Nutritionist thinks VSG is not for me

Hi everyone! I'm new here and happy to join your community! I finally made the difficult yet exciting decision to get wls and decided on VSG. I went to my initial consult and everything went well, but at the nutritionist's office they were discouraging me to get VSG. They thought that at my weight of 295/bmi 50+/height 5'3", I should get GB. One of the nutritionists was a former surgeon who practiced at the surgical center I'd be going through. They said they had seen so many people get VSG and only lose 20-30 lbs. I started internally shutting down after they said all that, so I can't really remember much about the rest of what they said.

I'm feeling super discouraged. My Polycystic Ovarian Syndrome and Hashimoto's Hypothyroidism are going to make it difficult for sure, but I thought I had made the right choice in choosing VSG. Can you share your thoughts?

Ana

I'm 5'4 and starting weight was near 280. I had vsg and lost over 20lbs in my first month. I had to have vsg because I have a blood clotting disorder called factor 5 leiden and I'm on blood thinner. I was afraid I wouldn't qualify for surgery, but am so happy I had vsg! I would suggest making a written list of questions and statements about you wanting vsg. Your input is taken into consideration, don't shy away from addressing your concerns.

there are people on here who've lost quite a bit of weight with VSG...like 100 lbs or more. Statistics indicate that people lose more with RNY (GB), but not by much - maybe 5% more. But that's just on average. Individuals vary pretty widely - mostly depending on their level of compliance. You can be very successful - or not - with either surgery. But at any rate, even if you go by the statistics, the average is a lot more than 20-30 lbs.

there are certain health issues that make one surgery more appropriate than the other. For example, I had GERD prior to surgery, so the surgeon recommended I go with RNY (although he would have done either). I went with his recommendation and have been very happy with my RNY.

I'm not sure if PCOS or Hashimoto's would be considered one of those "certain health issues" that would make one surgery more appropriate than the other, though. If they are, I'd at least consider what they're recommending. But if not, it really comes down to personal preference (well, it does in any event, really - my surgeon would have done VSG if I'd insisted on it)

My first question would be, what are they doing wrong that they have so many only losing 20-30lb? Overall, the VSG and RNY give very similar results in weight loss and maintenance, though each may be preferred in differing cir****tances.

I am a fan of listening to our professionals here, as much for what it tells me about them, as for what they can tell me about my situation. We all have a common problem (severe obesity) though often with differing histories and root causes. Our surgeons, RNs, PAs, RDs, etc. often have very different backgrounds, experiences and perspectives. So, we may here different things from different groups. That's why I think that it is good to explore several practices and look for some common threads before making a firm decision on procedure and program, to find the most compatible for you.

Surgeons and programs all have their own preferences. Some may prefer the RNY because that is what they are most experienced and comfortable with, and only do the VSG on the easiest cases, or on those who insist upon it. They often experience much better results with the RNY than the VSG as a result. Other practices may prefer the VSG and reserve the RNY for only those cases where cir****tances dictate it. There are practices out there that get results with the VSG that are as good or better than the RNY, even with patients in the 60 BMI and above range. Yet other practices prefer the DS as that usually sees better weight loss results, along with better maintenance regain resistance.

Talking to multiple practices, even just through their information seminars, is useful as while they may downplay the negatives of their preferred procedure (if they have one, some are fairly agnostic on such preferences) they will tend to highlight the negatives of the ones they don't prefer or offer. You can file away these factoids and bring them up in discussions with other programs (what about this problem - I know you say that it doesn't happen often so don't worry about it, but how do you treat it when it does happen?)

We know ourselves best; the surgeons and staff know their business of bariatrics better than we do. We only have a short time together to learn about each other to make this life changing decision. Many of us come into this preferring a procedure for relatively superficial reasons (the sleeve is "simpler", "less invasive", "I don't want my guts rearranged", "I don't want malabsorption", "the RNY is the Gold Standard", or "the DS has the best weightloss", etc.) but unfortunately, many of us need something more involved than what our initial impression may present. 10-15 years ago, many used similar thoughts to go with a lap band, only to not get the expected loss, or to need it removed when it failed - the "simplest" approach wasn't necessarily the best approach.

Metabolic problems may dictate stronger medicine than what you initially prefer (how readily do you lose weight - lose easily but can't keep it off, or can't lose anything, never mind keeping it off?) These give some clues as to your metabolic problems and what procedure might work best for you. While I am not all that familiar with PCOS and Hashimoto, I understand that there are some metabolic effects that can hinder your weight control; if that is the case, you should also have the DS (duodenal switch) on your radar as, while it is a more complex procedure than the others, is also a stronger metabolic tool that might work better in your case.

In short, don't rush into anything, and continue to research, research, research. Good luck!

Edit - I just wanted to add a final thought, that the choice of procedure is only one facet in one's success or failure at WLS. Most any of them will yield decent weight loss over the first few months, as we aren't eating much. Beyond one's starting metabolism, how far we can take it, and how well we maintain that loss, is more dependent upon brain games than the stomach. Developing healthy dietary habits that you can sustain in the long term is much more important than what the most popular diet on the internet is at the moment. The greatest fad diet that "supercharges" your weight loss is of no use if you give up on it once your loss stops (or sooner) and you revert to the habits that got you obese in the first place. A good program will help you make this transition and is more valuable than getting the "best" procedure. The after surgery support can be as powerful a tool as the WLS itself, so look for a program that cares for you as well in the years ahead as they do going into the OR.

I lost nearly 135 pounds with VSG. I respectfully and wholeheartedly disagree with your nutritionist. I met my goal of losing 125 pounds at 10.5 months after surgery. Put the work in, and you will reap the rewards, no matter which surgery you choose.

Thank you all for your replies! I'm feeling much more hopeful!

Iwas initially inclined to choose RNY, because I thought I would lose more. My surgeon told me that the difference in weight loss between VSG and RNY was statistically small. He suggested VSG for me, and I went for it. I lost all of my excess weight and now have a normal BMI!

I think it's rare for someone to only lose 20-30 lbs from either surgery. A much more common problem is losing a significant amount of weight and then regaining it. Perhaps your nutritionist meant that they saw a lot of people ending up only 20-30 lbs thinner after regain. I'm not aware of a big difference in regain between the two surgeries. Perhaps your nutritionist has seen differences in how people with PCOS or Hashimoto's respond to the surgeries.

I suggest you discuss the matter again with your surgeon to see what they think would be best for you. I would follow your surgeon's judgement here. But try to be open to changing your mind. Both surgeries are effective, and the recovery similar either way. I suspect the reason you internally shut down was that you felt stressed out with a suggestion for what seemed like a last-minute change. I can completely understand that.

Oh yeah! I totally did shut down for that reason! I am going to see the surgeon again and ask. Great advice! Thank you all so much!

That sounds a bit odd to me. Even though my starting BMI was lower than yours, I've lost 120 pounds since surgery day less than a year ago with the VSG. From what I understand, and keep in mind I am no expert, a lot of surgeons used to not take out enough of the stomach with VSG, hence the lower success rate. I think they are a lot better at it now than they used to be.

GB is a great procedure and all, there is plenty of reason to choose it over VSG. However, I would probably get a second opinion if I were in your shoes, because VSG can be a great surgery and I'm thrilled with my choice.