Duodenal Switch or Sleeve

Did you ever decide on a surgery? I hear DS is one of the best for resolving diabetes. I'm still deliberating.

The sleeve has been around for over 10 years. So, of course people are able to keep their weight off or they wouldn't still be doing it! (I'm almost 5 years out and I'm maintaining just fine.) 

This is the way I look at the two surgeries:

DS is a big surgery with a better excess weight loss average overall because you malabsorb 50% of your calories on average. That doesn't mean everyone who has it gets to goal or never has bounce back. In fact, I have two friends who had a DS. Both had less than 100 pounds to lose. BOTH are struggling to stay at their goal weight. 

OTOH I have a sleeve. I lost slightly over 100 pounds. I am not struggling to maintain my loss. 

So I don't think it's the surgery type that controls this. I think it's a combination of how much hunger control you will get (unpredictable), how much exercise you can or are willing to do (exercise is like an insurance policy -- it gives you a bit of wiggle room in your eating) and other factors such as medical issues that impact metabolism, head issues that may sabotage you, etc.

DS is also a powerful surgery with increased risks, a greater chance of malnutrition and a bigger supplementation routine. That extra OOMPH in weight loss doesn't come for free. So, if you want the insurance of the better weight loss stats, you need to pay the price.

I personally think the DS is a great surgery if you have exercise restrictions, if you have metabolic issues that won't be addressed by the sleeve (it does address some) or a serious amount of weight to lose. Otherwise, I think it's overkill. 

For most people with 150 pounds to lose, it's overkill. But not for all. That's something you have to figure out by comparing your own personal issues with those of people who have had both and have been both successful and not successful with both.

This is my situation: I always could lose weight on a diet. I couldn't keep it off but I could lose it. I would workout sometimes -- I was a social exerciser. So I figured I'd probably workout once I lost weight. I had only 100 pounds to lose. I didn't have a lot of head issues. I was (and am) a sweet lover. My main problem was with hunger. I was always ravenously hungry. All. the. time.

So I figured the sleeve was perfect for me. It would cut out most of my ghrelin that was making me hungry all the time. Without the constant hunger, once I lost the weight, I could keep it off, I was sure. As for losing it, I had lost it before without WLS so I figured I'd lose it with any WLS. Therefore, I didn't need the DS to lose it. So, for me, the extra risks of the DS didn't make sense.

MacMadame

Thank you for your thoughtful response. I am a binge eater-not a grazer. I am not a huge exerciser but I weigh 310 lbs right now and I'm only 5'2-5'3 so it's a little tough at the moment. That said, I do walk.  I love sports so I imagine that once I get enough weight off that I would get involved in a sport or hiking. I like to walk outside so I know I will do that. I am an emotional eater though so I'm unsure how that will play into which surgery is best for me.  I have lost 100 lbs multiple times but I would fizzle out before I could get below 190 then I would gain the weight back fast and furious. Now that I'm older-40+-the weight comes off somewhat slower but it does come off.  I can't say that I am typically "physically hungry" but I do use food as an emotional crutch. I work on that daily; however, it is not going to just go away over night.  I think the reason why I was leaning towards DS was because I have NEVER been able to maintain my weight loss and the DS is really great with maintaining weight loss. That said, it sounds like you have done a great job keeping off your weight with the sleeve. How does the sleeve help you, personally, maintain? I recognize that you have to work it, but how do you do that? If you don't mind my asking, do you know what size sleeve you have and are there tactics that you use to keep your weight stable?  Do you have to work out 6 days a week?  I'm just curious what life looks like for a sleever and if the struggle that we have prior to surgery still remains or if the load is lightened with the help of the sleeve. 

See, I don't think the DS particularly helps with maintenance any more  than any other surgery. I think that's DS propoganda. It goes something like this: With a VSG, it's like being on a diet all the time (cough bs cough) and, sure you can maintain your weight, but you have work like crazy (cough bs cough).

As I said, I know plenty of DSers who never got to goal and plenty who struggle with regain and maintenance just like some VSGers do.

For me, I find my hunger level post-op is pretty even and pretty normal. So I did go through a period where I was working out like crazy because I decided to do some Ironmans. During that time, I had to work hard not to lose too much weight. But then I hurt my head and couldn't work out *at all* for 1.5 years. During that time my head would send me mesages that I interpreted as being hungry and I did put on about 10-15 pounds. But then my neurologist put me on Topamax and the hungry message went away and the pounds came off... without exercising.

These days, my head is much better and I can work out a little. I workout about 1 or 2 times a week for 1-3 hours total a week. That's it! I hope to do more eventually but I have to watch my head injury.

I think success at WLS comes from a number of factors:

-adequate hunger control -- some people get down to a certain weight and that's it -- their bodies want to be at that weight and work to stay there and, if it's not the weight they want, they either accept it or go nuts fighting it. Statistically, the DS gets people down to a weight that is 10% lower than the VSG on average. Give or take. Depending on the study you look at and the surgeon.

-working on your head issues. Head issues will derail any surgery. No surgery can protect you from them. If you want to sabotage yourself, you can with any of them

-being willing to do the work and be strict with yourself early out so you can retrain your brain and your palette and develop good habits early out when it's easier. These will stand you in good stead later on when it's harder.

-being willing to follow some simple rules to maximize your hunger control so you stay at the bottom of where your body wants to be and not the top (things like eating protein first, not drinking with meals, keping carbs low). The amount of wiggle room you have here will vary.

Laughing...I like the cough bs cough part :)  I plan on working the tool-eating protein first and necessary nutrients then, if I have room left, something a little more fun occasionally but not often and many months out. My plan is to work the heck out of myself during the initial 12 months to take advantage of the honeymoon period and then pull back a little but not too much. The only thing I'm concerned with is carbs. I have to be careful with carbs because they trigger me to eat more than I want to. 

Yeah, carbs derail most of us. And DSers absorb 100% of simple carbs. Or so they tell me. (I suspect RnYers do too but no one talks about RnY that way.)

I think, if you are worried about regain, RnY is the one to avoid. The malabsorption of calories goes away after 18-36 months and so eventually you don't do anything different but now you are gaining weight -- it's crazy to me!

But you aren't thinking of bypass, so that's good.