best surgery for lightweight
hey everyone wanted to get youropinions on which i might have more success with VSG or RNY. I am 5' 2.5 ( hey the .5 counts lol) and 219 lbs. i have severe IBS and well i've been trying to kinda figure out what kind of eater i am volume, grazer ugh i dunno... im trying to make the best decision for me .. but need some help...
I am 5'3" and I weighed 218lbs when I had my revision nearly a year ago but I weighed 240lbs in 2002 when I had my first WLS. I was considered a lightweight then, too.
In order to know the best surgery for you it is important that you figure out what has led you to being obese in the first place. Also if you have an comorbidities such as diabetes, high blood pressure or GERD.
If you have gone on diets before and starved yourself and hardly lost any weight then you probably have a very slow metabolism and you probably need more then a restrictive procedure.
There is also the DS which is less restrictive but has a lot of malabsorption. This is helpful if you have a slow metabolism or if you have comorbidities such as diabetes.
The RNY also has malabsorption but not as much as the DS and not permanent. The bad news is that even though more calories are eventually absorbed vitamins never are absorbed as well again and you will always need to supplement and watch your labs. With the DS and it's high rate of malabsorption it is critical that you have extensive labs run and supplement accordingly.
The VSG is more restrictive but it has no malabsorption. You would still have to take vitamins because you aren't eating as much but it has less problems nutritionally then a malabsorptive procedure. The main problem with the VSG is lack of long term data as far as it's effectiveness, although I have heard that in 5 year studies the results are comparable to the RNY.
If you have eating disorders such as binge eating or carb addiction it is always best to address those because WLS may not have much affect on them and it could sabotage your success.
In order to know the best surgery for you it is important that you figure out what has led you to being obese in the first place. Also if you have an comorbidities such as diabetes, high blood pressure or GERD.
If you have gone on diets before and starved yourself and hardly lost any weight then you probably have a very slow metabolism and you probably need more then a restrictive procedure.
There is also the DS which is less restrictive but has a lot of malabsorption. This is helpful if you have a slow metabolism or if you have comorbidities such as diabetes.
The RNY also has malabsorption but not as much as the DS and not permanent. The bad news is that even though more calories are eventually absorbed vitamins never are absorbed as well again and you will always need to supplement and watch your labs. With the DS and it's high rate of malabsorption it is critical that you have extensive labs run and supplement accordingly.
The VSG is more restrictive but it has no malabsorption. You would still have to take vitamins because you aren't eating as much but it has less problems nutritionally then a malabsorptive procedure. The main problem with the VSG is lack of long term data as far as it's effectiveness, although I have heard that in 5 year studies the results are comparable to the RNY.
If you have eating disorders such as binge eating or carb addiction it is always best to address those because WLS may not have much affect on them and it could sabotage your success.
WLS 10/28/2002 Revision 7/23/2010
High Weight (2002) 240 Revision Weight (2010) 220 Current Weight 115.
Ladytazz, as usual provided a great response. I wish I could write what I wanted to say as well as she does.
I think you and I have talked about this before on the main forum, but here's my opinion again. I chose RNY because out of my options (VSG, RNY, Band) I felt it was the best suited for me. I dealt with IBS-D and Diverticulitis prior to surgery. Now I have the opposite problem, but mine is due to medications and the vitamins I take. It is managable most of the time. I also dealt with PCOS and GERD. My PCOS symptoms are now being managed without Metformin and my GERD is gone! Honestly, if my insurance would of covered the DS I probably would of gone that route. I like the fact that the RNY has malabsorption, but I hate the fact that it isn't permanent.
Do you snack a lot? Do you eat 3 large meals a day or are you likely to eat multiple smaller "meals"? I was a grazer and would eat 5-6 mini meals a day. The good news is I still sort of do that with my RNY. However, now my meals are a lot different than they were pre-op. Here is an example of my daily menu:
B: Protein Frappuccino
S: Cheese stick with apple slices
L: This varies a lot, but I love to have lettuce wraps. You take a piece of romaine lay some lunch meat on it and add your favorite cheese. Then I put a little mayo on it and eat it like I would a wrap in a tortilla.
S: Protein bar or Protein Snack (Kay's Naturals Chips or Just the Cheese)
D: 3-4 ounces of protein, various fruits and veggies
S: Syntrax Nectar
I get around 100g of protein a day. Knock on wood I haven't hit a stall yet in 8 weeks. I know it's coming though lol.
Another thing to take into consideration is medications. With the RNY you can't take NSAIDS (Advil, Aleve, Celebrex). That has been the most difficult part for me thus far. I have hip issues and some 800mg Motrin would go a long way. I do get pain relief though. Please don't think if you have the RNY you have to suffer, but you have to take different pain medications like Ultram or narcotics.
If I had to do it again with the choices I was handed I would still pick the RNY. I feel great. I've lost a lot of weight considering where I started and I'm happy with it. Good luck to you no matter what you decide.
I think you and I have talked about this before on the main forum, but here's my opinion again. I chose RNY because out of my options (VSG, RNY, Band) I felt it was the best suited for me. I dealt with IBS-D and Diverticulitis prior to surgery. Now I have the opposite problem, but mine is due to medications and the vitamins I take. It is managable most of the time. I also dealt with PCOS and GERD. My PCOS symptoms are now being managed without Metformin and my GERD is gone! Honestly, if my insurance would of covered the DS I probably would of gone that route. I like the fact that the RNY has malabsorption, but I hate the fact that it isn't permanent.
Do you snack a lot? Do you eat 3 large meals a day or are you likely to eat multiple smaller "meals"? I was a grazer and would eat 5-6 mini meals a day. The good news is I still sort of do that with my RNY. However, now my meals are a lot different than they were pre-op. Here is an example of my daily menu:
B: Protein Frappuccino
S: Cheese stick with apple slices
L: This varies a lot, but I love to have lettuce wraps. You take a piece of romaine lay some lunch meat on it and add your favorite cheese. Then I put a little mayo on it and eat it like I would a wrap in a tortilla.
S: Protein bar or Protein Snack (Kay's Naturals Chips or Just the Cheese)
D: 3-4 ounces of protein, various fruits and veggies
S: Syntrax Nectar
I get around 100g of protein a day. Knock on wood I haven't hit a stall yet in 8 weeks. I know it's coming though lol.
Another thing to take into consideration is medications. With the RNY you can't take NSAIDS (Advil, Aleve, Celebrex). That has been the most difficult part for me thus far. I have hip issues and some 800mg Motrin would go a long way. I do get pain relief though. Please don't think if you have the RNY you have to suffer, but you have to take different pain medications like Ultram or narcotics.
If I had to do it again with the choices I was handed I would still pick the RNY. I feel great. I've lost a lot of weight considering where I started and I'm happy with it. Good luck to you no matter what you decide.
With my insurance, RNY and band were my only choices. I wanted a sleeve.
However, I have been very happy with my RNY and still think I made the right choice between my choices. The only reason the sleeve would have been better is the ablitity to take NASIDs. I am looking at a knee replacement and I maybe could put it off a little if I could get some relief that way.
I have had no complications from the RNY being a more invasive surgery and that was my fear. I have to stay on top of my vits, but I have taken vits all my life so it isn't a big deal.
I was never a grazer, but I was a volume eater.
However, I have been very happy with my RNY and still think I made the right choice between my choices. The only reason the sleeve would have been better is the ablitity to take NASIDs. I am looking at a knee replacement and I maybe could put it off a little if I could get some relief that way.
I have had no complications from the RNY being a more invasive surgery and that was my fear. I have to stay on top of my vits, but I have taken vits all my life so it isn't a big deal.
I was never a grazer, but I was a volume eater.
66 yrs young, 4'11" hw 220, goal 120 met at 12 months, cw 129 learning Maintainance
Between 35-40 BMI? join us on the Lightweight board. the Lightweight Board
Hello!
Welcome to the lightweight board! I am 5'1 and started my journey at 219 as well! I think if you search around on this board long enough, you will see success stories for ALL the surgeries!
I think with your doctors help, you can narrow down the best one for your situation.
I personally chose RNY due to my huge carb and sugar addiction. I still eat "good" carbs but sugar makes me feel HORRIBLE and it's just not worth it.....I also had a HUGE hiatial hernia that made VGS pretty much impossible for me. I have 2 really good friends who had RNY over 10 years ago and have kept off their weight (within 10 pounds of their lowest) and maintain pretty normal lives....that was a BIG deciding factor for me as well. If you chose RNY, just be prepared to supplement vitamins FOREVER.....no really a big deal each day but NECESSARY!
( I never considered DS because my doctor doesn't do that procedure and it wasn't covered by my insurance. It seems to be a terrific option as well though...)
Bottom line....Good things and good health are just around the corner no matter which procedure you chose. Just keep researching and become an expert on whichever one you chose! BEST WISHES!
Welcome to the lightweight board! I am 5'1 and started my journey at 219 as well! I think if you search around on this board long enough, you will see success stories for ALL the surgeries!
I think with your doctors help, you can narrow down the best one for your situation.
I personally chose RNY due to my huge carb and sugar addiction. I still eat "good" carbs but sugar makes me feel HORRIBLE and it's just not worth it.....I also had a HUGE hiatial hernia that made VGS pretty much impossible for me. I have 2 really good friends who had RNY over 10 years ago and have kept off their weight (within 10 pounds of their lowest) and maintain pretty normal lives....that was a BIG deciding factor for me as well. If you chose RNY, just be prepared to supplement vitamins FOREVER.....no really a big deal each day but NECESSARY!
( I never considered DS because my doctor doesn't do that procedure and it wasn't covered by my insurance. It seems to be a terrific option as well though...)
Bottom line....Good things and good health are just around the corner no matter which procedure you chose. Just keep researching and become an expert on whichever one you chose! BEST WISHES!
HW/SW/CW/Goal.....219 / 206 / 122 / 130
I'm a VERY lightweight, weighed 203 going into the surgeon's office (35.2 BMI) and weighed 199 the day of surgery which was a 34.9 BMI and was NOT trying to lose any weight at that point in time.
I would have liked the sleeve but I have a Medicare Advantage policy and that was not an option for me. My choices were lapband (which I immediately tossed to the curb), a RNY or a DS.
My original doctor ruled the DS for me, he only performs them on those who's BMI are 50 or greater. I was too small and he said I would "LOSE too much weight". I did not agree but didn't know enough about the DS at that point in time to decide I needed it.
Okay, my co-morbids at the time were insulin dependent type II diabetes and on an insulin pump. I had high cholesterol, I had sleep apnea which altho had been temporarily "cured" by surgery was coming back. And I had GERD.
Given the GERD, one would assume that the RNY would have been best for me but there were some other factors NOT in the RNY favor. Between my initial visit in June 2010 and them "dragging their feet" on getting me scheduled, I had time to do more research and ask questions.
First, I discovered that the DS is very successful for lightweights. And that I could also lose TOO much with the RNY. (my initial doctor's objection). Second, I discovered that the DS or sleeve are best for anyone needing or possibly needing NSAIDS. You can not take NSAIDS with the RNY. Since the sleeve was not an option for me, that left the DS. But I also read the main board and the RNY boards gathering all kinds of information. Figured if I was gonna get a RNY, I better know all about it.
That was the third item and the deal breaker...the sheer number of threads I saw on reactive hypoglycemia on both the main and RNY boards. So I started digging for solid material and found several studies that lay RH dead on the doorstep of the RNY but no mention of the DS. Since I had already been diagnosed with RH over a decade ago, I did not need to add another reason for having it. Kept digging but also found a new surgeon but this one was out of state. He was willing to do a DS on a lightweight.
Well, my insurance balked...not at my getting the DS but on my going out of state to get it. So I appealed, twice and was on the third appeal when I was down to ONE surgeon here who would 1) take medicare advantage plans and 2) do a DS on a lightweight. Problem was, he was the partner of my original surgeon. They had to agree to the swap before I could go forward. They did and on 24 Jan 2011, I had a DS. In 4 months and 3 weeks, I've lost 51.4 lbs since surgery. As for losing too much...hasn't happened and I've slowed down considerably so I doubt I will.
How fast we lose is dependent on several factors. One is how much Excess Weight we have to begin with. Those with much higher amounts to lose, tend to lose copious amounts, esp in the first 6 to 9 months, often going well beyond 100-150 lbs but then again, we only have about 80-100 to lose to start...so we still hit normal much sooner than they do. BUT we also tend to lose most of our excess weight and get to goal sooner.
Now the papers I found. Here are the ones on the RNY and Reactive Hypoglycemia:
RNY and Reactive Hypoglycemia
More information on Reactive Hypoglycemia
You also need to read this:
Pyloric Valve - Why it's important to keep it
The other issue I had/have is NSAIDS. I needed them for the arthritis in my spine, etc that is degenrative. Based on those factors I lobbied for the DS.
I can hear you asking, well what about the GERD...the RNY is supposedly the best for fixing it but you know something, I haven't had an issue with GERD since my surgery.
For other reading, check out this paper comparing all the surgeries, and their outcomes for the co-morbid conditions, weight loss and percentage of regain.
Bariatric Surgery Medical Guidelines for Clinical Practice
IF you do not need malabsorption and not all of us do, go with the sleeve. If you do need the malabsoption, please keep doing your reseach and check out the revisions and regrets boards as well. Once you have done all your reseach, chose the surgery best for you but make sure you know ALL your options.
Liz
I would have liked the sleeve but I have a Medicare Advantage policy and that was not an option for me. My choices were lapband (which I immediately tossed to the curb), a RNY or a DS.
My original doctor ruled the DS for me, he only performs them on those who's BMI are 50 or greater. I was too small and he said I would "LOSE too much weight". I did not agree but didn't know enough about the DS at that point in time to decide I needed it.
Okay, my co-morbids at the time were insulin dependent type II diabetes and on an insulin pump. I had high cholesterol, I had sleep apnea which altho had been temporarily "cured" by surgery was coming back. And I had GERD.
Given the GERD, one would assume that the RNY would have been best for me but there were some other factors NOT in the RNY favor. Between my initial visit in June 2010 and them "dragging their feet" on getting me scheduled, I had time to do more research and ask questions.
First, I discovered that the DS is very successful for lightweights. And that I could also lose TOO much with the RNY. (my initial doctor's objection). Second, I discovered that the DS or sleeve are best for anyone needing or possibly needing NSAIDS. You can not take NSAIDS with the RNY. Since the sleeve was not an option for me, that left the DS. But I also read the main board and the RNY boards gathering all kinds of information. Figured if I was gonna get a RNY, I better know all about it.
That was the third item and the deal breaker...the sheer number of threads I saw on reactive hypoglycemia on both the main and RNY boards. So I started digging for solid material and found several studies that lay RH dead on the doorstep of the RNY but no mention of the DS. Since I had already been diagnosed with RH over a decade ago, I did not need to add another reason for having it. Kept digging but also found a new surgeon but this one was out of state. He was willing to do a DS on a lightweight.
Well, my insurance balked...not at my getting the DS but on my going out of state to get it. So I appealed, twice and was on the third appeal when I was down to ONE surgeon here who would 1) take medicare advantage plans and 2) do a DS on a lightweight. Problem was, he was the partner of my original surgeon. They had to agree to the swap before I could go forward. They did and on 24 Jan 2011, I had a DS. In 4 months and 3 weeks, I've lost 51.4 lbs since surgery. As for losing too much...hasn't happened and I've slowed down considerably so I doubt I will.
How fast we lose is dependent on several factors. One is how much Excess Weight we have to begin with. Those with much higher amounts to lose, tend to lose copious amounts, esp in the first 6 to 9 months, often going well beyond 100-150 lbs but then again, we only have about 80-100 to lose to start...so we still hit normal much sooner than they do. BUT we also tend to lose most of our excess weight and get to goal sooner.
Now the papers I found. Here are the ones on the RNY and Reactive Hypoglycemia:
RNY and Reactive Hypoglycemia
More information on Reactive Hypoglycemia
You also need to read this:
Pyloric Valve - Why it's important to keep it
The other issue I had/have is NSAIDS. I needed them for the arthritis in my spine, etc that is degenrative. Based on those factors I lobbied for the DS.
I can hear you asking, well what about the GERD...the RNY is supposedly the best for fixing it but you know something, I haven't had an issue with GERD since my surgery.
For other reading, check out this paper comparing all the surgeries, and their outcomes for the co-morbid conditions, weight loss and percentage of regain.
Bariatric Surgery Medical Guidelines for Clinical Practice
IF you do not need malabsorption and not all of us do, go with the sleeve. If you do need the malabsoption, please keep doing your reseach and check out the revisions and regrets boards as well. Once you have done all your reseach, chose the surgery best for you but make sure you know ALL your options.
Liz
Duodenal Switch (Lap) 01-24-11 | Surgeon: Stephen Boyce | High weight: 250 in 2002 | Surgery weight: 203 | Lowest weight: 121 | Current weight: 135 | Goal weight: 135
What the others have said is dead-on. For myself (5'4", 223 lbs), the VSG was the right choice as it is purely restrictive with lower risks of long-term nutritional deficiencies, strictures and bowel obstructions. Note that I did not say 'none' as any surgery has risks, but the nature of the surgery is such that there is less internal rearranging. I work in the health field and have seen many complications and for myself doing what I could to minimize these risks was good for peace of mind.
Best of luck on deciding what is right for you!
Best of luck on deciding what is right for you!
Height: 5'5" / HW: 223 / SW: 196 / GW: 125 reached 12/22/2011 / CW: 121
My surgeon finds his RnY and VSG patients get similar results in terms of co-morbidity resolution and weight loss so the only reason to pick one over the other is for personal reasons.
I wanted the surgery with the best ghrelin reduction and the least risk of complications. That's the sleeve.
I also didn't want to deal with dumping. I am a control freak and dumping is too iffy for me. I know I would constantly be playing with the line trying to figure out what I could and couldn't eat and driving myself crazy as it changed. I also don't believe in Bad vs. Good foods so I didn't feel like I needed dumping to keep me away from "bad" foods.
I was also self-pay and VSG is cheaper. So, even if I had been leaning towards RnY, paying more money for the same results with greater risk of complications would have made no sense. OTOH, if insurance was paying for my surgery, they didn't cover the sleeve back when I had it so that would have been a point in favor of RnY.
At the time, I didn't know about reactive hypoglycemia, but if I had, it would have been one more point in the VSG's favor.
Finally, I want to be able to take any kind of medication especially NSAIDs and time-release meds.
Btw, I was not a volume eater and I am a sweets eater and I have found the VSG works great for me. I think it's a lot more complicated than that anyway.
I wanted the surgery with the best ghrelin reduction and the least risk of complications. That's the sleeve.
I also didn't want to deal with dumping. I am a control freak and dumping is too iffy for me. I know I would constantly be playing with the line trying to figure out what I could and couldn't eat and driving myself crazy as it changed. I also don't believe in Bad vs. Good foods so I didn't feel like I needed dumping to keep me away from "bad" foods.
I was also self-pay and VSG is cheaper. So, even if I had been leaning towards RnY, paying more money for the same results with greater risk of complications would have made no sense. OTOH, if insurance was paying for my surgery, they didn't cover the sleeve back when I had it so that would have been a point in favor of RnY.
At the time, I didn't know about reactive hypoglycemia, but if I had, it would have been one more point in the VSG's favor.
Finally, I want to be able to take any kind of medication especially NSAIDs and time-release meds.
Btw, I was not a volume eater and I am a sweets eater and I have found the VSG works great for me. I think it's a lot more complicated than that anyway.
HW - 225 SW - 191 GW - 132 CW - 122
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