Two week post-op checkup...and a little disheartened

I had my 2 week post-op checkup (really 15 days post surgery) with my surgeon yesterday.  The good news is I'm down 12 lbs from surgery (probably a little more since I'm about to get my period and I always retain a few pounds of water ahead of time...plus I've been constipated).  So I'm happy with my weight loss so far.

The disheartening part though is I asked him what goal for weight loss I should set.  When I started my journey back in June, I weighed 370 lbs.  At my first appointment with the surgeon on 6/25, I was 363.  Morning of surgery (8/28) I was 338 lbs.   As of this morning, I am 320 lbs. 

I was surprised / shocked when he said I'd probably only lose about 100 lbs and that he'd be surprised if I got much below 200 lbs.  I'm only 5' 2", so 200 lbs is still in the obese category!   When I asked my PCP what weight he'd like to see me at from a health standpoint, he said 150 lbs.  When I mentioned that to my surgeon, the surgeon said that was unlikely.  

I'm really frustrated.  I didn't undertake this journey to stay obese for the rest of my life!   I don't need to be skinny, but I my goal was to get into the healthy weight range (for the first time in my life) or at the worse, the low-middle of the overweight range.  But certainly not to stay in the obese range!

Sorry for the rambling.  I'm just upset by what he said.

So my questions for some of you who have been at this for a while are:

1)    Did your surgeon tell you he expected your weight loss to be a lot less than you expected and, if so,

2)    Did that turn out to be true?  Or were you able to lose more weight and get down to (or close to) your personal goal?

I don't see why I should be limited to losing only to 200 lbs if I'm motivated and work my tool.  But it's hard not to take what a doctor tells you seriously too.

I guess I need a little reassurance.  He totally bummed me out yesterday ... and I'm still feeling down today :( 

Did you ask him why he thinks you would be unable to reach a healthy weight?  And why he didn't tell you that before performing your surgery?

I was able to reach the goal weight my surgeon suggested for me, actually ended up below goal for a little while, but then gained a little bit back.  I'm still at my goal now at almost five years post op.  My goal was to have a "normal" BMI.

He fell back on the "statistical averages".  He said the average weight loss was 100 lbs...so for me to get down to 200 (from my surgery weight of 338) was "optimistic" in his opinion.  I had never asked him point blank before what he expected me to lose.  But there was certainly nothing going along that indicated that I couldn't lose as much as I wanted.  He just used the old, we consider the surgery "successful" if you lose 50% of you excess weight and most people lose about 60-65% of their excess weight.

But I see lots of people on here who seems to have lost more than that. 

The reality is that RNY takes off 100 pounds pretty effortlessly. If you are truly motivated you can take off more. That will mean diet and exercise. Counting calories and moving. This becomes more important as time goes by. There is almost always a regain after the malabsorption wears off.

A 20 pound regain after the second year is common. My surgeon recommended setting a goal of 20 pounds under what I want to maintain for life. Most people lose 100 pounds and then gain back 20. Then they work hard to maintain their 80 pound loss. Your surgeon is preparing you for reality. Thank him for telling you the truth.

If you are motivated and work your tool for the long term, then you can take off and maintain as much as you want. My best weapon against regain has been weighing daily.

Thanks, that brings up something else he said that confused me.  I asked him to explain how the "malabsorption" part of the surgery works, and he said - "there is no malabsorption"...but then went on to say the certain vitamins and minerals were absorbed in the part of the small intestine that was bypassed, so that's why we have to take vitamins the rest of our lives.  So that was a little contradictory. 

I think we've met someone else who had your surgeon, (he gets pissed off with me every time I  pose the question when he says there is no such thing as malabsorbtion of food):

"Why would you let someone alter your digestive tract so that you malabsorb vitamins and minerals for the rest of your life and for no other reason?"  Huh?  Huh?  (I can hear his head exploding now LOL)   It makes absolutely NO sense but he likes his surgeon so much he is willing to accept ANYTHING he says!

As someone who has worked in the health profession for many years, I have very little faith in doctors - they will do and say whatever works for them - not that it would do you harm, but that it would make you comply to THEIR wishes.   We, as adults, should expect to have logical, reasoned explanations for everything they say - they have no right to treat us as if we are stupid!!!

 

  

I agree!  I didn't feel like getting into an argument with him, but I was asking myself...if there is no malabsorption, then why do all the medical studies, Web MD, other bariatric programs, etc. describe the Roux-en-Y as a Malabsorptive AND Restrictive procedure?   I just let that part of his comment go though.  Arguing with him didn't seem like it would get me anywhere.  

SOMETIMES you can take off more.  And sometimes you can't.  Yes, you can work hard and SHOULD work hard, but your body is going to take you where it takes you. 

Many of us have broken metabolisms.  It's how we got here.  We ate like other people, exercised like other people, but didn't weigh the same.  Doctors likely know the difference.  If you were an overeater and can get control of all of that, maybe you'll do better than average.  I was NOT an overeater, but definitely had and HAVE a broken metabolism - type 1.5 diabetes, PCOS and some other issues.  And, after 2 years, I hit right about the average (and I did not lose 100 pounds - more like 80-85).  And I was blessed to get there. 

Other people I know got down to or below where they wanted.  I would have loved to have hit 140-150, but I'm at 168 and that's the best I can do.  I can't go lower.  My body won't let me get there and it's not because I'm doing anything wrong.  It's just what my body is. And I accept it and am grateful for it.

I guess what I'm saying is that I believe we have to focus on health and not  weight.  Because, for some of us, if we don't get to an exact number, we're going to self destruct.  We're going to do things that don't promote our health.  We're going to keep comparing ourselves to others and find ways that we think we don't measure up.  And that's a bad place to be for people with weight issues.

I think your advice is really good - just adding to it.  Good luck.  I just hit 2 years yesterday!

Congratulations on your two year anniversary ... and for your successes !  And thanks for your input.  It's appreciated and helps keep things in perspective.  

DO NOT let this get you down.

Let's face it... there are a lot of surgeon's out there that think because we let ourselves get to be too heavy in the first place, that we aren't capable of ever making it to a "normal" weight. Sure, the tool will help us...butwe probably don't have the dedication and drive to make it to 100% EWL.  Plus, he's basing that number off of statistics that show something like most VSG patients lost 60% of their weight or something (somebody that pays more attention to actual research can correct me if I'm wrong)

Just not too long ago there was an article on the front page of the ObesityHelp website from a surgeon that will be speaking at the conference that said something along the lines of "Bariatric surgery can fail because patients have to great of expectations" and said that for the long term, we can only count on losing 25% of our weight. This isn't even from our surgery weight.... it's from our HIGHEST weight. Here is a passage from that article:

This can actually mean that the average 300 lb patient from the above example, who manages to lose 25% or 75 lbs before surgery, may experience no additional weight loss after surgery – in fact, the only reason I would advise this patient to still consider having surgery would be because surgery would make it so much easier and so much more likely to keep the 75 lbs off – that’s all!

Excuse my french, but screw that ****! If I were to lay down and just believe what a highly regarded surgeon like this one says I can expect from my surgery, I would have lost only 38 lbs after having 85% of my stomach taken out. I will not settle for that. I'm going big or I'm going home baby!   The reality is that maybe I will never get to a normal weight. Maybe someday I'll gain some weight back even if I do. What I do know is that I've made a promise to myself to never stop trying... and I will not let anyone tell me that I'm getting "too thin" or that I have "too great of expectations"   My surgeon quoted the 55-60% EWL statistic but also said "Of course, that is not representative of what any one person can achieve" and I appreciated that. He did not give me a "goal weight" and I did not ask him for his opinion. I know where I want to be, and that's what I'm going to keep trying for!!!