Question:
My Doctor told me that I need to loss about 20lbs before he would

even doing my surgery. What kind of diets would you'll suggest that I try to loss the weight.    — Mary C. (posted on October 14, 2003)


October 14, 2003
Why not find a different surgeon. I think such requirements are cruel.
   — bob-haller

October 14, 2003
Hi Mary, a lot of surgeons are jumping on this band wagon but mind did not thank goodness. Surgeons say that the surgical risks go up significantly with a BMI over 50, however I know of surgeons that do lap RNY's on people over 500 lbs with no problems. However, the liver gets fatty and it makes it more difficult to see what they need to see. I did Atkins on one of my other weight loss attempts and it's a quick way to lose 20 lbs if you stick to it faithfully the first two weeks.
   — Happy I.

October 14, 2003
I was asked to lose 10 - 15 pounds to get my liver into better shape for surgery. I lost 21. I'm proud of myself, and I had no complications in my surgery yesterday. Wanting to lower the risk of complications is hardly cruel. All I had to do was follow my surgeon's presurgical diet of salad, lean meat, cottage cheese, and protein drinks. Good luck!
   — Maria N.

October 14, 2003
Contrary to previous posters, I do not find the common requirement to lose some weight before surgery to be evil. It puts you in a better state of health to have the surgery and to recover from it. It also gives you practice in changing your eating habits, and less to lose after surgery. Lots of people find Atkins to be a quick method, but it can be very difficult, especially early on. Two of my employees are currently doing the South Beach diet, which is smilar to Atkins, but not as restrictive. Another of my employees is doing Weight Watchers (my weight loss has inspired them all). WW can be a good choice as the eating style is more "normal" and might be easier to stick with. Best wishes to you on your momentous decision to have the surgery, and much success to you in your upcoming diet.
   — Vespa R.

October 14, 2003
You know, if the doctors would change their thinking and approach about pre-surgery weight loss their patients would be happier. What if they said, "Here is your pre-surgery nutrition plan. It is designed to give you the best chance of having a successful surgery and shorter post-op recovery and pain. We want to build up your blood levels with vitamins and protein. And you also need to do these exercies -- deep breathing and stretching. That's all you can do them sitting or lying down, but you must do them 4 times a day, every day till surgery". What do ya think? Don't you think that would be much better received AND followed than, "You have to lose 20 pounds before surgery"? You say "you have to diet" to someone who is at the end of their rope and facing WLS as their last option and who has dieted for more than half of their life..... well, that's just silly (read stupid).
   — Marrilee M.

October 14, 2003
Personally I think it is cruel to say you have to lose X amount or you can't have life saving surgery. I agree with Marrilee that if it was put differently then people wouldn't think it was as bad. I can see saying "for your own benefit it would be advicable to try your best to lose X amount." But to refuse to do surgery because of it? It's not right in my personal opinion. I did lose weight preop, but that was because they had just upped my syntroid again because my thyroid was continuing to fail. I don't think 20 pounds is that harsh, but I've heard of some doctors saying 20 percent of excess weight and that could be quit a bit for someone 200 pounds over weight. And how about people who are at 40 BMI? They would lose enough to get below 40 BMI, and then what about their qualification for surgery? What about people who are also required to quit smoking before surgury? Even non MO people are proned to gaining weight when trying to quit smoking. OK, obviously I just think it's wrong to not provide a needed surgery because a patient is having difficulty losing weight preop. I could probably continuing ranting about it, but I'll stop now. :o) To the poster: The only time I lost 20 pounds or more preop was on diet pills. I'm sure the doctors don't want you to use those prior to surgery either. Sorry I don't have a better suggestion. S
   — sherry hedgecock

October 14, 2003
Amen, Marrilee
   — vitalady

October 14, 2003
Mary, I have had good success with the South Beach Diet. It focuses on lean high protein and low/good carbs. It has really helped me tremendously to give up bread/rice/potatoes and high sugar items. I do allow myself a Uturn bar (protein bar) once a day as a meal replacement and often use a protein shake as a milk replacement also. When I saw my surgeon for my consultation I had written documentation (I'd seen one of his associates a few months before) that I had lost 26 lbs as of that date thru Weight Watchers. My surgeon still asked for 20 more lbs by surgery 2 1/2 months later and told me there was no negoitation on it. So I have to be at 259 by my pre-op date of 10/28. As of today I am at 262, so only 3 more pounds to go. I'm pretty sure I will make it. It has added a more stress to all of this. However, he did explain that that by doing this my BMI would be below 50 (it had been 56 at the start of my referral) and that would make the surgery so much safer and less chance of complications for me. Another thing that has really helped is my exercise bike. I had arthritis in my hips and knees, so walking at times is pretty hard. However I can ride the exercise bike. I have ridden 341.4 miles since the end of May and it has been fun to track. I ride at least 4 times a week. In the beginning I could barely do a mile. Now I can do a minimum of 3 miles and even have ridden as far as 12 miles at one time. Has it been worth it???? You bet, About six week ago I was able to cut my blood pressure medicine in half and they are sure I will be able to stop it at the point of surgery. Not bad for someone who has been on it for 10 years. It was a major milestone for me. I have dropped 2 full sizes and feel better than ever. Many people have had success with the weight loss by doing a protein shake or bar as their breakfast and lunch then eating protein with veggies for dinner. One item that has really helped me is a snow cone machine. Amazon.com still has them available (go to http://www.amazon.com ) and do a search for snow cone. If you buy one be sure to get one that uses regular ice cubes not formed ice. For flavorings you can buy sugar free syrups, use crystal light, sugar free fruit juices etc. It's filling, crunchy and taste good. Sugar free syrups are often available locally, also http://www.vitalady.com carries them. She can not ship them during the winter months tho because of the possibility of freezing and breakage. http://www.davinci.com carries a huge varitey and are great with speed of shipping. I've order from both of them. I buy mine locally at Cost Plus World Market. They are in the sugar free section and also back by the coffee section. Good luck.
   — [Deactivated Member]

October 14, 2003
I agree with Bob.I would find another surgeon. Talk about added stress.
   — Debbie W.

October 14, 2003
While I do disagree with the pre-surgery weight loss requirement and didn't have it imposed on me before my surgery, I can somewhat understand what the doctors are doing. On one hand it goes against the very reason that they are doing this surgery in the first place - because it has been proven that most people without surgery who lose will gain it back anyhow and that we are genetically pre-disposed to being obese. On the other hand, any weight that you can lose before surgery will lessen your risks. I think, too, that some surgeons are trying to make sure that their patients are serious about making the drastic changes that come about as a result of the surgery because it won't be necessarily easy. Good luck losing the 20 lbs and with your upcoming surgery.
   — Judy R.

October 14, 2003
To play the "devil's advocate"... (as if the surgeon is the devil!??!), I think that we don't know what was said in that office other than that she needs to lose 20 pounds before surgery. Personally, I would rather have my surgeon feel that I was at a safer, lower-risk weight for the procedure, especially if it makes a significant difference in the WLS outcome. I think that taking the time to hunt down another surgeon is only prolonging a life-saving procedure, especially if it requires another insurance approval. Why attack the surgeon? Do we honestly believe he is a monster or something? I have a good friend going through the same thing, and I feel for her with all my heart. That being said, she has the same surgeon I had, and he only has the patients overall best interest at heart. Let's help her lose the 20 pounds, not attack the doc.
   — kultgirl

October 14, 2003
This seems to be a requirement for more and more surgeons now. When I had my WLS, my Dr didn't require it. However, he now does. I think it's a trend that we're going to see more of. I think it's more of a compliance issue for many surgeons than a weight loss tactic. I believe that your surgeon want's to see that you can comply with a restricted plan, and the side effect is weight loss- which helps lower risk for surgery, so, it's a win win for them. I should hope, however, that if you demonstrate, through a food journal and exercize program, that you have tried for a length of time and haven't lost the amount of wt. your surgeon wants, that he would be flexible enough to understand and work with you. If it's just a matter of 20 lbs, period, and don't bother me until you've lost it, then I would consider looking for a surgeon with a more empathetic and flexible program that can meet each individual's needs. Having said all that...try South Beach, it works pretty good for many and has great menus to follow.
   — LMCLILLY

October 14, 2003
I didn't have to do this but like the previous poster said, more and more doctors are requirning it. I would think that the Adkins Diet would be a good one to try as it is high protein, low carb - similar to what you will be doing after surgery. Good luck.
   — Patty_Butler

October 15, 2003
I would think doing something along the same lines as we do post op would be appropriate as well as exercising as much as your body will tolerate. As far as requiring it before surgery, I tend to believe it is a good thing. My doctor didn't require it but I've read so much about people eating, eating and more eating before surgery. That can't be good. And to suggest you find another surgeon is well, stupid. I would suspect before you picked out this surgeon you did all the research necessary to decide he was the right one. If losing 20 pounds is the impetus for getting to have WLS then why on earth wouldn't you do it? If you can't stick to a weight loss program prior to a surgery that you know will change your life, why would the surgeon think you will abide by his rules post-op?
   — D L.

October 17, 2003
I agree with Bob and others that this requirement is cruel. I hope you'll consider another surgeon AND another surgery, the DS; you can learn about it at http://duodenalswitch.com/. Dr. Elariny is excellent, and his patients have an online support group at http://groups.yahoo.com/group/DS_Elariny/ Good luck! Chris, DS 6/02
   — Chris T.




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