Obesity Discussion Forums

[MamaBear]

I haven't had a chance to read it yet, but I just downloaded the eBook "The Experts Guide to Weight Loss Surgery". It's written by the younger doctor on Big Medicine. It is supposed to give the pros and cons and the "real scoop" on weight loss surgery.

If it's worth checking out, I'll let you guys know. At first glace it looks interesting.

[MamaBear]

OK... I've read about 20% of this book now. (By some miracle, the baby went to sleep at a reasonable hour last night and I was able to do some reading!)

It's an easy read and not very technical, which is good and bad. Dr. Davis comes across as very compassionate and empathic towards his patients. You can tell he has a wonderful bedside manner and a good heart.

The book is, so far, unapologetically biased towards weight loss surgery. I did expect this as it is written by a weight loss surgeon. I believe his "bias", though, is quite sincere and he really believes that WLS is the best solution for morbidly obese patients.

The very first bullet point on the cover of the book says "Is it right for me?" so I was hoping it would really weigh out all the alternatives. There was one chapter dedicated to alternative approaches (diet, exercise, pills) but it presented to most disheartening research results to make you believe that such efforts are completely futile. Again, not a huge surprise coming from the perspective of a WL surgeon. Apparently, the only people he believes can expect a result from diet and exercise are those who are merely "overweight"... not the obese.

I'll let you guys know my impression when I am done reading. I guess so far it is what I have expected - a good sales pitch for WLS... but a sincere one coming from a doctor who I believe really cares. I'd hesitate to recommend this to anyone who is really wanting to contemplate their options, due to his bias... but it would be affirming and interesting to anyone who has already decided they will likely want to do the surgery.

It hasn't convinced me, yet. He cited valid studies in his book, but counterarguments were running in my head as I was reading. I'd still rather stick with the diet and exercise for now.

[MichaelB]

Thanks for the review, MamaBear!

I'm the same...not a big fan of anything that's permanent.

[monique]

I think hearing that everybody else fails makes a lot of people more likely to fail! You have to believe it can be done to think you can do it.

As I said once before, just the fact that only a small percentage of people lose a lot of weight by diet and exercise doesn't really prove anything, because EVERYONE has tried that. Most of us usually try and fail a few times before we really get in the right frame of mind to change bad habits permanently. Just because so many smokers need to try several times before they quit, does that mean if you smoke you should just resign yourself to lung cancer? Of course not! And if you're heavy and you never kept up a healthy lifestyle long enough to lose all your weight and then maintain it, that doesn't make it impossible, it just makes it something you haven't done yet.

Lots of people achieve major weight loss without surgery, look at Richard Simmons and all the people he helped! And just because even more people try than succeed, that only means people try before they're ready and serious about succeeding. And frankly the statistics for weight loss through surgery aren't very encouraging either! It's in human nature that we don't like to change, especially if it means sacrificing things we like, such as eating pastries and sitting on our butts! So we're not talking about the success rates of diets and exercise, they are absolutely proven to work. The statistics just show human nature's tendency to fall back into old patterns we're used to, even if they're unhealthy. It's not a high rate of "failure," it's a high rate of people who ultimately aren't willing to change for the rest of their lives.

If you see getting healthier as a lifelong goal rather than just having a number you want to see on the scale, you are in a much better position to reach that goal. It's like my doctor told me, even if you only lose 10 or 20 pounds per year, that will eventually be enough to get you to a healthy weight.

And also, a healthy weight isn't necessarily a low weight. Some people are not realistically going to get thin, but they can still be healthy. I was 120 pounds when I was 11 years old. There is no way in hell I am ever going to be 120 pounds again, and I wouldn't want to. I didn't even have breasts or hips yet, and I grew 3 or 4 inches taller since then. But I do think I can be 200 pounds, and that I would be very healthy at that size if I stay active and eat right. Meanwhile I am still not convinced that people who lose weight without changing their lifestyle just by having their guts rearranged end up healthy at ALL! There is hardly any research on long-term effects because it's only been done fairly recently in large numbers. There's just no reason for WLS. If you really want to lose weight, it's in your power, and if you don't want it bad enough to change yourself, then why bother risking medical complications? Especially considering that if you don't change your habits after the surgery you just gain the weight back eventually anyway.

~Monique

[Obesity Discussion]

Originally Posted by MamaBear

There was one chapter dedicated to alternative approaches (diet, exercise, pills) but it presented to most disheartening research results to make you believe that such efforts are completely futile. Again, not a huge surprise coming from the perspective of a WL surgeon. Apparently, the only people he believes can expect a result from diet and exercise are those who are merely "overweight"... not the obese.

That's just plain silly to say that exercise and healthy eating are futile for those who are classified as obese. We have plently of examples here that prove that wrong.

[MamaBear]

Originally Posted by Obesity Discussion

That's just plain silly to say that exercise and healthy eating are futile for those who are classified as obese. We have plently of examples here that prove that wrong.

Well, he does say that exercise is good and important. It's just not the answer to obesity (according to him).

I understand a lot of his arguments for why diets and exercise usually don’t work. But I don’t understand how, then folks getting the lap band can experience significant results. The lap band simply forces you to reduce intake, it doesn’t alter the digestive system. Granted, these folks have a harder time (physically) cheating. But the arguments against diet being effective included the fact that it slows your metabolism and your body is always striving to get back to a set point. The lap-band shouldn’t correct for these issues, as far as I can understand.

The most compelling study (in my opinion) he has cited was a Canadian study that followed a group that had WLS and an obese group that did not. The obese group that did not have WLS had a higher mortality rate than those that had WLS. I wish I had the actual study to review. I’d love to get my hands on the raw data (I’m a nerd, I’d love to run the numbers). I don’t know what sort of confounding variables there may have been, and how they were controlled for.

Studies on the safety of WLS indicate it is a low risk (as far as surgery goes). But I am honestly struggling to get my head around the idea of my innards being rearranged. It seems a bit Frankenstein-esque (except that I’d be using all my own parts).

I’ll post more once I finish the book. And that’ll depend on how much the baby feels like sleeping this week.

[Jasmine130]

Hi, Jasmine here .

I'm a gastric bypass patient, 20 months out. I put off having weight loss surgery for decades, and resisted my doctors' many pleas to look into having a lapband or gastric bypass. I lost a large amount of weight, 120 lbs. and more, 3 times, and in between those efforts, tried various diets. I worked out a lot and was quite active, even at 350+ lbs.

I began to suffer the consequences of decades of being super morbidly obese. I was pre-diabetic; osteoarthritc; hypertensive. I had severe obstructive sleep apnea, and had an average of 59 apneic events per hour, with some of them lasting over 30 seconds at a time. And no surprise, during my (required) psychiatric evaluation, I was diagnosed with a binge eating disorder/compulsive overeating.

So for me, having gastic bypass stopped the madness and helped me lose 218 pounds in 20 months. My co-morbidities are relieved, if not totally reversed. I track my intake and exercise daily on FitDay and am faithful with my vitamins and supplements. My caloric intake is ~1300 cals/day, at least 70 grams of which is protein.

Weight loss surgeons are surgeons, and cutters cut so quite naturally a book written by a weight loss surgeon will lean toward surgery. I'm a big fan of Big Medicine and both Drs. Garth emphasize that weight loss surgery is only a tool. They work closely with a therapist who assesses candidates and makes recommendations as to whether or not the patient is a good candidate for lasting success.

I think a good WLS surgeon is one, who like my own surgeon, emphasizes the importance of addressing the psychological issues around food and overeating. My surgeon tells potential patients (I attend his surgery support group meetings every month) that he is only the provider of a surgically-induced diet. The surgery gives great positive reinforcement in that for the first few months, the weight pretty much, for the greatest majority of patients, "falls off". This provides momentum for the patient, if they will focus and take advantage of this time, to start working on their "head issues".

In my case, the closer I got to goal, the louder the alarms sounded in my head that I needed to address my compulsive overeating. In the process, I came to understand that I have both psychological and physical addictions to overeating, and some foods in particular are binge triggers for me. I started attending Overeaters Anonymous meetings 9 months ago and am learning powerful tools for recovery.

I am quite convinced that if I did not address my "head issues" I would very likely regain weight. And I consider myself only a beginner in recovery. For me, obesity and food addiction is a lifelong battle, but the joy of having reached my weight goal and regained my life and health makes every effort worthwhile.

To be sure, weight loss surgery is not an easy way out, and it calls for a tremendous commitment to a drastic new way of eating and living. In my experience, any weight loss effort is a great deal of work!

[MamaBear]

Thanks for sharing your story, Jasmine!!

I had a chance to read a bit more last night... and I've since learned that Dr. Davis doesn't think Lap-band is the best surgery. He really believes in gastric bypass... but lap band has a lot of pitfalls and not as great of results (according to the book).

He does make it very clear that WLS is a tool. It isn't a magic bullet.

Jasmine - you touched on something I have always wondered about. I struggled with bulimia for many many years, so obviously I'm a compulsive eater at heart. Part of me always figured I'd never be approved for surgery because I'd probably never pass the psych test. (That's what the psych would be doing when I left the office.) You said you were diagnosed with COE during your eval. Maybe I missed this, but did they require you to get treatment before they would approve the surgery? Or was therapy and OA part of our post-OP care?

[MichaelB]

Hi Jasmine...really glad to have you posting here and sharing your story. Sounds like you have some good perspective and I appreciate you sharing your experience.

[monique]

Thanks Jasmine! I can see how the physical change would help your compulsive eating- you literally couldn't binge and keep it all down. But it seems like the only thing you couldn't have achieved without the surgery is speed. If you are maintaining the willpower to eat 1300 calories a day and deal with your emotional issues around food and attend support meetings, you would have succeeded even without the surgery! It just would have taken longer for the weight to come off.

I might be biased by the fact that I don't want surgery for myself, but it still seems to me like it doesn't have any advantages over diet and exercise except as you mentioned, that you lose FAST in the beginning. That's not to say I don't think it should be an option, just I'm surprised your doctor pushed surgery instead of OA and therapy if you had lost 120 pounds on your own before (which is SUPER impressive!). It sounds like since you needed a fast loss to help your health issues this might have been the right choice for you. It's nice to hear a perspective from someone who really explored all their options!

~Monique

[Jasmine130]

Hi Mama Bear, as far as psychological issues go, my surgeon's practice is to not perform surgery on anyone whose mental illnesses e.g. depression, bipolar disorder, is not currently under control. When it comes to compulsive eating behaviors, the therapist makes an assessment as to the likelihood that the patient will actively seek help and support. If the therapist does not think the patient is ready to address the compulsive eating behaviors in therapy and support groups, she recommends that the doctor not perform the surgery. Since the doctor wants good outcomes for his patients, he is more likely not to push counter to the therapists's recommendations. It's not an exact science to be sure .

With respect to post-op care, my surgeon provides the monthly support groups which are tremendously helpful. He and the therapist urged me to seek additional care and support, and I listened, but it was up to me to search for and engage a therapist ( I found another one with I "click" better) and I sought out OA on my own.

I guess you could say that when my surgeon and the therapist who did my psych eval said, You will really need to do your part to address your compulsive overeating....I took their counsel to heart and took action.

I can't claim credit or having strong will power for any of this. I knew these things for years, just like we all pretty much know we need to eat better and exercise more. Maybe I was just finally, finally ready to face the facts of my desperate situation and my heart and mind were in the right place to take action.

I don't know if any of this makes sense, but I'll post in the hope that it will help someone else

[Jasmine130]

Hi Monique, I understand what you're saying in your post and have some thoughts.

My surgeon didn't push surgery, in fact none of the 4 surgeons I interviewed pushed it. My radar is sensitive to hard sells and I'm skeptical by nature so had any one of them pushed, I would have stopped the process to re-evaluate.

Second...it's really not about willpower for me any more. My willpower is unsteady and unreliable. In the past, I white-knuckled my way to weightloss several times and then regained the weight because I didn't have tools to overcome my addiction.
I was blind to the fact, or at least fundamentally unwilling to admit that I *was* addicted.

The progression for me went like this:

use willpower to lose weight
succumb to addiction and gain the weight back
suffer alarming health problems
decide to have weight loss surgery
have weight loss surgery and begin to lose weight
understand I must address emotional issues
reach out for help with emotional issues and discover truth of addiction

Those are the "highlights" -- there's a whole lot of study, investigation and decision-making and effort in between all of those.

It's been an amazing journey!

I believe all of us *can* get "there" one way or another.

[Jasmine130]

Mamabear...with respect to the lap-band as compared to the gastric bypass -- when I first started pursuing the option of weight loss surgery, I was inclined to go with the lapband. I reasoned it involved less downtime and was less invasive than the cutting and re-routing involved with the RNY gastric bypass (or for that matter, the other forms of weight loss surgery such as the gastric sleeve or the duodenal switch). The different surgeons I interviewed concurred (separately) that given my degree of obesity and my penchant for sweets, the lapband would likely not give me the degree of weight loss I needed to get healthy. The duodenal switch was too extreme for me and *can* have markedly unpleasant side effects. The RNY gastric bypass is still considered the gold standard for weight loss surgery and taking all data, including all risks, into consideration, I chose RNY for myself. There are lots of patients for whom the lapband has worked beautifully; same for duodenal switch and the sleeve. But they're all pretty drastic and not to be entered into lightly. And weight loss surgery is definitely not for everyone.

[MamaBear]

I'm just about done with the book, and I have to say that he did a good job of not sugar coating things. He made it very clear that surgery was just a tool, and that the patient would have to do considerable work to have success. He talked about insurance issues, extra skin issues, and lots of other things that would be of more interest to me if I was seriously considering the surgery.

As for sweets and a lap-band... I think Dr. Davis said something to the effect of "No band will be tight enough to stop a milkshake from going though." Haha! I think I'd be nervous about the lap-band due to the fact that less research has been done with it, it's relatively new so we don't know all the long term consequences, and as uncomfortable as I am with the idea of my insides being rearranged, I am even less comfortable with the idea of a foreign object being introduced. (But that's just me.)

So... interesting book. Biased, but informative and thorough. Not a bad read for someone planning to have the surgery already - he goes into lots of information what to expect before, during, and after the surgery that would be helpful to review.

[BobBigBoy]

How long is this book?
I tend to have a somewhat short attention span ( prefer to read magazines or post on forums than Books. )

But I am very interested & might just read a whole book being how it can effect my life...

Does the book also run the list of all the negatives & side effects & mortality percentages & such?