Question:
Should a woman with a BMI of 38.8 be considering gastric bypass?

I am a 40 year-old woman who was 358 pounds last November 1st. I went on the Atkins diet and am still only eating 20 grams or less of carbs a day. Idon't think this healthy, so I continue to take multi-vitamins. The problem is, I have been here so many times before, and I know that if I EVER start eating ANY carbs again I will gain the weight back and then some. I have proven that I can stick with a diet, but what will I do for a permanent solution? I have lost down to 254 pounds and am so discouraged that even after all this time I probably still qualify for gastric bypass surgery. I am so proud of the loss so far. Many of my pains and my acid reflux are gone, but my hair has been coming out just behind my bangs and I am worried that I'll be bald if I continue eating this way. It sounds funny, but it is scary. Also, my skin is VERY loose, even though I am using my firm flex every day. Any advice will surely be appreciated. Thank you, Kate    — Kate R. (posted on May 31, 2004)

May 31, 2004
I don't see why you need the bypass. We aren't supposed to eat carbs so you are going to be in the same boat. Sometimes people forget but gastric bypass isn't for weightloss, it is to save someone's life. If you're not going to die from your obesity, then why do it to yourself? If you want carbs you need to exercise more. If you add in 50 grams of carbs you should add in an hour of cardio a day to balance you out.
   — mrsmyranow

May 31, 2004
Kate, I symphathize with you. I don't agree with many who say that you can eat the way you are eating now for the rest of your life or that you will have to after the bypass surgery. My urologist warned me that I could not continue to carry that high protein load long term or I wouldn't have a long term! I believe we need complex carbs in our diets to help aid digestion, prevent damage to our kidneys, get essential vitamins and minerals, etc. but, even after bypass surgery, I have to be very careful about the carbs I choose. I cannot eat even whole grain bread on a regular basis because it is a definite trigger for me. I do have legumes, veggie carbs, and occasionally fruit. None of those cause me to crave more. I cut out all white flour and sugar over a year ago, seven months before I had the surgery but the one thing that enabled me to do that and stick with it was knowing that I was soon going to have a very powerful tool to help me stick with a new lifestyle. You've done a marvelous job getting to where you are now but you are the only one who can determine what your decision should be. Many doctors won't even consider anyone with a BMI of less than 40 unless they have serious co-morbid conditions. At my first consultation with the nutritionist, I weighed 276 pounds. By the time I had surgery, I weighed 238 but even after successfuly losing that amount of weight, like you I knew I'd put it right back on if I ate even one bite of the foods that I knew caused me problems and I'm still the same way. The bypass surgery for me is a tool to help me maintain a more healthy lifestyle. I know, and knew before surgery, that I will NEVER be able to go back to eating white flour and sugar. I'd say talk to your doctor but be sure that you do lots of research. It is so important that anyone considering this surgery understands that it is not magic. It still takes dicipline and hard work to be successful long term. I wish you the best in finding an answer that works for you.
   — scbabe

May 31, 2004
I do not agree with Myra Jo regarding what she said about "we aren't supposed to eat carbs . . . " We need a balanced diet but need to concentrate on getting in as much protein as possible in a day. My nutritionist recommends the patients at my doctor's office to get in a MINIMUM of 60-80 gms of protein a day. The fact of the situation is that 97% of people that loose a large amount of weight will gain it back and then some. Those numbers were really an eye opener to me because I keep thinking to myself that I could go it alone and loose my extra weight myself. Well, I failed everytime. You do need to keep in mind that WLS isn't the permanent solution that people think, we that have had this surgery have to really really work at getting the weight off and keeping it off. Remember a person can eat around the surgery with getting lazy and just plain eating junk. The doctor has given us a wonderful tool to work with we just have to use the tool to better our health and use it accordingly. Kate, you may still qualify for WLS with a BMI of 38.8. Some insurance companies will qualify you with that if you have life threatening conditions like type 2 diabetes, GERD, high blood pressure etc. Do not disqualify yourself, think long and hard about how you are going to keep the weight off that you have lost so far. Talk to your doctor about your journey so far. Only you and he/she can say what is best for you in the long run. Good luck on your journey and congratulations on the loss so far.
   — ChristineB

May 31, 2004
AMOS MOD HERE! How I hate putting these notes up:( The site is to support EVERYONE! In this case the menmber like most of us MOs managed to loose a good it of weight but cant keep it off. Isnt this the story for many of us? I KNOW IT WAS FOR ME:( I encourage the member to contact a surgeon for evaluation. Then its up to insurance to approve or reject. No ones deciasion here. Please lets be nice to everyone, All of us were at one time or another in this persons shoes, just at the qualifying number or thereabouts for surgery. This surgery may well save the members life since we dont know what her co morbidities are. My surgeon gets people approved under a BMI of 40 depending on their co morbids. Besides if she eats just a few more carbs all the weight will return. My surgeon says less than ONE% of people whos BMI gets over 40 are able to loose a 100 pounds and keep it off for 5 years. So even if she doesnt qualify TODAY she most likely will within the next 5 years....:(
   — bob-haller

May 31, 2004
My BMI was 41.1 at the time I started my journey to have surgery. I was not unhealthy and had virtually no co-morbities. However, my concern came from my family history. ALL of the women gained and gained till they hit almost 500lbs....then died. I didn't want to be in that situation. My decision to have surgery was based on prevention more so than cure. The Atkins way of eating is very similar to the way you eat for the first 6 months to a year post op. Just less of it. Over time you realize what carbs and how many carbs you can tollerate before triggering gain or cravings. <br><br>The decision to have surgery is yours. One you should think long and hard about. Surgeons will do surgery on someone with a bmi of almost 39. That is not a steadfast rule. It is a guideline. Your entire health is taken into consideration, as well as your family history of diseases. Best of luck, Kate.
   — RebeccaP

May 31, 2004
I think you would be a good candidate for WLS. My husband had a BMI of 38.8 when he had surgery. My BMI was 42 when I had surgery. I also did the Atkin's diet and low carbed for over a year. I lost 35 lbs and that was it. As soon as I started eating carbs again, it all came back plus more. That's when I decided to have surgery. You are in a position where you have shown the ability to stick with an eating plan. After surgery, you will have the malabsorbtion and limited quantities of food to help you lose more. Also, your current weight loss makes surgery less risky! You should be proud of what you ahve done and I wish you all the best with your decision!
   — koogy

June 1, 2004
I think you're an excellent candidate for surgery. You've proved you can keep to a diet, which is important. Just being on this site alone, means you are doing your research.
   — jengrz

June 1, 2004
Kate- Congratulations on your success so far. Check with your insurance, but according to the NIH, you would still qualify for the surgery. You are at such a healthier point now and you would be less of surgical risk now. Good luck to you, whatever you decide.
   — Yolanda J.