Question for Graduates

Hello.  I have been looking at Lap Band and Vertical Sleeve.  This may be a really dumb question, but I don't understand with your stomach being reduced to hold between 2 & 6 oz. how you could possibly gain a lot of weight back?  Even if you stretch your pouch.....it couldn't possibly hold a lot.  Especially RNY - if you are not absorbing all of the calories you consume....how can you possibly regain?  Can anyone tell me what part I'm missing?  It just doesn't make sense to me. Thanks. Ann

Hi Ann! There are two issues here. The first is about calorie consumption, the second is calorie absorption. At three years out, my pouch can hold about 10 ounces of food (depending on the density)  or a little over a cup. But it can hold 10 ounces of food at one time or 10 ounces of food constantly. Particularly when people graze (or eat little amounts all day long), they can consume many more calories than they should for maintenance. Some folks also drink liquids with their food or soon after eating and push food through their system which results in hunger more quickly.  The other issue is that high calorie food is high calorie food. If I eat potato chips, they are still higher in calories and fat than an equal amount of vegetables. Not all of us dump or get sick on fat and sugar and some people have even figured out a system for eating bad food that avoids dumping and/or uncomfortable fullness. Why one would do this and then figure out a work around is beyond me, but it is true. The second issue is malabsorption. There is no malabsorption with a lap band (and I don't know about vertical sleeve - I'm not familiar) and mild malabsortion with gastric bypass. My doctor and nutritionist both told me that most of the caloric malabsorption is temporary - a year or two at best. The only permanent malaborption appears to be of some vitamins and minerals. So after a while, people who continue to eat poorly, don't follow most of the rules for eating and drinking or who discontinue exercise can find themselves gaining weight.  That's the best explanation I can come up with. I am certain there are others who can add other reasons but the same thing always runs through my mind when I eat something I'm not supposed to or drink too soon. They operated on my stomach, not my head. I still want and do things that are bad for me and I have to control my behavior - surgery is a tool not a magic bullet. Good luck in all of your endeavors! Judi

P.S.--In my first paragraph, I meant to say there are some people who have trouble STOPPING the weight loss and maintaining a high enough weight . . . !

Hi Ann, I agree with everything Judith has just posted; she explained it well.  I had the same questions you're having--what would keep a person from just continuing to lose & lose & lose . . .?!  Although there are a small number of RNY patients who have some trouble losing and/or maintaining a high enough weight, there are FAR, FAR more who have the opposite problem.   It's as Judith said:  the body gradually  compensates on the absorption issue (there are physiological explanations that I'm not good enough to gives details about) and eventually can absorb way better than at first.  And although the pouch does stay permanently smaller than before, it does get bigger and can easily contain whatever junk a person puts in it if he/she so chooses!  I am one of the unfortunate ones who does not dump on ANYTHING; therefore, I can consume  (through the course of a day's grazing and/or crappy choices for my normal meals & planned snacks) enough calories to gain weight back quite nicely! Although I knew intellectually that this is "just a tool" and that a person has to be diligent with food choices, exercise, etc., and I TRULY thought I "got it," I don't think I was fully prepared for the reality.  Other than not being able to eat the massive amounts of food AT ONE TIME that I once did, I feel in a lot of ways that I'm almost like "before" as far as difficulty in keeping it off.   I would have the RNY again IN A MINUTE--no regrets whatsoever--because it allowed me to take off 140 lbs. after decades of morbid obesity and multitudes of diets.  I am so much happier now--even with the difficulties maintaining (I have regained some) that I can hardly describe it!  But do not be deceived that you will be forever changed--without a lot of constant hard work and permanent lifestyle changes! You're asking good questions!  Continue to find out all that you can so that, if you decide on some type of wls, you will do it with as much info. and preparation as possible!

Thanks for shedding some light on that.  What you described makes sense now.  Good luck to both of you with maintenance.   Ann

I agree totally with what Judi and Jo said.  I just have 2 additional warnings.  I could never learn to eat slow.  It's very important that you comply with that.  Because I didn't, I know I stretched my pouch. I know you read our posts and said,  "I won't let that happen to me".  I know because that's what I thought 2 years ago.  But it does happen very easily.  this is a lifetime lifestyle change, not an easy diet you go on for a year or so. That said, I'd also do it again in a second!  Good luck to you!

when you say you never leaned how to eat slow, at what pace do you eat? I take a bout 1/2 hour on average and about 40min at most. I know Ilet myself got to hungry sometimes and I seem to myself to eat a little faster at times though.

ANN-You have gotten EXCELLENT answers to your questions--now--let me give you the "nursery school version"-the one that worked best for ME..lol...Take a funnel...try to cram 3 oz of chicken thru it--see how long it takes...Now..take a whole bag of fritos or potato chips..same funnel--start pushing them thru--bet they go thru easier/faster than that chicken did--make  sense? I saw that at the first seminar I went to and it just stuck with me..NOT to say that I never eat Fritos, or that I've been a "perfect WLSer"..not hardly..but..your question brought that visual image back to me, and I'm going to reapply it to my own life. Hope it helps YOU too!

Gina AKA Nurse Diva

I have gotten great answers.  Everything you all said has applied (even the part of "oh that won't happen to me").  The fact is, I'm scared to death that it WILL happen to me and since I am viewing this as a last ditch effort, I can't bear to imagine gaining back whatever I end up losing. Thanks for all of your input. Ann

Hi, Ann; You've gotten some really great answers to your question, and I can understand your fear at regaining, because it is an ever-present fear among all of us. All I can say is that I'm just celebrating my 2nd year "Surgiversary", and I've never been healthier.  Yes, there were the fears about dying during the actual surgery (but I could get hit by a bus, too). and those who said "Jus****ch what you eat and exercise more" (as if I hadn't done that for most of my life), and then the problems with "grazing" (which we all have to deal with), but I'd do it again in a NY second.  Whichever surgery you decide to have, the actual results will be up to you.  The doctors can only operate on your tummy;  you have charge of the brain!  You will always have to be aware of your food intake;  but you have to do that  anyway.  (Don't you already have to deal with that??  Fritos=Fear and Loathing) You will have to buy new clothes;  Goodwill should become your new best friend! I look forward to reading your future posts on the Main Board when you scream with joy as you freefall through several clothing sizes, or worry about that odd hard spot on your elbow (the elbow bone!!) or the ones  that show up in various unexpected places (hip bones or clavicles, anyone???!).   And just wait for the day that you lose your sweatpants when you are walking upstairs!  I hope your hands aren't too full when that happens! You go, Girl!!! Good luck on your journey!