Interested in input from sleeve vets

I would love to hear how far out your are and how much of your excess weight loss you have been able to lose. I would also love to hear how difficult maintaining your weight loss has been and what strategies you use. I am contemplating either DS or the sleeve and have been leaning towards the duodenal switch because I have heard that maintaining weight loss is difficult with the sleeve and that you have to eat excessively low calories. Is this true? Is it a struggle to maintain your weight loss? Would love to hear anything you would like to share.

I've lost all my excess (5'7", started 280, surgery weight was 264.. maintaining in the mid-140's.) 

I do not eat excessively low cal- but I also knew my metabolism wasn't messed up as I could easily lose weight, just couldn't easily maintain as I was a volume eater with no off switch for my bottomless pit of a stomach. I no longer track cals, I did that for 2+ years post-op.. but when I check in from time to time I get anywhere from 1400 on low-hunger days to 2000 on high days, averages around 1600-1700 a day. I do not work out hard, I do stay active. I do some body weight work, walk, and occasionally lift heavy things.

I don't struggle to maintain, but do have to be mindful of what I eat like any normal 40 something woman that wants to stay on the slim side. I eat a high fat, moderate protein, low carb real food "diet".. not a diet in my book as nothing is truly off limits, and I eat a lot of tasty fat! The only macronutrient I need to be fairly strict with is staying on the low side with my carbs, I get around 70g or less net after fiber most days as I don't eat grains, sugar or starches. I do have treats on occasion, but for the most part- I eat whole real food, no processed/pre-packaged crap, and avoid non-veggie carb sources. 

On the other hand, the DS was the only other surgery I considered- and it is the BEST at maintaining, no question. Almost anyone can lose with almost any WLS, it's maintaining that's the hard part. Study after study backs the DS in that regard- it's not my opinion, just a fact. You have to decide about the plusses and minuses of either surgery, and deeply understand your anatomy intimately and the needs that you will have post-op for life to maintain your health as they are different. You will need to be able to talk and explain things (multiple times usually) to medical professionals, and not be afraid to disagree with them, or outright dismiss their advice at times.. not an issue for me, but for some this is a major hurdle, and some suffer in health because they are unwilling to question their own Drs advice. This goes triple for the DS as most outside bariatric surgeons that DO the DS do not understand the needs of the DS! 

I would have went with the DS no questions asked if I had much more to lose than I did as a restrictive surgery like the VSG is not usually enough when you are pushing SMO vs just obese or morbidly obese (again, this is not my opinion.. there are exceptions to this but statistically it's true), if I had diabetes- that would have been a no brainer for me, the DS is the best at fixing that permanently as well.. it tends to recur in a good percentage with the VSG & RNY 5+ years out. If I had a sluggish metabolism, the DS would have been it for me too.. so, know thyself & think twice cut once as some wise women who used to frequent these parts would say! Good luck in your choice!

 

Thank you so much for your response. I know I can lose weight as long as I am dieting but I have never been able to maintain my weight loss very long. I was also never able to lose more than 100 lbs so I never got down to goal.  It's become a little more difficult to lose weight as I am getting older (in my early 40's) but not significantly difficult. Im 5'3 and  need to lose around 150 lbs and my doc felt I wouldn't be able to lose 150lbs with the sleeve but I have seen quite a few folks do just that.  I am 1 point away from diabetic, have high blood pressure and sleep apnea.  My doc feels DS would be better.

 

You mentioned that you eat a high fat, moderate protein diet with little in the way of carbs. Do you find that you have to weigh and measure or does your sleeve really help limit what you can eat so much so that you don't really have to monitor portion? I have had some folks say they don't measure or monitor at all and others who do measure and monitor. It seems to vary. Congrats on your success!

Do you know what size bougie your doc used?  Just curious.

36f oversewn, and he's known for making tight ones.. And yes, weighing and measuring everything, and I mean everything for quite some time (well past goal, imo) is very important. I only stopped a few months ago as I am at the point I can eyeball very well.. I have great restriction.. but I can still overeat if I plate up food and don't pay attention. If I start having issues maintaining, I know what to cut back on, so for me- the not tracking and not weighing everyday are ok, a year ago- no way. I was still learning my limits and what my body needed.

I basically agree with almost everything that INgirl had to say to you.  My numbers are different, but I am much shorter.  I eat about 1500 calories a day and I am 5'1" and  105 lbs.  That is about what any woman my age and size would eat to maintain.  I exercise moderately, nothing too intense and I maintained when I did not exercise too.  I am about 4.5 years out from surgery and just shy of about four years in maintenance.  I have a post a few posts up that explains much of this in more detail.  I am very happy with the VSG and am not having any real problems maintaining.  I also feel that if I ran into problems, I would have the tool necessary to lose the weight again.  If I was a heavyweight, the only other surgery I would have considered is the DS.  However, in my case, it would have been overkill.  

In girl and Elina got it pretty much covered.
I went from 338lbs to 148lbs in 13 months. I'm 4 years out and maintain a 5lbs range.
I will add that the VSG is not a standardized procedure. Lots of programs now days deem a 50-60% EWL a success and gear there surgeries and programs to that. When researching any WLS surgoen, make sure that your goals are similar to your theirs.

frisco

Most surgeons I have talked to say 50-60% weight loss for the sleeve. I know that my surgeon said he would use a 34 french bougie and that I would probably lose around 100 lbs. He said some lose more and others lose less. I am bout 5 ft3 and weight 300 so I would like to lose around 150 lbs.  This is why he recommended the DS. How did your surgeon gear your surgery to above 50-60%-just trying to understand. I know that my surgeon will not make the sleeve smaller as he feels it's a set up for strictures and terrible weight loss. He also will not make the sleeve smaller because if there is a problem with the sleeve and your sleeve is small it could be difficult to see the problem and to repair it.

I would totally believe your surgeon..... he is giving you his stats based on his experience and results.

Turns out bougie size is not a good barometer of eventual sleeve capacity for general forum discussion. Smaller should equate to smaller capacity, but that does not always happen as different surgeons use them differently.

The most effective sleeves seem to start out with about a 2oz. capacity and mature to about a 4oz. capacity.

Smaller sleeves are harder to make, so if you want a smaller one, it's in your best interest to find a surgeon that makes them smaller with a high success rate.

You and I are about the same starting BMI..... I was a 54 and your about a 53. That is SMO, it also helps to go to a surgeon that does well working with SMO.

I can tell you for sure that I've seen my surgeon get woman with your stats down to 120lbs. to 140lbs. consistently.

Here is a basic pie chart that illustrates what it takes to do well with any WLS, if your short in one area you must make it up in another. 

The DS is a very powerful procedure and only you can decide if you want to go down that road, as it turns out at 4 years out, it wasn't for me.

frisco

Mix up this chart any way you want...... in the end the best result is a full circle.

Difficult? I'm four months out today. BP cured, apnea cured, fitness level higher than ever, weight loss..... Numbers speak for themselves.......



Don't bet against the sleeve.