I've been watching the show for awhile and I've come up with a few questions for anyone who wants to answer them. As I understand WLS, the size of your stomach is reduced so that you cannot physically consume as many calories as you did prior to surgery and the weight comes off as a consequence (a simplistic view, I'm sure, please correct me if I'm wrong). How is this different from sticking to a low calorie diet and exercise plan? Is it because the surgery no longer allows the patient to "cheat the diet", so to speak? Are there other physical or hormonal changes that take place due to the reduced size of the stomach that aid in weight loss where calorie restriction alone fails? How many calories is a patient able to consume, on average, after the surgery? Are there people who fail to lose weight after WLS? What is the next step for people like that?

Thanks,
Nic

As impossible as it may seem, many who have had WLS find a way to "cheat the diet."
It is possible for a person who has had WLS to still consume high calories by drinking high-calorie beverages and sucking on hard candy, especially for those who are not blessed with dumping syndrome. As someone else said in another thread, the surgery is a TOOL that buys you time to re-learn your habits, not a magic cure. Just because you have had surgery does not mean you don't have to follow a diet and exercise plan. You absolutely do! The surgery is a tool that enables you to do that.
As for the malabsorption, that's a question for Dr. Garth or someone who has more medical expertise than I.
What's the next step for those who fail? I don't know and I don't plan to find out. I don't think there is a next step. I went into surgery with the mindset that this is the last stop on the bus.
Hope this was helpful.
Misscriss

As impossible as it may seem, it is possible for WLS patients to cheat the diet. You can still consume high calories by drinking high calorie liquids and eating candy, especially for those who are not blessed with dumping syndrome. Just because you've had WLS does not mean you don't have to follow a diet and exercise plan. You absolutely do! The procedure is a tool that makes it easier to do that. As someone put it in another thread, this surgery is a tool that buys you time to re-learn your habits, not a magic cure that will make everything perfect instantly. As far as how many calories I consume a day, I don't count, but I'd estimate it's around 800. As far as the malabsorption that occurs as a result of RNY, that's a question for Dr. Garth or someone who has more medical expertise than I.
Hope this helps.
Misscriss.

Oh, I almost forgot. I'm not sure about people who don't lose weight after surgery, but I know several people who have regained because they fell back into their old habits. What's the next step for people who do this? I don't know that there is one, and I don't plan on finding out. I went into surgery with the understanding that this is the very last stop on the bus.

I can tell you before my surgery I would never ever have been able to stick to a 1000 calorie/day diet (or even 1800/cal). I tried lots of times only to watch the weight come back. Now I can sit down with a desert plate of heathy food and feel full when I'm done (most people say my meals look like appetizers). Also this "tool" allows me to have things in my house like potatoe chips and cookies that everyone else can eat but not me (I've even watched a bag of chips last 4-5 days instead of 4-5 hours LOL). So really I know now I can stick to the low calorie diet that my doctors wanted me to years and years ago but just never could. Weight loss is still a matter of burning more calories than you take in. Also I have the strength and ability to move and exercise now which my aching joints never would have let me do before. It's so hard to explain to someone who hasn't been MO what waking up every day as me was like but I thank God for my new pouch and my wonderful new way of life.

Here's the difference, as far as I know. Obese people who go on diets fail more than 90% of the time. They may lose some weight, but they regain it. There are all kinds of reasons for this - and it's a gross injustice to assume it's just about lack of willpower. There is increasing research to support the notion that there are physiological and bio-chemical reasons too.

On the other hand, the failure rate for GBP is less than 10%. Lap band is a bit higher, but still a heck of a lot better than diet alone. And there is some evidence to suggest that GBP may help resolve diabetes as well - not just because of the weight loss. Some people leave the hospital, before they've even lost weight, no longer needing their diabetes meds.

Surgery should indeed be a last resort, but for people who are actually obese, whose lives are being shortened by their inability to lose weight, these operations may save their lives.

I understand where you are coming from. Once upon a time, I actually had myself convinced I could just have a psychological bypass. I thought...I'll eat a few ounces at a time no matter how damn hungry I am!! It didn't last, couldn't last as I was ravenous .

The bypass doesn't just work because of calorie restriction, even *IF* one could stick to a very low KCal diet the rest of their lives. It also bypasses some of the small bowel where the nutrients are absorbed. In my case, approximately 20% of my bowel is bypassed (I had a gastric bypass in June 2007) so in theory that means 20% of my calories (roughly) aren't going to be absorbed. For every 1000 calories I eat, that means only 800 calories are absorbed! Don't think any person would be able to stick with that long term.

Another aspect that makes gastric bypass different than "just eating right and exercising" is many WLS patients have minimal to no appetite after surgery. Something about the surgery affects a certain hormone that tells your brain "hey! I'm hungry. I *have* to eat and eat now!". I have not truly felt hungry once since I woke up from surgery. Well, let me tell you that this makes meal planning feasible for the first time in my life. I can actually sit down and treat food like the fuel that it is. Now I can plan a meal and say...Hmmm, I need 20 GM protein, no more than X amount of carbs, and I think I need something with more fiber...what shall I eat?!

The pouch being small not only makes it nearly impossible to take in too many calories if one is eating reasonable foods....but a 3 oz meal can leave you feeling like you've had triple servings of a Thanksgiving dinner. "Just eating less" would never do that.

I don't know about other gastric bypass patients....but on average I am taking in 800 calories a day. Remember, this means I'm only absorbing appoximately 720. No diet can do that for ya. On days where I've had higher fat foods like some pistachioes or no sugar added ice cream I've hit closer to 1000 calories. From what I gather in talking to other compliant RNY patients, it seems the calorie intake is 900-1400 or so a day.

Still, it's not comparable to compare and say "0kay, I'll just eat 900-1400 calories a day. Why would someone have surgery when you can just eat less?!".

There is the malabsorption and bypassed bowel to figure in, decreased appetite because of altered or lower appetite hormones, a small stomach that makes one feel full on a much smaller quanity of food. All of those things before we've even accounted for "dumping" and "forced" dietary compliance that ensues from that.

Marney is right. It's not just the restriction of smaller portions, but also the malabsorption of the calories eaten. Combine that with the fact that during surgery the nerve in our stomach/digestive system that signals our brains to eat has been cut... breaking that line of communication for hunger and over eating.

So the reason that RNY - Gastric Bypass works is:

1. smaller stomach will only hold small meals (1-3 ounces at first... up to 6-8 ounces later)

2. the stomach bile that start digestion has been rerouted and does not mix with your food until after your food is part way through your small intestine -- so digestion doesn't start right away (malabsorption)

3. your brain isn't receiving the signal of hunger from your digestive system. this signal interruption often comes back after your body has a chance to repair that nerve-snip, but it can take several months/years.

4. the type of diet that you eat post-op has a lot to do with weight loss as well. most diets focus on high protein and NO carbs (other then fruits and veggies). Sugar is strictly forbidden as well.

Exact malabsorption rates are actually not known. Marney's example of 20% gives a good picture of how it sort of works... but I've heard malaborption rates of anywhere from 25% to 60% (of calories not being used). I don't think it only has to do with how much of the intestine has been bypassed, there are other contributing factors that figure into that percentage. And no two people are the same.

YES - it's entirely possible for people to out-eat their surgery. And the people who are doing that are the people who need to get their head straight and deal with their food addictions, overeating tendencies and inability to deny cravings. WLS is more about the mental battle with food then it is about the physical. Once you get your head right and have a healthy relationship with food, it's easier to control the bad habits that put us in the position to need surgery in the first place.

There's a lot of science behind this surgery. It takes a lot of research and digging to learn all that you need to know before you take this life changing step.

Pam