Gastric Bypass questions

[DisMN]

I have a dear friend who is completely unable to get around anymore due to her *knee* problems. From what I can tell I think her weight is over 400#. She talks about having her knee taken care of surgically but she says they won't do anything unless she first loses weight.

I've asked her gently if she's considered gastric bypass surgery but she tells me they also won't even attempt this unless she first loses weight.



Is this true? Will they not do gastric surgery until you are down to a certain weight? If so I'm sad for her as her knee is so bad she can't get much exercise..........how the heck is she supposed to be able to lose weight?

 

[MomRN]

The ortho docs are right... she does need to lose weight before knee replacements. First, therapy is rough. Second, they can- and will- go bad just like regular knees and carrying that weight may require another surgery every 1-2 years.

The gastric bypass question I am unsure of. I know you have to try to lose weight before having the surgery. There are extensive requirements and psychological testing to gastric bypass.

Both of these surgeries are major surgeries and a risk to anyone overweight. Obesity adds a myriad of possible complications on top of complications. I am not being judgemental, I myself am obese (not morbidly, but I could definately lose 75 pounds), it's just a surgery fact. With elective surgeries it is best to be as healthy as possible.

 

[laurie31]

Aside from the risks of surgery for the morbidly obese, she has to change her eating habits before the surgery. People can actualy "overcome" a bypass if they go back to their old habits.

Since her doctor has told her to lose weight, I am guessing she has no medical problems that cause her to gain or be unable to lose, therefore she must be eating too many calories to maintain that weight. That sounds so simple, but it's very difficult to put into practice. Maybe she could meet with a nutritionist to help her assess what she's eating now and how she could make positive changes.

 

[terri01p]

 

[sandramaac]

Have a friend who made the choice to do GB. As an outside observer I can offer this advice---go to a hospital setting program that offers the months of counseling need to make this life choice. DO NOT go to a stand alone production mill bariatric center that provides two to three weeks counseling and then you have your surgery. This is a life altering event, and you must come to closure with the demons causing the over eating. Many of these stand alone centers (like the one I feel my fiend went to) do not offer the psychological testing and long term counseling needed prior to the surgery to see if the person is truly ready to make this choice. Now my friend who still at the core has many issues is suffering the ill effects of the surgery (vomiting, dumping, etc) because she thinks just three of the potatoes skins, with bacon and melted fake cheese instead of the whole plate she is fine. And yes she has lost a ton of weight, but because she throws up all the time, because she still make poor food choices. Just choose the right hospital based program!!!

 

[Lintasare]

I know with some health insurance companies if gastric bypass is covered the patient must try to lose weight for a year via conventional methods. They must also have a psych eval and have a coexisiting condition of obesity...like a hiatal hernia or gastrointestinal reflux.

I have a coworker who is very morbidly obese, can't go 3 feet without her power chair. Doctor told her to lose weight...what did she do...get her power chair.

All surgery has risks and those risks go up when you are obese. Which is why many doctors recommend losing weight before attempting surgery.

 

[momof1princess]

OP, your friend is either misinformed, or her doctor is not skilled enough in bariatric surgery. when i had my surgery over 6 1/2 years ago, i weighed 374.5 pounds, and my doctor had no qualms about doing my surgery. however, he is a highly trained, bariatric surgeon who had performed over 1,200 procedures at that time. people much heavier than what i was have had gastric bypass surgery. i would suggest your friend find a new surgeon. in bariatrics, 400 pounds is on the low end of the scale, trust me-people upwards of 700 to 800 pounds have had gastric bypass surgery (and yes, at that weight, it was much riskier, and requires a VERY skilled hand). a doctor who won't do surgery on someone at 400 pounds...well, i wonder about his qualifications and experience.
the PP is right...you can't just have surgery, because surgery only fixes your body, it doesn't fix your food issues-those are wired into your brain. i still struggle, and am struggling even more now, due to family issues, but i WILL win this battle.

ETA: as previously stated by a PP, i was required to undergo a psychiatric evaluation, and had to be approved by my insurance company. 6 months after my surgery, my insurance company began requiring a 6 month diet program before surgery approval-you had to prove you wanted it badly enough.

 

[SandrA9810]

She could try water exercises, which are high resistances, but low impact.

From what I've read, gastric bypass is a huge change. You have to change everything you do with eating. Many times, once people start on the program, they wind up loosing weight naturally. Small bites and chewing your food thoroughly are part of it. Most people these days will take a bite as big as their fist and swallow half of it whole. It's possible for the surgery to work, and just as likely for her to undo it all.

 

[DisMN]

Thank you all for the interesting info. After reading your comments I'm inclined to think everyone else (me included) is more interested in seeing her lose weight. She's so uncomfortable and can't go but 20 feet before having to sit down...whether it's her knee issue or the weight, I suspect it's both.

She's a sweet woman but I don't think she has the motivation to even try to lose weight...she always seems more interested in getting the knee fixed I guess, if that makes sense. LOL The weight is kind of an afterthought after she makes her routine complaint about her knee difficulties.

Thanks again for the detailed info.

 

[SandrA9810]

You can't make any one loose weight till they want to loose it. She knows she can get away with saying she has problems with her knees to get people to feel sorry for her. It seems her doctors are looking past the excuses to the real problem. Their first line of defense should be a nutritionist.

 

[maslex]

I have a friend who is in her late 50's, about 300-320lbs and has severe arthritis in both of her knees and back. Both of her kneese are bone on bone. It is extremely hard to watch her try to walk. She almost looks like a robotic penquin. It's almost like her knees don't bend when she walks.

She has already talked to the doctor about getting her knees replaced (dr has told her that she needs both knees done) He told her that he wants to see her start off walking 1 mile a day!!! She looked at him like he was on crack. She said to him, didn't you see how long it took me just to walk in here? She's is in constant pain with it, no meds seem to help, she's had cortisone shots that won't even touch the pain. She's just miserable. Doctor told her she had to lose atleast 75lbs before he even thought of operating on her. This discourages her so much. She doesn't see how she can lose the weight without being able to do some sort of exercise, even if it is just walking, which is very difficult for her. (And yes, she is a healthy eater)

I also have another friend who was 311lbs when she had the lap-band done. She had to go for the psychological classes for about 6 months, I think before having her surgery. She also was told by the doctor that she had to lose X-amount of weight before the surgery. I'm not sure if this is to prove that she could lose weight? Don't know why that is. She had it done about 3 1/2 years ago. Lost about 130lbs. Looked great, felt great, went out and bought all new clothes, couldn't be happier. But even though the surgery took care of the weight it did not help her mind. She still ate the way she did before the surgery (she went through these periods where all she ate was candy). She said it was the easiest thing to keep down (everything else was coming back up) so that's what she stuck with. I swear, she could have kept the M&M's company and Cadbury in business all by herself (and I'm not exagerating, it's sad really) Now she's in a Chinese food kick. She basically lives on eggrolls and chicken wings. Needless to say, she's up 40lbs+ now. She's had to go out and buy all new clothes again (just a bigger size)

I'm really not sure what I'd do.....I myself could stand to have a weight loss surgery done but I don't think I could go through it. I know I'd have to learn how to eat properly and get moving and that it'll work just doing those two things. And I know the surgery doesn't do that for me. I just can't imagine losing all that weight and then watch yourself gain it back. It must be truly heartbreaking for her.

Sorry for the ramble. But yes, I have heard that you need to lose weight before a doctor will operate on you. I guess it lessens the risks while on the table?

 

[luvmyfam444]

My MIL had the gastric bypass done - its been a while now - I guess maybe 6 yrs? She lost about 80 pounds I guess. That's the most I can I remember her bragging about anyway. If you met her on the street you wouldn't have a clue she's had any wieght loss - she's still that large. But if you see before pics you can tell she's lost some. (she was about 300 I think) she wears a 18-20 now but was probably only a 22 -24 before - she could still get clothes @ regular stores taht sold plus size. She's short - about 5'3.

She was told to go on a diet before surgery - she didn't - I guess she just lied. She did go to some sort of counseling - but back then it probably wasn't as extensive - or @ least I hope its better now. I've never seen her on a regualr diet - and we'd eat out every weekend & she'd eat a hamburger right along with me up until the surgery.

Then she had it & within a year (maybe sooner) she was back eating hamburgers & drinking Diet softdrinks - she exercised briefly.

But I so agree with everone else - everyone says you have to know what causes you to be overweight in the first place -

 

[scrapquitler]

Is this true? Will they not do gastric surgery until you are down to a certain weight? If so I'm sad for her as her knee is so bad she can't get much exercise..........how the heck is she supposed to be able to lose weight?

As I understand it, the doctors won't do gastric bypass or any other weight loss surgery until you have shown a good faith effort to lose the weight first. I think it's because they want to see that you are committed to losing the weight and making the effort/sticking to a plan...because even with weight loss surgery you have to drastically change your eating habits and lifestyle...and if you can't show the commitment, there's not point (and you will cause yourself lots of medical complications if you don't follow diet/eating plan afterwards)

 

[Agri]

Obesity aside, doctors have to look at a situation objectively. If someone is that overweight, how will she recover from having the surgery? Its very painful recovery from joint replacement surgery as your body gets used to having something foreign in it and you get used to moving around with it - add on a few more persons to the amount of weight you put down on your joint and that causes a lot of problems. And along the same lines - what is the point in doing a bypass on someone who is just going to continue eating the way they do now? Its a waste of the doctor's time and resources.

I had a friend who has had weight loss surgery, and she had to lose weight (or at least try to) and do the counseling before the surgery. She had the surgery in April and her before and after pictures are already amazing. I'm so proud of her because she's made the effort to eat healthier for herself and her son.

Someone my mom worked with had weight loss surgery years ago and didn't make any lifestyle changes and is now HEAVIER than when she had the surgery.

WLS is the absolute last resort for patients, it is NOT the first line of defense which is why you have to jump through all these "hoops" to be able to have it done.

 

[Pea-n-Me]

I think they also want to see that you can demonstrate you know *how* to make the food choices that enable you to lose weight before the surgery.

Gastric bypass has a higher mortality rate than many surgeries, so those undergoing the surgery need to a) be aware of it and b) be that committed to losing weight to be willing to risk their lives over it. It's a difficult choice, especially for those with young children (or who aren't willing to die). I know someone who had it done a year or so ago and it seems she's more depressed now than she was before the surgery. I think it brought up a lot of emotional issues that she thought would improve, but didn't. It brought some new problems with it as well.

I think the commitment to changing eating habits (and exercise) for the long term can't be understated - for both the gastric bypass and the lap band. (Which actually begs the question - if you can really do that, would the surgery even be necessary?) I know several people who had the lap band who regained the weight they lost - and more. I posted an article yesterday on Carnie Wilson, who's also struggling with her weight again after her drastic surgical weight loss 10 yrs ago.

As for the friend in the OP, if she is to lose weight using exercise as part of her regimen, it's going to need to be something low impact, such as swimming. But she may need to rely primarily on diet, at least to start. Then once she gets down a bit, she may be able to physically do more. I hope she can find whatever it is she needs to get started.

 

[laurie31]

As I understand it, the doctors won't do gastric bypass or any other weight loss surgery until you have shown a good faith effort to lose the weight first. I think it's because they want to see that you are committed to losing the weight and making the effort/sticking to a plan...because even with weight loss surgery you have to drastically change your eating habits and lifestyle...and if you can't show the commitment, there's not point (and you will cause yourself lots of medical complications if you don't follow diet/eating plan afterwards)

Yes, this is what I was trying to say last night.

It's not HOW MUCH she weighs that matters, as much as the fact that she has to be able to stick to a low calorie diet. She will still have to do this if she has the surgery, or it will all be for nothing.

Someone who weighs 400 pounds and is maintaining that weight is consuming far too many calories. If she can't change what she's eating, then there is no point in having the surgery.

 

[jlder72]

I have a dear friend who is completely unable to get around anymore due to her *knee* problems. From what I can tell I think her weight is over 400#. She talks about having her knee taken care of surgically but she says they won't do anything unless she first loses weight.

I've asked her gently if she's considered gastric bypass surgery but she tells me they also won't even attempt this unless she first loses weight.



Is this true? Will they not do gastric surgery until you are down to a certain weight? If so I'm sad for her as her knee is so bad she can't get much exercise..........how the heck is she supposed to be able to lose weight?

I have had gastric bypass in MN in 2006. Which surgeon is she looking at? I know the ones associated with Allina (Mercy/Unity) require like a 10% weight loss prior to surgery but the surgeons with Park Nicollet (Methodist) do not.

She may have to look for another surgeon. Think long and hard about the surgery. Unlike some of the other posters I have had problems keeping weight on. Now I am dealing with anemia and not able to gain enough weight. I am 5'5" and down to 125 pounds. Now, statistics say this is a good weight but I look sick and am not able to put on weight.

Your friend can PM with any questions.

 

[Arielle22]

My sister had gastric bypass 4 years ago. She never said her starting weight but has commented she lost as much as my daughter weighs (160 lbs).

She did have to lose weight before surgery. I believe she lost 20-30 lbs. She cannot eat sugar (or she dumps) and cannot drink fluid with her meal. She has to wait until the end to drink to ensure she gets enough protein before her stomach fills up.

She was committed to changing her life and has succeeded. She went to a group session before and after weight loss with others who had the surgery or who were considering it.

She saw several people who had the surgery but did not change their eating. She said some got very sick due to continued alcohol consumption while others did not lose much weight.

I am proud of her committment to change. She said she didn't want her son (now 5) to have the fat mommy in the class. She did say that it is tough for her when she is stressed because before she would eat but not needs another outlet to help her calm down.

After her weight leveled off she also had a tummy tuck and breast lift. She looks great now and wishes she had the surgery years ago.

 

[arminnie]

. She doesn't see how she can lose the weight without being able to do some sort of exercise, even if it is just walking, which is very difficult for her. (And yes, she is a healthy eater)

Exercise is a very good thing, and yes it can help with weight loss. But it is not impossible to lose weight without exercising at all.

And eating healthy food is NOT the same thing as being a healthy eater. A healthy eater does not consume so many calories that they maintain a weight of 300-400 pounds.

I was bedridden after a botched gallbladder removal for a few months. I lost a ton of weight while barely moving.

I've lost 3 friends in recent years totally due to massive obesity - ages 42, 52 and 53. No cancer or specific disease - their bodies just wore out prematurely. I just remembered another one (56) - that makes 4.

I am not a health fanatic nor am I particularly thin. I think our society is too obsessed with being thin. But someone who is 200 pounds overweight has a serious health problem that should be addressed.

 

[tlbwriter]

OP, your friend is either misinformed, or her doctor is not skilled enough in bariatric surgery. when i had my surgery over 6 1/2 years ago, i weighed 374.5 pounds, and my doctor had no qualms about doing my surgery. however, he is a highly trained, bariatric surgeon who had performed over 1,200 procedures at that time. people much heavier than what i was have had gastric bypass surgery. i would suggest your friend find a new surgeon. in bariatrics, 400 pounds is on the low end of the scale, trust me-people upwards of 700 to 800 pounds have had gastric bypass surgery (and yes, at that weight, it was much riskier, and requires a VERY skilled hand). a doctor who won't do surgery on someone at 400 pounds...well, i wonder about his qualifications and experience.
the PP is right...you can't just have surgery, because surgery only fixes your body, it doesn't fix your food issues-those are wired into your brain. i still struggle, and am struggling even more now, due to family issues, but i WILL win this battle.

I think you misunderstood. The doctor didn't say she was too big to have the surgery. He said she needed to lose weight on her own first. From what I understand, that's a standard practice no matter how much you weigh before surgery. It has nothing to do with any lack of skill.