Can someone PLEASE explain this to me????

My wife is currently embarking on her quest for WLS. She is opting for Rou-en-Y I believe it is called. I am heavily into bodybuilding, so forgive me if I don't seem sympathetic to this general idea of WLS being a good thing. I went to a support group meeting with my wife this past week and found it to be no more than a live infomercial filled with ideology that I cannot seem to comprehend. They say that only 5% of those overweight can achieve long term weight loss through diet and exercise, and the reason is a breakdown in Behavior Modification. Yet, as I see it, this is the basis for WLS actually being effective. So very simply my question is this: Why is it so accepted that this person looking to undergo WLS can for the rest of their lives modify their behavior, in fact the same modifications that one would have to make to achieve their goals naturally, after surgery, but cannot do such without the WLS? And, if they can then why do the Doctors continue to do this procedure instead of teaching these people how to feed their bodies instead of their taste buds or stomachs?

The answer is that this surgery is actually "Surgically induced behavior modification". When you attempt to quit smoking first you throw away your cigarettes and put a rubber band around your wrist. when you want a cigarette you snap yourself and have a negative effect. When you want a cigarette bad enough you have one. Weight loss surgery on the other hand helps the patient out because number one we cannot just throw food away and go cold turkey and we cannot just start eating what we want when we want just because we are tired of the diet. This surgery #1 decreases the amount of food that can be taken in period. If we want more and eat more we get #2 a negative effect (the rubber band). We "dump". Our hearts race, our faces flush, we dry heave, we may vomit or have explosive diarrhea. If we had these effects from making poor choices without surgery no one would be fat, but we don't and some of us are unable to follow behavior modifications without an involuntary negative effect. It is a life long process. We learn to follow the rules or suffer the consequences. I hope this helps. Good luck to your wife Dawna 280/140/140

WLS is SOOOOO much more than behavior modification . . . to start . . . 1. Surgically induced malabsorption. Most obese people have hyper efficient metabolisms. Every calorie eaten is stored for famine. Post-op, those calories are much less likely to be stored (exception is sugar). 2. Alteration of the hunger cycle. Dieting, and behav. mod. makes the metabolism worse, not better, and can really screw up the hunger signals. Lets see if we can find something you could relate to . . . ever had the proverbial blue set? Got some, and an hour later, you're blue again? That's prolly as close as I can come to describing it to you. 3. WLS is *not* behavior modification, but *does* require some. WLS makes one feel satisfied on a tiny amount of food. That's *not* behavior modification. I think that you wife has a tough road ahead . . . and I hope you will do a *LOT* more research, with a much more open mind than it sounds like you have now. And if you're not going to be any more supportive than you sound, maybe you should cut her loose now, so that when she's *hot*, she's single?

Firstly I take incredible offense to your assumptions. My question was not that of,"What is WLS?". It is, and if you are as informed as you think that you are you may understand, the behavior modification that is needed to make WLS successful, ie. diet, exercise, etc., being that it is so very similar to what is needed to achieve the same goals without WLS, why is WLS necessary? If one can make these changes after, then shouldn't they be able to make them before or without? As for my support of my wife, well... If I didn't want to support her then do you really think I would be here where people like you make undue assumptions as to my state of thought or support of my wife. My question is out of concern not disdain, but if I am going to be replied to in a manner such as this then I have no interest in learning from you or your board. Regards.

Alfred, I don't really understand your hostility, both toward the people at the support group and the people here. I'd like to help you understand why weight loss surgery may be necessary if you are able to take a step back and listen. The key word missing from the statement in your first message that makes a big difference is "morbidly" obese. Studies show that people who are morbidly obese (which means a BMI of 40 or above) may be able to lose weight through diet and exercise, but will most likely gain it back in 5 years or less. I hope this helps you understand. As a health care provider and as a morbidly obese person, I have seen this sad process time and time again. Caryl Mauk, RN, CNS-AD

Ms. Mauk, I thank you for your time to post and my hostility was not toward you or any other except the person who twisted my inquiry and stated that I should leave my wife. Truth be told I would not be here asking questions if I did not want to support my wife. Being on this board allows you ananymity that you would not have face to face. You only know what I tell you and visa verse. This has nothing to do with my relationship this has to do with I do not personally believe in this procedure and my wife has elected to have it. I appreciate that many people feel that by being forced to change their life style by undergoing WLS that they feel it will be their salvation from the yo-yo dieting and a permanent solution to their weight problems but from what I have been reading this is truly not the case. Fact in point is that more than a few eventually gain all of their weight back. Secondly is that all have now put their bodies in a position where they will be fighting malnutrition for the rest of their lives. Thirdly this is a dangerous procedure in itself that 1-200 die on the table and many more have sever complications afterwards. The way I see it this is a last ditch effort that should be held simply as that. Last ditch. I understand battling weight. I myself have had to my entire life, but through knowledge I have found that this is possible without resorting to such invasive means. What is worst is that doctors know this. The biggest problem in the US is knowledge. People are not informed about proper nutrition until they have already developed a destructive eating pattern in which case it becomes hard for them to change. These patterns are what these doctors need to focus on and after educating and monitoring then weed out the ones who have become so morbidly obese that they have no other alternative, but the rest will see that through proper nutrition, not dieting, and physical activity they will attain far healthier results and can move on with their live in a normal fashion. This is not a bash on you or any other but an honest question from a sincerly devoted huband about why my wife has chosen this surgery and what to expect afterwards.

Alfred, I did not have the RNY, I had the Lap Band. Lots of people haven't heard of it, so I'm going to explain a little that you may or may not know. With this, instead of creating a pouch by bypassing a large portion of the stomach, they instead install a band around the upper portion of the stomach so that the person can eat less, without the issues of malabsorbtion. It's also adjustable, so that if you feel like you can eat too much, you can go in and have it tightened (for life if need be). There are risks, but I feel they are lesser than with the RNY (my opinion, not a dig at any RNYers). The band can slip, or move down on the stomach where its' not supposed to be, which usually causes reflux, and sometimes requires surgery to reposition (but sometimes can move back on it's own when the band is emptied). Erosion, where the band actually 'digs into' the stomach's lining. Same as the other, sometimes it can be fixed by emptying the band (temporarily), but sometimes requires surgery to fix. The mortality rate with the band is about the same for general anesthesia by itself, which I believe is 1 in 2000. I say all that as an alternative choice for your wife, who I can tell you are worried about. Now, as an answer to your original question from my perspective: The RNY wasn't an option for me, but without the band, I couldn't make myself keep those lifestyle changes for very long. In my mind it wasn't ever a lifestyle change than a diet, which had a beginning and an end. I also had a very much "all or nothing" mentality. If I messed up and ate something I wasn't supposed to, that was it, the diet was ruined and I might as well give up. For whatever reason, just having the band helps me know that it's always there, and I can just start again with the next meal (not tomorrow, or "Next Monday"). I don't know why I couldn't do it by myself and why I can do it now, and that's probably a question that will take much therapy to answer, but for whatever reason, it seems to work. Obviously, this isn't true for ALL people, as you have seen people who've gone through WLS stop losing and start gaining, but I think it's true for a good majority. And I think also that people who have help losing the weight are more prone to work harder to keep it off. Like when you have all the weight, it's too big a problem to tackle, but once the weight is gone, keeping it off is more managible. I'm not at goal yet, so I can't speak to that personally, but it's just a thought. Hope this helps. Sarah

Alfred, I understand your concern and agree that RNY should be last ditch only. It took me five years of saying "No way would I ever do that" before I came to the conclusion that it is the only way left for me. I will start by telling you that you and your wife should read my profile. I have kept a journal since the moment I decided to have the surgery that I keep posted there. Sometimes I post 20+ days a month, sometimes 3 but you can see everything I went through and where I have been mentally at each stage. I read through hundreds of profiles before I decided to finally do this life (and body) changing procedure. I DO NOT REGRET IT - not even for one second. However, I do not believe this surgery is for everyone. My fiance and my mother for instance. Not a single soul was happy I was doing this. My son was scared I would die or turn into a wild **** He has mellowed. My fiance was worried I would leave him. I can understand that concern since the relationship break-up rate is high after this surgery. He is now more comfortable but also knows this is NOT for him. There is alot to give up and you have to prepare yourself for that. If you are not prepared then you will most likely set yourself up for failure. I have seen success and failures long term. It took me FIVE years to come to the determination that this is what I had to do. I couldn't do it on my own. I had done all sorts of diets and they all stalled and I would get frustrated and give into the hunger. When you have this surgery it gives you the opportunity to change your habits because for at least 6 months you have no hunger, you can't eat much and you don't want to eat either. I didn't want to eat for the first 4 months and then I started to explore more. I am 9 months out today and although I am a success - I sometimes worry that I will get lax and start into old habits. I feel like I am eating like a pig when really I have only eaten a side salad or four nacho chips covered in cheese. I feel stuffed and therefore I feel like I used to at a buffet and psychologically feel like a pig and out of control. I always feel better if I set a certain amount to eat and don't exceed that. I don't feel when I am just full... I feel it if I am overfull. This is probably more information than what you are looking for but I will tell you that I have tried diets and exercise routines for years and I ALWAYS stalled out at about 3-6 months and felt like I was doing it in vain because there would be no progress. I have yo-yo-ed for years and I pray that this isn't just a huge yo-yo. Time will tell. I do feel guilty because this month I have wasted empty calories on alcohol and only lost 7 pounds because I slacked off. I do make sure I get a protein shake in everyday (I have missed maybe 5 days in the past 9 months) and I keep track of what I eat and how much exercise in fitday.com which is another tool that I use to make sure I didn't waste this opportunity to be normal again. I am a size 12 right now and feel like I am still fat even though everyone tells me I am crazy. I DO feel so much healthier which is the true goal. I love all the things normal people take for granted... movie theater seats and booths fitting, sitting in a plastic lawn chair and not breaking it, walking without being out of breath or in pain, even fitting in a normal bathroom stall is a big deal. I know this is long and somewhat off topic, but I suggest you and your wife read my fiance's profile and mine... there is a link to his off my profile but his name is Ed Fife. I wish you both the best of luck and I hope you find your answers. The way we found our answers is by reading everyone elses stories. You can also read the message boards - especially the dated ones... like those that had surgery September 2004 would show you what the issues are at 9 months out, where May 2004 would show you the issues at one month out. You can read those and get TONS of information for your wife and so you know what to expect. One last thing... not a SINGLE person I told was truly happy I was getting this done before I did it... now ALL of them agree it is the best thing I could have done for myself... some are jealous, some are threatened, but most are happy for me. I'm truly blessed... so far. Laura RNY 9/7/04 9 months today! 330/181/140

Ms. Koenigs, Thank You very much for your response. I will look at yours' and your fiances' profiles. I have reserved myself to the fact that she is going o do this. I am still unsure but I am being as supportive as possible. At the moment we are waiting for insurance approval and a date for her surgery. I am very fitness oriented and an avid bodybuilder, non-competitive, so many of the supplements and protein powders are here at the house already along with anything she will need to carry her food with her as I already do such. If this works for her, I will be the happiest for her. I do not want her to do this and it not work. I am not really worried she will leave me afterwards. Truth is if that was the case it will happen either way and I don't have time or energy to worry about something I can do nothing about. I wish you continued success Sincerely, Alfred

Alfred - I think you are asking a really good question, and one that all of us who have had the surgery (RNY or Lapband) asked ourselves....Why can't I lose the weight without having WLS? The reality is that most of us have lost hundreds of pounds over the years, only to find that we put it all back on, and more. Prior to my surgery (lapband) my surgeon wanted me on a High Protein low carb diet for 2 weeks. I chose to follow the South Beach diet for those two weeks, and I lost 14 lbs. My friends and family said "You're doing great, is it making you think about cancelling the surgery?" To be honest, yes I thought about it, but I also know myself, and my weight loss histroy. As soon as I feel good about myself I slack off, and will gain it all back...and start a new gain\loss cycle. I know that my lapband is a tool, it's to help me keep the weight off after I lose it. Does that mean I'll never gain...no, but I know that I can get back on track. My personal hope is that after I lose a substantial amount of weight, and become more active I can do many of the activities that you enjoy, and hopefully your wife will find that as well. Once I'm more active I can hopefully keep it off by being more active, which to your point, will make me more healthy. However, until I get a lot of the weight off, just trying to go to the gym and work out is an excercise in futility, and is very frustrating, and the more frustrated we get...the easier it is to quit. It sounds like you truly love, and support your wife - which makes her a very lucky woman! My partner has let me go at my own pace, and been there with me, cheering me, and reminding me why I wanted to do this. I hope this helps! Denise