Please Help!!!!!

Question
Dear Karla,

Hi Karla, my name is Kim and I am writing in hopes that someone will help me find the answers I am looking for.  I think my pouch has stretched, or something is wrong because I am a year out from having Roux En Y and I am just so depressed over my results.  I was 305lbs when I went to have the surgery done, I lost weight very rapidly, like 100lbs by Christmas time, but then it just stopped I had my surgery in June of 2009 and by Jan. 2010 I was 195lbs and that was it, it was over, I felt like I was robbed, the doctors, nutritionists, and PA's promised me continued weightloss for at least a  year to 15 months, I admit I am happy for losing what I did but I am no where near my goal weight or what I am suppose to weigh for my height and bone structure, I am still considered obese and I don't know what more to do.  I don't eat I don't lose weight, and I stay active like clean around the house and do outdoor work, I was gonna join a gym in the fall in hopes that it would do the trick, I'm not sure what to do. What I want is a revision, I would love to have another gastric bypass, I don't want to weigh 0 I just want to at least weight what I am suppose to for my height of 5'8''.  I cant stand those protein shakes and anyway they make me really sick, but I just figured I stretched my pouch back out because I can eat and get full to where I'm sick but within a couple hours I'm starving again, and now I can eat bread which I never could before.  I know my surgeon is not gonna give me a revision they will somehow say its my fault and make me do a food log or something like that but why do some patients get to their goal and others don't, and if we both do what we were suppose to do.  I'm just so depressed that this surgery just let me down so much, and I go up and down all the time, sometimes its between 5-10lbs.  Please help.  thank you

Kim

Answer
Hi Kim:

I'm so sorry for your frustration.  You have done great, though--even though you haven't lost 100% of your excess weight.  You went from a BMI of around 46.4 to one of 29.6--which is defnitely a success.  (At 5'8" and 195, you're not obese anymore either.  You're just overweight.)  I hope you understand that typically, people do lose 50-70% of their excess weight with the Roux-en-Y.  Losing 100% is the exception, not the rule.  Often times, on weight loss boards, you'll meet a bunch of people in the honeymoon phase (usually the first year or two), where everything (including weight loss) is pretty effortless.  You'll also see a bunch of people who did lose close to 100%--because those that do not, tend to get frustrated and not hang out.  Yet, if one looks at all of the studies out there--no bariatric surgery promises 100% EWL--especially maintained weight loss.  50% EWL? Sure.  60%? Maybe.  70%? O.K.  But anything above that, not typical--although the DS does post slightly higher numbers.  Also, often times the dumping syndrome goes away after one year--which makes things more difficult.  

If you are truly interested in a revision, than rather having a Band put around your pouch or your bypass lengthened, you should probably investigate a duodenal switch.  The weight loss percentages are higher, and one does not need to be as strict with what one consumes.  You will need to be diligent about labwork and vitamins for life--similar to with the RNY.  You can find out more at dsfacts.com, duodenalswitch.com, and the Revision and DS boards on Obesity Help. Can you find a surgeon to do the surgery? Yes. Absolutely.  But it is unlikely to be covered by insurance.  Most insurance companies require the same criteria as an initial surgery for a revision--so BMI over 40, or 35 with comorbidities.  Many will also require you to go through the dreaded physician supervised diet again.

You are not to blame, regardless of what your surgeon says... you have simply reached the limits of your surgery.  As to why some people hit goal and others do not, I really don't know the answer.  I think that part of the equation may have to do with how long one was morbidly obese prior to surgery.  Another factor is simply choosing the right surgery for your starting BMI and health history.  We know that with a BMI over 50, one's best bet is a DS, yet as not that many surgeons do the DS, they often go ahead with an RNY regardless.  Similarly, you'll find people who are revised from a Lap-Band to a Sleeve Gastrectomy--when typically, if one does not do well at one restrictive surgery, having another restrictive-only surgery isn't the answer.

Another option, as you really don't have that much to lose, would be to look into a commercial weight loss program like Weight Watchers, Jenny Craig, or NutriSystem.  It's not the same as trying to lose pre-surgery, plus you'll have a lot of support.  You could also look into working with a trainer and see if that gives you what you want rather than seeking out another surgery.  If it were me, I'd try that approach for 3-6 months and just see what happens, before going under the knife again... but that's just me.

You really have been successful, but I understand the frustration at not being where you want to be.  I hope you find your way there.

Karla

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