Is WLS successful in the long run?

I guess I qualify for your question since I am 6 1/2 years out revision and I have a BMI of about 19-20.  I have been maintaining under a 25 BMI for over 6 years now.  

I agree about people joining and dropping out.  Been there.  Most do regain, many don't but just don't want/need the support any more.  Many, many more never even get post WLS support anywhere.  So you can't depend on what you see or don't see on these boards to tell you anything.  The majority are pre-ops and early post-ops, when support is needed the most.  They do start dropping off around 2 to 3 years.  I have over 200 "friends" and every now and then I look at the list and I can barely count on one hand those who are still around.

Now, the reality.  I had WLS in 2002.  The DS.  I lost weight steadily for about 2 years and then turned around and regained.  I did not maintain for one minute.  I didn't even try.  I thought that was the surgeries job and all I had to do was go along for the ride.  Even while regaining I kept expecting the gain to stop and for me to arrive at my happy place.  It never did.

I regained the good old fashioned way.  I ate my way back to over 220 lbs.  I had no restriction but even if I did I would have just ate more often.  I am sure I had malabsorption, I was just eating more than I could possibly malabsorb and of course simple carbs are absorbed 100% and that was mainly my diet.

I remember when I realized I was flirting with 200 lbs again and I finally realized I needed to do something about it.  And that is when I finally understood that if I wanted to lose weight and keep it off I had to do exactly what I did before WLS.  There were no short cuts.  I had to eat less, cut out the refined carbs and quit grazing.  A nice way of saying I always had food in my mouth.

So, the numbers.  In 2002, before my first WLS, I weighed 240 lbs.  In 2004 I got down to 117 lbs.  When I had my revision in 2010 I was back up to 220 lbs.  A big net loss of 20 lbs.

But you know what?  If I had never had WLS and kept up at the rate I had been I would have been at least 300 lbs in 2010.  So in a sense my surgery was a success.  I weighed less than I did 8 years early.  Something that never happened to me before.  It wasn't great but I did have improvement.

So now the bizarro world began.  When I had my revision my surgeon's plan was to reduce my malabsorption.  I was initially given a common channel of 100 cc.  I was also given a very large sleeve.  My surgeon told me he reduced it by 50% (no bougies in 2002).  I wouldn't have known I had any reduction in my stomach.  By one year out I could eat as much as before surgery.  My surgeon wasn't a fan of malabsorption (and didn't perform the surgery well or correctly) and I guess he figured that by leaving my stomach big I couldn't do as much damage nutritionally.  he was wrong.  Even though I could eat a lot of food I still didn't absorb much nutrients from it.  Of course there isn't a whole lot of nutrition in refined carbs anyway so that little scheme didn't help me any.

So he gave me a RNY pouch.  Well actually he left me a pouch after removing all my stomach except about 30cc, if that.

So I have a lot of restriction.  And even though my common channel is supposed to be 200 cc I still have a lot of malabsorption.  I suspect that my surgeon also had some kind of unique way of measuring things.  

My quality of life was very poor after my first surgery.  The bottom line was that whatever he did when he performed the surgery left me with a blind limb and CIBO.  I found this out in my second year when I came down with BADAS, which is a rare complication that can occur in patients who have had Biliopancreatic diversion, which is a WLS that was the precursor of the DS and what I suspect I actually had.

Anyway, I was advised at that time to have a revision but I refused because I was still losing weight and I didn't want to regain my weight back.

By 2010 I had already regained the weight and was so sick I would rather be fat than live like that any more.  I begged him for a reversal.  He told me that a reversal wasn't possible but he could give me a revision to help the problem.  And it worked.  That was the last day I suffered from SIBO and if that had been the only result of my revision I would have been perfectly happy.

I did not have a revision to lose weight.  In fact my surgeon reiterated to me several times that I probably would not lose any weight.  I don't know if he told me that because I had failed so miserably after my first surgery or what but I honestly could care less.  I just wanted my health back.  It took a long time but I finally have regained my health.  The weight loss was an unexpected benefit that I didn't really expect.

In fact I would like to weigh about 15 to 20 lbs more.  I am older now and I look terrible at this weight.  My original goal was 120 lbs only because I figured that would give me bounce back room.  I wanted to settle around 135-140 lbs.  At about 145 my BMI is 25 and that would be ideal for me.  But now, do to a combination of too small of a pouch and too much malabsorption my weight stays right around 110-115.  I have only once gotten over 115 lbs in the last 6 years.  

For the first 5 years I followed a very strict eating plan.  In the first year I didn't deviate from my eating plan at all.  I had been so undisciplined in my eating that I had no clue how to eat or what to eat and I didn't trust myself to make good choices so I worked with the nutritionist and ate exactly what she told me to eat.  After a year I started being a little more experimental with my eating but I didn't touch anything with gluten in it for over 5 years.  I had such bad reactions to refined carbs with the original surgery that I was afraid to eat it.  I finally did start adding it back and found that I don't have the same physical problems with it that I had before.

I do still have the same mental issues, though, and I have to be very careful with refined carbs.  But I found that the WLS preferred eating style works great for me know.  When I center a meal or snack around protein I really don't have a lot of room left over for anything else.

I still avoid sugar like the plague and always will because I dump terribly with even a little.  I found out by accident when I had something I thought was sugar free and it wasn't and even today if I accidentally eat some I get very sick, sick enough that I don't want to chance it.

So, I am sure I have gotten way off the topic and onto some kind of tangent, which is why I try not to get started.  Being concise isn't my strong suit.  All I really wanted to say is that WLS does work and does what it is designed to do when the patient does what they are supposed to do.  WLS isn't magic.  It really doesn't make a food addict into someone who no longer has any issues with food.  It doesn't change the fact that you have to eat less in order to lose weight and keep it off.  If just make eating less doable over a longer period of time.

I don't really credit WLS with my weight loss.  I've done that dozens of times before.  But the one thing I have never done is keep it off for any period of time.  I don't think I have ever maintained the same weight from one year to the next.  So for me to have maintained a normal weight for over 6 years is nothing short of a miracle.  But it would be no less of a miracle if that weight was over a 25 BMI.  Staying the same size over any period of time is no small feat.  

Again, sorry this is so long and for anyone who has stuck through this I appreciate it more than I can say.  Maybe someday I will learn how to tell my story in fewer words.  But I do credit sticking around OH, and the people who have been doing this longer than I have, as one of the main reasons I have made it this far.

You might check out the research on people's expectations of what WLS can deliver.  I am providing research citations because, at 10 years out, you need real data, in addition to the personal stories you will hear here. This is general info and may not apply to your situation.  It may help someone.

Conclusions

Across all three surgery types, women, Caucasians, younger patients, and those with higher initial BMIs were more likely to have unrealistic goals. Informed consent procedures should help patients, particularly those most likely to be unrealistic, understand likely outcomes as part of education on risks and benefits of weight loss surgery.

http://link.springer.com/article/10.1007%2Fs11695-009-9982-8

Obesity Surgery

February 2010, Volume 20, Issue 2, pp 148-153 

I understand and agree that surgery isn't one-size-fits-all and many people have unique cir****tances.

That said, I have seen a LOT of posters here who claim to be special exceptions to medical knowledge, but in truth simply aren't using their tool, eating crap, and wondering why their surgery "didn't work." Calling someone out for eating cheerios, which should NOT be on a post-op eating plan, is INDEED "realistic support."

I've never seen a cir****tance where hand patting results in weightloss ...  

You are right on - WLS and maitenance is a medically complicated subject and science doesn't even fully understand why and how it works - esp why diabetes is made better before sig weight loss. 

Too many people have unrealistic thoughts of what WLS can do.  Few people will be and stay a size 2/4/ or even a 6/8.  Keeping of 50% of your EBW is considered success because that is what WLS can do for most people, long term.  While not 'skinny' that level of loss improves your health.  Remember that is why health insurers cover wls - it's not so we can wear size 2s, even if that is why we went into it.   25% of all people will gain it all back - so if you did, you are in good company, not that that helps.  There is a strong genetic component and other medical conditions can accelerate regain.  In many ways, you pays your money and takes your chances.  It the docs knew why and who would regain it, they would not do the surgery on those people - or at least the insurers would not pay for it.  

At 276, before WLS, my dream was to get under 200.  I knew if I could do that,  I would be backing away from death's door.  My secret dream was to get to 165 - the lowest I was in High school (after I returned from teenage fat camp.)

At 2 years out, and at 140, I am hoping that I can stay here, or at least under the 165 mark, long term.  I also know there is a 25% chance that I will not keep it off.  Perish the thought - and I hate even writing it - but not everybody gets or stays at 25-30bmi and despite my best intentions and effort, it is still a crap shoot for me. ( Working on bad habits as they creep back in is my focus right now.  I am active, but will return to weight lifting when I am over the plastic surgery.) 

I still hate the fact that just 50-100 calorie extra a day is deadly to WL goals.  This is like 1/2 an apple a day or an extra chick wing. WTF.  

I honesty did not read all 70 of the posts to this topic, but I would still want to encourage the poster to work with their doctor or psych to get healthy - which may mean a  size 14-18 instead of a size 24.