TW: Weight Loss Surgery - Beginning the process Updated

[followyourarrow]

I've been thinking about weight loss surgery for the last 6 months and I'm ready to start talking to my doctor about it.  I have an appointment with my endo next week, do I start with him, or do I go through my PCP?  I've looked at my insurance and it looks like it's covered as long as it's medically necessary, I'm morbidly obese, have type 2 diabetes, and high blood pressure, so I assume I'll qualify.   I want to do it to improve my quality of life, I enjoy being active, I like hiking and walks, I want to be able to keep up with nieces and nephews.  I want to be around as long as possible and be healthy doing so.  I need knee replacements sometime in the future, I'd like to be as healthy as possible before I do them to have the best success.  

Where do I start?  Who do I talk to?  How is it determined what kind of surgery I'll need?  Any prep work I need to be doing now?  I know therapy will be helpful and is often required, do I find someone now, or do I need to wait and go through their person? 

[lessel]

I started with my PCP. She recommended a surgeon, and I made appts that surgeon and two others. The surgeon is definitely key, but look at their wider practice and the supports they offer as well (more on that in a sec).

My insurance required 12 dietician visits. (Most of these were done via telehealth.) Most of these were focused on building habits now that would benefit post-op. And as you got closer to the surgery, education about the post-op diet and process. If I'm remembering correctly they do get you started on some bariatric vitamins before the procedure... I tested a few to figure out what one worked best for me.

My insurance also required a mental health provider letter of support and a letter of support from my primary care doc. I had an individual counselor at the time to do this, but the surgeon's office also had a list available that could do basically a screening/consult call/interview and would write a letter.

I also had to have an endoscopy and a slew of bloodwork (like the most blood I've ever had taken!).

Back to the surgeon. I met with three when I started the process. I liked the one that my doc recommended and went with him. He kind of gave off some aloof surgeon vibes, but nothing too unexpected. We talked through all the pros and cons of the surgical options with relation to my specific health situation, goals, etc. I did the whole pre-surgical process with his office. Aaaand then it all fell apart in the few weeks pre-op...

I did a pre-op appt about 3 weeks before the surgery where they gave me my pain med rx (it's liquid and not super commonly stocked in pharmacies, so they gave it in advance so I had time to fil..) But the appt was really just odd. The staff was disorganized and I just got a weird vibe. (Keep in mind most of my interactions had just been telehealth with the dietician, so I didn't have much interaction with the wider office.) I got home and realized the folder they gave me with everything was for another patient. I had a ton of her medical and personal information, her pain med rx, etc. I called them back and they were like HAHA, whoops, guess you have to come back! It was weird the complete lack of seriousness they handled the situation with and I was left feeling nervous.

Then a few days later my kid got Covid about 2.5-weeks before my scheduled surgery (2021). I was supposed to be starting a pre-op diet within the next few days and I called and called and called his office trying to figure out if I would have to be rescheduled or if I should go ahead and start the diet, etc. No return calls. Full voicemails. Emails not responded to. I tried to email the provider. No response. Realized a couple days later that the message I sent had been deleted from the system. I completely lost trust in their practice and pulled the plug.

I went to a new surgeon's office and the difference was night and day. He was super understanding and just had a more positive and encouraging demeanor. The nurses were SUPER responsive, even to texts. Same with the dietician. So I ended up switching. I didn't have to start everything over, but the records transfer and insurance re-approval was a bit of a nightmare, but it was SO worth it. I had a couple of minor issues post-op (scary at the time, but nbd) and the nurse/dietician were SO quick to help me.

I saw all of that just to emphasize that you work REALLY closely with that whole office for the months leading up to the surgery and the few months after surgery, and then have an ongoing relationship with annual check-ins and stuff. So when you're exploring options keep that whole system in mind--is it a functioning, supportive, responsive team.

[gottadobe]

I would start researching the different types of surgery to determine which one YOU think will be best for you. Some surgeons don't offer the DS (duodenal switch) and won't recommend it even though it may be the one you need. There are forums and FB groups you can join to get additional information.

Unless your insurance requires a referral, you should be able to skip the primary care doctor step and go straight to the source to get your information.

I chose a very well-respected surgeon in my area who performed ALL the surgeries. The DS is the most complicated, so I figured he could do the others. We chose the VSG for me - I had it in 2015, and it's been wonderful for me. I currently have GERD issues (very common after VSG), and he wants to convert me to bypass (failed LYNX). I do NOT want that surgery, so I am stalling.

[letsgetweird]

Oct 2, 2024 8:04:29 GMT -5 followyourarrow said:

I've been thinking about weight loss surgery for the last 6 months and I'm ready to start talking to my doctor about it.  I have an appointment with my endo next week, do I start with him, or do I go through my PCP?  I've looked at my insurance and it looks like it's covered as long as it's medically necessary, I'm morbidly obese, have type 2 diabetes, and high blood pressure, so I assume I'll qualify.   I want to do it to improve my quality of life, I enjoy being active, I like hiking and walks, I want to be able to keep up with nieces and nephews.  I want to be around as long as possible and be healthy doing so.  I need knee replacements sometime in the future, I'd like to be as healthy as possible before I do them to have the best success.  

Where do I start?  Who do I talk to?  How is it determined what kind of surgery I'll need?  Any prep work I need to be doing now?  I know therapy will be helpful and is often required, do I find someone now, or do I need to wait and go through their person? 

I would start by getting a referral (if required) or start researching/setting appointments with bariatric surgeons.

I had WLS in October 2019. I met with 2 surgeons. I believe my surgeon was okay with me choosing which surgery I wanted but most seem to lean to the sleeve (he did explain the pros and cons.)

My insurance requires 6 dietician or weight loss appointments. I had met with a doctor that prescribed me Phentermine in the past and that counted towards the 6.

My personal advice having had the surgery....I mean to be as gentle as possible with this question, what has lead to you become morbidly obese? For me, the issue is/was a food addiction. I had tried many diets, outpatient ED treatment, a psych nurse that claimed yo treat ED. I saw an ED therapist before and after my surgery (2 different therapists). Nothing has cured my food addiction including WLS.

I was on a path of full on binges and emotional eating and had gained weight. I knew I was going to gain all my weight back if I didn't do something. I started attending Overeaters Anonymous meetings in January and I've gone to hundreds of meetings at this point.

It's very easy to go back to poor eating habits. Junk doesn't take up much room in your stomach so it gets easier and easier to eat more as time goes by after your surgery.

I hope I haven't overstepped and I don't know what your story is. But if you can relate to my struggles with food at all, it's something to consider. I wish I would have started going to OA before my surgery.

[picksthemusic]

Have you discussed/thought about the possibility of doing a GLP-1 injectable instead of WLS? I have spoken with many people who opted for trying the GLP-1 medications vs. WLS and were very happy with the results and many doctors have likened the results of GLP-1s to that of WLS. I have also seen many people who have had WLS then turn to GLP-1s because either the WLS stopped working (they started gaining again), or as maintenance for appetite control.

The fact that you have T2D and other factors, you would be a great candidate for the medications. Mounjaro/Zepbound (tirzepatide) is extremely effective for most people with conditions just like yours. How much weight do you have/want to lose, if you don't mind me asking? I am on the Reddit forums for these meds (as I also take MJ), and have seen many start at even over 400-600lbs and have amazing success.

I'd for sure get all the necessary information you need from reputable WL surgeons, read experiences from those that have had the same type of procedures you're considering, and maybe even meet with a registered dietician to have a food plan in place that you can live with for the foreseeable future.

Good luck with whatever you decide!

ETA: I just realized that you ARE on MJ! I'm so sorry - I felt like I remembered seeing you in the injection thread and I was right.

Have you tried going up in your dose? I know you were considering it and concerned about your blood sugars. I'd for sure talk to your endo about going up in dose before going with WLS - a lot of diabetics that I've read about only really started losing weight on the higher doses (12.5-15) so maybe that's an option?

I've been on 10 for 2 months and change and have lost 5lbs. I'm a slow loser, but it is for sure coming off.

Good luck again - I'm sorry I forgot about your current MJ journey.

[followyourarrow]

Oct 2, 2024 14:11:17 GMT -5 picksthemusic said:

Have you discussed/thought about the possibility of doing a GLP-1 injectable instead of WLS? I have spoken with many people who opted for trying the GLP-1 medications vs. WLS and were very happy with the results and many doctors have likened the results of GLP-1s to that of WLS. I have also seen many people who have had WLS then turn to GLP-1s because either the WLS stopped working (they started gaining again), or as maintenance for appetite control.

The fact that you have T2D and other factors, you would be a great candidate for the medications. Mounjaro/Zepbound (tirzepatide) is extremely effective for most people with conditions just like yours. How much weight do you have/want to lose, if you don't mind me asking? I am on the Reddit forums for these meds (as I also take MJ), and have seen many start at even over 400-600lbs and have amazing success.

I'd for sure get all the necessary information you need from reputable WL surgeons, read experiences from those that have had the same type of procedures you're considering, and maybe even meet with a registered dietician to have a food plan in place that you can live with for the foreseeable future.

Good luck with whatever you decide!

ETA: I just realized that you ARE on MJ! I'm so sorry - I felt like I remembered seeing you in the injection thread and I was right.

Have you tried going up in your dose? I know you were considering it and concerned about your blood sugars. I'd for sure talk to your endo about going up in dose before going with WLS - a lot of diabetics that I've read about only really started losing weight on the higher doses (12.5-15) so maybe that's an option?

I've been on 10 for 2 months and change and have lost 5lbs. I'm a slow loser, but it is for sure coming off.

Good luck again - I'm sorry I forgot about your current MJ journey.

I haven't gone up on my MJ yet, but plan to talk to my dr about it next week.  I've lost 49 lbs on MJ but I have another 100 lbs to go and I'm not sure I can do that with MJ and exercise.  That is a good question though and one I'll ask.  Food noise is the biggest thing for me.  MJ helps that so much.  

[mustardseed2007]

I had WLS earlier this year. I'm 5 months post surgery and very glad I did it. It took several months for me to go through all the requirements of my insurance. Your endo or PCP may have a recommendation but honestly I found my surgeon by doing searches in a couple neighborhood mom groups where people interested in the surgery had asked for recommendations and receive them. One place was recommended that was close to me and I made an initial consulting appointment. Their office has a dedicated team to coordinate all the insurance requirements, which in my case included a counseling session and 3 nutritionist visits. They were able to schedule and coordinate all of that for me. Their office was a little bit of a machine, but also it was comforting to know that they were helping me do all the work to get it approved by insurance.

FWIW from what I understand there are some people who get WLS and eventually also add WL drugs to help quiet food noise more, with the surgical change and medicine working in concert with each other. I don't know anything about the wisdom of that or pros and cons because I just recently had the surgery but it's something I've heard and read.

ETA: yeah and what the PP said about it not being a cure all is very true. The dietician and doctor I worked with has always emphasized that it's just a tool. 

[picksthemusic]

Oct 2, 2024 14:50:54 GMT -5 followyourarrow said:

Oct 2, 2024 14:11:17 GMT -5 picksthemusic said:

Have you discussed/thought about the possibility of doing a GLP-1 injectable instead of WLS? I have spoken with many people who opted for trying the GLP-1 medications vs. WLS and were very happy with the results and many doctors have likened the results of GLP-1s to that of WLS. I have also seen many people who have had WLS then turn to GLP-1s because either the WLS stopped working (they started gaining again), or as maintenance for appetite control.

The fact that you have T2D and other factors, you would be a great candidate for the medications. Mounjaro/Zepbound (tirzepatide) is extremely effective for most people with conditions just like yours. How much weight do you have/want to lose, if you don't mind me asking? I am on the Reddit forums for these meds (as I also take MJ), and have seen many start at even over 400-600lbs and have amazing success.

I'd for sure get all the necessary information you need from reputable WL surgeons, read experiences from those that have had the same type of procedures you're considering, and maybe even meet with a registered dietician to have a food plan in place that you can live with for the foreseeable future.

Good luck with whatever you decide!

ETA: I just realized that you ARE on MJ! I'm so sorry - I felt like I remembered seeing you in the injection thread and I was right.

Have you tried going up in your dose? I know you were considering it and concerned about your blood sugars. I'd for sure talk to your endo about going up in dose before going with WLS - a lot of diabetics that I've read about only really started losing weight on the higher doses (12.5-15) so maybe that's an option?

I've been on 10 for 2 months and change and have lost 5lbs. I'm a slow loser, but it is for sure coming off.

Good luck again - I'm sorry I forgot about your current MJ journey.

I haven't gone up on my MJ yet, but plan to talk to my dr about it next week.  I've lost 49 lbs on MJ but I have another 100 lbs to go and I'm not sure I can do that with MJ and exercise.  That is a good question though and one I'll ask.  Food noise is the biggest thing for me.  MJ helps that so much.  

So for me and food noise, I notice that if my blood sugars are low (which does happen occasionally, usually in the morning if all I have is my protein coffee), I eat something like fruit or even a handful of trail mix or M&Ms and it helps a TON. I also notice when I don't eat enough protein from food sources, that also makes my food noise come back and I get snacky looking for that 'something'. Hot tea is also super helpful (with a drop of honey), hard boiled eggs, peanut butter/banana toast, etc. Eating full meals is hard for me so, the bento box style lunches with options is very helpful, especially at work where I tend to not eat because I just work through (not healthy).

My RD gave me lots of amazing options to help me feed myself well - and I think that's a big problem with my ADHD and remembering I need to eat and nourish my body. Remembering that it's OKAY to eat, but eating well. I've seen recipes (and TikTok videos) about making Dense Bean Salads that would be amazing for work lunches because you make a huge batch and eat them through the week.

[ksun]

Hey there, I had VSG about 21 months ago and have lost 90 lbs. I am now on GLP1s to lose the last 40 or so

Talk to your PCPbut also look into WLS surgeons around you and your insurance. I have loved my experience with my surgery center.

As for the surgery, you'll have to do your own research. I chose VSG. RNY is just as effective. I would also find a dietician. I love mine that I still see now once a month (virtually) TheGuacwardDietician on IG. I would also look into an actual therapist. I struggled with binge eating disorder.

If you need anything, feel free to message me.

[pinkdutchtulips]

I don't have experience with it personally but my xh had WLS. 

The good news was that he dropped 100#.  He got his done in Mexico bypassing all of the normal/routine stateside appointments (dieticians, mental health) bc he didn't want to do that. 

The bad news is that his form of surgery, bariatric lap band, tightened up when he was stressed and he couldn't eat or drink anything. His mental health took a beating with it. Anther thing and this was mentioned upthread, have another 'addiction' preferably a healthy one in place. Food was his addiction too and when he no longer had that addiction, he turned to something else. His was alcohol bc it destressed him and went down easy. Take a good look at what got you to this point. 

He eventually had his removed after we separated. He was hospitalized for some reason and the decision was made to remove it. 

I also have friends who had gastric sleeve surgery and their only complaint is that they can no longer eat certain foods (steak) but the payoff to not being morbidly obese anymore is worth it. They've been able to maintain their healthy weights for years. 

[letsgetweird]

Oct 3, 2024 11:14:13 GMT -5 pinkdutchtulips said:

I don't have experience with it personally but my xh had WLS. 

The good news was that he dropped 100#.  He got his done in Mexico bypassing all of the normal/routine stateside appointments (dieticians, mental health) bc he didn't want to do that. 

The bad news is that his form of surgery, bariatric lap band, tightened up when he was stressed and he couldn't eat or drink anything. His mental health took a beating with it. Anther thing and this was mentioned upthread, have another 'addiction' preferably a healthy one in place. Food was his addiction too and when he no longer had that addiction, he turned to something else. His was alcohol bc it destressed him and went down easy. Take a good look at what got you to this point. 

He eventually had his removed after we separated. He was hospitalized for some reason and the decision was made to remove it. 

I also have friends who had gastric sleeve surgery and their only complaint is that they can no longer eat certain foods (steak) but the payoff to not being morbidly obese anymore is worth it. They've been able to maintain their healthy weights for years. 

Good point. Transfer addiction is a real concern.

[followyourarrow]

I had an appointment with my endo yesterday and I asked him about weight loss surgery. He'd prefer to keep me on Mounjaro and up my dose, in his opinion, it's safer. So I'll try that and he said we could revisit things at my next appointment in 6 months if needed. He did feel that I could lose another 75 lbs on Mounjaro though.

[gottadobe]

Oct 8, 2024 8:13:17 GMT -5 followyourarrow said:

 it's safer. 

Did he say how/why it's considered safer?
I would still go to a bariatric surgeon who also offers weight loss drugs (mine does) and get a second opinion.

[followyourarrow]

Oct 8, 2024 8:16:45 GMT -5 gottadobe said:

Oct 8, 2024 8:13:17 GMT -5 followyourarrow said:

 it's safer. 

Did he say how/why it's considered safer?
I would still go to a bariatric surgeon who also offers weight loss drugs (mine does) and get a second opinion.

He did.  I probably won't explain well, but he talked about the risks, what could go wrong, and that it's more invasive and not as easily undone, and some forms can't be undone.  With Mounjaro, if I up the dose and don't react to it well, I can simply stop or back down my dose.  

[krystee]

I had it done, lost 90 lbs, and then the pandemic came and I was working 65-hour weeks and had a two-year-old home. It was a nightmare and I gained 60 lbs back easily. Such a bummer because I was so happy and felt so great for a year and a half. I just can’t get it back off.

[expectantsteelerfan]

followyourarrow, it sounds like you have a good plan in place. It makes sense to me that your Dr. would like to try any/all less invasive options first. It's not like they are saying, no you aren't a candidate for weight loss surgery, but that they are saying, before we consider that, let's try these other things first and see if they COULD work because there are less risks.
I hope going up a level on mounjaro works without any negative side effects for you!

[pugz]

Hey! I think it's worth meeting with a bariatric surgeon to discuss the options and your questions. From what I have seen folks that do bypass have much better long term results than the in between options like the band. (You can talk to your cousin about that as her surgery basically failed but nobody knows why).

The injections have limits though. And I don't know that it's research backed for your endo to say you can just keep losing on MJ. Studies show 15-20% weight loss is typical. The injections don't really care what our goal weights are unfortunately!

[ksun]

I don't think many places even offer the band anymore.

I would still consult a bariatric surgeon. Yes, it can't be undone but it's a tool. GLP1s are also tools. Often times they're used together, but if I had just used Zepbound and gotten a 20% weight loss from my initial weight I still would weigh MUCH more than I weigh now after surgery (even 2 years out)

[mustardseed2007]

Just again as someone who recently had WL surgery, I do think it's totally fine to continue not to go that route immediately.

For me, I did my initial appointment with the doctor and talked to them about gastric bypass. I then left the appointment and thought about it for a while, and then I started the process which took several months. Like I said, they were a bit of a machine in getting things done, which was really helpful. But I also know from first appointment to surgery, I did it as fast as I possible could and it took about 5 or 6 months.

The first few appointments were a therapist visit and dietician visits so you could have the appointment and then just think about it. Or even have the appointment, go down the path, and have your therapist meeting and dietician meeting and change your mind without being out too much, depending on what your insurance requires and pays for.