This is a repost of something I wrote nearly 5 years ago. Apparently, people appreciated it, so I'm reposting it here. (And if you see something like it elsewhere, it is there without my permission; if you see it rewritten and not credited, I consider it plagiarism.)
Post Date: 5/9/09 9:09 am
Someone asked me a very thoughtful question via PM, and I thought I would generalize the answer and post it here. It related to several recent posts complaining about sub-optimal weight loss being experienced by some post-ops.
1) The AVERAGE long-term weight loss for the DS is 75%. That means a (somewhat skewed) bell curve centered on 75% -- some people lose 100% (or a tad more), some people (fewer than 10%) lose less than 50%. Expecting 100% is unreasonable. It is POSSIBLE, but expecting it is unreasonable.
2) The heavier you are, the less likely you are going to lose all your weight anyway. 50% EWL of a 350 lb person with a goal of 150 leaves them weighing 250 lbs -- 50% EWL of a 250 lb person with a goal of 150 leaves them weighing 200. Both are considered a successful result.
3) Some people can't or won't change their eating habits long-term. I myself was so pleased to NOT be dieting and losing weight that my weight loss stopped when I got to 205 at one year out, down from over 290. That was a healthy 205, in normal sized clothes, so I tried not to care. My cravings have changed over time, so now I'm not having as hard a time resisting that which I should not eat, so I have lost another 35 lbs in the last 2.5 years. I could have lost more if I was stricter with myself, but I am happier not dieting than I am at the idea of being under 170. 171-173 is pretty steady right now eating whateverthehell I please. I'm not saying one or the other mind-set is right or wrong, but it is a trade-off that I am responsible for choosing.
4) (In answer to a question about a specific person who had posted about stalling at a pretty high weight, and who was eating a lot of carbs, which concerned the person who asked me the question.) The person you mentioned started out over 400 lbs., and pre-op said that she had no intention of getting below 250, that she was only doing this because of her health, and was happy being a person of size. Then, as she started losing weight effortlessly in the immediate post-op period, it seems her goals changed to be more optimistic, possibly because she started thinking and believing she really COULD lose to lower than 250 (which I think she didn't really believe pre-op, and had geared herself to believing was OK, so long as she was healthy -- a NOT unreasonable goal), but -- it appears she didn't control her carb intake sufficiently during the effortless part, and now the results are coming to bear. 150-200 g/day of carbs is way over the top for someone who is SSMO and supposed to be trying to maximize her weight loss in the "window," despite the fact that the weight loss was impressive for the first few months no matter what she ate. Starting out SSMO and not controlling carbs sufficiently during the weight loss phase is more likely than not going to lead to sub-optimal weight loss overall, even if it didn't seem to matter at first.
5) Some surgeons do not do adequate operations. That's just fact. Drs. X, Y and Z (I'm not going to name names here, but I will give my opinions privately) seem to have more patients with worse results on average than others. And I'm wary of the surgeons who are giving people REALLY small stomachs and longer common channels -- some surprisingly long (150-200 cm). I have my doubts about them. My opinion, of course, and not a fact, and all based on anecdotal evidence. Personally, I would never accept a common channel longer than 125 cm, but that is my OPINION, not fact. The smaller stomach (3 oz vs. 5 or more, but no smaller) I think is a good idea, depending on the person.
6) Some people are just biologically resistant to weight loss. People of black and Hispanic ancestry in particular. Short women tend to lose less well. Tall men do better. People who have failed previous WLS do less well, as do people who have dieted severely several times previously. Age often matters, though I'm not sure if that is because older people are more sedentary or are more likely to have wrecked their metabolism worse with multiple starvation diets. There needs to be more study on optimizing common channel and alimentary tract lengths, as well as stomach size, with people's metabolisms. I'm NOT OK with surgeons who do a cookie-cutter surgery without measuring the small intestine (which can vary from something like 7 feet to 23 feet in length) and doing a proportional DS, or who don't vary the procedure based on age, BMI, health issues, etc. -- it has to be personalized.
7) People need to take personal responsibility. The DS makes this journey much easier, but it rarely makes it effortless. You have to control your carbs, more or less depending on YOUR particular situation. If you are older, have starvation dieted several times previously or have a previous failed WLS, you are probably going to have to be stricter and work harder than a younger person who hasn't wrecked their metabolism as badly, in order to get the best results. If you don't exercise, you are making it less likely that you will have as good results -- the same weight of muscle burns more calories at a resting state than fat and occupies a smaller volume; exercise tones your body, strengthens your bones, makes you healthier overall. If you don't care about getting optimal results if it means working harder, by controlling your diet and/or exercising (and I count myself among those people until the last 18 months or so), that's fine, but qwitcherbitchin'!! You've made a choice -- take personal responsibility for the effects of that choice.
TANSTAAFL.* It's the universal law. Some people get it easier than others, but who said life is fair? This is NOT a set-it-and-forget-it cure for morbid obesity. We have to be proactive about our health, and that includes setting realistic goals and taking personal responsibility.
*
en.wikipedia.org/wiki/TANSTAAFL
