On the Wagon - Off the Wagon - On the Wagon

Hello! I am a about a year and a half out from having gastric bypass surgery, after spending several years on MFP. I'm here to give you my opinion on this... you may or may not like it.

I used MFP to lose, and maintain, a 100lbs loss prior to resorting to my RNY. I stalled for a year at that point, and it was after many attempts and changes to boost and restart my losses that we started the process. I started seeing my team in April of 2016. I had surgery in November 2016. I have been in counseling for my disordered eating and emotional wellness for 9 years and gained serious control over my issues in 2012. Yes, it took grueling work for 4+ years to lose 100lbs and that included 3 surgeries after which I regained 30lbs each time during recovery due to swelling and such. It was arduous and not nearly as fast as anticipated but the point is that I always trended down and all regains had medical reason. Despite my extensive time spent in therapy, the surgical psychologist declined me because he thought my honesty about my binge/purge cycles was not honest... However, my surgeon chose to accept my regular therapist's authorization instead, and I had my surgery.

I'm not sure where you are or what program you're working with but the timing of your visits seems very spaced out to me. It's also unclear as to whether or not you were seeing a counselor the entire 4 months (since late November until now) or only for the approximate 3 weeks. At this point in your timeline, I was preparing for my all-liquid pre-op diet, which lasted for 3 weeks.

At day 1 of my program, I started a 100g+ protein with primarily only veggies otherwise diet that was consistent about 5-6 days a week, allowing myself to be more relaxed on day 7. I did this by doing only protein shakes for 2 meals a day and having a meat and veggie dinner, much like they suggest for patients after they are at the 3 month post op mark. This was not a dictation by my program, but a choice on my part because I wanted to be sure I met my pre-op criteria within the 6 month minimum time frame that insurance typically requires. I quit smoking cigarettes prior to even seeing the surgeon. I quit all my extras and I had a 5 day a week exercise program I built for myself that the physiologist of the bariatric program felt she couldn't really improve upon at that time.

By the time I hit 5 months into my program, I had only lost 18lbs. This in itself was a clear indication that my medical situation required surgical intervention, because my body was not responding as it normally should to such a restrictive diet. My blood work improved in most areas, including my body fat % and my measurements, but the weight didn't come off. The fact that you have lost 15+ lbs in about 3 weeks of modest restriction tells me that you could probably do a lot of progress without surgery.

Yes, they hold you accountable to each little thing. Yes, you will have to answer for your choices and if you admit to "breaking the rules" they will hold you to that too. If you are eating sugared foods regularly during pre-op, not participating in exercise, allowing being sick to be an excuse for eating terribly for a couple weeks, getting emotionally disturbed when they want to discuss potential triggers, you're simply not going to be a good candidate right now. One of the reasons they push on the family button is because family is going to be your primary support system and responsible programs will NOT allow you to have surgery unless you have at least 4-5 support persons in your life... and if your family is an emotional trigger, you're an emotional eater, and you choose to maintain relationships with those family members, it's a recipe for DEATH. It's not a recipe for simply failing to lose weight.

WLS is an extremely serious surgery and should not be done simply because you can't stay on the wagon. Having a smaller stomach doesn't cure the cause of overeating, it just makes it physically impossible to put extra food in at one time, and it makes it a life-threatening issue if you push it too far. I've watched many people push to have surgery, pay out of pocket because their insurance wouldn't cover it when the doctor said they weren't ready, people lie to their doctors to meet the marks, people flying to Mexico to have surgery in Tijuana... and I will tell you this, the people I've seen who died or had huge problems after surgery are the ones that wanted to cut corners or not address their issues/adhere to dietary demands before surgery.

My program, they use examples of people saying in nutrition classes "I could never live without Mountain Dew, I'll just hold it in my mouth until the bubbles are gone" as examples of patients that do not get cleared for surgery based on diet. This includes DIET soda. It's not just sugar foods! You have to cut sugar, carbonation, caffeine, nicotine, alcohol, weed (all substances), NSAIDs (Motrin, aspirin, etc)... If you have a bypass or a duodenal switch, you have to cut fatty foods too. Your meals will be less than a medicine cup in size for at least 2 weeks, sometimes up to a month. Every drug you take has to be tiny or crushed up... You get used to the flavor of medicinal salts after a while.

After surgery, everything is less than 5g of sugar, high protein... You get very few fruits. It's all veggies, meat and cheese when you get to actually eat... Prior to that, it's all liquid. ALL. Blended soups, protein shakes, soup soup and more soup... and you'd be surprised at how many soups have too much sugar in them.

My point in all this is that if you want this surgery, you HAVE to choose NOW that the change starts NOW. You don't get to wait until your stomach is changed. Given that it's been almost 5 months since you sat down with them the first time, I'm sure that they expected that the education and materials already provided to you would have already established some habits in you at this point... Being a successful bariatric candidate requires a commitment for life, from the day you sit down with them and ask to be considered for surgery.

All this isn't to say that you give up now. What you have to understand is that the demand of immediacy is part of the problem here. Accepting that their clearance will come with time and commitment will go much farther towards the goal of surgery than arguing against recommendations or having issues with their lines of questioning. If they want you to work on your family relationships, there just might be a valid reason; perhaps you should consider that rather than reject and deny the validity. Renew your commitment every day. Fall off the wagon one hour, get back on the next hour.
If you want someone to have your back from the emotional health standpoint, do weekly therapy for at least 6 months and make it clear that you are working towards this goal. The social worker's job is to make sure your life is set up to support the post-op lifestyle and believe it or not, their interest is your success. A program doesn't gain more patients with fail stories. It's ultimately up to the surgeon to decide if you're prepared and if the risks of your case are outweighed by your potential for success.

There's nothing that stops you for asking for more guidance and detail... But I'll tell you now that most programs don't give you a detailed diet to follow. They give you guidelines and instruct you to construct your own meal plan. This is part of the habit learning you need to do for success. You won't have a set diet plan made for you for life...

This is practice time, when you have room to fail and learn through trial and error. I promise, that first day when you wake up from surgery, you will be absolutely miserable in pain but I've met plenty of people that woke up from surgery hungry. You have to be ready with the emotional strength and the dietary tools before you're faced with the trigger that is pain and feeling like crap... Because you will feel those things... because every ounce of you will want to put chocolate in your face (or whatever it is that makes you feel good) and for those few days, you'll barely manage to drink medicine cups of water and maybe a little protein shake and jello, if you're lucky. Your body will go through devastating emotions and you'll be exhausted. I guarantee there will be times where you will 100% regret changing your stomach.

I spent my first year of my RNY experience doing weekly updates on YouTube so I could go back and watch my evolution and remind myself of how things have changed. I go back and watch them occasionally, and I'm happy to share the channel with you (and anyone else that bothers to read this) if you want to have a peek. It's not sponsored, I don't give instructions about diets or anything like that really, I just talk about my feelings and stuff. Some of it isn't pleasant. I continued the journey recently because my weight loss did indeed cost me my fertility so it morphs into my experiences being 35, childless and a hysterectomy recipient.

What I will say, however, is that all that nitpicking and trouble and struggle is 100% worth it if this is the right path for you... There are many patients that have to go a few rounds through the process before they are truly ready for their WLS and it just might be that you are not ready at 6 months. Maybe you'll be ready at 12... Maybe 18, maybe 24... I started my consideration in 2012 (as you'll see in my first video if you watch them) but I didn't resort to the surgery till nearly 5 years later. I learned a lot about myself, my self-worth and my health in that time frame, and I'm absolutely glad to have had the experience...Even with all the struggles.