That boughie size thing again

I know some may not like this but....I think all this talk about bougies and regain is BS.

My doctor said something to me that really hit home. We all talk about the sleeve being a tool. And that's exactly what it is.

He said that it's important to develop good habits in your first six months to a year as that will help you maintain for the rest of your life. Developing good eating habits and exercising is key.

I think that if you get your mind in the right place and maintain a good diet and exercise program that's what will help stop the regain...not the size of your boughie.

My doctor also said that some regain 15 to 20 pounds after the two to three year mark. I intend on being one of those that fall in the error of margin for that particular stat.

That's my view...

Bravo!  Well said.

My surgeon said the same thing. Focus on developing good habits in the first 6 months to a year. If someone does this, they will be successful in the long term. Develping good eating habits and exercising are key, but I would also add food journaling into the mix. Research has shown that people who journal their food intake, lose twice as much weight as those who don't. I plan continuing journaling for the rest of my life. I've been given a gift and I don't want to abuse  it or lose it.

Bougie size is certainly an interesting topic and out there somewhere I read a Cirangle/Jossart paper on why they went to using the 32 exclusively, why they start their staple line a certain distance from the pyloric valve, why they keep the staple line very flat and even , why they end it where they do and a bunch of technical stuff. Made me feel good to know I had the benefit of this knowledge pool which is out there for other surgeons to share.

But having said that I agree that there is to some extent an art to this whole piece of surgery and certainly some variation in bougie size and other factors besides that size that make the surgery successful. And paramount, as others have pointed out, is the establishment of new habits and acceptance of lifestile changes that are going to lead to lifelong weight control. you can have the most miniscule bougie in the world and if you live on milkshakes you are not going to solve your weight problem. I am personally thrilled with the bougie that I have - and cirangle gives you no choice - but am more pleased with my ability to make these life changes so far (knock on wood) as they are the things i failed at repeatedly so often prevously. So its interesting to hear what different surgeons do and they have their reasons and skilled professionals can differ, but ultimately its what we do from the time we leave that hospital that determines our long term weight loss fate. mikey mike is right - we gotta take the lead from that point on.   diane

I think there has to be something to it or they and other surgeons such as in australia and other countries would not have dropped down from using bigger sizes.

It probably isnt when we are eating on plan, that makes the biggest difference, but probably more so when we step off plan... and no surgeon can control what we will and wont eat..but if someone with a small bougie with alot of restriction can eat a ton of junk what happens to the person that can eat 3 times as much when they step off plan to eat junk...

It would be nice to think that everyone who goes through the proccess was able to keep all their weight off with none to little regain... i certainly hope we all can, I think since most of us here had this while it was considered investigational, so time is the thing that will give us our answers...
But seeing people like MS shell, and Donna who do well with their sleeves (whom we know are not 32f) and then others like Rana and thin Lizzy and Dianna whom are further out doing well i think there is hope for us all.

Good one Linda! 

This pretty much sums up how I feel also!!  Especially your take on Bougie size and re-gain...

Well, it's all BS if you look at it one way. I mean we all know someone who smoke and drank and ate fatty foods their whole life who wasn't overweight and died at the age of 98 in their sleep so I guess all those studies that suggest that's not the way to live a long and healthy life are just BS, right?

But seriously, I think statistics *can* tell us truths about the world. They can't predict what will happen to any particular individual, but by looking at large groups we can get an idea of how the world works. We can then use these truths to make informed decisions.

But we aren't going to make the same decisions because we all aren't the same and the right answer isn't going to be the same for all of us.

As an example, one such truth that research shows us is that the DS is the most effective of the WLS. So I guess that means we should ALL get one, right? Well, no, there are other considerations.

As for boughie size, I used the information I had to pick a surgeon who used a 32f. I wanted the best chance I could to keep the weight off. But I didn't go for a DS because I felt the risks didn't justify the minimal (for me) additional benefits and I didn't like the post-op lifestyle all that much. Other people are going to make other choices and that's fine. We all have different values, different goals, and are coming from a different place.

Plus we're all post-ops here so there isn't anything we can do to change the size of boughie our surgeon used to make our sleeves. Therefore, I think the best thing to do with this information now is to be aware and to use it work for us the same way we can use the information about the ileal brake, ghrelin, how to keep the stomach full longer, vitamin deficiencies with a sleeve, and all the other information that gets throw out there in this forum and for different people that's going to mean different things.

Btw, Dr. C is adamant that people change their lifestyles and eating habits if they want to be successful in the long term. He certainly doesn't say that we're safe from regain because he used a 32f on us. He knows better than that. But he doesn't use the 48-60f that he used to use either and, if it was all BS, I think he would.

Well put, Marie. I totally agree.

Theoretically if there was "nothing"  to it we would not need ANY restriction to lose weight......right?   We could just "change"  our eating habits....and live "healthy"   We ALL needed restriction to lose weight successfully.  Some do fine W/ less some do fine W/ more.    I felt personally,  I needed the MOST restriction possible.  Yes people can get to goal, and be very successful W/ larger sizes.(insert joke here!)   If  evidence shows patients are doing well at a 32f or 34f, (and that evidence is coming from one of the most prolific/skilled VSG surgeons)  I feel it merits further investigation.  Only time will tell.  If in ten years we.... (32F patients) find that we are malnourished, and having lots of issues due to our tiny stomachs.......I would want that info to be for public consumption too!  The goal is for people to have as much info/help that is available.  Then they can make an "informed" decision.  For most of us.....we gots what we gots.....make the most of it and........"work it like a pro!"    

exactly, Marie, it isn't all BS it is useful information and I would rather be as fully informed as possible. same as when I was a pre-op, I want to know everyone's experience especially if they are further out than I am.