Dinah

Curious about long-term results of sleeve vs. your past experience with dieting

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Greetings everyone! I am considering a gastric plication as I live in the Czech Republic and the surgeon here is quite an expert. But I am writing about your experience because there is something I find a bit confusing and I know you all have opinions on this topic! After doing extensive research and speaking with the obesity center psychologist and nutritionist over and over, the point seems to be that after the honeymoon period your hunger comes back and if you don't eat EXACTLY THE TINY AMOUNTS you are told to, then your stomach expands and you are back to where you started. So I find this puzzling. It seems that people do regain their appetite, albeit they are much thinner when that happens than when they started out. But in such a case, if I could possibly lose the weight I need to through diet and fitness, which is a maybe:), then what is the difference between say me being hungry after losing 80 pounds naturally and me being hungry after losing 80 pounds after a bariatric operation? What I mean is,   it seems of course that it would be easier to maintain a weight once your stomach has been surgically reduced. And yet time and again, people seem to get their hunger back. Further, the nutritionist and psychologist say that if people eat above the tightly prescribed teeny tiny amount at each meal, well it's all over! That is weight gain begins and the stomach expands (or it just gets back to normal). So I don't really see how that is different from the more intense self control, so to speak, you need after losing weight without an operation. Except that in that case, you have more freedom possibly not to eat teeny tiny portions. On the other hand, you might need to do an absurd amount of excercise and eat very little because of the metabollic rate issue. So am just trying to understand the difference in the long term because I do not want to get an operation that will be short lasting and face the same hurdles as I have in the past. I am 5.7, 225, (down from 236 after a few weeks of intense fitness and dieting). I have dieted since my 20s and lost weight and regained too many times to count. Skinny before that period. Lowest weight in my 20s was maybe 135 and 145 in my 40s. Am 53. I am very pro surgery so please don't think I am doubting its wonderful impact. Am just trying to mentally prepare. Thank you!!!!!!!

 

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Hi Dinah. Sorry, this is a common misconception. There is very little scientific information to support the idea that there is any significant expansion of stomach pouch volume. The fact that many people can "eat more" at one sitting 6 months after surgery than right afterwards may not be anything more complicated than the swelling have gone down after surgery and they have become more adept at eating to fill. Your pouch volume DOES NOT, on average, increase when surgeons have measured pouch volumes over time.

The uptick in hunger after the honeymoon period exists, but it is not like you become a raving hungry creature. Hunger is largely, but not solely, controlled by the filling up your stomach, and it is still less prominent after surgery than in people without surgery. The decrease in hunger is not well understood, but it is real. 

Eating over the recommended amount means you either don't lose as much or you regain some of weight. It is not "all over" as may have been suggested to you. It means you either regain some of the weight or you pay attention and the next day eat less and stay on track. One of the aspects of the honeymoon period is that it gives you time to develop the habits that allow you to succeed over the long run. 

Lastly, your potential point about there being no difference between dieting and going through surgery is not supported by the data. Success rates for WLS are widely quoted as being > 80% for at least a 50% reduction in excess weight. Some places and surgeons and groups have even higher success rates. The chance that you can go from a BMI of 40 down to top-normal BMI  of 25 and maintain it through dieting has been measured at 1 in 1500 to 1 in 5000 (e.g. way less than 0.1% success rate). WLS is > 80% successful versus < 0.1% for dieting. They are profoundly different in terms of effectiveness. I think you have ended up in a logical knot that is just not supported by the data. WLS gives you a small stomach and less hunger. Dieting gives you no smaller stomach, no less hunger, and wreaks havoc with your metabolic rate by reducing it. 

Take a look at the series of articles on metabolic rates and why WLS surgery works, largely in Science columns from the NYTimes, that @Jen581791 posted. 

Good luck!

 

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Excellent information from @BurgundyBoy!  I would chime in and add that the people who regain most or all of their weight post-op do so by constantly grazing; by eating slider foods (those foods that have lots of calories but don't stay in the pouch creating a feeling of fullness) and by drinking their calories.  They also tend to not work on the problem of "head" hunger vs. true physiological hunger. 

I went to a continuing education workshop a couple weeks ago on eating disorders and one portion of it was devoted to Binge Eating Disorder.  This presenter's experience is that a tremendously high percentage of "failed" WLS patients have undiagnosed or untreated Binge Eating Disorder preop.  It was very interesting; I'm hoping programs will do a better job of recognizing and treating it now that it is an actual DSM diagnosis.

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This is so incredibly helpful, thank you!!! I have many times read about the rates of success of dieting vs surgery, am just trying to understand why:).  Do people who keep the weight off continue to forever eat the required portions? In my case here it’s 150ml. I forget what that is in ounces. Do you still measure everything? How hard is that to maintain for life?  The head work: I was not a binge eater naturally but became one after years of dieting. Am not sure how to address that pre op but am doing my best to eat healthy now and exercise, which is a start. I feel great for the first time in eons but I know there is a long road ahead. Thanks again for your patience.

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9 minutes ago, Dinah said:

This is so incredibly helpful, thank you!!! I have many times read about the rates of success of dieting vs surgery, am just trying to understand why:).  Do people who keep the weight off continue to forever eat the required portions? In my case here it’s 150ml. I forget what that is in ounces. Do you still measure everything? How hard is that to maintain for life?  The head work: I was not a binge eater naturally but became one after years of dieting. Am not sure how to address that pre op but am doing my best to eat healthy now and exercise, which is a start. I feel great for the first time in eons but I know there is a long road ahead. Thanks again for your patience.

I rarely measure anything anymore.  Once in awhile I do just to "spot check" myself but I've gotten pretty good at eyeballing it.  I measured faithfully for probably the first 2 years or so.  Really for me the key to maintenance is not grazing or mindlessly snacking.  To be purposeful about eating protein first then veggies; fruits, nuts and good carbs for snacks when needed and the occasional treat.  Staying active and never ever forgetting that I can easily be right where I started if I "just this once" pretend I can eat like I used to.  To find other ways besides food to manage any boredom, anxiety, anger or even celebrations that come along.  To drown out the mean "feed me demon" who used to constantly encourage me to "have more, it tastes so good and you deserve it".  It is complex and yet it is so glorious to finally be free to live without the burden of the extra 120 or so pounds. You're gonna love it!

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Hi @Dinah, it sounds like you’re hearing some things that sound pretty confusing. @BurgundyBoy‘s reply had some great info. I’d add that hunger pre and post op are pretty different for me, and I actually eat quite a bit for my tiny pouch now. It seems like people’s experiences tend to vary, and *science* can’t quite explain why, but in general people are successful, statistically speaking, after WLS. People who need to lose a lot and keep it off are, statistically speaking, not successful.

Here’s a link to the articles post. There are so many compelling stats here. Have a read. Better to go in with your eyes wide open! Reading some people’s experiences on the blogs page might be helpful to you, too.

 

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9 minutes ago, msmarymac said:

I rarely measure anything anymore.  Once in awhile I do just to "spot check" myself but I've gotten pretty good at eyeballing it.  I measured faithfully for probably the first 2 years or so.  Really for me the key to maintenance is not grazing or mindlessly snacking.  To be purposeful about eating protein first then veggies; fruits, nuts and good carbs for snacks when needed and the occasional treat.  Staying active and never ever forgetting that I can easily be right where I started if I "just this once" pretend I can eat like I used to.  To find other ways besides food to manage any boredom, anxiety, anger or even celebrations that come along.  To drown out the mean "feed me demon" who used to constantly encourage me to "have more, it tastes so good and you deserve it".  It is complex and yet it is so glorious to finally be free to live without the burden of the extra 120 or so pounds. You're gonna love it!

You nailed it all. Thank you so much!

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It also sounds to me like you're worried about your own success.  Maybe you're used to eating a lot, or whatever/whenever you want - and you worry that you won't be able to control that after surgery, so your surgery won't be successful.  This is something that worried ME before surgery.  I couldn't understand how I was going to keep the weight off if it depended on me controlling myself; after all, if it were that easy to control myself, I certainly would have done so before I got to 355 lbs!

I had RNY, not gastric sleeve, but the experiences seem basically the same.  Let me try to put your mind at ease.  Before surgery I could not control the amount or the kind of food I ate.  I ate junk, and a lot of it, on a daily basis.  I felt totally out of control.  After surgery, I was not one of those people who get an aversion to food; I don't get dumping syndrome; everything that tasted good before surgery still tastes good now.  But now, I have advantages:

1) Even though I can now eat more than I could right after surgery, I still can't eat anything like the amount I could before surgery.  I get full MUCH sooner, and it is not the kind of full that allows room for "one more bite."  When I get to the last bite that fits, no more bites go down - period.

2) I spent 4-5 months with no real desire to go off plan, because of surgery.  Now, I'm so in the habit of being ON plan that I usually don't even think about eating the stuff that I used to binge on.

3) When I do eat something I shouldn't, it's just worlds easier to stop at a bite or two, or a very small serving.  I don't WANT more than that. 

I could go on and on, but the upshot is - you will have a different relationship with food after surgery than you had before surgery.  Part of that will be physical, and part of it will be the force of new, better habits.  As BB said above, science is not 100% sure why surgery works, but it DOES work. 

There's another advantage those of us here have:  each other.  This is a great place, and full of positive reinforcement for my better angels.  It keeps me honest and accountable, doesn't judge me when I slip up but also calls me on my *&amp;^%.  ;)  Stick around - there is a lot to learn, and a lot of people willing to share their experiences and support!

 

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The restriction will always be there and so that means that you will always have a tool to help you. My hunger is measured by the noises my stomach makes now at 3 1/2 years out. At first I would NEVER have hunger pangs and now I do on rare occasions. I'm "normal" now and that means that I eat like a normal small person would. As far as regain goes that is an individual thing, everyone has it, you control how much. Good luck

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6 minutes ago, latina63 said:

The restriction will always be there and so that means that you will always have a tool to help you. My hunger is measured by the noises my stomach makes now at 3 1/2 years out. At first I would NEVER have hunger pangs and now I do on rare occasions. I'm "normal" now and that means that I eat like a normal small person would. As far as regain goes that is an individual thing, everyone has it, you control how much. Good luck

That not quite the case latina63. 

If we aren't careful with the amount of food we eat on a regular basis (regardless of whether it's a RNY or VSG or DS), you can (and will) stretch your pouch or sleeve and if that continues,  more food is needed to satisfy us and ultimately, that could lead a regain of weight previously lost.

Although this is about the VSG, the same applies to the RNY and DS:  GASTRIC SLEEVE SURGERY – WILL MY STOMACH STRETCH AFTER SURGERY?

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I guess I'm speaking from my own personal experience. I CAN'T eat a lot, it starts to hurt and becomes very uncomfortable...I guess if you still have the food addiction you will eat past the pain but for me...I can not. Your stomach will always be smaller even if you stretch it (which is odd in my opinion), there is a lot of discussion on actually "stretching" your stomach, some drs say yes, others say no..you would have to eat a LOT of food to stretch it out and I just don't see how?? Maybe if you eat heavy every 30 mins?? That seems a bit extreme...but I guess it can happen. Regain happens when our brain puts a halt to our "medical" starvation and starts to try to repair us...it definitely makes it harder to lose weight but eventually it will catch up if we treat it right and not abuse it with junk. There is a "healthy" number for everyone...it may not be the one I want but I guess my body knows best ESPECIALLY if you know you are doing right in your eating.

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I'm 11 years out latina and I can't eat much in one sitting but I've always planned my meals/snacks and weighed/measured my portions and when it's gone, it's gone.  I also eat by the clock.  If I feel empty, I just drink more water.

Were I not to weigh/measure and eat at the appointed time, there's no doubt that I could nibble and graze my way through the day.

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On 8/31/2018 at 8:39 AM, cinwa said:

Although this is about the VSG, the same applies to the RNY and DS:  GASTRIC SLEEVE SURGERY – WILL MY STOMACH STRETCH AFTER SURGERY?

This article is very validating for me. I've been worrying that I'm snacking too much and worried about eating carbs, even though it's almost exclusively carbs in dairy or whole grains with an occasional treat or cocktail once a month or so. I have only overeaten maybe twice since surgery 10 months ago and it was a bad experience both times. I do not want to do that again! This article helped me see that I'm actually doing the right things already. Thanks for sharing! 

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