Gastic Sleeve OR Optifast Diet? Help!

This is a good point that I hope the OP hears - Optifast is NOT a permanent lifestyle, it's just a temporary fix.  You can't live on Optifast forever.  Better to go for a solution that is permanently sustainable.  

I had lost 30, 40, 50 and even 100 lbs. on various diets and always had regain. My 100 lb. loss was with Medifast. As soon as I went back to regular foods (and I was making healthy choices at that!) I regained.  My problem wasn't ever that I was making terrible choices in the types of foods I was eating, it was the volume I was eating tied to my slower than normal metabolism. The VSG just simply doesn't allow me to eat the volume I could have in the past. I still need to make mostly good food choices and exercise but I finally feel that I can actually keep the weight off this time.

I wish I had gotten surgery at 25.  I'd argue many more of us regret not getting it younger and waiting.  

If Optifast worked so many of us would not get surgery, IMO.  Surgery does things no diet can, like resetting the metabolic switch, for instance.  I resisted for years, but the difference was night and day.  I have struggled the past six weeks due to family junk, but I also have an eating disorder.  Even with that, surgery has been such a huge blessing.  I don't know how I lived without it.

And fear is absolutely common!  There is no shame in being afraid of surgery.  It's quite natural, as surgery is a huge step.  My VSG was my third major abdominal surgery and it was still terrifying.  

Ok, so here are the results of one study done on Optifast tracking regain up to 3 years. I am giving just a small excerpt, but you may want to peruse it. Just be careful to read all of it carefully- percentages for example are derived from the "completers", thus factoring out those who go off plan. Our vsg stats include all patients, off plan or not post surgery. Additionally, it is explained that for the purpose of this study is was "highly structutred" with tons of support, phases, education, etc. and it mentions how the U.S version is not nearly so robust. Ergo the US stats it is implied are not as good. Anyway, these folks only lost 45% of the EWL, but had regained 15% back by the third year... please keep in mind that this is only counting the people who were compliant and went the distance. If you factor in howver many that couldn't stick with it those numbers would be impacted quite negatively. Terrible stats compared to the sleeve. 

When I had mine done the regain was 5% of EWL, and the percentage of EWL lost was much higher (although I will have to try to track that number down to be more specific). So in a nutshell- we lose more and keep more of it off. A lot more. Even when you factor in the folks who completly derail and don't follow the plan.  Factor those folks out, and I have to believe our numbers seriously improve!

Here is a link to the study so you can read all of it in case I misinterpreted or simply skipped important parts!

To be honest I think I am going to try the Optifast. I believe that I am ready for a change and I can moderate my diet afterwards. I am also going to continue working out. I have been on Optifast now for a week and I don't mind it, I actually like how I have my meals already done for me. I have lost 60 pounds in the past due to just diet and exercise but I was young and basically didn't follow any diet afterwards, my life consisted of take out and high carbs. I am doing Optifast for 3 months and then slowly going to incorporate healthy meals 5 times a day into my life. My cousin got the sleeve done about 2 years ago and I see he is gaining weight back! Both ways I believe can succeed in moderation and portion control. It is easier to portion control and not be so hungry with the sleeve. I believe I am strong enough to fight temptations and I think people gain the weight back because they do not control what they put into their bodies. I have another cousin who lost 150 pounds naturally in a year with just diet and exercise and he has kept that weight off now for 3/4 years! He also did the shakes but jus****ches what he eats and splurges one day a week on a meal!!.. I believe I am ready to do this, optifast is just giving me a little push for 3 months! After this push I am going on low carb diet and continue working out 1 hour a day with high intensity training. Thank you tho for your input but I think I have made the right decision for myself. 

It sounds like you carefully reflected what is best for YOU- something no statistic can ever capture! Even with the sleeve, you can stand 3 of us in a row- I lost more than 100% of EWL, the person next to me 50%, and the third lost and regained it all back There is your average. Only you can decide if you are the 100% ewl, the 50%, or the regainer! Doesn't matter which path you take that will always be the case!

Quick follow up- I read the rest of the study. They cited a US study on Optifast that had worse results. The surmise it is due to the high need for the structutred follow up care. They also cite regain stats compared to the bariatric group- 15% for Optifast, 5% for us. Only 7% of the Optifast group maintened (or improved on) the weight loss. 7%. They cite that 30% of the Optifast folks were declared succusful (keeping of 10% or more of that EWL-- not that much weight relatively!) S0 70% must not have kept of 10% or more of the weight lost. 

The say " The relative weight gain 3 years after lowest recorded weight is about 5% in surgery studies"... look carefully at the wording. They are using the "lowest weight" to compare the regain and define succes. With Optifast, success was defines as 10% of EWL- a huge difference in the amount of weight loss and kept off.

Here is another quote, "On the other hand, bariatric surgery, depending on the extent of malabsorption induced, is definitely less prone to the risk of weight regain compared with all non-surgical intervention programs."  This is what our boards are talking about- it is not enough to just lose the weight. Most of us have histories of lowing huge numbers, but the regaining it back and more. VSG- we keep off statistically 95% of what we lost, and we lose a lot more than the Optifast too. 

Don't get me wrong- Optifast showed good things too. Losing 10% is shown to improve your health. 3 years out and keeping of 10% is nothing to sneeze at. But are stats kick the crap out of that, and we don't constantly fight feeling hungry and deprived to do it. 

And just to reiterate- look at this quote, "In completers, the average excess weight loss after our non-surgical intervention was 53%, which is close to the overall weight loss of 61% reported in a meta-analysis about bariatric surgery." Two points here, we would all agree 53% is so much better than 0%, but 61% makes a signficant difference- that difference matters. And then, that 53% for Optifast was including ONLY the completers. What happens when you factor in those folks who couldn't stick with it- a super common problem generally speaking?

This will just be a hodge podge of facts that I find for your. (You got me intersted in updating my numbers- 4.5 years is a long time for new research to come out!). I will supply links from articles so you can review more if interested.

"

Expected weight loss

The sleeve gastrectomy is quite successful in initial weight reduction as well as maintaining the weight loss. Weight loss after a sleeve gastrectomy tends to be faster than the other common operation. Most patients can expect to lose 60 to 70% of their excess body weight over 6 to 12 months.

Advantages of a sleeve gastrectomy

• Great dietary quality of life. All foods can usually be eaten, but in much smaller quantities.
• Generally rapid and reliable weight loss.
• It does not require any on-going adjustments which are required with other procedures, such as the gastric band. However, regular follow up is necessary to ensure weight loss is appropriate and intake is nutritionally adequate  Link

Different article on the sleeve by ASMBS:

1. Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with maintenance of >50% Link   

One more article- this is showing how much of the EWL was kept of 3,4, and 5 years respectively:

"The percentage of excess weight loss was 76.8%, 69.7%, and 56.1%, respectively."  Keep in mind this is only 1 study, not a meta type number posting from ASMBS. But it if dated from 2015. Keep an eye on when stuff was published, it matters. The surgeons refined and improved their technique over the last few years. So in this study, 3 years out 56% of EWL was documented. Optifast (I would need to go back to my earlier post) I believe was 15% of EWL, but only 30% of the people kept off 10% or more.... the numbers were even worse for the US study on Optifast, and this only included the "completers". In comparison, this particular study lost track of some of the participants- we see this kind of thing on the boards. People gravitate away because they got it figured out, or because they might not be doing so hot- this study cannot confirm what was going on with the ones they couldn't keep track of.

In a nutshell- we lose significantly more and keep significantly more of it off.  :) There is more reseach out there, but this gives you a pretty good idea overall of where it stands. Please know I am not saying that if you choose Optifast that it is the "wrong" choice. I only hope to show you some hard numbers on it just flat out not being as effective... but no surgery too. You have to weigh the trade off there.

Just putting in my 2 cents, for whatever that is worth...I had RNY.  I never made it down to goal and I had massive regain.  By all means, a "failure".  However, at no time have I regretted my decision to have weight loss surgery because I had tried everything else humanly possible before making the decision to alter my body.  I knew it was the right decision.