Considering DS - Advice Appreciated

[Sunshine Too]

I have spent the past 9 months thoroughly researching bariatric surgery and doing some serious soul searching as to whether it is something I need to do in my life. I am very interested in DS, but I am still struggling with a number of questions and apprehensions. I apologize that this will be a long post, but I figured the more information I give the better advice I might receive back. Thank you to all of you who have spent countless hours posting your experiences to these forums, and especially to those who respond to this post.


My stats and conditions:
Age: 41
Height: 5’9”
Current Weight 260 (lifetime max)
Current BMI: 38.4
High cholesterol/low HDL/high triglycerides (on Lipitor but hate the leg pain)
High blood pressure (started meds recently after years of being borderline)
Sleep apnea (very bad and can’t use CPAP due to nasal blockage)
Pre-diabetic (getting close to Type II)
Metabolic syndrome

I live in south Louisiana outside New Orleans. Food is a way of life here in our state and in my family. A local saying is that “We Live To Eat” rather than “We Eat To Live”. Most meals with family and friends are spent reminiscing about how good some past meal was, and planning ahead to the next big meal or get together. For those who have visited New Orleans before, you know that our cuisine is second to none. This food heritage runs deep in my family as well. In addition to my love of eating, I also love and gain enjoyment from cooking for others and seeing them enjoy it.

I’m giving you this background so that hopefully you can understand how much good-tasting food is ingrained in my daily life. For me, its not an ice cream addition or a potato chip addiction or a coke (aka “soda pop” for those from the north) addition. Rather, its an addiction to all the good tasting food that surrounds me. I’ve always said that food addiction is the worse possible kind of addiction. Babies aren’t naturally born craving cocaine, alcohol, or cigarettes. But we all naturally have to eat to survive. The desire to eat is naturally built into us, and we can’t quit cold turkey and walk away like with other addictions (not that I am belittling the difficulty for those that face those addictions).

I have lived a life of continually increasing weight. I graduated high school at a somewhat healthy 185 (27.3 BMI). College brought me up to around 220 (32.5 BMI). I’ve tried various diets (Atkins, chemical, starvation, “no French fries/no coke”, Sensa) which have resulted in me yo-yo-ing up and down between 210 (31.0 BMI) and now 260 (38.4 BMI). Between the way my body is wired, the way I have lived my live, and the food environment in which I live – it is simply unrealistic to believe that I will ever lose enough weight and keep it off to be healthy.

My health issues have also gotten progressively worse over my life. The list of conditions above can all be linked directly to my obesity. I’m so out of shape I can hardly walk across the room without getting out of breath, much less have the energy to play with my kids. Its hard to find clothes and most of them don’t fit right. I’m so tired all the time I nearly fall asleep at the wheel most days when I’m driving. As I get older, these health issues become riskier and continue to grow. I know that diabetes is next on my list if I don’t do something.

Through all of this, and through my recent soul searching, I have come to accept the following:

* I am going to die early if I do not lose a significant amount of weight and keep it off

* I am not physically or emotionally capable of losing enough weight on my own to alleviate my health issues (any weight loss would improve, but even at my low of 210 I did not eliminate health issues)

* I know I need to improve the quality of my food intake. However, I am unwilling to live life hungry all the time or limited to eating food I do not enjoy. I refuse to give up alcohol and carbs in the long run, although short term 12-18 months is do-able. All these things would make me miserable to the point that I would rather eat what I want and die early. (Horrible conclusion I know, but I’m trying to be blatantly honest with myself here)

* I currently live a sedentary lifestyle and that must change. That said, I hate the gym and it is unrealistic that I will become a 4x a week gym rat. I am reluctantly willing and will commit to improvement in this area, but I will still fall short of the ideal level of exercise.


I have done a tremendous amount of research on the various weight loss surgeries. I’ve read thoroughly on bariatricfacts.org, dsfacts.com, weightlosssurgery.proboards, etc. I won’t get into why I don’t like the other surgeries. I’m interested in DS because it’s the most effective at long term weight loss, it’s the most effective at alleviating comorbidity health issues, it lets you eat the most “normal” both in terms of what you eat and how much you eat.

The things I’m comfortable with regarding DS:

* Lifelong vitamins and bloodwork. I take pills now 2x daily with no problem at all and I regularly have bloodwork. I can be religious about this.

* Taking charge of my own diet and health. If you can’t tell, I’m a research fanatic. I plan on being an expert on DS by the time I may have it. I am confident I can monitor my food intake, vits and labs so that I manage my own health before problems arise.

* Higher risk/mortality rate. I’m going to die early if I don’t do something. I will research and choose a good surgeon. If its my time to go on the operating table, so be it.

* Need for protein intake. I’m a meat lover. I eat 127g of protein daily right now without even trying. With some effort I can shift some intake away from carbs towards protein.

* Need for low carb during honeymoon period. I’ve done Atkins before and can do it again. As long as there is a finite ending involved, I can make myself do it.

* Insurance – Looks like it will be covered.

* Time off work – Very cooperative employer.


My major DS questions and concerns are as follows:

1. Am I too lightweight to have DS? I’m currently 38.4 BMI which is my lifetime max. I lived for a long while at 34.0 BMI, and I believe I could get back there and stay there without too much difficulty. Repeated dieting has shown that I hit a wall at 31.0 BMI and I can’t ever maintain at that level. I have read about other lightweights like Southern Lady who have done fine. But I am concerned over whether I may lose too much weight and not be able to eat enough to be healthy. Is it enough risk to push me to another surgery that I may not prefer (sleeve).

2. I am somewhat confused on DS math. Great post on that on dsfacts. Lets look at a few scenarios (note that I’m talking long term here post 18 months):

a. My current unrestricted intake is 3,400 calories; 127g protein (15%); 334g carbs (39%); 176g fat (46%). Based on 30% fat absorption, 50% protein absorption and assume 100% worse case simple carb absorption – if I didn’t change my diet at all then post DS I should be absorbing 127x4x50% + 334x4x100% + 176x9x30% = 2065 calories daily. Depending on who’s calculator you believe, that would support a weight of 185lb.

b. Now lets assume long run my stomach is 1/3 smaller and my new mix is 2300 calories; 115g protein (20%); 201g carbs (35%); and 115g fat (45%). My net carb intake should be 115x4x50% + 201x4x100% + 115x9x30% = 1345 calories. Some of the calculators say I would be 100lb and malnourished.

How many total and net calories are most of you consuming? I know the saying is protein first then don’t worry about calories. But I’m worried about whether DS will be too much for me. Any other lightweights out there that had a problem with this?

3. I eat a lot of carbs. Too much. During the 18 month honeymoon, I can do anything. Atkins sub 30g carbs daily bring it on. But long term I can’t eat that way. Once past the honeymoon, are they any of you that do eat a significant amount of carbs? I know tolerance varies from person to person, but how likely is it that I could consume in the range of 200g of carbs daily?

4. I drink a lot while I eat. Like 5 glasses of water per meal. During honeymoon I can try to limit this to get in protein as needed. But long term, do many of you drink while you eat?

5. Does anyone have particular surgeons they would recommend that do lightweights? I do know about Dr. Paul Kemmeter in Michigan who does lightweights and is very reputable. I would love to find someone closer to home or easier flight like Houston, Dallas, Atlanta. But also willing to travel to get good surgeon with sound advise on doing DS as lightweight.

6. For those who did have surgery with a long distance surgeon, how have you gone about managing post-op between surgeon and your PCP? Both during honeymoon and long term.

7. What am I thinking about wrong? Don’t hold the punches. I want to be sure that I’m having the right surgery and approaching it with the right expectations. Some of what I have said in here does not line up 100% with what the surgeons or many of you advocate in other posts. But again I am trying to be blatantly honest about who I am and what I feel that I am realistically capable of doing post surgery. If you think my mindset is incompatible with DS and will lead to failure, please tell me.

Again – sorry for the long post. I appreciate whatever advice you may offer. Thanks.

 

[southernlady]

Welcome, @Sunshine Too

My major DS questions and concerns are as follows:

1. Am I too lightweight to have DS? I’m currently 38.4 BMI which is my lifetime max. I lived for a long while at 34.0 BMI, and I believe I could get back there and stay there without too much difficulty. Repeated dieting has shown that I hit a wall at 31.0 BMI and I can’t ever maintain at that level. I have read about other lightweights like Southern Lady who have done fine. But I am concerned over whether I may lose too much weight and not be able to eat enough to be healthy. Is it enough risk to push me to another surgery that I may not prefer (sleeve).

2. I am somewhat confused on DS math. Great post on that on dsfacts. Lets look at a few scenarios (note that I’m talking long term here post 18 months):

a. My current unrestricted intake is 3,400 calories; 127g protein (15%); 334g carbs (39%); 176g fat (46%). Based on 30% fat absorption, 50% protein absorption and assume 100% worse case simple carb absorption – if I didn’t change my diet at all then post DS I should be absorbing 127x4x50% + 334x4x100% + 176x9x30% = 2065 calories daily. Depending on who’s calculator you believe, that would support a weight of 185lb.

b. Now lets assume long run my stomach is 1/3 smaller and my new mix is 2300 calories; 115g protein (20%); 201g carbs (35%); and 115g fat (45%). My net carb intake should be 115x4x50% + 201x4x100% + 115x9x30% = 1345 calories. Some of the calculators say I would be 100lb and malnourished.

How many total and net calories are most of you consuming? I know the saying is protein first then don’t worry about calories. But I’m worried about whether DS will be too much for me. Any other lightweights out there that had a problem with this?

3. I eat a lot of carbs. Too much. During the 18 month honeymoon, I can do anything. Atkins sub 30g carbs daily bring it on. But long term I can’t eat that way. Once past the honeymoon, are they any of you that do eat a significant amount of carbs? I know tolerance varies from person to person, but how likely is it that I could consume in the range of 200g of carbs daily?

4. I drink a lot while I eat. Like 5 glasses of water per meal. During honeymoon I can try to limit this to get in protein as needed. But long term, do many of you drink while you eat?

5. Does anyone have particular surgeons they would recommend that do lightweights? I do know about Dr. Paul Kemmeter in Michigan who does lightweights and is very reputable. I would love to find someone closer to home or easier flight like Houston, Dallas, Atlanta. But also willing to travel to get good surgeon with sound advise on doing DS as lightweight.

6. For those who did have surgery with a long distance surgeon, how have you gone about managing post-op between surgeon and your PCP? Both during honeymoon and long term.

7. What am I thinking about wrong? Don’t hold the punches. I want to be sure that I’m having the right surgery and approaching it with the right expectations. Some of what I have said in here does not line up 100% with what the surgeons or many of you advocate in other posts. But again I am trying to be blatantly honest about who I am and what I feel that I am realistically capable of doing post surgery. If you think my mindset is incompatible with DS and will lead to failure, please tell me.

1. NO, you are not too lightweight to have the DS BUT a surgeon may want to adjust your common channel. I had a starting BMI of 35.2. My surgeon made my common channel longer than his typical...mine is 175.

2. DS Math is just a starting point...to give people an idea of how we manage to eat so many calories and still lose weight, AS LONG as the vast majority of said calories are protein or fat based. We each have to find our happy spot. I think I've counted actual calories about 6 times in almost 5 years. I do keep a running total in my head of carbs ingested daily.

3. Not all of us keep our carbs to the Atkins level. I never did. During my losing phase, I tried to stay between 70-100 carbs a day. Now, in maint, it typically stays between 120-150. Lately, it's gotten a bit out of hand and I need to rein them in. I'm gaining more than I want to see.

BUT I eat a bite of rice about 2 times a year even now. A baked potato, SMALL ONE is split with my husband and is a vehicle for butter, bacon, cheese, and sour cream.

Getting a handle on carbs is very hard. JUST reining them in during your 18-24 month "primary window" isn't enough. You will need to rein them in the rest of your life. I only know of a handful of people who regained most of their weigh back after a DS but every one of them did not keep carbs under control after the surgery. You will need to take a look at why you eat carbs...and as a southerner, I completely understand since mac and cheese is considered a vegetable here in the south.

4. I SIP while I eat now...but early on, drinking while eating fills up your new stomach too much to get protein in. I am glad to see that fluid is a given for you. That will help but go to sipping to see how well you do.

5. My surgeon will do the DS on lightweights (Dr. Boyce in Knoxville, TN) and I know there are others. Dr. Elariny in VA has done a number of lightweights.

6. For the first 3-6 months being in contact with your surgeon is best but having a trainable PCP is best LONG term. I haven't contacted my surgeon for 3 years now. All my care is handled by my PCP.

7. The biggest issue I see is this:

I live in south Louisiana outside New Orleans. Food is a way of life here in our state and in my family. A local saying is that “We Live To Eat” rather than “We Eat To Live”. Most meals with family and friends are spent reminiscing about how good some past meal was, and planning ahead to the next big meal or get together. For those who have visited New Orleans before, you know that our cuisine is second to none. This food heritage runs deep in my family as well. In addition to my love of eating, I also love and gain enjoyment from cooking for others and seeing them enjoy it.

.
We have others from Louisiana. In fact, @star0210 is also from Louisiana. Food tastes/menus CAN be changed. Work at it now to find a way to eat to live...not live to eat.

 

[DianaCox]

Let's face it - you are going to have to DRASTICALLY alter your eating. And if you can't wrap your head around that, you are going to be miserable anyway.

Starting with drinking 5 glasses of water per meal. IM-POSSIBLE. I'm 12+ years out and can only drink about 10-12 oz/meal, IF I eat slowly and sip.

You can't eat all the carbs you want, in particular wheat and rice based carbs (and maybe more), and most importantly, you can't eat them during the day when you're going to be around other human beings 4-6 hours later (YMMV) - because you will become a bloated, gassy, chemical-warfare weapon of mass destruction. Your carb consumption MUST come down, and be regulated carefully by time, or you're going to become persona non grata at work, at your family gatherings, and maybe in your own home. And farting in a closed car even when you're alone, you may well offend yourself grievously.

Instead of lamenting what has to change, maybe you can focus on how you are going to adapt, and perhaps help others in your circle of people who may also be dying of obesity realized that there is another way out, which makes you have to change, but still enjoy food, within a generous but not unfettered realm.

 

[Larra]

@DianaCox is right that your eating habits will need to change drastically, BUT - you will have powerful weapons to help you with those changes that you don't have now. These are 1) restriction - you simply will NOT be able to consume the large amounts of food you consume now. Of course you will have less restriction as time goes on, but I'm over 9 years post-op and I still have some restriction, and I'm grateful for it. It still makes a difference.
2) malabsorption - some of the calories you consume will not be absorbed, esp fat calories. However, that doesn't get you off the hook for carbs. But you will learn which foods cause you problems, meaning diarrhea and/or bad gas, and then it's up to you as an intelligent adult to determine when and how much of these foods to eat. You will still be able to enjoy good food, but less of it, and less carbs.
The DS also causes metabolic changes that, for most (not all) people, permanently resolve type 2 diabetes. There is no other operation that does this on such a consistent basis. Given that you are prediabetic, there is an excellent chance that your prediabetes will resolve and you will not progress to full fledged type 2 diabetes. That's HUGE.
As far as your sleep apnea goes, the results for that depend on amount of weight lost, and the DS has the best statistics of any bariatric surgery for percentage excess weight loss and for maintenance of that weight loss. There is NO guarantee that your sleep apnea will resolve. Some thin people have sleep apnea due to the shape of their airways. But I think you can at least anticipate improvement. And maybe, after you lose enough weight such that surgery is safer for you, you could do something about the nasal blockage. I suspect the sleep apnea is contributing to your daytime fatigue, but beyond that, it is a potentially fatal disease in and of itself, so anything you can do to improve or resolve it should be done.

You have, IMHO, a very strong reason for the DS even as a lightweight, that being the sleep apnea. An operation where you don't lose much weight isn't likely to fix your sleep apnea. While you may be looking at this comorbidity as a quality of life issue, which it is, the damage it's doing to your health and risk of death from it are of far greater significance.

Dr. Boyce in Tenn is probably your closest good choice. There is no one in your state that I could recommend. If TX is better for you, then head to Denton and Dr. Ayoola.

Oh and yes, you do/will need to add some exercise to your life, but it will be a lot easier when you are less fatigued and not short of breath. But you do need to accept that even the DS isn't a substitute for some degree of lifestyle change.

 

[newanatomy]

I am like you in that, I live to eat, too! I love delicious food. I work hard to control my carb intake and I have been successful with my DS. I just spent 10 days in beautiful sunny Orange County, California with my sister. I ate at some fabulous restaurants and had a wonderful time. I went to Rome (best food in the world) in March and a trip to Ireland in July (can you say fish and chips?). I did just fine maintaining my weight. I truly travel on my stomach. My vacations are planned around where I get to eat! I have to be careful by not allowing myself to get carried away in a carb frenzy. I still get to enjoy great food however, there is no free lunch!

There are challenges to the DS. I deal with a frequently bloated belly, carbs or no carbs. It ranges from uncomfortable to downright painful. The gas that makes your intestines feel like they are overblown balloon animals is a real drag!! It seems to be a part of my life right now. I have to say though, if I am super strict about being low carb, it seems to be better. I am just not willing to give up all carbs right now.

By the way, I am over 22 months post op and have lost about 134 pounds and am a size 4 or 6 depending on the pant. At 5'8", I am pretty stinking happy with my weight! I have not lost any weight in months and have had about a 6 pound bounce back which, is to be expected. I think I am finished loosing and am officially in maintenance.

I live an active, healthy life now. I get to make choices that I could never have made without having the DS. I felt completely hopeless before my DS. I had about a 39 BMI when I started to research the DS. When I had my surgery, seven months later, I had allowed myself to reach an all time high BMI of 43. Now, my DS allows me to choose to eat less food, better food. I am committed to eating right and supplementing for my new insides. I knew what the DS would require and felt it was something I could live with for life. It isn't for everyone.

 

[duh_Mom]

Hi @Sunshine Too , welcome! I do not have anything to add to the ladies comments, they are all excellent comments. I am not a long termer yet, just over 4 months out. But I can tell you that post surgery your tastes change so dramatically you will be surprised. As for carbs, not a free ride at all, as the ladies said, you can eat them but most have to 'pay' for them.
Congratulations on all the research you are doing- Dr. B in Knoxville did my surgery and what drew me to the surgery is the 5% weight regain stat. I have lost and regained so many frinkin' times, I could not do it again. I was hopeless.
Also, any doc you visit will strongly encourage you to try the cpap again - there are numerous types of masks that can be used regardless of nasal blockages. It reduces the chances of post op respiratory challenges if you are breathing well.
Good luck to you and I look forward to following your journey.

 

[aaa]

Let's face it - you are going to have to DRASTICALLY alter your eating. And if you can't wrap your head around that, you are going to be miserable anyway.

Starting with drinking 5 glasses of water per meal. IM-POSSIBLE. I'm 12+ years out and can only drink about 10-12 oz/meal, IF I eat slowly and sip.

You can't eat all the carbs you want, in particular wheat and rice based carbs (and maybe more), and most importantly, you can't eat them during the day when you're going to be around other human beings 4-6 hours later (YMMV) - because you will become a bloated, gassy, chemical-warfare weapon of mass destruction. Your carb consumption MUST come down, and be regulated carefully by time, or you're going to become persona non grata at work, at your family gatherings, and maybe in your own home. And farting in a closed car even when you're alone, you may well offend yourself grievously.

Instead of lamenting what has to change, maybe you can focus on how you are going to adapt, and perhaps help others in your circle of people who may also be dying of obesity realized that there is another way out, which makes you have to change, but still enjoy food, within a generous but not unfettered realm.

Love the way you write.

 

[Munchkin]

You are very honest with yourself and that's a good thing!

You will be much better off with the DS than without. Even if you don't do a perfect job changing your diet. You will be better off without the diabetes that's just around the corner. I wouldn't be shopping for a longer CC either. You know the only way your weight is going today is up. The DS will certainly level the playing field.

Don't underestimate the power of being thin. Most of us eventually gave up on diets because we could never get thin and stay there. Size 22 and 24 are both fat so why bother. But if you are wearing a size 6 and you have to choose between a pile of shrimp or beignets...you might be motivated to make the right choice. And with the DS, you are not forced to give up food. There is always something you can eat.

Bottom line, the DS is the best out there today. There is nothing better. Best of luck to you!

 

[Soonerjoseph]

I was an extreme lightweight (chemically induced) and just had the DS (22nd). I obviously don't have any actual advice like these vets have, but something you said really hit home and something I kept repeating to people:

"I’ve always said that food addiction is the worse possible kind of addiction. Babies aren’t naturally born craving cocaine, alcohol, or cigarettes. But we all naturally have to eat to survive. The desire to eat is naturally built into us, and we can’t quit cold turkey and walk away like with other addictions (not that I am belittling the difficulty for those that face those addictions)."

I don't see how you can take damn near anybody that has an addiction and tell them they can have a little alcohol, a little cocaine, a little tobacco, and expect them to stop. It's sure not a part of any 12 step program let alone common sense. If it's an addiction, the very definition defines it as improbable if not impossible.

 

[Clematis]

12 step program

There is a 12 step program for food that has been around for 50 years or more: Overeaters Anonymous (OA). Abstinence is defined as 3 sensible meals a day -- no snacks. (They do not tell you what to eat or not eat.) The peer-to-peer meetings help you sort out the psychological reasons as to why you're overeating.

 

[Sunshine Too]

There is a 12 step program for food that has been around for 50 years or more: Overeaters Anonymous (OA). Abstinence is defined as 3 sensible meals a day -- no snacks. (They do not tell you what to eat or not eat.) The peer-to-peer meetings help you sort out the psychological reasons as to why you're overeating.

Clematis I think you miss the point. Abstinance by definition means completely avoiding something. Eating ANYTHING isn't abstinance from food. Overeaters Anonymous can call it what they like (and I applaud their efforts in battling obesity), but it's not abstinance. The point of my post is that with other addictions you can literally walk away and never partake of the addicting substance or behavior again (drugs, alcohol, even sex). But you can't do that with food. Rather, you are forced to endure having small tastes of the addictive substance, but then are told to not over indulge in it. The whole reason for abstinance is to detox and break the addictive cycle. With food addiction, you can never do that. It is truly a unique addiction in that way.

 

[southernlady]

Overeaters Anonymous (OA). Abstinence is defined as 3 sensible meals a day -- no snacks.

And if I ate JUST three meals a day as a DS'er, with no snacks, I would be in a serious world of protein hurt. I simply can NOT eat enough at one sitting to get my daily goal of 120+ grams of protein a day.

Oh, and "sensible" meals are heavy on the veggies, LOW fat anything, heavy on the fruits (esp bananas which are very high in sugar) and heavy on the starches. A recipe for a disaster for a DS'er.

DS'ers need to basically turn the damned food pyramid on it's head, the bottom that is all grains needs to be on the top and the top that is fat, needs to be much closer to the bottom.

A DS'er pyramid would have protein on the bottom, Dairy and fat the next level (where it shows fruit/veggies). Fruit and veggies would be where the milk and protein is near the top and the grains would the the "USE SPARINGLY" section.

 

[Clematis]

SoonerJoseph said that he was not aware of a 12 step program for food addiction -- I was simply sharing that indeed there is.

Since I was familiar with it in the 70s when 3 meals a day was "abstinence", I see they now say "Abstinence is the action of refraining from compulsive eating and compulsive food behaviors while working towards or maintaining a healthy body weight."

 

[Sunshine Too]

Clematis, I wasn't trying to be combative or cut your head off. Hope you didn't take it that way, and if you did please accept my apology. I was simply trying to point out that food addiction is the only addiction I know of where you can't quit and be truly abstinant.

Thank you all so much for your responses. The few minutes you take to share can help impact a lifetime decision for people considering surgery. God bless you each in your own journey and for caring enough to share with others. I do have more questions forthcoming so stay tuned.

 

[Kittykatkris]

Sunshine-
Keep me posted if and when you decide to get your DS.
I am meeting my surgeon tomorrow morning to go over details and specific questions and...TO FIND OUT MY SURGERY DATE!
I already did 6 months of weigh ins and nutritionist appts so I am about 1 month away from having the surgery.

I too go back and forth, hour to hour actually. I even tell myself things like well if I ate small Frequent meals, protein first and carbs last I could loose weight on my own. Well the problem is I have, but then I gain it all back and then some!
I think the DS surgery gives us a permanent reason, a continual kick in the butt if you will. To keep ourselves doing what we know works for us.

I have PsuedoTumor Ceribi, and PCOS, I am also on Metformin and the statistics state that I will more then likely develop diabetes in my life time.
Well I should be on meds for the Psuedotumor ceribi (Im not because its a med that dries out all your organs and causes serious issues so I decided to stop taking them), I take a number of over the counter supplements that I researched for things like PCOS and overall health, and I take the metformin.

So if I can take those things daily then why not vitamins/ minerals and other supplements? I am doing it anyway.
I will just have to up the doses and stay on top of it continually. I think thats a easy trade off to be a size 6 or 8 instead of 20/22.
Dont you?

Anyway I hope that helps you and if you have any insight and comments please tell me cause like I said I go back and forth myself!