I've been there with you but backed away a bit because I wanted to give it one more chance before doing something so drastic (not that THAT is working out so grandly mind you).

But then again you have the immediate health issues to consider and that is a big issue. So pursue your options. You have to do something...

If I had kept going I would have chosen the same as you for the same reasons. One of the criteria for surgery that I needed to satisfy was that I needed to have weight loss medically monitored for six months (weight watchers meetings count too). I was seeing some improvement from that so even that part of the process helps.

The one thing I'd add that I didn't see you mention is that the studies I've seen on the lap band seems to show that they lose effectiveness after two years or so. You have to go into it thinking it is a chance to give your health some breathing room and to more easily develop habits that will sustain you later because it is likely not a permanent solution.

We're in a hard place, one that not a lot of people understand, but it is good that you're on considering positive action -- best of luck!

I hadn't heard about those studies about the lap band. I'll have to check further into that. My program requires at least 3 months of medical supervision, and has a very good reputation. I have to attend several classes and support group meetings, have to meet several times with a dietician. Also go through screening with psychologist, cardiologist, neurologist (because of the TIA I had last year), and a few other professionals. I also have to lose at least 5% of my body weight, and keep it off until the surgery date. There is a long list of criteria I have to meet. And I'm glad of that. I wouldn't want to be part of a program that would perform the surgery on anyone who wanted it.

I'd encourage you to read the 4 Hour Body or Wheat Belly if you get a chance. They both may shed some light on potential problems you've had with weight loss - the tie in with diabetes makes me think the solution isn't the overall restriction of calories, but the wheat and carbs.

I've known a few people who've had the surgery. They have all been glad they did it, they are gradually gaining weight back and have had some complications, so it's not a one time permanent solution, but it has overall improved their lives I think. The side effects from the surgery are less than the side effects of the weight they were carrying. I'd still encourage you to read one or both of those books though.

It's not so much the losing weight that I struggle with as much as keeping it off. I've probably lost hundreds of pounds on many different diets over the course of my life. But the weight always comes back. I went on my first diet when I was only 12 years old. I don't think of surgery as a cure, just as a powerful tool. But it's a tool that will require me to change the way I do things for the rest of my life.

focus more on considering it a lifestyle change.

I did atkins before and lost a decent amount of weight, and then returned to eating "normally" - adding wheat and sugar and pasta right back into my diet, and gained it all back (and more). These are more about permanent changes not in the amount you eat, and in fact it's specifically NOT about calorie restriction, but getting a better understanding chemically of why it's better to cut out those types of foods 6 days a week - and (in the 3 hour body plan) why it's better to have a refeed on day 7, as part of a permanent plan to increase your metabolism and control insulin/insulin resistance, instead of a temporary plan to drop pounds. For me, mentally, knowing I can eat whatever I want once a week is the thing that makes it possible for me to stay on it. (I'm at 7 months right now, hoping to stay permanently on it.)

I don't know that a refeed of grains/carbs would work with bypass though - I'm not sure if there's a quantity of food you'd be limited by that would prevent the two plans from being compatible. I do know that both books gave me a better understanding of why things were making me gain weight even though I ate healthier than almost everyone I know, excepting some vegans.

The surgery itself very often stops the disease. Not the same with lap band.

There should be a waiting process of all types of bariatric surgery. Many insurance companies require a six-month supervised weight loss program. Others just require a certain BMI. Most good surgeons - they should be Centers of Excellence - have a pre-op program that takes a few months. It's good because it allows patients to learn new habits. No soda, no drinking with meals, eating really slowly, chewing a LOT. And they should require a psychological screening.

Have you looked into the vertical sleeve gastrectomy? It's another option along with band and bypass. Basically it's the first part of the gastric bypass that reduces the stomach but it doesn't realign the intestines. So the malabsorbtion issue isn't there.

I personally know many people who have had weight loss surgery with successful results. I also know people who have had the lap band but find a way to defeat the process and end up having it removed and a revision to bypass done.

With all of these surgeries, taking vitamins and supplements will be a life-long thing. And dumping doesn't have to happen. People dump on sugar and fats. But not everyone experiences it the same way, or at all. But the negative reinforcement of dumping can be a good thing. It'll keep patients from eating things that will sabotage their efforts.

Good luck.

But both of my parents and my only sibling developed type 2 diabetes in middle age. They were also all obese. Considering my weight and family history, it's suprising that I haven't developed it yet.

The hospital I am going through is a Center of Excellence. Their pre-op program is pretty extensive. I have just started the process. I went to the the introductory nutriton class earlier this week, and the food plan they prescribe includes everything you mentioned. They also do sleeve gastrectomies. But I am hoping to go with the least invasive procedure possible. I know people who've had both gastric bypass and lap band. The person that had the lap band done has struggled somewhat, partly because it does allow you more freedom and choice. But she has lost a significant amount of weight, and has kept it off 18 months after surgery. But she still has some more to go.

I don't want to never have another sweet treat for the rest of my life. I would just like to be able to eat like a reasonable person, and be able to stop at just one.

I researched for about 3 years before making a fully informed decision as to which surgery would be best for me.

*edited to add* I went from 302lbs to a maintained weight loss of 139lbs. I had surgery March 15th 2005.



As you well may know there are many types of surgery for weight loss.

Lap Band, least invasive of all surgeries but without the huge weightloss results. I have 2 friends who've had this and neither is happy with the results.

Roux en Y, Does not retain the pyloric valve therefore you lose the advantage of digestive juices and also RNY patients are prone to dumping syndrome. People who have the RNY have a pouch.

Sleeve Gastrectomy, the stomach is made smaller therefore your intake is restricted. this surgery is often done in preparation for the BPD/Ds on patients who are so obese that the entire surgery, the diversion with the switch could be life threatening. Stage two is often done after significant weight loss and health improvement.

Bileopancreatic Diversion with a duodenal switch is the most invasive of all the surgeries. The stomach is reduced in size to about 3-4 ounces (it will stretch a bit over time) and the intestines are re-routed. This is also the most successful of all the operations. Not only do you get the restrictive element but you get the malabsorption part too. IF you don't look after yourself properly, IE: take all of your vitamins and supplements, eat properly and stay hydrated the malabsorption can lead to serious problems.

I have found that most primary physicians are not well schooled in Bariatric Surgery. They seem to be of the opinion that they are all the same. You'll need a good Surgeon, a good Primary for follow up and probably an endocrinologist to monitor all your lab work/results.

When I was looking for a new Dr I prepared this for him.

*****************************************************


• I have had a combined restrictive-malabsorptive procedure in which the restrictive part will substantially resolve over time, but malabsorptive part is permanent.
• Because of this malabsorption, I need regular bloodwork to confirm I am absorbing enough protein, vitamins, and minerals. Please see the list that I have attached of blood tests that I need annually or more often if I am having a problem.
• I malabsorb DIFFERENT vitamins and micronutrients from gastric bypass patients, and I need you to NOT make assumptions based on what you may have read about regarding different procedures. In addition, time-release medications may not be appropriate for me.
• Fat-soluble vitamin and calcium malabsorption are primary concerns because of the duodenal bypass, and must be monitored closely -- and SPECIFIC tests that my surgeon recommends must be ordered routinely -- this is NOT negotiable. Calcium must be monitored via PTH and vitamin D3 -- perhaps not the usual tests you routinely order for non-DS patients, but none the less I will need this testing frequently and I will need your support in this matter. I may also ask you to provide me with or fax copies of my lab results to my DS surgeon, who has additional expertise in helping me manage my post-op long-term care. A copy of my annual lab requirement is attached.
• From time to time there may be specialized tests that my DS surgeon will request and I will need you to support and respect these requests.
• Other tests, such as albumin, liver function, etc., are also extremely important, as is a baseline and at least every other year I will need a DEXA scan.
• I do not absorb 80% of the fat that I consume, so please do not get concerned that I am eating too much fat. I also malabsorb about 30-50% of the protein and complex carbohydrates I eat, so I must eat more protein than you might think appropriate.
• My primary challenges with living with the DS are, in no particular order:
o Eating 80-100 g of protein/day
o Taking my supplements
o Monitoring my labs to head off any problems as quickly as possible
o Dealing with the stool and gas issues, both volume and smell, which in most cases may be a direct result of my diet: complex carbohydrates, especially white flour, increase the smell and volume of both, and too much fat can cause diarrhea
o Sometimes, constipation is also an issue.

• The intestinal bypass may result in imbalance in the bacterial flora and I may ask you to prescribe unusual antibiotics from time to time -- perhaps even prophylactically if I have difficulties with gas and diarrhea - I need to know if you have a problem with this. You may be interested in information I have access to about non-prescription probiotic replacement products that I would be happy to share with you, and which you might find useful with your "normal" patients with intestinal issues such as IBS as well.
• Because I have a normally functioning stomach, I should not have any particular problems with taking NSAIDs or anticoagulants, in contrast with RNY patients.
• NOT every problem I have will be DS-related, just as NOT every problem I had pre-op was obesity-related (an unpleasant and dangerous issue many morbidly obese patients have experienced). Nevertheless, my DS needs to be taken into consideration if problems
•
• arise, either as a source of the problem or as a consideration in how medication will be absorbed.
• As with any abdominal surgery patient, I have an increased risk of bowel obstructions, even years after my DS surgery. These can be because of bowel slipping into internal hernias, or holes in the mesentery, as well as into spaces that develop because I have lost abdominal fat. However, there is one very important issue that is particular to the differential diagnosis of bowel obstruction in DS patients (as well as, to a lesser extent, in RNY patients): we can have a complete intestinal obstruction and still be passing stool and gas, because the obstruction can be in the biliopancreatic limb (and thus the alimentary limb could still be fully patent). Thus, it may be necessary to order a CAT scan for me if I present with severe belly pain, even if I am still able to pass stool and gas.

************************************
REQUIRED LAB orders.

ANNUAL DUODENAL SWITCH LAB ORDERS
Dx: POST-SURGICAL MALABSORPTION, 579.3a
Please Draw the Following:
• CBC
• COMPREHENSIVE METABOLIC PANEL
• FASTING LIPID PANEL
• FERRITIN
• FOLATE
• IRON
• MMA (Methylmelonic Acid)
• PHOSPHORUS
• PTH, intact with Calcium
• TSH
• VITAMIN A
• VITAMIN B6
• VITAMIN B12
• VITAMIN D, 25 HYDROXY
• ZINC
Note:
VITAMIN A REQUIRES 2 ML FROZEN SERUM
VITAMIN B6 REQUIRES PLASMA - FOIL WRAPPED
*********************************************

I hope this helped And good luck to you !!

aA
kesha
edited to fix 130lbs to the correct 139lbs --darned fingers.

where you are in the process ...

wishing you luck.

aA
kesha

So I've got a long ways to go. I still have to be screened by the neurologist, cardiologist, and psychologist. Still have the sleep study to go through, plus all of the medical tests you need before surgery. It will be at least June before I have surgery. I've already lost 10 lbs of the 13 lbs I need to lose before I can get approved. My problem has always been one of keeping weight off. I know I can lose weight when I put my mind to it. But it always eventually comes back.

I'm kind of scared of all the internal 'plumbing' changes associated with gastric bypass. And I'm ok with the slower weight loss associated with the lap band.

and (what sounds like)your determination you'll probably do very well with the lap band.

I don't know if you read my post above but I had the most invasive of the surgeries, the BPD/DS. I'm not in the least bit sorry that I did but I have had to deal with a LOT of differences in my life and a few health issues.

Even with the lap band you will have to be vigilant and listen to your body for any signs of anything that might be going wrong.

You're on a good path by the sound of it though.

aA
kesha

I was 360 at my highest. Something needed to be done. My Dr recommended the "sleeve" surgery. Honestly, if my insurance had paid for it, I might have had it done. They didn't and I went, instead, to Weight Watchers.

Best decision of my life. In hindsight, I would never consider the surgery again. Right now I'm down to 275 a year and (almost) a half later. It's a slow run, but I think that is best. I have learned a lot about why I eat and am learning the right way to control it.

I've been on many different food plans and weight-loss plans. I know why I overeat. I can lose weight, but I just can't keep it off. Because of my family history of diabetes, stroke and heart disease, I have decided that I need to do something that will help me keep my weight off for the long term. If I were younger, perhaps I would think differently.

At my highest, I weighed 359 lbs. I am down to, and maintaining about 155 - 160. I was considered heavy enough for a Duodenal Switch, and a sleeve was often considered a "first step" to make the DS safer.

By the time I started researching, many people had been having good results with the sleeve alone, and some insurance companies have started covering it as a stand alone procedure.

It has some advantages. There is no foreign body left inside, no need for "fills" and nothing that can break down. The plumbing, if you will, is not rearranged so there aren't some of the absorption/dumping issues that other procedures have. While there is a need for vitamin and mineral supplements, there is no requirement for a regimen of any other kind of maintenance meds.

One disadvantage is that there is no going back. (not that I can imagine wanting to).

ANY kind of bariatric surgery can be sabotaged. I I were to go back to constant grazing & snacking, I could put significant weight back on.

My biggest regret is that I didn't get it done when I was younger.

I'm glad to hear the sleeve worked out for you. I know a number of people who've gone that route and are very pleased with the results.

Good to hear from another person who's had bariatric surgery.

aA
kesha

And the hospital that I'm working with offers it. I am glad it worked so well for you.

If I were to consider a surgery other than the band, that would be my next stop. The less cutting and stitching of internal organs I can get away with the better.

I'd recommend it over the lap band to be honest. I think, and I've spoken to many who have had the lap band and have gone for revision surgery after not losing the weight they want to, that the sleeve has more chance for success and is much less invasive/intrusive than the Biliopancreatic diversion with the duodenal switch.

I realize the lapband is the least intrusive but for me, there are just too many ways to eat around it etc.

You know (I hope) that I wish you well in what ever you decide to do.

We'll be here to support you as you make the journey.

aA
kesha

I live outside of Philadelphia, PA. In Jan 2009 I had lap-band surgery. It’s a long, frustrating story, but my surgeon’s staff just flat out didn’t believe me about anything. I lost 30 lbs in 6 weeks, then started feeling sick and stopped losing, but was constantly sick. They told me to “come back when I was ready to comply”. I was complying!

I tried for 18 months to find a bariatric surgeon who would take me on. Nobody would post-op. Until I found a fabulous surgeon at Abington Hospital. He found that the band had slipped to around my esophagus, and was starting to erode the esophagus. Emergency surgery to remove the band. It was growing into my stomach and esophagus. Lots of scar tissue now L

Then I had to wait until a year after that procedure! But now I am in the midst of pre-cert for ds in June, hopefully.

Hopefully, since I already did the clear liquid/full liquid/soft foods progression with the lap-band, I’ll at least be prepared for it this time. I already take tons of pills, and figure I will just be taking vitamins instead of prescriptions! I also know even better how important support will be.

Diane

From: duodenalswitch@yahoogroups.com [mailto:duodenalswitch@yahoogroups.com]

One of the program "ambassadors" at the hospital's weight management center had a similar experience. He eventually had the band removed and had a gastric bypass. I realize that there are risks with every one of the procedures. But the program has a very good record, and has done thousands of bariatric surgeries.

I would likely go with either the sleeve or gastric bypass if I were significantly heavier than I am (My starting weight in the program was 261 - I am currently at 249), or if I were at more imminent risk of dire health consequences.

I know that it is easier to cheat with the band. I have watched a good friend struggle with that. But I know that I can lose weight. My biggest struggle is keeping it off permanently. Several years ago, I was able to lose 80 lbs, only to gain it all back over the following 3 years. What I really need is something that will make it difficult to fall back into those old patterns, and I think the band will do that for me. I know there will be a lot of hard work involved, whichever way I go.

But don't have a surgery date yet. I expect it will be sometime over the summer. My insurance requires (among other things) at least 3 months of medically supervised weight loss before they will approve surgery. I've lost 21 pounds this way so far. I have so far been approved by the psychologist, the neurologist and the dietician, and just had a whole batch of mandatory tests at the hospital last week. (Upper GI, abdominal ultrasound, chest x-ray, echo-cardiograph, blood tests, etc.) I meet with the cardiologist and surgeon later this month, and will be tested for sleep apnea later this month as well.

This program is very thorough, and I'm glad about that. I'm still feeling good about going forward with the surgery.

Thanks for asking.

Gives you time to wrap your head around the need to change eating habits, for example. I'm sorry if you've already said this but are there local support groups for you to attend?

Practicing how to eat S.L.O.W.L.Y is a big one. Chewing the heck out of everything. Putting the fork down between bites. Giving up carbonated soda and cutting back on caffeine.

And the waiting period also weeds out some who aren't willing to make the commitment.

Best of luck!

Like the eating more slowly and chewing more completely. There are support groups and educational classes available through the hospital's weight management center. I'm starting one later this week about the psychological and emotional triggers of overeating.

I have cut back on both carbonation and caffeine, but haven't given it up completely yet. I know the bubbles will have to go away forever. I'm told that I will be able to have a little caffeine after I recover from surgery, although it is discouraged. I know this is a huge committment, a forever committment. I'm glad that they make you wait. It's not something that should be done lightly.

and that bodes very well for them.

I'm glad you're still feeling good about your decision to have the surgery, it will go a long way towards your over all committment.

Congratulations on the 21 pound loss!!!

Do keep us posted please.


aA
kesha

I'll likely be so happy when I finally get my surgery date that I'll want to tell everyone.

Very sorry about that. So you going in for another surgery now? Post- op checking is very very important. This is why they say a weight loss surgeon must be very friendly and open and must be good all in all.

My journey is documented elsewhere in this thread.

I've lost much more than I now weigh and I'm very happy with my success.

My surgery was done in Michigan in 2005. There are a LOT of excellent surgeons here in the USA that perform Bariatric surgery and it's important to do your research.


Are you considering surgery? Are you planning on going to India? You seem to advocate going out of the country and I wonder what your reasoning is?

thanks.

kesha.

Looking through old OPs on Bariatric Surgery and found this.

I know you are still active and wanted to check in. Are you still pleased with your results?

I am well on my way towards a sleeve but not yet certain. Just curious about how it has been for you 6 years later.

Initially it's wonderful. I went from 360 to 155 over the course of about a year and 1/2. The thing is, the sleeve is only a tool. You still have to USE it properly to maintain results. While I can't eat very much at any meal (which is good). I am home most of the day, and I have always been a "snacker". Snacks can sabotage a sleeve easily.

I have regained a good chunk of what I lost, but am still in a much better place than I was. My weight HAS stabilized and I feel pretty good.

It is not an easy decision and I am seeking every scrap of information that I can find. I trust my DU community so I was hoping to find some heartfelt advice here.

I have heard a mixture on the long term efficacy of keeping the weight off. But if you kept at least part of it off, that is a plus.

I have never been much of a snacker. My problem is just eating too much at meal time. I can't be positive that I won't turn into a grazer but I have hopes that it could work for me.

Thank you so much for your answer and good luck in your continued journey.

It went well. Liked her a lot, and she thinks I'm a good candidate for the band. I still don't have a surgery date yet. Still need to get the sign-off from the cardiologist (appt is next week) and get tested for sleep apnea. (scheduled for 5/31) Once all the tests and doctor sign-offs are complete, the weight center will send everything out to the insurance company. If/when the insurance company approves, they'll be able to give me a surgery date. I'm hoping it doesn't take too long.

In the meantime, I've lost 25 pounds on my own in the last 3 months. I've always been pretty good at losing weight. But I totally suck at keeping it off for the long-term. The surgeon says that is one reason that I would be a good candidate for the band rather than the more drastic surgeries.

I'm glad you're keeping us posted.

Good vibes coming your way for the insurance approval. I hope they cooperate and don't give you any hassle at all.




aA
kesha

The surgeon says she thinks I'll get approved easily.

approved me! I was ecstatic and then, the nervousness hit !! LOL

You'll be fine. My surgery was about 5 hours long and so very involved. I wouldn't change a thing though.




kesha.

And will only require an overnight stay in the hospital.

I just found out that my employer-sponsored insurance will be changing as of 7/1/12. Because we are very close to going for insurance approval, if the cardiologist approves me tomorrow, my surgery date will be either 6/11 or 6/18. Will know more after tomorrow's appt.

Kind of nervous, but in a good way.

tomorrow night. We're leaving for a long weekend vacation and I won't have internet. Please post as soon as you get clearance! (See, I know you're gonna get clearance)



kesha

Unless my insurance turns it down, or a meteor strikes the hospital. Hoping neither of those happens.

Still waiting to hear if the insurance company will approve.

Even though the surgery date of 6/18 is rapidly approaching. Had the pre-op appt at the hospital this morning, including meeting with the anesthesiologist. The Weight Center told me not to worry, but I worry anyway. This won't be happening without insurance authorization.

All systems are go for surgery on 6/18.

I am SO happy for you.

Sit back and relax now and you'll be on your way soon.



aA
kesha

I have the mandatory pre-op 'band class' at the weight center this morning. Then I meet briefly with the surgeon again, then off to work. Another class at the weight center tonight after work (I told you they were thorough), part of a series of classes I've been attending about overcoming binge eating.

that you will be successful in your quest to lose unwanted pounds.

I look forward to following your journey and being supportive in any way I can.

You're going to feel wonderful!

aA
kesha

since 2/22. As I've said before, I'm pretty good at losing weight. I just suck at keeping it off. I'm hoping that having this surgery will help me finally lose the weight and keep it off for good.

And some of my friends are offering to take me out for meals that aren't all that healthy. This is what's known as "Last Supper Syndrome" by the folks at the Weight Center. Since I've lost significantly more weight than was required to qualify for surgery, there's no way I could gain back enough in one week to be disqualified. I did give in once so far, and let my best friend take me out for lunch for Mexican yesterday. (She had a 2-for-1 coupon for a local Mexican place) And while I enjoyed the enchiladas, I didn't feel all that good a few hours later. There is another friend offering to take me out for a meal this week. I will try to stick to healthier fare the next time.

and felt like hell afterwards!

I don't have many friends or relatives that live near me so I took myself out, hubby was working.

I bet you're getting excited!

kesha.

I've got a class at the Weight Center tomorrow called "Healing Faster", which deals with anxiety around the changes from the surgery, and teaches relaxation methods. Then a blood test on Saturday morning, because it has to be done within 48 hours of the surgery. And I'm due at the hospital at 6:00 AM Monday morning, with surgery scheduled for 7:30 AM.

Any positive, healing vibes you can spare would be welcome. If all goes well, I should be home mid-to-late afternoon on Tuesday.

have been researching the weight loss surgery and found this group. Again I hope everything is going well and all works out for you.

You're welcome to ask any questions you might have re weightloss surgery. I had the biliopancreatic diversion with a duodenal switch in 2005.

aA
kesha

for an appointment to talk with my GP about his recommendations. I will most certainly ask questions as they arise. Again thanks for the welcome.

After having lap band surgery on Monday. Doing well so far. If you decide to go this route, make sure you get into a good program. There are some less-than-reputable ones out there.

I totally agree with you about finding a good program. I did my research and went to a program that does over 1000 bypass surgeries a year with a 1% complication rate.

Not having much pain at all. Mostly I'm just tired. And I'm not really hungry. But I will be glad when I can eat solid food again. First post-op week is clear fluids. Second week goes to soft/pureed food. And if all goes well, I should be back on solid food by the third post-op week.

Lap band has the advantage of being reversible, but there all those band adjustments where they have to add and subtract fluid.

which is the fill level that works best for you.

Whichever program you get into will likely stress this as well - Remember that a band or a bypass is just a tool, not a cure-all. There is still a lot of hard work to be done after the surgery.

...I'm already obsessively neurotic about what I eat; surgery will just let me get results from being obsessively neurotic.

I've heard that Bariatric surgery cures diabetes, if so i'd certainly be up for the operation but my Endocrinologist says at 65 i'm too old to go under Canada's health plan and even if i did qualify it could be a several year waiting period, private clinics are numerous but they charge $20K+ for the procedure.

Well.......It is true that a bariatric surgery can cure diabetes. But this is true only if the cause of that diabetes is obesity. A bariatric surgery mainly helps reduce weight and in the process diabetes is cured. And yes....at 65 getting a bariatric surgery can be a little risky.

OHIP has sent many patients to Michigan.

My surgeon has looked after many Canadian patients.

I'm Canadian, living in the USA.

I had the Biliopancreatic Diversion with a duodenal switch.

I've gone from 302 to 136 at last weigh in on Monday past. My surgery was in March of 2005.

aA
kesha

My endocrinologist hasnt recommended the USA option as yet, i might bring it up on the next visit,I assume when he says i'm too old he was referring to an age cap that the Quebec health system will pay 65 being the cut off point. While i'm sure an American clinic would be more than happy to perform the procedure i suspect having the operation done in the USA will not be covered by Quebec Health Insurance and will probably cost more in the USA than i can afford.

I envy your success..

I think the program into which you enroll is the most important. You clinic and surgeon etc etc must be good, supportive and have years of experience behind them. Having a bariatric surgery IS a big step. Which one have you decided on?

I've lost a total of 77 pounds in the last year, including the weight I lost during preparation for the surgery. The program I went with was very experienced and highly rated.

Do you find it more difficult as you get closer to goal weight?

My weight loss has slowed quite a lot lately. The more you lose, the harder you have to work to lose the rest of the weight. Since you are carrying around less weight, you burn fewer calories for the same amount of work. What I really need to do is ramp up the exercise. And it being winter right now is not helping this effort.

It's so hard to get out there and do something in this weather. I'm still in the "honeymoon" phase of my bypass when weight just falls off but I worry about coping as I get nearer my goal weight and get hungrier.

a hyperlink to a Bariatric Centre.

What is your experience?

aA
kesha

I might, given the right circumstances, go out of country for surgery. Some overseas centers are excellent. I would not, however, make that choice based on a random link spammed to an Internet message board.

to take a look but as at now, it appears to be spam.

aA
kesha
just lookin' out for the folks here