Further pondering here in long term

[CCPM]

This weekend I'm at a conference actually here to speak about research around new GP federations, I worked with a local one to prepare their bid to the Prime Minister's Challenge Fund and that was something many were interested in.

All OK no surprises there but I also sat through a workshop this morning about funding cases of exceptional circumstances, including bariatrics. I have to say the tone was very negative. The general feeling was that people had brought it on themselves, should have avoided doing this and why should surgery be funded. It made very interesting listening I really got the vibe that a very hard core of resistance is building against funding bariatrics.

Now I was lucky enough to fund my own surgery and subsequent plastics. Do I believe the above argument? I have to say in respect of myself that I do. I have no problem loosing weight once I get started, its keeping it off that is the problem. So yes really I failed myself. I do think that I should have learned the lessons and applied then through to maintenance. Even now I easily slip back into over eating or eating the wrong things. Yes at present I, at 10 stone from almost 35, am managing well but the current low is due to a major illness. As I get better the lack of control and making bad food choices is rearing its head again along with the inability to keep control.

Some few folks seem to be able to get their head round eating sensibly, exercise and act like a 'normal' person. I am so hoping that I can make this shift too this time I need to I must do

What do other long termers think?

 

[ThinnerJemima]

I would have been sitting on my hands to prevent me slapping someone.

Two years ago on a cruise an Israli woman at dinner became too scared to sit next to me at dinner as she started banging on about fat people on the cruise, the other lovely couple on our table knew about my surgery and didn't judge me. I didn't slap her but I let rip on her for sure.....

If I could keep this off without 8 procedures and £30,000 then I would have.

 

[chrisa]

People are very opinionated and while people do respond like this about funding what they don't realise is that it takes well over a year for most people to get surgery done. I certainly didn't enter into this journey lightly, however I do think there is not enough aftercare. Its head aftercare we need and I WILL BE TOTALLY HONEST=I AHVE ALWAYS ATE HEALTHILY, bigger portions than I needed but have been on a ww based diet for years always fruit n veg water and exercise. At my heaviest I did Zumba and pilates and the gym never missed a session. I like you have done it myself but always managed to put it back on. I too have come to that part now where some has gone back on. I am greatful I got funding for my op but plastics was something I never ever thought about. I still have a sweet tooth, I am 3 1/2 years post and find that I am better off eating a proper meal than a sandwich. I do enjoy a sandwich but feel like I should have something else as well. That's the old head issues again though. I think those who twist want to walk in these shoes and try them on for size. I have spoken to people who have decided on a whim to go private and then thought they had mad a big mistake and no after care whatsoever. A t least I had nearly 2 years to get my head around things. Also there are a lot of slim people out there who can eta fro England and any old crap too and put on no weight at all so its juist not clear cut at all.

 

[los in it]

I think some people see overweight people and think "they have lose control its his/her fault why should I pay for them to have WLS cut back on the pies and exercise" as we all know its not just about the over eating its so much more than that the amount of times ive read and done myself ,joined slimming clubs, brought slimming pills, got healthy cookbooks lose some weight but something happens and you fall off the wagon ,put it all back on and then some extra for fun(!) its like a merry -go- round of misery but to those who know us we put on a mask to get thru the day but inside we are slowly dying it takes something in our life`s to make us take that first step to change our life.
I sometimes think when you see overweight celebrities on tv saying "size don't matter im happy been fat" I think you fibber I know how you feel ,then I see them losing weight looking happy and I think ,told you your a fibber
I will always be thankful that I was funded by the NHS and I tell anyone that ask me that
this WLS as been the only think to have taken the weight off and kept it off I may be only just 5 months post op but the difference as been amazing I feel like a new woman given a gift to change my life and I can only wish that those who bar hum bug it could just spent time with someone in our group life our former life for a day a week even all parts of it not just a fat suit and extra large meals ,all the head stuff we go thru ,get a true understanding of our life, the way people whisper about you when you walk by, not sitting next to you on a tube /bus incase they catch been fat from you (!)looking at what is in your shopping trolley looking for sweet treats the list is endless. I think I was very lucky to get my WLS when I did as I guess its now a hot topic and the rules for WLS seems to have changed making it much harder to get I guess if I was starting my journey now it may take so much longer and much more hoops to jump ,so im one of the lucky one`s
sorry that turned into a bit of a rant !

 

[shell-]

I'm not sure if at 6 months out I'm considered a long-termer, but I'm here

I'm sad to hear there seems to be such a resistance to bariatrics. Especially when the medical evidence is starting to clearly show that bariatric surgery is the best way to deal with long-term obesity, especially when there are co-morbidities.

As stated above, though, aftercare is seriously lacking. Once the op is done, that's it. Nobody cares about your head. I had my op at Salford, and the team there seems OK, but I've only seen them a couple of times, and last time I was there (about 4 months out?) I was discharged from them. That's fine for me, I'm doing really well - my head issues haven't seemed to come back (but at six months, I consider this to still be early days), and my whole life and attitude have changed. But I'd love something like a support group in person to attend. We do have one at the hospital once a month, but it is strongly geared for pre-ops, and I just don't get a thing out of them.

 

[Yvessa]

I have to be honest here CCPM, I'm all for personal responsibility, as that is what has kept me losing, but I completely disagree. I ate exactly the same as my sister when younger, if not less as she was allowed 'nicer' things in her lunch and I was not because I was too fat. I tried very hard to lose weight to the extent that I stopped eating more than one meal a day. If I wasn't so fat, people would have worried I was anorexic. My mum actually thought it was a good thing. Ultimately it emerged there was a hormonal issue and I was told to only eat salad.

Since the op I am so much more aware of the hormonal urges and the events leading upto a day where I have less control. I have tried many things and at the moment am trying clean eating (cutting out all process food and added sugar). This scared me. I honestly did not believe I could do it. But having done it, I have zero cravings.

Now, its been my choice to be as compliant as I can be, but the chemical crap they put in food as standard messes with the brain. And frankly I couldn't afford to buy the better stuff until my circumstances improved.

I also think that the medical profession don't like what they can't fix. I think they know obesity surgery is a bit like sticking a plaster on an open wound - its not a real fix in the sense that the issue is the head and the hormones. And they know they can't fix that.

 

[HelenAngelfish]

I agree with Yves. People don't like what they can't fix easily.

I too have a hormonal imbalance (pcos) which makes my body physically crave carbs/sugar (has led to insulin resistance/too much insulin resulting in weight gain)

Yes. Personal responsibility does come into play, for some people. But obesity isn't just about eating too much of The wrong things, it's so much more than that.

My Bariatric team have been great. But now I'm 7 months out my check ups are now every 6 months and I'll get discharged after 2 years... I still have cravings for carby food (note my crisp addiction) as my hormonal imbalance is still a major factor. Loosing weight is harder even with surgery... I've been told they can't help with this. As the endocrinologist only can advise to lose weight (seems losing 8st isn't enough). I've had CBT and this hasn't helped, as the cravings are physical not mental. The psychologist basically said they can't help either, nor could a psychiatrist.

So even with surgery, I will always have a yo-yo battle. And as this is still new ground medically, I think I'm pretty much on my own with this for the rest of my days.

More funding is needed into bariatrics, not just the surgery. But the hormonal side of it.

Cutting away peoples stomachs or rearranging the digestive system is just the beginning... People's ignorance and fattist attitudes need to open to see this medical condition is far more I depth than someone's eating too much.

The government also need to control the foods that are being sold.

Too much processed and plumped out foods.

I've tried extra hard to eat from only butchers, farm markets. Everything cooked from scratch. Only halal meats etc. And 99% of the time it works. But my hormonal cravings are still there!

PCOS is a new illness (less than 60 years old) as is crones... The sugars and processed crap in our diets has a lot to answer for.

xx

Sent from my iPhone using WLSurgery

 

[CCPM]

Ah didn't explain myself well. I agree obesity has many causes. Hearing the speakers at conference I agreed in part with what they said FOR ME. I was always able to loose vast amounts of weight but NEVER keep it off. For me Bariatrics has proved a temporary fix but not a permanent solution. That solution seems to lie in my head.

Now I do truly believe there are many with underlying things that mean they cannot loose weight easily whatever they may be. What I was saying was that I (and I think many others) would not succeed due to bariatrics alone. Given the high incidence of regain for post op bariatric folks this would seem to be true. If this is the case then in times of such extreme funding pressures then funders seem right to question support of bariatrics, for a health economist the financial outcomes would just be too poor.

Here we return to my constant drum beating if we only retained more folks who had the surgery and saw their real life outcomes, no truth withheld, we could argue against/for this far more effectively.

I have absolutely no criticism of anyone seeking bariatrics. I know there are many genuine cases of not able to loose weight out there but there is a vast difference between can't loose weight and can't maintain weight loss. All I suggest is we keep an open mind. How many folks post "can't loose weight' but do the milk diet or other diets to get the surgery and do loose? Yes well how did that happen if you can't loose weight? Hmnn can do it for 2 weeks, 3 months, get the op. OK but need to agree yes you could loose weight. That isn't the issue its loose weight when employing bariatrics then can't maintain it. That is the cost implication for health economists.

Look at the regain stats and realise just how relevant this is. My post is not to justify cutting bariatric support just to get folks who see it as the holy grail the once and for all solution to wake up and smell the coffee. Get the op, enjoy the honeymoon fine ……. AND THEN WHAT? For a brief moment many are relatively slim…enjoy that moment without a plan hard work and following a controlled eating plan and exercise it won't last.

Now who the devil tells you that pre-op? Who will be in your corner whispering that truth in your ear to give you a heads up as to what you will very likely need to do? And how many out there pre-op give long term a second thought, they will cross that bridge (successfully of course) when they get there.

Hope that makes it clearer. Oh and by the way never worry about disagreeing with me thats what it is all about healthy debate

 

[HelenAngelfish]

Aaaaaaaaa I see your point.

I'm only 7 months out and you're right. Did I think about my eating long term when I had the surgery? Not really. I just wanted the op so badly.

I also didn't have to jump through hoops or do milk diets, just my preop - which I did stick to like a religion! For fear my op wouldn't happen although it was hard.

You're also right that I can't see any after care for the mind. My head is the same with the exception that I have not touched a fizzy drink - the only rule I seem to be able to stick to. More long term care is needed.

In America (the TV programmes I've watched) once patients have the surgery the need to submit food diaries, to show they are sticking to the plan, showing calories and protein intake. And if the scales don't show a loss matching that? They are told off.

Now if I had to do this I can honestly say if I had to do that. It would probably help me more. xx

Sent from my iPhone using WLSurgery

 

[Yvessa]

Ah didn't explain myself well. I agree obesity has many causes. Hearing the speakers at conference I agreed in part with what they said FOR ME. I was always able to loose vast amounts of weight but NEVER keep it off. For me Bariatrics has proved a temporary fix but not a permanent solution. That solution seems to lie in my head. Now I do truly believe there are many with underlying things that mean they cannot loose weight easily whatever they may be. What I was saying was that I (and I think many others) would not succeed due to bariatrics alone. Given the high incidence of regain for post op bariatric folks this would seem to be true. If this is the case then in times of such extreme funding pressures then funders seem right to question support of bariatrics, for a health economist the financial outcomes would just be too poor. Here we return to my constant drum beating if we only retained more folks who had the surgery and saw their real life outcomes, no truth withheld, we could argue against/for this far more effectively. I have absolutely no criticism of anyone seeking bariatrics. I know there are many genuine cases of not able to loose weight out there but there is a vast difference between can't loose weight and can't maintain weight loss. All I suggest is we keep an open mind. How many folks post "can't loose weight' but do the milk diet or other diets to get the surgery and do loose? Yes well how did that happen if you can't loose weight? Hmnn can do it for 2 weeks, 3 months, get the op. OK but need to agree yes you could loose weight. That isn't the issue its loose weight when employing bariatrics then can't maintain it. That is the cost implication for health economists. Look at the regain stats and realise just how relevant this is. My post is not to justify cutting bariatric support just to get folks who see it as the holy grail the once and for all solution to wake up and smell the coffee. Get the op, enjoy the honeymoon fine ……. AND THEN WHAT? For a brief moment many are relatively slim…enjoy that moment without a plan hard work and following a controlled eating plan and exercise it won't last. Now who the devil tells you that pre-op? Who will be in your corner whispering that truth in your ear to give you a heads up as to what you will very likely need to do? And how many out there pre-op give long term a second thought, they will cross that bridge (successfully of course) when they get there. Hope that makes it clearer. Oh and by the way never worry about disagreeing with me thats what it is all about healthy debate

but in the case of regain, only rarely is it total regain. From what I've read the health improvements are maintained. I do think bariatric surgery is not the final answer because it continues to be a battle but equally it is the best answer out there. And certainly with people still living in the dark ages and barking just eat less and move more, is enough being done to find a total solution?

 

[shell-]

I'd be interested to see the regain stats that are being talked about. Most of them I read talk about minor regains (20 pounds-ish), which in the scheme of things isn't much at all.

 

[chrisa]

My regain is about 2 stone just over I have manages to get 4lb off in the last 3 weeks. It is maddening really because I know my clothes were getting tighter I just didn't want toi admit it, once over seeing those numbers would have knocked me into a binge on some sweet things or just excessive meals even though they were healthy. I wish i HAD NEVER GONE BACK ON ANY SWEET THINGS AT ALL my cravings are stronger now than they ever were. Its a hard ball game now xxx

 

[CCPM]

The stats I can access come via my work so I can't post them up. However not copping out just pop gastric bypass regain into google or look on any American weight loss site and you see many folks undergoing regain way above 10-20%. At my weight loss that would be regain projected at a max of 4.5 stones. Not many folks loose 23 stone so the regain may be half that at most, say 2 stones, many regain far more than that. If we all coped with 2 stones of weight gain and stopped it getting further none of us would have been candidates for wls in the first place would we? Why after wls should we all be able to cope with sticking at a 2 stone regain unless we have changed our ways or our medical problem has gone away? If we had done that why are we regaining? Questions not criticisms.

Plus if post op you have little or no after care then your outcome is lost to the system. Surgeons stats reflect what they know and record not the whole picture. Accepting regain at 20%, when is that measured? 1 year, up to 5 years? What then? There are just not the UK data sets available yet.

Never want to be too contentious, so would always say that if people believe that is the maximum regain level that is fine. Knowing over 12 people who had their op when I did 6 years ago who report regaining over 65% of their weight and 3 all of it, plus the research I've done, I post just what I see with my aim to promote long termers discussion of core topics. One person's opinion no more no less, everyone to their own thoughts and all valid.

 

[shell-]

Pop gastric bypass regain into google or look on any American weight loss site and you see many folks undergoing regain way above 10-20%. If post op you have little or no after care then your outcome is lost to the system. Surgeons stats reflect what they know and record not the whole picture. Accepting regain at 20% when is that measured? 1 year, up to 5 years? What then there are just not the data sets available yet.

Never want to be too contentious, so would always say that if people believe that is the maximum regain level and that is fine. Knowing over 12 people who had their op when I did 6 years ago who report regaining over 65% of their weight and 3 all of it, plus the research I've done I post just what I see. One person's opinion no more no less, everyone to their own thoughts.

I get what you're saying, and that's why I asked about the stats. Wondering if I'm deceiving myself that I can get down to my personal goal, and if I can maintain it. Educating myself on avoiding the pitfalls and issues that cause regain, and trying to keep myself motivated and happy like I am right now.

 

[tranquil_butterfly]

On the regain point. Admittedly I had problems with my band but when I got to the end of July of last year and started the pre op for the first time for my revision surgery I weighed myself and weighed the same as I did when I started the pre op for my first WLS in 2010. I was shocked. How did that happen? Reflecting on it - lack of after care - when things started to go wrong they were not really focussing on what was happening to me through all of it. I had not learned enough about coping with my issues with food and how I got to where I got to in the first place.

Will things be different this time? Well...time will tell. I would like to think not. With a sleeve I hope it will not be so easy to regain that quickly - I say I hope. I think a lot more about my relationship with food. I want to be healthy. I appreciate the second chance I have been given and owe it to my late dad and the rest of my family to get this right this time - even though I still have not got round to telling them about my revision.

Never say it can never happen to me because it can.

TBx

 

[CCPM]

but in the case of regain, only rarely is it total regain. From what I've read the health improvements are maintained. I do think bariatric surgery is not the final answer because it continues to be a battle but equally it is the best answer out there. And certainly with people still living in the dark ages and barking just eat less and move more, is enough being done to find a total solution?

Not sure that is what I was saying Yve and there is no denying for the majority eat less and move more does work, but again only if you keep it up. Personally given chronic arthritis I couldn't move less if I tried. Is there a total solution to this no I don't think there is yet?

As regards health improvements remaining I hope that they do but out of interest one of my colleagues is currently investigating the recurrence of diabetes in patients over 5 years post bypass. He has a number of incidences and is exploring further. Its early days it may not be significant but it is there. What happens in the very long term is just not known thats all I would say.

 

[Yvessa]

I would agree that some do regain all. Personally I aim to keep within a stone either side but I know it won't be easy.

 

[Yvessa]

Not sure that is what I was saying Yve and there is no denying for the majority eat less and move more does work, but again only if you keep it up. Personally given chronic arthritis I couldn't move less if I tried. Is there a total solution to this no I don't think there is yet? As regards health improvements remaining I hope that they do but out of interest one of my colleagues is currently investigating the recurrence of diabetes in patients over 5 years post bypass. He has a number of incidences and is exploring further. Its early days it may not be significant but it is there. What happens in the very long term is just not known thats all I would say.

yes that I would agree with wholeheartedly. But surely the answer there is to continue monitoring past the two year point.

 

[ThinnerJemima]

Definetly think that more diabetes monitoring is needed. My surgery didn't cure mine, if anything as time goes on my medication is increasing. But who knows without the surgery things could have been a lot worse.