and I know what your saying. I started my weight loss journey at 368lbs and Im weighing in at 262 as of now.  If you dont mind me asking where are you from? Im from the binghamton area.  Well good luck in your quest towards weight loss surgery or information on changing over to a healthy lifestyle.  Welcome to the boards!!

Kelley

Thanks Kelley..
I live near Watertown NY which is quite a bit upstate from you. I am considering Dr. Michael Hill in Saranac Lake, but still doing my research. Thanks for the warm welcome!

Hi!! I'm Lin and I LIVE in Watertown!!!!! I went to Dr. Carl Weiss in Auburn and he's coming up here on November 19th. I'm one month post-lap-band and love it! I feel GREAT! I'm exercising again (holy canoli! LOL) and that's not bad for someone almost 60! LOL If you want to send me a private email I'll give you a call... we Watertown-ians have to stick together! :O)

Lin

Hello Sarah WELCOME!

SOunds like you are takign some of the very first most important steps in this journey, ASKING, READING & EMPOWERING yourself with knowledge and power! GOOD FOR YOU!

http://www.obesityhelp.com/content/wlsurgery.html
http://www.asmbs.org/Newsite07/patients/benefits.htm
http://www.asmbs.org/Newsite07/patients/resources/asbs_story.htm
http://www.nawls.com/
http://www.livingafterwls.com free newsletter!
https://www.bariatricsupportcenter.com/
http://www.wlscenter.com/ free enewsletter!

OH MAGAZINE:
http://www.oh-magazine.com

WLS LIFESTYLES MAGAZINE:
http://www.wlslifestyles.com

FIND a support group near you!
http://www.asmbs.org/Newsite07/patients/resources/asbs_directory_supportgrp.htm

Maybe not what I wish I knew but what I wish I could of accepted and let go of! (All the thinking I did to avoid feeling! as well as judgments and regrets! Whatever you think of after is hindsight and is 20/20 as they say but I think now, HOW IS THAT HELPFUL other than to further shame myself and keep me down. I instead attempt to reflect with the goal to learn and grow so notice w/o judgment, letting go of need to do things perfect has helped me a lot with this)

The little things I so worried about (such as what to bring, if I needed a fan, if I could bring extra pillows or having the perfect plan postop etc really were attempts to soothe my anxiety and fear of the unknown (death especially!), now I see that but the lesson just keeps coming up until I master it, the lesson is acceptance, letting go, making a decision and being ok with the outcome regardless if it turns out as I hoped because my plan is not always what is best for me!

Making an educated and informed decision is important, for myself though letting go of the need to be perfect, rigid thinking (all/nothing), needing to control everything and in doing all the thinking avoiding the feeling and life, being consumed with WLS in general so much I 'lost my life/identity' to a LABEL (I was a WLS person) when in fact I am much more than that. That despite the OPERATION the need for myself to do personal growth (therapy, 12 step work, develop supportive network, learn to take care of me FIRST) around my personality/character traits of codependency and how they are so intertwined into my obesity no tool can fix those (although I wi**** could of, that would of been magic as many of us hope WLS will be!). That in acceptance of myself at any moment, healthy boundaries, taking care of myself I could succeed or at least learn to reframe success as something more than a number on a scale or if I ate enough that day in protein or didn't eat too many carbs or drank enough fluid or got exactly enough exercise in etc.

Surgery was the easy part looking back although going through it I thought it was the hard part (ha how skewed that was!) living the lifestyle after in a consistent, self responsible manner is the most CHALLENGING thing I have ever chosen to do, I did not realize preop the immense effort it takes each moment to be healthy! It is so worth that energy though the freedom it brings!

I wish I had accepted vs. known intellectually that Happiness and Success will NEVER EVER come from an external source (person, object, number on the scale). It can and will ONLY come from internal self-discovery and love. Listening to my BODY is key, my natural physical hunger, my body knows and will not let me down

Sometimes we consume our lives with food, thinking about what we can and can not have, when we can eat or should eat, how much, how often, how it should be cooked, when to buy it, how much, etc that we occupy so much time and do not even realize that we have no time left to feel (the point) in an addiction, it takes over us so we can forget us and what we are scared/fearful of feeling/being. I think the WLS lifestyle can be a sort of addiction and escape for a while ****il life overwhelms the beauty of the honeymoon!) and for myself exercise became an obsessive addiction as well.

I wish I had known that WLS is one of the million steps on my life's journey *it is not the destination*!

I wish I had worked more on finding inner peace with my decision to have WLS with living preop best I could by taking some time to meditate, journal, pray, use positive affirmations like those found at http://www.dailyinspiringquotes.com or http://www.nawls.com/public/department27.cfm or here http://www.unityonline.org/pray_prayersaffirmations.htm etc on my decision.

Writing all the reasons why this was my choice, what my expectations and goals were (*considering those beyond wt loss itself), what I was so fearful of. All my core fears (Death, Failure, Making wrong decision, not being accepted and loved/abandoned, not perfect enough etc)

I recommend those preop consider trying to fill their minds with as much optimism and positive thinking as possible! Basically, become more conscious of what you are thinking and feeling, and start preparing yourself to think of food and your life in a different way. This is a courageous step for you to take, and it's not just about weight changing -- it's about life changing. This is why so many of us are challenged by the enormity of the decision.

In closing I would not be who I am or where I am without my past, I am choosing to be grateful today for all my struggles/challenges, as they were only lessons and opportunities that presented themselves and that I have been able to embrace and learn and grow from. Without them I would not be where or who I am today a STRONG WARRIOR! I needed those things such as my exercise addiction to be able to see that balance is possible, that feeling is okay, that I am perfect the way I am, that I am loveable, that I can make decisions and live with the outcome!
Be well! And thanks for the topic!
LASTLY AN ARTICLE! IT IS A GREAT TOOL!


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Bariatric Surgery: A "Tool" in the Treatment of the Disease of Obesity
How much weight do you estimate that you lost in your life from diets or anti-obesity drugs? More importantly, how much weight do you estimate you have regained following weight loss programs? Did the weight stay off for less than a year? For two years? Is there anyone who suffered from morbid obesity who was able to maintain their weight loss for more than five years?
Long-term studies have found that approximately 2/3 of people who lose weight on a diet program will regain all of their weight within 2 years. Approximately 99% of individuals will regain all of their weight by 5 years post-diet.
With diet drugs, weight loss is generally around 5% to 10%, which represents a weight loss of only 10 to 20 pounds for someone who is 100 pounds overweight. Weight regain is unusually rapid when the drug is discontinued. And, long-term studies have shown that, even if the anti-obesity medication is continued, weight gain occurs over time.
Weight loss success for the morbidly obese is even more difficult. Most individuals who are morbidly obese not only regain all of their weight loss following conventional therapies (diet, exercise, behavioral modification, or anti-obesity drugs) but, generally, gain even more.
Why are conventional therapies not successful in treating obesity long-term? Conventional therapies fail because obesity is a disease - a progressive and life-threatening disease -not unlike cancer.
Once an individual has the disease of obesity, it progresses rapidly, affecting all body functions, often with fatal consequences. And, similar to cancer, obesity stubbornly responds to treatment. Even when the disease appears to be arrested, the reprise is generally temporary; the disease often returning with vengeance, causing even greater fat tissue proliferation and weight gain.
Studies have found that most individuals who are morbidly obese are not eating thousands upon thousands of calories each day. In fact, several studies have found that the individual with morbid obesity eats fewer calories more than someone who is normal weight but, even so, continues to gain substantial amounts of weight. Why?
The morbidly obese are essentially trapped in a series of fat-promoting biological cycles that cause a greater proportion of calories consumed to be stored as fat. What are some of these fat-promoting cycles responsible for the progression of the disease of obesity?
For one, obesity causes hormone changes, such as an increase in insulin, defects in sex hormone production, low growth hormone, and elevated cortisol. These hormone changes increase fat storage and/or prevent the breakdown of fat, thereby, causing even more weight gain and obesity.
The disease of obesity also alters activities of various enzymes that control fat metabolism, causing less fat to be burned for energy and more to be taken up into fat cells and stored, increasing fat cell size and total body weight. Furthermore, serious obesity (as well as childhood obesity) may not only increase fat cell size but also increase fat cell number. An increase in fat cell number, according to several reports, significantly reduces an individual's chance for successful and sustained weight loss.
Weight gain further enhances the spread of fat tissue by altering the production or actions of several important regulators of eating behavior. By altering these regulators, the disease of obesity may cause an increase in appetite, food cravings, or reduced satiety (feelings of fullness). These defects, in turn, are likely to promote further weight gain and progression of the disease.
To make matters worse, obesity causes numerous health problems that may reduce an individual's desire for physical activity, lowering the numbers of calories the body burns for fuel and increasing those stored as fat. And, ironically, obesity-associated health problems, including diabetes, hypertension, depression, and arthritis are often treated with medications that cause further weight gain.
Bariatric surgery helps to 'break' many of these obesity-promoting cycles, improving the need for medication, normalizing hormones and some of the weight-promoting eating behavior regulators, increasing physical activity and calories burned, improving metabolism, and resolving disease and the need for medications that can cause weight gain. The interruption of these vicious weight gain cycles with bariatric surgery, coupled with the restriction that the surgery imposes on nutrient intake, induces massive weight reduction.
With gastric bypass, as well as the biliopancreatic diversion and duodenal switch, weight loss is rapid and substantial. Excess weight loss one year after surgery is generally 70% or more. Studies have found that 5 years after gastric bypass surgery most individuals will have maintained 48 to 74% of their excess weight loss. One study found that even 14 years after surgery, average excess weight loss for over 600 gastric bypass patients exceeded 50%.
Bariatric surgery, therefore, is effective in inducing massive weight loss in individuals suffering from the disease of morbid obesity and in helping to maintain much of the weight loss for years and years. Still, the surgery is not a 'cure' for the disease of obesity.
Although it is extremely rare for an individual to ever regain all of their weight loss following surgery, some weight regain generally occurs. As discussed above, an individual may lose 70% or more of their excess weight loss with gastric bypass surgery and maintain a 50% or more weight reduction long-term. Although such a high degree of weight maintenance is considered exceedingly successful for the disease of morbid obesity, some weight regain does occur, evidence that the disease is not arrested.
Longitudinal studies of large groups of gastric bypass patients have shown that around the second post-surgical year there is generally a weight regain of approximately 5% to 10%. This increase in body weight tends to happen about the same time that many individuals complain of a 'reawakening' of some of the symptoms of the disease, such as an increase in appetite, food cravings, and a loss of satiety.
How, then, can an individual maintain all their weight loss after surgery? For continued maximal weight loss success, the bariatric patient must realize that their surgery is not a 'cure' for obesity but rather a 'tool' that can assist in keeping the disease 'suppressed'. The surgical 'tool' is effective in inducing and helping to maintain weight loss by substantially reducing total calorie intake. And, as mentioned earlier, the surgical 'tool' breaks those obesity-promoting biological cycles that contribute to the progression of the disease and prevent the afflicted individual from gaining control over their body weight.
The pioneers of obesity surgery recognized years ago that the surgery was not a 'cure' for obesity but rather a highly effective 'tool' that assists in halting the progression of the disease. These individuals worked diligently to see that the morbidly obese patient would have every opportunity for life-long weight loss success. Through their efforts, the National Institute of Health, the National Heart, Lung and Blood Institute, the American College of Surgeons, as well as the national and international societies representing bariatric surgery, all recommend that patients who have bariatric surgery be followed by a multidisciplinary team of obesity healthcare professionals.
The multidisciplinary team of professionals aids the bariatric surgical patient in making lifestyle changes that, with the assistance of the surgical 'tool', helps to keep their disease under control. The multidisciplinary team generally includes (in addition to the surgeon and clinical staff) a nutritionist or dietitian with knowledge of the specific nutrient needs of the bariatric patient, a mental healthcare professional who understands obesity and the psychosocial consequences of the disease, and an exercise physiologist or trainer who can prescribe physical activities that help to promote maximal weight loss success and long-term weight loss maintenance.
There are now several studies reporting the effectiveness of the multidisciplinary approach to the surgical treatment of obesity. The early findings of these studies clearly show that individuals who participate in such programs have greater weight loss success and long-term weight loss maintenance than do those who do not take advantage of the multidisciplinary program.
What can you as the bariatric patient do to keep you disease under control? First, recognize obesity for what it is - a progressive and malignant disease. Second, know that your surgery is a 'tool', rather than a 'cure' for your disease that can enable you to lose massive amounts of body weight. Third, recognize that the surgical 'tool' can help you to keep your disease suppressed and enjoy long-term weight loss maintenance, provided you are willing to make lifestyle changes necessary for long-term weight loss success including: 1) regular physical activity, 2) good nutrition and appropriate vitamin/mineral supplementation, 3) assistance in improving emotional status, and 4) continued involvement in a bariatric support group and in your clinical program.
Cynthia Buffington, Ph.D.
Cynthia Buffington, Ph.D., is the Director of Research for The Obesity Wellness Center
http://www.beyondchange-obesity.com/obesityResearch/bariatricSurgATool.html

Preparing for Weight Loss Surgery

http://my.webmd.com/content/Article/101/106101.htm?printing=true
By Heather HatfieldWebMD Feature Reviewed By Michael Smith, MD
From psychological exams to support groups, weight loss surgery takes thorough mental and physical preparation, but most importantly, it takes commitment.
For those who consider weight loss surgery, they are at the end of their ropes. Traditional methods of diet and exercise have had no effect, and this procedure is a last resort. But by no means is the leap from thinking about weight loss surgery to the operating table a short one.
"People need to be aware, in great detail, of the risk and benefits of weight loss surgery so they understand what it is all about," says Harvey J. Sugerman, MD, president of the American Society for Bariatric Surgery. "The procedure is not without risk, and there is a great deal of anxiety that comes with it, so it takes considerable preparation."
From checking on insurance coverage to psychological exams to support groups, preparing for this life-changing procedure takes time, physical and mental readiness, and most of all, commitment.
First Steps
"From the time a person first thinks about having weight loss surgery, to the time they make the commitment to have it done is typically about two years," says James Kolenich, MD, a bariatric surgeon at the University of Pennsylvania Medical Center, Horizon. "Most people don't rush into this, they talk to family and friends, they talk to the hospital, they go home and they think about it more; it's usually a very thoughtful approach."
More than 60 million obese people are living in the U.S., according to the American Obesity Association (AOA), and about 9 million are severely obese. Weight loss surgery, also called bariatric surgery, can be successful when diet and exercise have failed, and a person's health is on the line. Overweight is the second leading cause of preventable death, after smoking, in the U.S., according to the AOA.
"The first thing a person should do is contact his insurance company to learn if he is covered for the surgery, and he should contact his primary care doctor to find out if there is documentation of his struggle with obesity," says Kolenich. "Many insurance companies want to know that a primary care doctor has tried to help the patient lose weight with psychological counseling, diet, and an exercise plan for five years, and for many patients, this is a big road block."While there are other options, such as personally financing the procedure, they are costly: The National Institute of Diabetes and Digestive and Kidney Diseases web site states that this procedure can run from $20,000 to $35,000.
With such a hefty price tag on weight loss surgery, it pays to ensure that your doctor documents your battle with obesity early on, to open up options down the road.When you've crossed all your t's and dotted all your i's in the insurance category, it is time to find a hospital or center, and a surgeon, that are first-rate.
Finding a Bariatric Surgeon
"When you're looking for a surgeon, ask if he or she is board-certified by the American Board of Surgery," says Kolenich. "Is he a member of the American Society of Bariatric Surgeons? What is the mortality rate of the surgeon, the morbidity rate, the success rate?"Clearly, the surgeon you find should be well experienced in the area of weight loss surgery.
"Make sure the surgeon you choose is an experienced and qualified bariatric surgeon," says Daniel Herron, MD, chief of bariatric surgery at Mt. Sinai Hospital in New York. "It's clear that the more experienced the surgeon, the lower the risk of mortality. Ideally, you would prefer to find a surgeon who has performed at least 100 of these procedures."
What you are looking for doesn't stop with numbers and statistics -- you will also need a support system. Look for a center or hospital that offers educational seminars to those who are just beginning the process so you can learn more about the actual procedure, the benefits, and the risks. Also look for support groups, that can be utilized pre- and post-operatively. The preparation, both physical and mental, comes next, and is as crucial to the entire process as the actual procedure.
Preparing for Weight Loss Surgery
"The single most important factor is that they have to realize the surgery is not a cure for obesity," says Herron. "It's a very powerful tool used in the fight against obesity. It needs to be considered as part of a process, and a lifelong commitment to follow up with physicians, a regular exercise program, and healthy eating. If a person doesn't understand that this is a lifelong commitment, that it's not a quick fix, then he or she is not a good candidate."
From a physical standpoint, the preparation for weight loss surgery involves meeting with doctors -- a lot of them."There are a number of different aspects to preparing for weight loss surgery," says Herron. "The physical is making sure they are meeting with a number of medical doctors, including cardiologists, pulmonologists, and other physicians, to make sure their health status is optimized before surgery."
A person also needs to meet with a nutritionist, to begin to better understand the elements of healthy eating, and how eating habits need to change before and after the surgery.
"By getting into a proper nutritional mindset before surgery, such as learning to eat smaller portions, eating slowly, paying closer attention to the nutritional makeup of meals, a person is better adapted for the major changes in their lifestyle after the surgery," says Herron.And, in many cases, it will mean they lose weight before the procedure, which helps their cause, and underscores his or her commitment to change.
"Some surgeons request that a person try to lose 15-30 pounds prior to the surgery as demonstration of their commitment, if they can," says Kolenich. "A person also might be required to quit smoking, both for their health, as well as to improve the outcome of the operation."
Understanding the Risks
Understanding the possible outcomes of weight loss surgery, including the risks, is an important part of preparing for the procedure.
"Education is a tremendously important part of the preoperative process," says Herron. "There is no question that there are major risks associated with the operation. However, those risks can be minimized by having a thorough preoperative workup so there aren't surprises during the procedure, and by making sure the surgeon is experienced and qualified."
Nonetheless, dealing with the emotional toll of this procedure can be difficult, especially when considering the possibility of death."There have been good studies looking at the risk of dying after weight loss surgery, showing that although there is a risk of death with surgery, the overall survival rate is improved with surgery compared to not having the surgery at all, and living with obesity," says Herron.It helps that most centers and hospitals and insurance companies, require psychological evaluations prior to the allowing the procedure -- which benefits both patient and doctor.
"You have to fill your mind with as much optimism and positive thinking as possible," says Joe De Simone, PhD, a psychiatrist in private practice in N.Y., who works with patients preparing for weight loss surgery. "Basically, the preparation is to become more conscious of what you are thinking and feeling, and start preparing yourself to think of food and your life in a different way. This is a courageous step for people to take, and it's not just about weight changing -- it's about life changing."
Post-Op Expectations
While weight loss surgery does have a major impact on a person's life, it requires, like any surgical procedure, some recovery time."The recovery period is quite variable," says Herron. "I have some patients who take a week off and are back full time, and others who take three to four weeks to recover. While it's certainly physically possible to be back to 90% of capacity after a week, most people take longer to adjust to the new lifestyle."
New techniques have also helped to lessen recovery time. Today, the procedure can be performed minimally invasively via small incisions. In a few centers around the country it can even be done on an outpatient basis.Patients also need to remember weight loss surgery is not a cure.
"It's not a magic bullet, but is an amazingly powerful weight-loss tool," says Herron. "A person will find they will lose about a pound per day for the first month or so. Then they'll lose between 50%-75% of their excess body weight typically during the first 12 months after surgery."
What follows is dedication to a healthy diet and exercise regimen, continual follow-up with doctors to monitor progress, and commitment to a new life.
Quick Questions
Ask yourself these questions, from the National Institute of Diabetes and Digestive and Kidney Diseases, if you are considering weight loss surgery. If you answer yes to many or all of them, start by calling your primary care doctor and insurance company.
Are you:
· Unlikely to lose weight or keep weight off long term with nonsurgical measures?
· Well informed about the surgical procedure and the effects of treatment?
· Determined to lose weight and improve your health?
· Aware of how your life may change after the operation (adjustments to the side effects of the operation include the need to chew food well and inability to eat large meals)?
· Aware of the potential for serious complications, dietary restrictions, and occasional failures?
· Committed to lifelong medical follow-up and vitamin/mineral supplementation?
Published Feb. 25, 2005.

SOURCES: Daniel Herron, MD, chief, bariatric surgery, Mt. Sinai Hospital, New York City. James Kolenich, MD, bariatric surgeon, University of Pennsylvania Medical Center, Horizon, Pittsburgh. Joe De Simone, PhD, psychiatrist, private practice, New York City. Harvey J. Sugerman, MD, president, American Society for Bariatric Surgery, Sanibel, Fla. American Obesity Association web site. National Institute of Diabetes and Digestive and Kidney Diseases web site.

http://my.webmd.com/content/article/101/106105.htm?printing=true

Life After Weight Loss Surgery
By Denise MannWebMD Feature Reviewed By Michael Smith, MD
Though weight loss surgery has tremendous benefits, dealing with the aftereffects can also be very challenging. Part 2 of a 4-part series.

Unlike past cruises, this summer as Susan Kochman, 57, and her husband, Ed, sail the Western Caribbean, she plans to spend significantly less time grazing the round-the-clock buffets and much more time touring Cozumel, Grand Cayman Island, and other ports.
The reason?
Like growing numbers of Americans (including such famous folk as weatherman Al Roker and singer Carnie Wilson), Kochman, who lives outside Philadelphia, underwent weight loss surgery on Dec. 3, 2004, and has since lost 54 pounds.
"I have so much more energy," she says. "Before I had the surgery I needed to nap every day. I almost never nap anymore." What's more, she is off all of her heart failure medications and almost completely weaned off of her blood pressure medications.
"The surgery met my expectations, and I had high expectations," she tells WebMD. In fact, she says this past New Year's Eve was the first ever that she did not shed a tear for auld lang syne. "I was so happy and so looking forward to the next year."
But weight loss surgery isn't a quick fix or a free ride. It is a major surgery that involves shrinking the stomach size by sealing off most of the stomach and creating a small, thumb-sized pouch that greatly restricts food intake. The pouch also bypasses part of the small intestine to reduce the amount of calories and nutrients absorbed from food. And the surgery is often only the beginning.
What follows can include additional surgeries and severe lifestyle restrictions, and sometimes disillusionment.
Weight Loss Surgery a Last Resort
That's why for Kochman and many others, weight loss surgery is often a last resort. "After years and years of dieting and losing a little weight and then gaining more, I knew that I had reached a point where it was do this or concede that I was going to die early," Kochman says.
In 2004, about 140,600 people underwent weight loss surgery; a 36% increase from 2003. Preliminary estimates from 2005 suggest the number will increase even further, according to statistics from the American Society for Bariatric Surgery (ASBS).
This especially holds as more and more people are deemed acceptable candidates. For example, elderly patients can safely undergo weight loss surgery and can be expected to experience similar benefits from the operation as currently experienced by younger patients, according to a recent study in the Archives of Surgery.
Buoyed by the increasing popularity, surgeons are also honing their skills and refining their techniques. Today, the procedure can be performed minimally invasively via small incisions, and in some centers, such as Cedars-Sinai Medical Center in Los Angeles, it can even be done on an outpatient basis.
Not Risk-Free
Like all major surgeries, weight loss surgery can have complications. As many as 20% of patients need additional surgery to mend complications such as abdominal hernias. Because of malabsorption in the shortened digestive tract, roughly 30% of patients develop conditions due to malnutrition, such as anemia and osteoporosis, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Some obese patients who have had weight loss surgery will also develop gallstones.
It's also not all that glamorous. The new stomach requires several tiny, nutrient-rich meals a day supplemented with additional vitamins and minerals. Eating too much or indulging in rich, sugary or fried foods can overload the pouch and cause dumping -- a term used to describe the sweats, chills, and nausea that result from food filling the pouch and overflowing straight into the small intestine.
"Initially after the operation, it's recommended that a person eat pureed foods to give the operation a chance to heal, but after that, behavioral modifications are key," says Harvey Sugerman, MD, emeritus professor of surgery at Virginia Commonwealth University in Richmond, Va., and president of the ASBS."You can't eat large volumes of food, and you get full more quickly," he says. But not indefinitely.
Regained Weight May Be an Issue
And that's why as time goes on, not all former weight loss surgery patients remain as pleased with the surgery as Kochman does right now, says Jacqueline Odom, PhD, the psychological director of the Beaumont Weight Control Center in Royal Oak, Mich.
"A year or two years out, patients are reporting struggling with weight regain because they are struggling with their old eating habits and may have not incorporated portion control and exercise," she says.During the immediate aftermath of the surgery, people can only tolerate small amounts of food, she explains, but after a while they can eat more because the pouch opening gets stretched out. "Food cravings start coming back and medical problems can follow suit," she says.
"Surgery is not a cure for obesity, it's only a tool," she says. "One has to have the mindset or resolve that lifestyle changes are inevitable. A lot of people have been disappointed in surgery long term because they really thought it would cure obesity and it hasn't." Odom runs a monthly support group for patients considering the surgery as well as those who have undergone it.
Nothing Tastes as Good as Thin Feels
"The significant weight loss that occurs within the first year is a very big motivator, but food urges start coming back and people get scared and have to learn to cope with food urges without acting on them," Odom warns.Kochman believes she has this part covered. "When it came to dieting all my life, I always felt like a failure, but now my capacity is different and that's the tool that I have been given," she says. "Between that tool and the changes in my own head, I feel like a success."In other words, "it's more important to feel good about myself than to have a cookie," she says.
Another issue that some former weight loss surgery patients face is that they think surgery will improve everything in their lives, and it doesn't. "A difficult marriage before surgery will be a difficult marriage after surgery," she says.For Kochman, the only major change in her marriage is that "now I am a cheap date," she quips.
When she and her husband dined out the other night, "I ate a hamburger without the roll, got half way through it and was so full," she says.
Decrease in Medication Aids Motivation
Other motivators are the reduced dependence on medications and freedom from the lifestyle restrictions of obesity.
"The data are pretty strong that patients who have the surgery have a lower mortality risk than those who did not have surgery, and clearly there are dramatic improvements in comorbidites of obesity such as diabetes, hypertension, and obstructive sleep apnea," says Sugerman.
In a recent review of 136 studies published in The Journal of the American Medical Association, weight loss surgery reversed diabetes in 77% of obese patients, eliminated or improved high blood pressure in 78%, and improved cholesterol in at least 70%. In addition, obstructive sleep apnea resolved in 86% of patients.
The New You
When a person loses a large amount of weight in a short period of time, particularly after weight loss surgery, they may have large amounts of extra skin that requires some significant nipping and tucking.
"Different people present with different degrees of deformity," says Al Aly, MD, a plastic surgeon in private practice in Iowa City, Iowa, and a spokesman for the American Society for Aesthetic Plastic Surgery (ASAPS).
Most weight loss surgery patients who undergo body contouring will have a minimum of two and as many as three to four surgeries following weight loss, he says. And as the trend toward weight loss surgery increases, plastic surgeons are learning how to best sequence these surgeries.
"The most common thing is the lower trunk [which comprises] the belly, hips, waist, sides, and buttocks," he says. "Essentially the tummy is the area that bothers people the most, so it is often one of the first things addressed," he says. "The upper arms and thighs are two other areas that are quite problematic for massive weight loss patients as are the area from the neck down to just below breasts," he says.The excess skin and the amount of follow-up surgeries can come as a surprise to massive weight loss patients, he says.
"People are not told what is going to happen when they lose weight," he says. "In the average person when they lose weight, especially massive weight, their skin is not going to contract down," he says. "If your skin is a balloon that's blown up pretty extensively for an extreme period of time, when you take the air out, it doesn't go back to same shape."
Most Would Do It Again, Despite Obstacles
As Al Roker said in November 2004, about two and a half years after his surgery: "For anybody who thinks that this is a magic bullet, you do this and it's done, you're making a mistake. It's not."Sugerman agrees. "Some people go into it thinking it's a free ride, and we try to make it clear it's a procedure designed to help them help themselves," he says.
And despite the fact that this is a major surgery involving a whole host of often-difficult lifestyle changes and the potential for even more follow-up surgeries, Kochman would do it again -- in a "New York minute."That holds for the vast majority of weight loss surgery patients, says Sugerman. "I have had patients 18 years out who control weight and are extremely grateful."
Published Feb. 25, 2005.

SOURCES: Jacqueline Odom, PhD, psychological director, Beaumont Weight Control Center, Royal Oak, Mich. Al Aly, MD, plastic surgeon; spokesman, American Society for Aesthetic Plastic Surgery. Harvey Sugerman, MD emeritus professor of surgery, Virginia Commonwealth University, Richmond, Va.; president, American Society for Bariatric Surgery.
http://my.webmd.com/content/pages/20/105347.htm?printing=true
Body Transformed
A Journey of Surgical Weight Loss

Making the DecisionJuly 14, 2001Today I read a Reader's Digest article about Carnie Wilson. She had a new type of stomach stapling called Roux-en-Y gastric bypass surgery. Apparently it's a different type of surgery than has been performed in years past. She's lost a lot of weight and looks great. I'm going to do some research. Maybe this surgery is the answer for me, too.July 22, 2001I've been a busy girl! Researching gastric bypass surgery has taken over my life. I've learned a lot about how the surgery is different from the stomach stapling procedures performed back in the 1980s. Because part of the small intestine is sectioned off and reattached to the newly created "pouch," fewer calories (and less nutrition) from the small amount of food eaten actually ends up being absorbed by the body. Apparently this surgery is pretty new and the risks associated with it are high. About two people out of 100 die either during the surgery or from problems that occur shortly afterward. That's a scary percentage.Aug. 4, 2001I talked to my therapist, Emily, today about gastric bypass surgery. Not surprisingly, she was against it. As a psychologist who also deals with an eating disorder herself (anorexia and bulimia), Emily believes that we have to deal with the emotional reasons behind our eating problems, rather than focusing on the physical results of those food issues.I know that the eating problems are the cause, but the results are beginning to cause health problems that need to be dealt with. My blood pressure is high, so I take medication to manage it. I had insulin-dependant gestational diabetes with all three of my pregnancies, and both my father and paternal grandparents developed type 2 diabetes in their later years, so I'm bound to end up pushing insulin again some day. I've used a CPAP device when I sleep due to severe sleep apnea. Which of these issues will take my life much too soon?
Body Transformed: The Archive Making the Decision 07/14/01: Making the Decision 08/23/01: Leaving Bill 09/18/01: No Job 09/20/01: Just That Quick The Family and Friends Plan 09/19/02: Why Not Me? 12/26/02: Comparisons 03/22/03: Jumping on the Bandwagon 05/20/03: How I Met Ed 08/18/03: The Big Squeeze 11/06/03: New Body, New Husband Seeking Approval 02/04/04: Time to Get Approved 03/12/04: Journey Begins 04/26/04: I'm Approved 06/13/04: Pre-Op Testing 06/20/04: In the Waiting Line Making the Cut 07/10/04: Saying Goodbye 07/11/04: Sleepless Night 07/15/04: The Surgery Strange Changes 07/22/04: Yummy Water 07/30/04: Smaller Tummy 08/16/04: 37 Pounds Down 09/07/04: My First 50 Pounds 10/31/04: Different Food, Same Love New Body Countdown 11/07/04: 67 Down and Counting 11/12/04: Melting Away - 73 down 11/20/04: Breaking 200 11/26/04: Giving Thanks - 83 pounds Holiday Madness 12/08/04: Slowing Down 12/15/04: Fortune 100, and Counting 12/27/04: Weight GAIN? Quiet Rewards 01/06/05: Jeans Older Than My Kids 01/19/05: No Lap, But I'll Take the Luxury 01/28/05: A Most Unusual Revelation 02/07/05: Body and Sole 02/14/05: Flowers in the Mirror

© 2004 WebMD Inc. All rights reserved.

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The Basics About Weight Loss Surgery

In words and pictures

Is Weight Loss Surgery for You?WebMD Medical Reference Provided in Collaboration with
Weight Loss Surgery: Gastric Bypass OperationsWebMD Medical Reference Provided in Collaboration with
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Obesity SurgeryWebMD Medical Reference from Healthwise

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Weight Loss Surgery Has Long List of Benefits - May 17, 2004

How To Choose A Bariatric Surgeon
So you're considering bariatric surgery. You are not alone. Over 100,000 patients this year will undergo some type of bariatric procedure in the United States alone. Media attention is at an all time high. Patients are evaluating their bariatric surgical options now more than ever. The number of surgeons performing bariatric surgery continues to increase each year. The choices for obese patients have never been more plentiful, but some would say they have never been more difficult.
Bariatric surgery was once a club, if you will, of dedicated surgeons who had great interest in the treatment of the morbidly obese. Over the last ten years, bariatric surgery has developed into a society and more recently by necessity evolved into an industry. With more and more surgeons claiming their "bariatric expertise" every day, patients now have more choices regarding bariatric surgeons. How does the patient choose a bariatric surgeon? Here are some points for you to consider:
What are my surgeon's credentials regarding bariatric surgery?
This is one of the most basic questions you should ask yourself and your surgeon. In this day and time of new technology and innovative techniques, almost anyone can claim to be a bariatric surgeon. Each day I receive across my desk brochures soliciting my participation in a "weekend course" to learn about bariatric surgery. These are programs where interested surgeons attend to learn about the field of bariatric surgery and discuss pertinent issues with leaders in the field. Attendance at one of these courses does not imply that one has been trained in bariatric surgery. These courses should be utilized as opportunities for interested surgeons to investigate bariatric medicine and evaluate the level of commitment necessary to embark on such a specialty. So know how your surgeon became interested in bariatric surgery, and ask what proportion of his practice is involved with bariatric surgery. Is bariatric surgery 10%, 40%, or 90% of their practice? Proficiency in this field is initially hard to grasp, and difficult to maintain, therefore I feel a dedicated bariatric surgeon should devote at least 50% of his practice to bariatric surgery to be considered a specialist by his peers. Did my surgeon receive special training in bariatric surgery within his residency program? Did my surgeon complete a bariatric fellowship? Is my surgeon board eligible/board certified? Is my surgeon in good standing with the state medical board? All these questions are important, and should be asked early on. Being technically able to perform a gastric bypass or place a LapBand does not a bariatric surgeon make. As I will discuss later, practicing bariatric surgery is more than just learning a surgical technique. I know from my practice, the operation itself is less than 10% of the total package, and I will discuss this further later.
What is my surgeon's reputation in the medical community?
This will tell you a great deal about your surgeon, because one physician cannot do it all. Bariatric surgeons should work closely with other physicians in their community when caring for bariatric patients. What does your family doctor think of your bariatric surgeon? Your cardiologist? Does your neighbor or an acquaintance that is a physician feel that your choice of a bariatric surgeon is a good one? Any "inside information" from the medical community could be very helpful.
Are other patients satisfied with my surgeon?
Any Internet chat room can help you with this process, but beware. Not everyone who is obese is a candidate for bariatric surgery. Be on the lookout for a disgruntled patient who had a bad experience with a particular surgeon, and spends his or her free time trying to trash that surgeon, that surgeon's office, and staff. Pay most attention to the majority, not the exceptions. Attend a support group meeting and ask other patients their opinion of their surgeon.
What are my surgeon's complication and mortality rates?
This can be difficult information to obtain, but the best way is to ask. Any respectable bariatric surgeon will be honest and open with you regarding these issues. Remember, some bariatric patients are quite ill prior to surgery, in essence making them great candidates for bariatric surgery. With pre-existing co-morbidities comes increased risk. This is not however a license for higher complication rates or high mortality rates. The accepted mortality rate (chance that a patient will die within 30 days of surgery) is roughly 1%. The accepted morbidity rate (chance that a patient will experience a complication of some kind in the immediate post operative period) is roughly 15%. These complications include things like wound infections, incisional hernias, deep venous thrombosis, and post operative bleeding. If you never ask, you will never know.
What is my surgeon's office like?
This is a very important observation that all patients make. First, start with the waiting room. Are chairs there you can sit in comfortably? Do the chairs have arms? Is the waiting room cramped? Then look at the examination rooms. Are the examination tables large enough for large patients? Do they have scales for weighing patients in excess of 500 pounds? Is the staff friendly and courteous? Does my surgeon have a bariatric coordinator who can be contacted easily?
Is my surgeon offering an operation or a program?
Some bariatric surgeons pride themselves on the ability to operate, and measure the success of their patients by the immediate postoperative course. Once a patient recovers from their surgery, the bariatric surgeon may dismiss them to follow up with their family doctor. This leaves the patient with little follow up in the weeks, months and years to come from a surgical standpoint. Most dedicated bariatric surgeons spend the majority of their practice in bariatric surgery, educating their patients pre- and post-operatively. The vast majority of their operating time is spent performing bariatric surgery, not just adding a gastric bypass or LapBand on if there is a shortage of hernia repairs or gallbladder excisions. Truly dedicated bariatric surgeons see this specialty as demanding of their time and resources. Their program starts with education and evaluation prior to surgery, and leads to life long follow up after surgery. The more comprehensive a program, the longer the process from first consultation to operation. Beware of the surgeon who sees you in consultation one day, and offers you a bariatric procedure the next week. Not much of a program there if you ask me. The more involved your surgeon, the more satisfied you will be.
What does my surgeon expect of me before and after surgery?
This is tied into the operation vs. program question. My feeling about bariatric surgery is that the operation itself is approximately 10% of the entire package, but a very important 10%. Information sessions are a great way to learn about the options for bariatric patients, and some surgeons require prospective patients to attend a free information session prior to an office consultation. One should not see this as an "unnecessary step". This gives a patient, but most importantly a patient's family or loved ones a chance to learn about this exciting opportunity at no cost and in a non-threatening environment. What about post-op? Long-term follow up is necessary, and in most elite bariatric practices, mandatory. Are labs checked, weights assessed with each visit, support groups offered and encouraged? In my experience, the success of a post-op bariatric patient is dependent on four major points: completing a successful bariatric procedure, taking daily supplements for the rest of your life, adherence to an exercise regime with a strength training element, compliance with a strict post-operative diet, and commitment to long term follow up and support group participation. If one of these elements is missing, the post op patient's level of success will be limited.
Is the hospital specially equipped for the bariatric patient?
This assessment can begin in the admissions department. Don't be afraid to ask questions, because without questions, you will get no answers. Are the chairs large enough? Do they have special wheelchairs, stretchers, and hospital beds? What about reinforced toilets or extra large bedside commodes? Are the gowns large enough to fit? Is there specialized equipment in the operating room, specifically an operating room bed that can accommodate a person greater than 500 pounds? Is anesthesia specially trained to care for the bariatric patient?
Is my surgeon a member of the American Society of Bariatric Surgeons?
Last but not least, one if not the most important question you should ask of your bariatric surgeon. Involvement in this society is considered mandatory for the true bariatric specialist. Members evaluate current research, discuss new techniques, and set standards for the society to follow. If you had a bad heart, would you seek the consultation of a cardiologist who was not a member of the American Heart Association? I rest my case.
These are just some suggestions, and take them for what they are. Remember; choose a surgeon and a program where you feel comfortable, even if you have to drive an hour or two out of you way. It is your choice and you are the customer.
C. Kenneth Mitchell, JR., M.D., F.A.C.S.
http://www.beyondchange-obesity.com/medicalMatters/howToChooseASurgeon.html


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When you're looking for a Bariatric surgeon/points to ponder:
http://www.amylhwilliams.com/questionsforsurgeon.html good link also

1) Check out info on this site: http://www.nydoctorprofile.com/ (*search under his name & look for any malpractice suits, payouts etc. You can ask about that).

2) Is he board-certified by the American Board of Surgery?
www.absurgery.org
American College of Surgeons?
http://web3.facs.org/acsdir/public/Detail.cfm?CHKDGTS=00299031800

3) Is he a member of the American Society of Bariatric Surgeons? http://www.asbs.org/html/about/membersearch2.html

4) What is the mortality rate (is the number of deaths) of the surgeon, the success rate (those losing > 50% of their excess wt at 5 yrs out)? Complication rates (wound infections, hernias, strictures, leaks, reoperation etc)? Average length of time in hospital.

5) The surgeon you find should be well experienced in the area of weight loss surgery (BARIATRICS). It's clear that the more experienced the surgeon, the lower the risk of mortality. Ideally, you would prefer to find a surgeon who has performed at least 100 of these procedures. (I say over 500!). I also recommend a surgeon who dedictes his practice to WLS, not one who does a case a week....

6) What you are looking for doesn't stop with numbers and statistics -- you will also need a multidisciplinary team one that includes: Surgeon, nutritionist, exercise physiologists, psychological support & support groups, that can be utilized pre- and post-operatively.

7) Look for a center or hospital that offers educational seminars to those who are just beginning the process so you can learn more about the actual procedure, the benefits, and the risks.

8) Is the hospital a Bariatric Center of Excellence? http://www.asbs.org/html/about/coe.html or http://www.surgicalreview.org/locate.aspx
http://www.facs.org/viewing/cqi/bscn/fullapproval.html

9) The preparation, both physical and mental, comes next, and is as crucial to the entire process as the actual procedure. Look to a surgeon that requires clearance from (what is indicated w/ your particular medical status) various doctors (psych/endocrine/hemotology/pulmonary/cardiology/nutrition etc). No this is not @ hoops this is making sure your health status is optimized before surgery. Preop smoking cessation, preop wt loss..etc.

10) What procedures does he do? Open or Lap? What is his follow up plan? Recovery time?

Education is a tremendously important part of the preoperative process & there is no question that there are major risks associated with the operation. However, those risks can be minimized by having a thorough preoperative workup so there aren't surprises during the procedure, and by making sure the surgeon is experienced and qualified. This is a courageous step for people to take, and it's not just about weight changing -- it's about life changing. SO take your time, find the right surgeon/surgical program for you for your life and your health and success long-term! WLS is a decision many of us make, but should not be made impulsively (*the average time one thinks about and has WLS is 2 yrs!) as we as MO people can feel quite desperate and see this as a last resort and can sometimes go with whoever is telling us they will perform, that may not be in our best interest!
EDUCATION IS KEY, AS IS A COMMITMENT & dedication to a healthy diet and exercise regimen, continual follow-up with doctors to monitor progress, and commitment to a new life.

Ask him all these questions or any others think of or you think of, if HE isn't right, find someone who is! After all you're putting your life in his hands and needing someone to care for you for life!!! Be an educated consumer of your own health! HUGS!

http://www.bariatrictimes.com/ good free enewsletter
www.vitalady.com about suppliments postop
or www.bariatriceating.com among many good sites!
If any specific ??? email me [email protected]
I am 7 years out this week! Also 29 weeks pregnanat with my first baby!

Hi Sarah, and welcome!  I am Dawn, and I will be having Duodenal Switch surgery with Dr. Hill on Thursday.  I did a ton of research, and had started with Dr. Rosati out of Albany med-but switched over to Dr. hill when I decided not to go with RNY.  So far, so good...I will update everyone after my surgery, so if you have any questions, feel free to ask me anything!

Hi Dawn. So nice to meet someone using him. I just called today and they told me i have to go to the informational session first before i can schedule a consult. Which is fine i was just a little bummed. How long did it take you to get a consult? The information session is on Nov 4th so i guess i'll just continue my research until then :-)

It was a bit different for me because I had called them just as I was about to be scheduled for an RNY at Albany having pretty much finished all requirements.  When I called, they sent me the packet of paperwork that they usually give at the informational session so I could fill it out and bring it with me, because they gave me an appt for the consult  for the same day (or the day after-hard to remember) as the informational session.  Perhaps they will send you the information packet if you ask them to?  It is VERY long and involved -and it would save you time if you could have it filled out before you get there.

Anyhow, that appointment was April 14th.  It took me 6 months from that day to get a date for the surgery-however I was held up over a month due to an incidental finding on a chest xray-that led me to a workup, then surgery.  Once I got the go ahead from the surgeon, I was able to continue and finally schedule.

I also want to mention that at the time I began with Dr. Hills' office, he was the only surgeon there who was actually performing surgery. I believe they have now brought in another surgeon-Dr. Moon-(I am not sure which -if any-surgeries he is performing)-so Dr. Hills' schedule may be freed up a bit. 

BTW-I forgot to ask-which surgery (or surgeries) are you interested in?