Doctor suggested gastric bypass--freaking out!

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Hi guys,

I love reading your posts and have learned tons from them. I was hoping for some advice on my current situation. I was anorexic all through high school and early college. Midway through college, I developed bipolar disorder, and med-induced cravings caused weight gain to 235lbs at a height of 5'5". To be clear, I'm not blaming the meds for my problem, as I didn't have to give in to the cravings, and I certainly could have been more active. However, with the help of a nutritionist, therapist, and MFP, I was finally feeling as though I was back on track. I've lost a little over 30lbs in the past 6 months, and am now 5'5" and 203lbs. I make sure to eat at a calorie deficit and aim for 10,000-20,000 steps daily. To be honest, I feel pretty darn good because for the first time in years, I'm neither binging nor starving myself, and I'm living an active life.

Here's the thing. I've been pretty tired lately and my PCP ordered a sleep study. I met with the doctor (pulmonologist) yesterday, and he said my tests showed that I have positional sleep apnea (breathing interruption when sleeping on my back, but not when sleeping on my side or stomach). He said that since I have a BMI over 30 and near 35, plus one weight-related comorbidity, I would be a perfect candidate for gastric bypass surgery. He offered to refer me to a bariatric surgeon to get the process started.

I am reeling in shock from this. I am acutely aware that I'm too fat, but I've been losing on my own, albeit not rapidly. I didn't think things were bad enough that such a drastic option would be necessary. I have normal blood pressure, a normal A1C, and a good lipid panel. The only weight-related complication I have is the sleep apnea, and that can be controlled by wearing a device to keep me from sleeping on my back. I know you guys can't offer medical advice, but do you think it's unreasonable of me to want to keep doing this on my own rather than via surgery? I'm terrified of the surgery and don't want to live the rest of my life without being able to indulge here and there. I actually enjoy exercise and feel my appetite is under control--I mean, I'm eating at a deficit and losing weight--so I don't see why I can't continue on this path given that there are no signs that I'm in imminent danger. I asked the pulmonologist that very question, and he said the gastric bypass is better for maintaining the weight loss long term and he would strongly recommend that option. Personally, I feel like I need to keep battling my personal demons through therapy, etc, and that if I do that, I will be able to reach a healthy weight and maintain there.

Sorry for the long post--I'm just really scared. I didn't think I was at such a bad point that surgery would be recommended. What do you guys think? Any feedback would be appreciated!
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Replies

  • ndj1979
    ndj1979 Posts: 29,136 Member
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    I would suggest getting a second opinion from another doctor, and also explain your current life style change to that doctor.

    Does your current DR know that you are currently losing weight?

    my two cents would be to continue to lose weight the regular way without the need for surgery; however, I have no knowledge of your current situation or what the risks are if you do not have surgery.
  • usmcmp
    usmcmp Posts: 21,220 Member
    edited December 2015
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    I think that with your history of anorexia the suggestion from your doctor was completely inappropriate. You are not at a life threatening point, you have made significant progress and you are doing it in a healthy way. I think you should keep doing what you are doing and ignore the suggestion.

    ETA: If they only suggested surgery and not a CPAP machine please consider another doctor.
  • soapsandropes
    soapsandropes Posts: 269 Member
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    Get a second opinion, you are heading in the right direction all on your own. My guess is that the doctor is used to people looking for a quick fix and without your history. If it were me I would want to try to lose the extra weight on my own and manage the sleep apnea without the surgery first.
  • jkal1979
    jkal1979 Posts: 1,896 Member
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    I find it odd that they would recommend gastric bypass when you are currently 53 pounds overweight (according to the BMI scale). You are doing a great job losing on your own, just keep doing what you are doing and if you are concerned about it then get a second opinion. Don't let his recommendation stress you out.
  • colorfulmosaic
    colorfulmosaic Posts: 9 Member
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    Thanks so much guys! I was very shocked, as my PCP was thrilled at my progress on my own and never mentioned any imminent risk of death or heart disease, so I didn't expect this from the pulmonologist. I know I could have lost more in this time span, but I was trying to look at things positively and focus on the fact that I am losing (albeit slowly) and am feeling great. As for why the doctor didn't recommend a CPAP machine, I think it's because he said a positional device would keep me off my back, which is the only position where I had interrupted breathing, and the CPAP machine would be too drastic since it's noisy and uncomfortable, and I'm fine when I'm not on my back. I found it ironic that he considered the CPAP drastic and not the surgery, but I'm not the doctor...

    It was just really hard, as a former anorexic, to hear that I'm at the point where weight loss surgery would be recommended. Honestly, most of my overeating came from not being able to manage cravings, and I don't see how the surgery will really help that--I mean, the cravings will still be there, right? Plus, selfishly, I'd like to be able to eat a Snickers bar once in awhile without "dumping". I will definitely take your advice to get a second opinion. Thanks again guys!!
  • colorfulmosaic
    colorfulmosaic Posts: 9 Member
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    I should also mention that I have celiac disease and am concerned about messing with my GI tract any more than necessary, and I'm also not thrilled about the idea of a future where I need more food restrictions than just the gluten...
  • CharlieBeansmomTracey
    CharlieBeansmomTracey Posts: 7,682 Member
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    I agree with everyone else. find another dr and keep losing weight on your own. you are losing and not severely obese,just find a dr that deals with breathing issues and sleep apnea and see if you can get a cpap machine. to me at your weight there is no need for weight loss surgery. if you can lose it on your own then keep going.if you know you can lose the weight without surgery then do that instead. good luck with everything. and congrats on losing weight as well.
  • SeanNJ
    SeanNJ Posts: 153 Member
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    To be clear, your primary physician didn't recommend the surgery, the doctor responsible for reviewing your sleep study results did?
  • colorfulmosaic
    colorfulmosaic Posts: 9 Member
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    SeanNJ wrote: »
    To be clear, your primary physician didn't recommend the surgery, the doctor responsible for reviewing your sleep study results did?

    That's correct; it was the pulmonologist who recommended the surgery. Even when I was 235lbs, my PCP didn't even hint at a need for surgery.

  • Nuke_64
    Nuke_64 Posts: 406 Member
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    I'm a little confused as I thought the normal recommendation for gastric bypass was class III obesity (BMI 40+) or class II (BMI 35-40) with a weight related complication.

    Anyway, both categories are considered morbidly obese. Being labeled as that when my BMI was around 37 (I'm male and a smidge taller than you) was one of the motivators for me to lose weight. My PCP never mentioned WLS.

    You are about 20 lbs away from an overweight BMI. I'm not a doctor, but I really question this recommendation. I recommend you get a second opinion.
  • SeanNJ
    SeanNJ Posts: 153 Member
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    SeanNJ wrote: »
    To be clear, your primary physician didn't recommend the surgery, the doctor responsible for reviewing your sleep study results did?

    That's correct; it was the pulmonologist who recommended the surgery. Even when I was 235lbs, my PCP didn't even hint at a need for surgery.

    Then might I suggest you, as a courtesy, mention the suggestion to your PCP and then subsequently ignore it, unless your PCP thinks it's worth considering...and I'd be very, very surprised if they did.
  • CharlieBeansmomTracey
    CharlieBeansmomTracey Posts: 7,682 Member
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    wow so the pulmonologist suggested it? I would find another one then. that was wrong of them to suggest it. I would contact my pcp and let them know what they suggested and let him/her know that you are losing weight on your own and you dont want to do the surgery. see what your pcp says.
  • christinaleigh44
    christinaleigh44 Posts: 28 Member
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    I agree, you aren't THAT overweight and you are doing the right things to continue loosing weight and being healthy. I'm also 5'5, my starting weight was 197. I'm now at 137. Healthy eating and exercise work and you've proved that, i'm really surprised at that doctor.
  • daniwilford
    daniwilford Posts: 1,030 Member
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    I am 5'3" and weighed 237 in March, I was treating with medication, anxiety, depression, high blood pressure, and high cholesterol. I had been using a CPAP for almost a year. I then had an elevated A1C. My physician did not suggest bypass surgery but we agreed that I needed to make some changes. I began monitoring my carb intake and walking immediately. Shortly there after I began counting calories. By July I was walking five miles a day and losing an average of 2 pounds a week, my A1C was back to normal, my blood pressure medication was lowered by half. I have continued to lose weight, and have added strength/weight training. I have been able to discontinue my cholesterol medication completely, while keeping my A1C and blood pressure in normal ranges. Emotionally, I have never felt better. The CPAP, eating at a deficit, and increasing your exercise combined, can result in a greater or equal total fat loss than a gastric bypass in 6-9 months, with addition health benefits. With only the diagnosis of sleep apnea, you have time to try diet and exercise for a few months, before consenting to surgery.
  • colorfulmosaic
    colorfulmosaic Posts: 9 Member
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    Thanks guys--I will put in a call to my PCP as you suggested. It was a definite wake-up call to see "morbid obesity" as one of my diagnoses, but I'm willing to put in the work if it means avoiding a lifetime of dietary restrictions...plus, the complications really scare me!
  • AnnPT77
    AnnPT77 Posts: 32,787 Member
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    I second the second opinion opinion! Perhaps a weight-loss specialist (non-surgical)? I suspect the GP & sleep clinic doctors see a lot of overweight and obese people who swear they'll lose weight . . . then don't. Or who backslide and re-gain weight they've lost. That isn't you now, and it needn't be you in future.

    Speaking as someone with sleep apnea (obstructive, not positional), I know that some people have compliance problems with treatment devices, and the doctors see that, too. (My insurance company made me prove, via intra-device monitoring, that I use my CPAP before they'd pay for it. I know you may have a different treatment, but I suspect the compliance problem still occurs a good bit.)

    So, maybe your doctors are skeptics, based on what they see. Not surprising. You needn't be typical, though - you can be extraordinary. Right now, you're proving that. Check in with another doctor with a different view of the world.

    I don't encourage people to refuse treatments that are *strongly* recommended by their doctors, about which they've gotten second (or subsequent) opinions supporting their chosen direction. But I've personally refused treatments (statins; and vitrectomy, an eye surgery, for a couple of specific examples). I did this only after extensive careful, science-based research/reflection, by pushing back assertively but politely on the very doctors who recommended those treatments in the first place. It won't happen in all cases, but they were willing to support/treat me when they saw how determined I was. I don't know whether they would've reversed that support eventually, but they didn't need to: I did what I told them I'd do.
  • colorfulmosaic
    colorfulmosaic Posts: 9 Member
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    I am 5'3" and weighed 237 in March, I was treating with medication, anxiety, depression, high blood pressure, and high cholesterol. I had been using a CPAP for almost a year. I then had an elevated A1C. My physician did not suggest bypass surgery but we agreed that I needed to make some changes. I began monitoring my carb intake and walking immediately. Shortly there after I began counting calories. By July I was walking five miles a day and losing an average of 2 pounds a week, my A1C was back to normal, my blood pressure medication was lowered by half. I have continued to lose weight, and have added strength/weight training. I have been able to discontinue my cholesterol medication completely, while keeping my A1C and blood pressure in normal ranges. Emotionally, I have never felt better. The CPAP, eating at a deficit, and increasing your exercise combined, can result in a greater or equal total fat loss than a gastric bypass in 6-9 months, with addition health benefits. With only the diagnosis of sleep apnea, you have time to try diet and exercise for a few months, before consenting to surgery.

    Congrats on all of the progress--you are a real inspiration to me!
  • colorfulmosaic
    colorfulmosaic Posts: 9 Member
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    AnnPT77 wrote: »
    I second the second opinion opinion! Perhaps a weight-loss specialist (non-surgical)? I suspect the GP & sleep clinic doctors see a lot of overweight and obese people who swear they'll lose weight . . . then don't. Or who backslide and re-gain weight they've lost. That isn't you now, and it needn't be you in future.

    Speaking as someone with sleep apnea (obstructive, not positional), I know that some people have compliance problems with treatment devices, and the doctors see that, too. (My insurance company made me prove, via intra-device monitoring, that I use my CPAP before they'd pay for it. I know you may have a different treatment, but I suspect the compliance problem still occurs a good bit.)

    So, maybe your doctors are skeptics, based on what they see. Not surprising. You needn't be typical, though - you can be extraordinary. Right now, you're proving that. Check in with another doctor with a different view of the world.

    I don't encourage people to refuse treatments that are *strongly* recommended by their doctors, about which they've gotten second (or subsequent) opinions supporting their chosen direction. But I've personally refused treatments (statins; and vitrectomy, an eye surgery, for a couple of specific examples). I did this only after extensive careful, science-based research/reflection, by pushing back assertively but politely on the very doctors who recommended those treatments in the first place. It won't happen in all cases, but they were willing to support/treat me when they saw how determined I was. I don't know whether they would've reversed that support eventually, but they didn't need to: I did what I told them I'd do.

    Thanks so much for this! I think you're onto something with the doctors seeing people who promise to lose weight and never do. I think this sleep clinic sees a lot of large patients, as the toilet seat in the bathroom is like 5 times larger than your normal toilet seat and some of the chairs in the waiting room are huge. I will strive to be extraordinary, as you said :)
  • dwoodmanjr
    dwoodmanjr Posts: 89 Member
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    From your post, it sounds like he was simply stating that you would be a candidate for WLS. Having suffered from apnea due to excessive weight, my pulmonologist suggested the same. I was already exploring the lap-band, so I took his suggestion and filed it away. The apnea and the BMI over 30 are comorbidities which would allow most insurances to cover the expense of the WLS (it is extremely expensive - mine ran over $30,000 including all the discounts the bariatric surgeon had with the hospital)

    I had lost 70 pounds on my prior to my surgery - the bariatric surgeon even asked me if it was something I really wanted to do 3 days before my scheduled surgery.

    I agree with the other posters - talk it over with your PCP
  • MostlyWater
    MostlyWater Posts: 4,294 Member
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    My sister, who's in her 50's, is just short of a year with the lap band.

    It's what you make of it - you do still have to watch what you eat. And it's surgery, risky, and isn't comfortable. She figures another 20 lbs off and she'll ditch her CPAP machine.

    Go on sites with members who have done the surgery and see what they say, and/or go to some group therapy, if you have any nearby.