159.6

0.6 above goal.  Creeping downward from a recent high of 162.8.

Yup, I'm going to have to Watch My Weight for the rest of my life -- and I knew that going into the duodenal switch.  One of the more irritating things I used to read on DS discussion boards were folks who believed that the DS would give them license to eat whatever they wanted.

I do believe that, in general, the duodenal switch is the most powerful form of WLS currently available in terms of 1) the greatest amount of excess body weight lost and maintained over time; 2) the reversal of Type II diabetes; 3) allowing the greatest flexibility of amount and kinds of foods that one can eat. The data in JAMA and other medical journals all bear this out: I did my research, inside and outside the bariatric communities, and that's why I chose the DS.  The stats for these categories in terms of gastric bypass and lap band are good and okay, respectively (ironically, the lap band has gotten a lot of press recently for its ability to reverse Type II diabetes, but its stats for that are still not nearly as good as those for the DS), and that's why I selected the form of surgery I did. 

(Caveat emptor:  surgery is not for everyone, and if you've determined it's your choice, then you need to pick the surgery that's right for you. Each form has its advantages and disadvantages. As with most things in life, one size does not fit all.)

BUT.

But eventually the window of easy weight-loss closes, even with the DS. Eventually losses slow and stop.  Eventually old habits and tastes tend to creep back into your routine -- and then you'll have to monitor yourself.

Also -- and this is important --  if you haven't done the head work and psychological investigation of why you ate to excess before and the extent to which your food issues were tied to emotional issues, they'll surface and bite you in the ass. Hard.  Those don't go away with weight loss, if they were there to begin with.  Trust me. Trust Jen.  My own ass would be very sore right now if I hadn't had 8 -- yes, 8! -- years of psychotherapy in my 20s-30s.  As it is, I still have bouts of emotional eating, and I still trip out playing the Scale-and-Mirror Mind Fuck game.

Eventually you will want those Girl Scout cookies again, even though sweets may have had no appeal in the first 6-9 months after surgery.  Or you'll want the bread. Or whatever.  And you can have them --  but if you eat them to excess, you'll  gain weight. Period.

And that's okay -- because the DS is still an extraordinarily powerful tool.  Cut back on carbs, increase your protein, add a little more activity -- and your weight will drop. Relatively quickly and efficiently. And that's a gift because the immediate weight loss reenforces those positive habits in ways that I just didn't experience pre-WLS.

Just understand the gift going into it, if you possibly can, and do what it takes to get ready for it.

Comments

[Dagny]

Ultimately, I look at what all these surgeries help YOU do, and as you said, YOU must be willing to do the work! Personally, I get so tired of the arguments for or against one surgery or another because what you do with the tool you've been given will decide what your results will be, not statistics. We all figure out eventually that it only SEEMS like the surgery does it FOR you. What it does FOR you is facilitate behaviors you must make your second nature before the training wheels come off! Statistics and averages and percentages and study results---it's all a useless load of crap if you don't do the work! My neighbor got gastric bypass results with a lap band. My high school friend lost about 50lbs with her lap band and nothing more. I went from high blood sugar and being on Avandia to normal blood levels and no drugs in a month. ONE MONTH.

Get the results you earn for yourself from any of the surgeries!

[Deluzy]

To an extent I agree with you, Dagny -- you have to own the surgery you pick. On the other hand, I firmly believe people really need to do their homework about the kinds of surgeries that are available. They need to figure out what they are and are not willing to do in order to pick the one that they can "work" and that will work best for *them*.

Statistics, averages, and percentages aren't guarantees of success or failure -- but they're not useless information, either. It seems to be that a lot of folks don't do the research BEFORE or the work AFTER surgery -- and there's plenty of both to be done on all fronts.

[Dagny]

Indeed...the best example here is probably the people who choose lap band. If they try to compare that surgery to any version of gastric bypass, they need to understand they'll have to do MORE work, probably for LONGER, and their work and issues will be different from what people like you and me had to deal with.

I've had a long conversation about the WLS impact on blood sugar with someone I know. He's been struggling to lose weight for about a year and a half and he deals with blood sugar problems. I'm not sure if he's full-blown diabetic now. I know he's on meds that have made it difficult for him to lose the last 75-ish lbs. he wants to lose. He's lost over 100 with diet and exercise but his blood sugar is still a problem. He's told me his doctor has suggested lap band to him.

So now they're claiming lap band impacts blood sugar. Hmmmm. Well, here's what has always intrigued me. My doctor told me I was on a collision course with diabetes. I was on Avandia. I was pricking my finger twice a day. I went off Avandia before my surgery and never went back on it. I lost just 27lbs in my first month. BUT MY BLOOD SUGAR WENT TO NORMAL. In a freakin' MONTH!

Had I been able to lose 27lbs with diet and exercise in any amount of time, I do not believe I would have had the same result. What was it about having had surgery that brought my blood sugar to normal in a MONTH with just a 27lb weight change???

My mother works at a major medical center in Florida where they perform gastric bypass. One of the things the surgeon says is that a patient's blood sugar is stabilized when they leave surgery. WHY? HOW?

If my friend has lap band, will his blood sugar respond in a way that a previous 100+ lb weight loss hadn't accomplished??? What does surgery cause to happen that "conventional" weight loss does not???

I DON'T KNOW!!! But I'd like to know....

[*S*]

Unfortunately, even with the DS, not everybody is so lucky. I absolutely agree with both of you about surgery v. lapband, but there is a really unfortunate group who won't have the resolution despite surgery + compliance. The current scientific thinking is that the length of time one has had type II affects the efficacy of the surgery, i.e. after five years of being diagnosed with the disease, your chance of complete resolution (medicine free normal glucose levels) decreases. Interestingly enough, the effect appears to be less pronounced the higher your BMI, which probably supports some part of Dagny's query.

*S*

[Deluzy]

*S*, you're right about most of the literature indicating that the complete resolution of Type II diabetes may occur less frequently, even with the DS, the longer that one has 1) been diagnosed with the disease; 2) had poorly controlled diabetes. There's likelihood, there's luck, but as I always say, there are no guarantees.

I lucked out: I'd been diagnosed as a diabetic for well over 10 years, my blood sugar had been out of control for about the same length of time, and I did not resolve immediately -- but I did resolve within a few months. I'm in full remission at the moment: normal glucose, off all meds.

Will that always be true? Hard to say. My instinct is probably not: my mother was tall, thin, and diagnosed with Type II diabetes in her 50s. The same thing could easily happen to me. But I'll have bought myself some time.

Dagny, "What was it about having had surgery that brought my blood sugar to normal in a MONTH with just a 27lb weight change????" Actually, I spoke with a DS surgeon about this, and the jury (i.e., conclusive medical evidence) is still out on this one. However, there's some indication that the lowering of glucose levels with both the RNY and the DS are linked in part to the ways in which the surgically tweaked body now processes *fat*, interestingly enough -- not that they're identical in both kinds of surgery, but on the other hand, that component is entirely missing with the lap-band.

[*S*]

Ah, I always forget you had type II that long, Deluzy. I'm thinking of Starry's husband and my mother, mostly, the latter who wasn't given a very rosy prognosis with the DS from Rabkin or Buchwald. She's got other complicating factors as well, including MS, and one person does not a sample make.

Some people's issues resolve immediately. I was the horrid opposite. I went into surgery with normal blood glucose. I came out of surgery with levels of 300+. Glucose was being pumped into one arm and insulin shot into the other. It was surreal and disheartening. I had no idea if this was post-traumatic or post-surgical diabetes or if I'd just bet all my money on the wrong horse. Fortunately, mine did resolve in about 48-72 hrs and I've never had any problem.

I think there is a huge link between the way that fat is a) broken down/processed/stored and b) how that process affects hormones. But that is a layman's speculation, not based on any research I've done.

*S*