WLS for BMI 40?

Hello all! I am a newbie here, so hopefully this is the right forum to post this...

I am 25 years old, happily married for 4 years now, and looking to get RNY OR LapBand.
My husband is military so I have to try to go through Tricare (so anyone with this experience, please let me know!) I am hoping I won't have a hard time getting approved through Tricare, but I am unsure of whether I should do a RNY or band procedure.

I am 5'6, 255 lbs, which puts me at a BMI of around 40. I do not have any comorbidities yet, but obesity and diabetes are VERY dominant in my family. My mom is 62 and has lost 6 toes, dealt with bleeding in her eyes, almost lost her entire leg, open wounds for years, etc and I want to get the surgery now instead of waiting until it is too late.

My dad, 2 uncles, and an aunt have all had gastric bypass approx. 10 years ago. I know the surgery has changed dramatically since then but even with the higher risk, I think I am more comfortable with RNY because I kind of know what to expect.

On the same note, I feel like I am not really "big enough" to get it. My dad was around 400lbs when he got it in 2006 and I am obviously much less than that. Also, I haven't had kids yet and hope to in the next 5-7 years.

Can anyone provide any insight? If you have had these surgeries, how have they worked for you? Has anyone had this surgery as a smaller person like me? Any help at all would be appreciated!

Well I'm 32 and I'm four months in from having the gastro sleeve done. My starting weight was 299 and I'm now 230.5 in four months. And honestly this was the best decision I've made.  I as well don't have any children yet but I do work with them so maybe that's why. I feel alot better now that the weight is coming off and I'm even doing things that I haven't done I  years. 

I was scared in the beginning to even think about getting the surgery because I knew someone who passed away after she had it done. And I always told the drs no I'm okay I can handle this and lose it on my own. Well I was wrong the weight didn't want to leave and I just got bigger.  And then the dr said nine words to change my mind. And they were you can die any day now of a heart attack. And that's when I started doing my research and decided I was going to start the process to get the surgery.  

My whole process took me 6 months because I had to have blood work done and I also had to see a therapist. And my health insurance also wouldn't approve me till I did 6 months with a nutritionist to try and lose weight. Well even with help I lost and then gained as well. And my insurance figured I was a good candidate and I was approved thank goodness.  

Best of luck to you time has changed and things are better then when it was first out. Hope you get approved and things go smoothly for you as well.

My highest BMI was 40. I lost enough on my own that I qualified around 35 and went into surgery at 35.3. It's been 33 days. I've lost 39 lbs and am almost into the 20s.

The good: I've had no need for my diabetes medication since discharge. My right knee still clicks but no longer hurts when I use the stairs. My mother flat out told me before I had surgery she didn't want me to do it because she was worried it would negatively impact my health. Now every time she sees me she is delighted by the changes.

Now for the bad. I don't want to scare you but I think it's important to share the whole experience. It hurt. It hurt a lot. I think I surprised the nurse in recovery because I woke up crying and she had to give me two shots of morphine. I had a low grade fever for over a week, which made me miserable and sweaty. Then I got a high fever and ended up in the hospital for another six days with an abscess and a drain in my back. I just finished the antibiotics a couple days ago so my stomach's still pretty sensitive. 

And yet, do I regret it? No. Though my diabetes was well controlled, I was scared of going blind or losing pieces of my limbs like your poor mom. I also have hopes that hubby and I can conceive in the future. We will be old-ish but one would be nice. There are many other considerations, but mainly my health problems were mounting up and I just turned 34. I want to have a life with vibrant health and want to be around to tickle hubby as long as possible.

I was a BMI of 36.8 and got the most drastic WLS because it had the best long term results of all the ones I researched. I'd stay away from the band due to complications such as erosion and slippage, and look at the RNY or Sleeve (if Tricare adds it to their list).  Take all the pre-op tests and see if you have a qualifying comorbidity such as sleep apnea, it may help the approval process.  The current qualification for WLS is 35 BMI with several comorbidities or 40+ BMI without several comorbidities.  Diets don't work, so WLS is about the only weapon we have to fight our body's constant threat to store fat. Good luck and keep us posted.

--gina

good luck with your decision.  My insurance would only pay for band and RNY and after being on these boards for 5 yrs now, I am so happy I chose RNY.  Other than the fact that they are all major surgeries, and that can cause complications, these days they are pretty safe surgeries.  I had no complications, even at 62 and it was my 4th abdominal surgery.  I was 4'11", 220.  I have never been happier.  I can now lead the active lifestyle I want and am off all meds.  Yeah, many of us got the "your not big enough"  but we knew what we were living with and why the surgery was necessary.

You'll have to decide if you are ready.  Most of the people on this site are huge proponents of the surgery, myself included, because its life changing!  But ultimately If you're not ready, you should definitely think about it first and get your mind to accept that you are (or are not) before you move forward.  That said research is the best way of making up your mind, so feel free to ask questions. 

Everyone in this forum is about in the weight range you are when we started, so you should be able to relate to us.  Several of us were also Tricare (me too) so if you have any specific question feel free to ask.  I usually post this link to the TRICARE Bariatric Approval pg so folks know the conditions that are required for approval: Tricare bariatric_surgery.

But the basics: They only approve Lap Band & RNY.  They require 40% BMI or 35% with comorbidities. 

You mentioned lap Band Vs RNY.  Most people who had the lap band were not successful (not all though) and are now converting them to RNY, but that's only what Ive read.

Good luck on your journey either way!

I was 25 and weighed 274 when I got my lap-band. I don't regret it exactly because I did lose a lot of weight (I'm also 5'7") but within 2 years I had issues with the band and looking back now, I might have had issues the whole time and just not realized it.

I don't think you're "too small" for RNY since you could lose 100 lbs and still be within your normal bmi range. I would never recommend the band to anyone, after living with it for 5 years. And I was one of the more successful people with it! 

And, I know this might sound horrible, but you might want to eat heavily a few weeks before your consultation to make sure your weight puts you over 40 BMI. Without co-morbidities, they might be more strict about that. I have no experience with Tricare though. 

Best of luck! I'm sure you will not regret getting the surgery and avoiding the health issues that you're prone to. 

I understand your concern, I had basically the same starting weight (we are the same height), so same BMI.  I can tell you it's the BEST decision I've ever made (complications and all)...I just wish I had done it sooner - at your age!!!  Both of my parents had the RNY and both were bigger than me, so I understand that too!  Good luck with your decision.  xoxo 

I had a BMI of 39, but was insulin dependent, hbp and cholesterol.  The diabetes scared me more than WLS.  I went with the DS as it has a 98% cure rate for diabetes.  I'll be 7 yrs out next month and have no regrets.  A Kaiser surgeon said I wasn't big enough for WLS, a grievance with Kaiser and then opened a case with Calif DMHC and won.  

My BMI was 37.5 with no co-morbidities to start with. I found out I had mild sleep apnea and my blood pressure was starting to get high. I wasn't at the point of medication yet. I did have high cholesterol, but not medicated yet. I was an avid exerciser, but tried for 10 years to lose weight and was largely unsuccessful. I had a very, very strong desire to lose weight and many failed efforts. In the end, my insurance paid because of my high blood pressure. It was THE BEST decision I've ever made. Still a struggle to make the right choices and do the work - it isn't magic. But I have no doubt that it was the right tool for me. And that was with my lower BMI. For those that may judge me, I just can't worry about that! This is my journey and it was the right, best decision for me!