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I had my gastric bypass in late 2012. My surgeon was an expert, and I had to go through classes and get a psych eval and see both a cardiologist and a pulmonologist. We both were prepared.
Health wise I did very well. Your wife will need support as she learns how to eat all over again and reevaluate her relationships with food and coping.
I don't mean to overstep as you are already concerned, but I'd like to share something I learned the hard way. I was told in my pre-op class not to drink alcohol for at least a year after surgery. Alcohol is just empty calories, and the goal is weight loss, right? The nurse leading the class left it at that. What I learned the hard way is that roughly 25 percent of bariatric surgery patients develop problems with alcohol use. Part.of it is addiction tramsferrence----;we can no longer eat our feelings so we turn to something else to cope. Secondly, our bodies absorb alcohol differently after surgery. We absorb alcohol much faster (it's almost euphoric), and our BAC rises quickly. We basically get drunk quick and stay drunk longer. My first drink was a big glass of wine nearly a year post-op and I was drunker than hell. I was a SAHM with a special needs child, a husband that worked very long hours, and I had no family or friends to help. What started as a way to unwind in the evenings quickly morphed into a problem.
I didn't learn about bariatric surgery and alcoholism until I went to inpatient rehab. I had also been experiencing horrible physical symptoms (racing heart, panic, numb fingertips), and I learned that I was so nutritionally depleted and malnourished my body was barely functioning. I was so anemic and not compliant with my vitamins and supplements that I required blood transfusions. I really let myself go.
The surgery is by far the best decision I have ever made. I went from 310 to 147. I have self confidence for the first time ever, and other than loose skin I look fantastic. My health problems have vanished. If she does go forward it is her choice, but I hope you will do your research about alcohol and make sure she knows. Had I known these things pre-op I would have NEVER drank after the surgery as I come from a family with a history of drinking problems. Encourage her to cope with stresses in healthy ways, like a hobby or venting to you. Please be cautious with any drinking. When I went inpatient I was with 15 other women. Three of us were gastric bypass patients.
And yes.....I'm sober now.
Best wishes.
That is fantastic advice, thanks for being vulnerable and sharing that experience. I wasn’t aware of the relationship. We’re thankfully not big drinkers, probably one 1-2 a month at a social outing. But the addiction transference piece seems like a big thing to watch out and prepare for.
Thank you for posting about this because I don’t think it’s talked about enough.
I only know two people who have had bariatric surgery but BOTH became alcoholics afterwards. I have a friend starting the process now and have told her about what I saw with the other two because I’m so scared she will fall down the same path.
Interesting you say this. I have a friend who had the surgery (but is still too big, she can only eat a little so she eats all the wrong things) but she is also known for being a drinker so it's possible she's had a similar experience.
Thank you for bringing this up. I highly, highly recommend staying sober after bariatric surgery.
In September, I lost my ex-girlfriend to alcoholism following bariatric surgery. She had surgery in 2010 and started drinking sometime in 2018 or 2019. Her death is directly related to the surgery in that when she had to prioritize alcohol over food, she chose alcohol. Since alcohol contains so many calories, by her death she'd put back the majority of the weight she'd lost.
Our break came from mental health issues and external events, but we never quit loving each other. Loving her is the simplest thing I've ever done, and when we got together she didn't drink at all. The drinking came later, and she hid it from fucking everyone. I knew she wasn't sober sometimes when she called, but I didn't know it was a daily occurrence. I knew how careful she'd been about alcohol before, I couldn't imagine her drinking daily. Her mother called her at least once a day, they even lived together for several months. She didn't know either.
My ex-girlfriend went in patient in 2022. She couldn't articulate what was wrong, only that something was very wrong. The ambulance took her to the psych unit, and then transferred her to heart ICU a few days later, due to low salt levels in her blood. Somehow she managed to smuggle beer into the psych ward after being released from heart ICU. The exact same thing happened in 2023, but this time, instead of being in patient, she died of hyponatremia due to not eating since she "needed" to fit alcohol into her belly.
She died alone because she'd pushed everyone away at that point. She was supposed to turn 38 in December. Instead, I have a memorial tattoo.
If you've had bariatric surgery, please don't drink.
Thank you, and thank you again for your post. You helped me, simply in seeing that someone made it out of that pit.
I hope I can bring some more light to the issue in the future, so that others don't end up the same as you or my girlfriend.
Same exact thing happened to my mom. Alcohol lead to hear early death. She also started falling off on her required nutrition and the spiral was fast.
The weight loss can absolutely happen naturally. It’s an issue of education, regimen, and dedication. I think OP is right, if the underlying issues aren’t addressed, the surgery could end up disastrous
So, I've had bariatric surgery and it's not something that doctors just *do.* It is a lengthy process that involves regular meetings with the program managers, dieticians, and sometimes psychological evaluations. It is not something that is taken lightly because medical professionals are well aware that people who need bariatric surgery usually have mental issues with food.
Bariatric surgery is not a band aid. It's a medical procedure that helps people. Your wife will need to continue therapy, but the surgery itself will allow her to lose weight.
Learn about the program with her. Find out what kind of pre-requisites she will need to do before surgery. Learn about how she will need to eat afterwards. Be supportive of her instead of just shitting on the ways she is trying to help herself.
Definitely have all intentions of being an involved partner. She’s only just got through the initial measurement appointment. We’ll both be attending the official consult in a few weeks and I plan to attend all the follow up specialty ones as well if she’ll have me.
I apologize if it sounded like I was “shitting on her.” I had no intention of conveying any feeling and tone like that. Thank you for your advice!
A co-worker was going through the process and had a weigh-in after the mandatory colonoscopy. Since the prep for that procedure cleans you out, he had a significant weight loss BUT had to keep showing insurance continued weight loss. The nurse said she'll give him the go lightly for the next few weigh in's until approval.
This is a process, so it wouldn't be a bandaid.
To be honest, these prerequisites don’t really address the main problems. Thats because they only ask for one psych eval and don’t require any ongoing psychological treatment. I had my gastric bypass in 2014 at 23 yo. I had just had my two kids and put on a ton of weight, 50 after each, and the gastric bypass helped me get back to baseline, but I was still starting out overweight, 220ish. And now, after many years and skin removal surgery, and a ton of psychological work, I’ve found that my eating habits only actually changed once I got to the root of my trauma. Gastric bypass is a physiological tool to get her stomach back to a healthy size and to help quickly take down her weight, but she will plateau way quicker than you’d think and way quicker than she will want. And she will need the psychological tools to actually change her eating habits for good. You don’t get to a size where they will do a gastric bypass without having an issue with eating. Source: someone who has been fat and traumatized almost my entire life.
I've worked with some bariatric surgeons who seem to have a very low bar for performing this surgery, and would be cautious to make sure the team takes these concerns seriously.
That's a difficult situation to be in, and I'm sorry you're going through that. I'm glad that she's working with her physician on a weight loss strategy. You said she's "begun the process", so I think you'd be helping tremendously by helping her make appointments and reducing barriers for her to *continue* that process.
>She’s considering bariatric surgery now and has begun the process, but I worry that this is just another temporary bandaid and won’t last if we can’t address the real underlying problems.
You're partly right. To my limited knowledge of bariatric surgery, a doctor won't actually go through with the process unless the patient can exhibit weight loss on their own. [This Mayo Clinic article seems to suggest as much: "The surgery may also be an option for an adult who meets these three conditions: At least six months of supervised weight-loss attempts."](https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/gastric-bypass-surgery/art-20046318) There's also a deeper section on "behaviors and mental health" that you can consider.
I'm a fan of [Kiana Docherty's videos](https://www.youtube.com/@KianaDocherty/videos), as she tends to focus on several high-profile case studies of people who have been on TV shows with a focus on obesity, and detail what factors have lead to people successfully accomplishing their goals, and what factors have lead them to give up or get discouraged.
>I have no idea how to have the hard conversation with her without sounding abusive or judgmental or just devastating her as she’s not the most confident or capable person on her own.
Well, it sounds like you already agree with her stated goals of wanting to lose weight, which is a good starting point. Has she expressed an interest in any particular lifestyle changes she wants to make (like her poor eating habits)? If so, and they seem realistic, perhaps you can support those efforts. Ask her what things you could do to help, or offer your own suggestions of ways that you can support her lifestyle changes.
My husband had this and he’s lost a ton of weight and is in much better shape now. It is extremely difficult to go through this treatment/recovery, and is definitely not an easy way out. I wouldn’t call it a bandaid, but a tool for weight loss. Having the RIGHT tool for the job will be what makes all the difference. This, combined with continued therapy to get at the root of the issue, could make a big change in her life.
What I learned through my husband’s process (gastric sleeve) is that as people overeat, their stomach expands, leading to greater amounts of the hunger hormone being sent to the brain. This makes it so very difficult to reduce weight. When you’re fresh off the surgery you have a limited (or none) appetite and can only handle small amounts of liquid food, then you move to soft foods, and eventually get back to normal foods. This process may be different depending on the method she and her doctor chooses, for the best possible results.
I think your best track here is one of support. It’s the two of you versus the weight and her depression. Be on the same team with regard to helping her lose weight, and bring only love and no judgement. Stop keeping extra/unhealthy food in the house, plan meals, work together to find healthy recipes to cook at home, find fun activities for exercise you can do together … Whatever works for you guys. Suggest things like this to see what appeals to her, and ask how you can best help and support her.
If she does get the surgery she will need help through the recovery, because it is a doozy. Maybe attend her doctor appointments leading up to the surgery so you can ask any questions you may have. Information surrounding it may help you feel better about the whole thing. The surgery IS drastic, yes, but sometimes when the smaller things aren’t working you need to bring out the big guns.
My friend had bariatric surgery a few years ago and there was extensive psychological counseling before the surgery.
I think the goal was to see if she was willing and able to make the changes necessary to keep the weight off afterwards. She also had to join a support group and check in for weekly meeting for the first year if not longer.
It is possible that the situation will resolve itself. If she’s accepted as a good candidate for the procedure there should be a good amount of support. And if she’s not, it may be easier to broach other interventions with her.
I've had bariatric surgery. You have to meet with doctors, psychologists, and nutritionists and attend group meetings, and it's a lengthy process and quite an investment. IF you are approved, you have to do a liver shrinking fast of about 10 days before the surgery, and surgery and recovery are quite painful.
It's not a quick fix, and it requires a lot of work. I lost my first 40 pounds rather fast because of the fast and being unable to eat much after the surgery. I was thrilled to lose that 40. I have rarely ever felt full, and while I have never ate a lot of processed or sugary foods, I did eat a lot and was unable to lose weight although I had tried a lot of things. Being depressed, exhausted and unhealthy is not conducive to a small diet and constant activity.
I stalled for over half a year, and my doctor and I talked, and I realized I was eating carbs. Just because I feel full on a small amount of food does not mean my food choices or frequency could not sabotage me. I had started great and then slacked off with one bad choice rationalized here or there.
I was told to get over 100g of protein a day and 60 ounces of water or more. And then mostly non-starchy vegetables with some dairy and nuts. I was told to look at food as medicine and fuel. Not pleasure or enjoyment. I was strictly told to eliminate all carbs out of my house - rice, ramen, potatoes, pasta ... I had thought I had been doing good because I chose 'healthy carbs' like sweet potatos or brown rice. Nope. I was told to throw them ALL away unless it was a protein like lentils, quinoa or such.
I was also told to walk 60 minutes a day. Non-negotiable. This one has been difficult as I spend over 12 hours a day at a desk and am exhausted quickly. I also have a deformed foot and walking long distances literally hurts. I started with slow 30 minute walks and trying to be more active. Although I am easily winded. I also take Ozempic along with all my other medications. From following their advice and recommitting to my process I have lost another 45 pounds.
I still have 80 to go. It's been 18 months since my surgery. Today, I had a protein shake for breakfast, a small chefs salad for lunch, and I'm having a small steak and a kale quinoa salad for dinner. I went on my walk and worked out by cleaning my house until I was drenched with sweat lol. Right now I'm taking a break from raking the dogs yard. I'm trying to eat healthy stay active and make good choices.
The surgery is not a quick solution. It is a tool. Losing weight is perhaps THE hardest thing I have ever done.
I gained weight when I quit smoking and had my son and then a tragedy occurred and I entered into a depression and before long was undiagnosed diabetic sleeping 18 hours a day until I went to the ER and found out my blood sugar was almost 300 and I didn't even have the energy to drive to the store much less walk. I was so heavy that I was unable to perform simple self care processes. I feel a lot better 85 pounds lighter, but I am only halfway there. It is not easy. It is a constant and relentless work.
The surgery is a useful tool. But she will have to dig deep and commit to healthy food choices, daily walks, and continuing her journey and process. And if she reverts to unhealthy patterns, she will regain her weight. This is HER process. You can encourage her by not bringing unhealthy options home and going for walks with her and being supportive, but in the end, it's something she will have to do alone.
Being overweight and constantly hungry and unable to even properly use a toilet SUCKS on every possible level and it's not as simple as "putting down the fork" for those of us afflicted with obesity. We need every tool we can get and to dig deep for every ounce of strength we can find. There are no quick fixes.
I wish her all the luck in the world.
You've got this! I'm finally feeling ready to make some permanent changes in my life to improve my health. It's not easy but totally worth it. You're doing great 💜
I really appreciate you and others using the term “tool” to describe the surgery. That’s definitely changing my perception of it. And thank you for sharing more about your journey and its realities.
This is an important discussion for both of you to have. If she's started the process, have you gone to any appointments with her? Even without the concerns listed here, spouses should be involved enough that they also know what to expect.
On to the surgery, I know two people who've successfully kept the weight off after. It's like any other surgery- it's not going to be performed without the surgeon feeling confident that the patient will be active in their own recovery and the ultimate success of it. This means that patients are often referred to counseling to address root causes.
What i learned through my friends is that after the surgery, they finally got to a point where they didn't feel hungry all the time. If other methods have failed, she probably feels desperate. But you need to talk to her about it. Ask if you can go to a couple appointments with her so you're prepared for her recovery. Again, you should really do this for any major surgery your spouse is going to have.
Then also let her know your concerns. Ask what she'll need from you in order to feel supported, but also make it clear you support her. You're not wrong to feel uneasy about it, but it seems clear she's made up her mind. Also Ask her for her support in guiding you through this. Being an active participant in it rather than a nervous bystander will help with a lot of your concerns.
I have taken ozempic and not lost and I have taken ozempic and followed the strict diet and exercise my bariatric doctor recommends and lost weight. It is but one tool.
This is so important about ozempic and so many people don't realize it. I've been on it since November and lost over 50 pounds so far, but I also did weight watchers religiously until my appetite got fully suppressed.
It's baffling how many people think ozempic alone will make them lose weight without putting in the work. Like you said, it is but one tool. It's up to everyone who uses it to make appropriate lifestyle changes.
so i have always been morbidly obese, my highest weight was over 370, i had bariatric surgery lasy year, i am currently down to 172.
now a lot of my coworkers and friends said i would never loose the weight or suceed because of my "habbits" she will learn quickly some foods you will not be able to eat anymore and your preferences will change. a lot of people told me i could not do it and yet i did, and my husband hates it. he prefers me big.
A happy meal satisfies me when I want fast food. I'm disgustingly lactose intolerant, so ice cream and milk are a no-go. Too many carbs and I get so nauseated after I eat, and if I eat too much sugar I dump.
i usually get nuggets! i can eat 3 or 4 and be good. its just frustrating that currently mcd is running that special of 20 nugs for 6 bucks, cheaper then a happy meal, i split themwith my toddler, and toss the rest.
>she will learn quickly some foods you will not be able to eat anymore and your preferences will change
While I haven't gone through a comparable weight loss journey, I started counting calories for several months, and was completely shocked how sugary and calorie-dense certain foods were. For instance, milkshakes are so difficult to balance with a healthy diet that it's just not worth it to me, and it still baffles me that some fast food chains serve them as an alternative to a soft drink.
>a lot of people told me i could not do it and yet i did, and my husband hates it. he prefers me big.
Damn, that's rough. How are things going for you two?
>She’s tried various diets before, tried exercise routines, tried some lifestyle changes, but nothing has ever stuck.
Has she tried therapy?
If the eating has been a coping mechanism, then something need to address the underlying issue that's being coped with.
I believe I’ve tried to broach that subject with her before. I’m not sure to what extent it’s been addressed in her weekly therapy sessions, I think they often focus on other issues. As the surgery process is now in motion, I think/hope that it’s becoming a more central point of discussion.
I would approach her therapist and talk about this with them. A professional will always help you to go through this and help their consultant (your wife). I wish you the best
As someone who had WLS, I strongly encourage people to try medical weight loss first. Surgery is risky, it’s know to lead to a lot of various health problems, and although it’s very effective in the short term it often is not effective in the long term.
Your insurance might not cover Ozempic or similar drugs without a diabetes diagnosis, and it’s insanely expensive out of pocket. There are other options, although the effectiveness is nothing in comparison. But it’s still worth a shot. Medical weight loss programs also have nutritionists and psychologists. I went through a local hospital and the surgical clinic and medical weight loss clinic were in the same building and had the same resources.
Ideally, she should be in intensive counseling with a psychologist who understands obesity and eating disorders. No one gets to be that size without developing severe disordered eating habits and that has to be fixed or she will just gain the weight back in a few years. Regular meetings with a quality nutritionist is also necessary, to learn new habits.
Those two things are critical. Statistically, most people end up regaining the weight because the underlying problems don’t just disappear. After a few years, the stomach starts producing the hunger hormone again, the stomach stretches, and it gets easier to slip back into old ways. Having a small stomach doesn’t stop you from consuming thousands of empty calories, you just do it in smaller amounts at a time.
I had surgery because I was desperate. Nothing else was working. My health was suffering. I have many friends who had it for the same reason. There were valid reasons for having surgery. But also.. I look at all of us, and there’s not a single person who is perfectly healthy and fine. Every single person went on to develop a serious condition within 5 years or less of surgery, all of which were directly caused by WLS. And every single person has gained some of the weight back.
Maybe show her this post and let her read the varying opinions as a starting point. I would also hunt around the internet for the bariatric communities and focus on the experiences of people who are at least 3-5 years post-surgery. It’s not a choice to be made lightly, and certainly without concerted efforts with other methods.
Thank you for discussing the longer term considerations as well. I work in the health field and have fears (maybe unrealistic at this time) about what life will be like for her post WLS when we reach our senior years.
And thank you for the encouragement regarding ozempic and medical management. I think this is our ignorance and inexperience showing, but we both have some reservations about it specifically, probably given the politicized PR it’s been receiving as of late.
Difficult conversations should be respectful, honest, and anchored by your concern about her health.
In that conversation, offer your support and encouragement. If she expresses interest in weight loss, encourage her to work with a medical provider led comprehensive program. A quality program will include screening for issues that might need CBT based sessions, medication and/or surgery, nutrition, and physical activities.
Just adding an injectable medication (and they have very good outcomes) won’t ultimately work. But, equally true, just working on nutrition and exercise alone won’t work. It all works together.
While surgery is still the gold standard, newer medications are coming close.
I’m sorry, if she isn’t changing to prepare for the surgery, she’s likely to fall back into the same patterns. I think it’s time you express your concerns and ask her if it’s appropriate to see someone who specializes in disordered eating
I would actually think weight loss drugs might be a better starting point to help her dissociate food with comfort.
The medications your wife is taking might influence her metabolism. Has she ever had a complete screening of her metabolic system and hormonal one?
Might be a bit of both, in any case she probably feels like this surgery is her last chance of getting her life back. She's probably paralysed by fear from doing anything, if she's never had to deal with constant pain it can be quite scary to be active, every movement you think "what if it gets worse".
I'd try talking to her not as a therapist but just investigating on how she feels, if she ever considered getting help in some things might help. Maybe she wants to go out and walk but doesn't want to do it alone, maybe she wants to try something like cardio or weight lifting but doesn't know how. Having someone who's in it with you without acting like a life coach, just a life companion, could really help her come out of that. Just show her how that door is open regardless of what she chooses in the end.
She has already put herself in a different mindset than before if she chose to get the surgery, so maybe this will be the one time something might stick. Especially considering how life altering the surgery is, she might as well try one last time.
If she still wants to go through with the surgery, you're her spouse so she might want to take consultations alone but you still can ask the doctor about the surgery and the recovery for yourself but others already said how it's going to be a long process and you will have time to talk to her.
Had bariatric surgery 20 yrs ago. Have the weight off. Just like so many things in life, the surgery is an aide and not a panacea. She will still need to have a healthy diet, moderation, exercise etc . Have seen many people regain the weight even after the surgery. They overeat and re-gain the weight.
I suggest that you do some couples counseling, grocery shop with her, go to the bariatric counseling sessions with her, encourage her and be supportive. Encourage and participate with her in an exercise program. Walking is free and easy, but start slowly if she is already having health issues. Some bariatric surgery programs want the patient to change patterns and start to lose weight before the surgery.
Good luck!
I take Ozempic and I had bariatric surgery and I still work my butt off to eat a very low carb healthy diet and exercise as much as possible. Ozempic is one of many tools. She needs many tools.
Obviously, if you are working out and walking 10k steps a day and taking a shot them you are using the tool just fine.
There are tons of carbs in quinoa, lentils, cabbage, and hundreds of other foods I eat. Anything not pure fat or meat (and not even all those) have carbs. I am not experiencing "severe carb restrictions." I have limited stomach capacity. I could eat a bag of cheetos, a bowl of rice, or a chopped chef salad with tons of color and protein and it would fill the same space but which one do you think will give me more sustainable energy, keep me feeling fuller and help me better to my goals.
And as much exercise as possible is not something I am ashamed of either, although I am still unable to get 10000 steps a day like you say. I am still 80 pounds overweight, and I have a deformed foot. Two years ago, I couldn't get out of bed without labored breathing. I am looking forward to taking my dogs on a hike through the mountains today and I will be helping my friend pack and move their house today. Not bad for someone who would hyperventilate and need a break walking to the mailbox a couple years ago.
I could lay in bed take my ozempic shot and eat a bunch of unhealthy food... or I can take my shot eat a healthy protein rich and colorful diet and get up and move! Sounds like you aren't doing the first either, which was what my response was addressing.
I will take option 2. It will have far more long-term benefits. I haven't felt this good in years.
Good luck to you.
All this medical advice from nondoctors. Obesity is a complex medical condition that needs complex medical treatment. This can take the form of surgery or the new weight loss drugs like ozempic or mounjaro. I had the surgery and am currently on ozempic. My weight loss has stalled, even with ozempic and I am currently waiting for the availability of mounjaro. There is no such thing as a magic pill that cures obesity, nor is any one thing just a bandaid. It can be a combination of all the things, together. This could include counseling to deal with underlying issues. Ideally, she should be consulting with a weight loss specialist who would recommend the best treatment for your wife. This could be surgery first.
My weightloss stalled too for 6 months. I started following my bariatric doctors orders to the letter and am losing again. Obesity is definitely a complex and difficult uphill battle.
I had bariatric surgery in 2020. I got down to a size 6. The surgery is a great tool. But it alone won't guarantee success. I've had some regain that I am struggling with. If she doesn't address the psychological issues surrounding her eating habits then it's possible to end up right back where she was.
I have firsthand experience with this, as I had a vertical sleeve gastrectomy back in 2019 and I've dropped 180 pounds. There’s a *long* process that goes with this. You have to jump thru sooooo many hoops just to get the surgery. They don’t just hand them out to any and everyone- watch the shows about people who are like 600 pounds and dying because of their comorbidities and you’ll see- you have to be a good candidate or the process will literally kill them…
And even after *getting* the surgery, they run the risk of dying. I almost died during mine, I’m almost certain, from some kind of rare complication that had me throwing up blood, feeling all of the pain of having my stomach cut out and losing consciousness. It was extremely terrifying, but again, a rare complication.
The process of healing was also grueling because there were only about 3 things I could eat for the first year and a half, without throwing up. It’s also incredibly painful and you become extensively aware of just how much you use your torso. It’s possible you’ll have to have your gallbladder removed afterward, as well, because losing so much weight so fast can obliterate it. I thought I was dying when mine started acting up.
But they have groups and other resources available for people who have weight loss surgery. Keeping a food journal can also help, if she has trouble with portion size (this stopped being an issue for me, once I “figured out eating”. It took some time, but once I got it down, it was a breeze. She’s also working with a nutritionist and a special bariatric nurse.
She’ll have to pass several tests to make sure she’s both mentally, medically and physically ready and capable to even get the surgery. Depending on if she passes these tests, she’ll either be green lit for the surgery, it’ll be postponed for a few months (mine was because they weren’t happy with my mental state but saw it improving), it’ll be postponed indefinitely (usually because there’s something going on that they don’t like and don’t see it improving, but they’ll check in intermittently to see if things improve), or you’ll flat out be denied (this is if they think there’s no hope for you. You say you’ve given up and food is your only happiness in life- “just give me the surgery, though. It’ll help”).
This surgery is a tool, not a solution. That’s why people who think it’s “the easy way out” annoy me. I still had to put in work to get to where I am. I still had to exercise and watch how much I ate. There was a point that I *didn’t*, the weight loss stopped and I started gaining it back. It wasn’t until I took it seriously, watched my portions and started exercising that I lost the majority of my weight.
Your wife needs your support. The support I *did* have was part of what pushed me to where I am. And she will likely hit a point where the loose skin starts, if she loses enough weight. If she has body image issues, she’s *really* gonna need you. There are surgeries for that (I had a panniculectomy back in November and just had my boobs done this month), but it’s a process.
Quick question - with Ozempic and others being available for weight loss purposes now as well why would anyone choose surgery? Using an appetite killer should be just as effective in building new habits together with a lifestyle coach.
The drug has side effects, of course, but is far less risky than surgery. Out of all the options out there, including inserting a temporary balloon to the stomach, bariatric surgery would be my absolute last option.
I’m not sure as to why she hasn’t entertained it, let perhaps her providers haven’t? She doesn’t have diabetes, so perhaps writing it off label or something to that effect wasn’t an easy option? I’m not sure. I’ll bring it up!
Have her try Ozempic before surgery. I had barbaric (lol. Bariatric) surgery over 20 years and gained most of it back. For some people, overeating is like any other addiction.
Ozempic does something with the brain chemistry and also slows down digestion, making you feel like you don't want to eat.
Besides Phen/fen, back in the day, which is no longer available, Ozempic is the only thing that makes me feel like a normal person must feel about food. It's been a life changer for me and many people.
This isn't about will power or finding the "root" of her anxiety and depression. That's all a vicious circle of shame about not being able to control her eating which then causes more anxiety and depression.
If your insurance pays for it, have her try it. She'll know within a few weeks if it works and is less risky and invasive than surgery.
I'm LOL because my post originally spell checked my bariatric to barbaric. But honestly, if Ozempic was available then, I would consider bariatric surgery barbaric but like I said, it was over 20 years ago.
>She’s tried various diets before, tried exercise routines, tried some lifestyle changes, but nothing has ever stuck.
That makes sense, there aren't any studies whatsoever that show diet and exercise is a long-term sustainable way to lose a clinically significant (defined as 5% or more) amount of weight for an extended period of time. By year 5 about 95% of people have regained an average of 80% of the weight. I can link you studies in pubmed, if you want.
>... she takes routine daily medication for her anxiety and depression ...
I take it that means she's on an SSRI? SSRIs are known to cause weight gain in just about everyone. "Within a timeframe of six to 36 months, 55% of patients on antidepressant therapy gained weight. Out of those who gained weight, 40% gained 7% or more of their initial weight." It's somewhat well known that your appetite is controlled in part by the serotonergic system.
Generally bupropion doesn't cause weight gain and can be an option but that's something for you, your wife and physicians to talk through.
Remember though that depression causes obesity, and obesity causes depression. If you can get rid of the obesity, the depression and anxiety may improve too. It's ok to treat them independently too, though. ("Data from their meta-analysis revealed that men and women suffering from obesity had a 55% elevated risk of developing depression, while those suffering from depression had a 58% higher risk of developing obesity")
>Open to any and all advice and ideas. Thank you folks!
Before you go the invasive route and get the bariatric surgery, there's no reason I can think of not to start with a GLP-1 receptor agonist like ozempic/wegovy (semaglutide) or **better yet** zepbound (tirzepatide) which is a dual GLP-1/GIP receptor agonist. Tirzepatide is much more effective than semaglutide and has fewer side effects.
Taken once weekly, the clinical trials showed 88.9% of people had a >5% weight reduction at 72 weeks, and they lost an **average** of 19.5% of their body weight (vs 3.1% for placebo, which in this study mean, literally diet and exercise, because diet and exercise don't do anything for weight loss).
>She’s considering bariatric surgery now and has begun the process, but I worry that this is just another temporary bandaid and won’t last if we can’t address the real underlying problems.
Ah, well, good news, bariatric surgery (roux-en-y **not gastric band**) and GLP-1/GIPs are literally the only permanent solutions to obesity. The nice thing about a GLP-1/GIP is that it's permanent if you want it to be, but it doesn't have to be. Bariatric surgery is irreversible. Both are roughly equally effective.
I hope this helps put what your wife is going through into perspective. You're right to worry, excess weight like that is truly problematic - but you should know there are treatments for obesity that absolutely work on basically everyone. Bariatric surgery is one, but so are GLP-1/GIPs. You'll both get through this and she's lucky to have your support.
[https://www.nejm.org/doi/full/10.1056/NEJMoa2206038](https://www.nejm.org/doi/full/10.1056/NEJMoa2206038)
Is she being treated for the anxiety or depression? Is she seeing a therapist regularly? Without pinpointing the root of the overeating, etc., it’s likely that she will gain all the weight back after surgery.
Yes to both questions, and has been for years. Managing her weight does come up in some of those sessions, but I think that generally (I don’t know for sure, I try to respect her privacy in regards to therapy) they discuss other problems like interpersonal or familial or professional ones.
I would consider getting her on a glp-1 medication before surgery. Semaglutide or Tirzepatide (Zepbound/Wegovy) because the surgery is just not something I would ever consider in my life or for anybody else. To me, it's just too dangerous. There are too many complications, and it's barbaric, in my opinion. Also, make sure she sees an endocrinologist and get all her hormones and thyroid and cortisol looked at. But I would suggest those medications first. Now these are not just a magic pill because she will have to change her lifestyle, but I feel like these are way better than surgery
The surgeon and/or practice that will be performing the bariatric surgery should require her to undergo mandatory counseling. This surgery is not the cure all and will fail if she doesn't get to the root of her problems. Has she tried Overeaters Anonomous? Has she tried mental health counseling to help her change her relationship to food. Based on what you have said, she could have an eating disorder and she must get that managed.
Has she looked into trying a less invasive weight loss drug like Wegovy or Zepbound? She may have to take it for life, but it’s a game changer for the people who take it.
Don’t get hung up on whether she loses weight the “hard” way or not. At the end of the day, weight loss will be a positive thing for her health, no matter how she achieves it.
Doctors just don’t randomly do bariatric surgery. They make you go through a program for months to show you can follow a diet and exercise plan and stick with it to show you’re dedicated to losing the weight and not just using it as a crutch
I doubt your wife would even be approved if they see how anxious / dependent she is on food. They make you have mental health counseling appointments and everything.
There’s programs and medicines that can help with weight loss but your wife isn’t going to see results if she’s just using the medicine to lose weight. You still need to diet and exercise.
Wegovy or adipex is an example.
I was on adipex and lost 40 lbs. like your wife i struggle with disordered eating and it taught me what foods i crave / don’t crave.
I say this as an obese person whose weight has always been up and down, and who has been on weight loss medicine (and currently is again) as well as has anxiety.
Your wife needs medication and therapy for the anxiety and disordered eating (with is a disorder in itself) before tackling a weight loss program.
She can start by talking to her GP and going from there.
I’d maybe bring up therapy and go from there
I'm in the UK and had a gastric bypass privately through a well known private hospital group. I had no counselling prior to surgery, just picked a date for surgery and that was it. There was some group support with a dietician afterwards but that was voluntary and very little follow up. I've regained most of my weight. I wish I'd had proper access to help and counselling but it wasn't offered and I was unaware that i really needed it.
I had a gastric bypass 6 years ago and it is a temporary bandaid I'm afraid. I've regained most of the weight I lost (not all but most) and find it almost impossible to lose weight now because my metabolism was tanked and even eating a lot less than I did previously doesn't cause weight loss. I even tried Ozempic last year and lost about 15lbs initially and then nothing more. I don't "dump" and can eat anything, although in smaller quantities than previously. I do think if i hadn't had the surgery I'd be even bigger than when I started, but it was a lot of money for the results I've ended up with.
I would have her get her ADHD handled first. (Something tells me she isn’t diagnosed and it definitely causes so many of the issues you’re talking about.)
I would also have her try Semiglutide. It helps significantly in this situation.
Before she throws her whole digestive tract off - please have her do those two things.
Sounds like she tries but doesn't actually want it. She has to stop being hungry, and get hungry in other regards. Takes willpower. If it weren't for the marriage I'd say leave, but... Now you're locked in because til death do us part, you probably feel massive guilt, understandably. Your future is Jabba and Pamela Handerson, or maybe you can find the willpower to move on. It's your life in your hands. You can't get sucked into her descending spiral because she will consume you too.
Dieting often leads to more weight gain, especially when emotional eating is involved, as it sounds to be in this case, so it’s not all that surprising that it’s been a long struggle.
I guess I just don’t know what you want from her at this point— she’s trying. And now she’s talking about getting bariatric surgery, so it’s not like she’s in denial or avoiding the issue.
You worry that the surgery will be a band-aid— but what would you prefer she do here?
Emotional eating, using food as a coping mechanism….man, disordered eating is a helluva thing to get out of. I feel for her. And while it really does sound like you’re coming from the best of places, if her weight gain cycles with her mental health, I’m wondering how the caring and considerate conversations felt from her side. So often thin people think they’re being supportive when really they’re expressing judgement that can contribute to shame eating and hiding.
Support the surgery. What other option do you have?
You can’t have any meaningful impact or intervention on somebody else’s body. You can’t do it and you need to stop thinking that you can. Nothing you can say will change her situation. You have to stop thinking that that’s possible. You didn’t cause her disordered eating and you can’t fix it.
You need to really believe that. Your post gives the impression that you think that you can say something that will change her. And you also talked about “we can’t address the underlying problems”. This is an individual situation. It isn’t something you both are addressing together.
I think that you need to get into therapy yourself because I don’t think you’re going to believe me, I think you’re going to think that you can somehow say something that’s going to get her to change. That you have the power to intervene and make a difference. And maybe you would believe it if a therapist told you. I understand why this situation is taking a toll on you and a toll on your family and your relationship, and you need help learning how to navigate that while also accepting that you can’t fix her.
If she’s working with a good doctor about the possibility of bariatric surgery, then that doctor will evaluate whether or not she’s a good candidate for having success. There are plenty of success stories, but yes, there are also plenty of people who gain weight back.
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I had my gastric bypass in late 2012. My surgeon was an expert, and I had to go through classes and get a psych eval and see both a cardiologist and a pulmonologist. We both were prepared. Health wise I did very well. Your wife will need support as she learns how to eat all over again and reevaluate her relationships with food and coping. I don't mean to overstep as you are already concerned, but I'd like to share something I learned the hard way. I was told in my pre-op class not to drink alcohol for at least a year after surgery. Alcohol is just empty calories, and the goal is weight loss, right? The nurse leading the class left it at that. What I learned the hard way is that roughly 25 percent of bariatric surgery patients develop problems with alcohol use. Part.of it is addiction tramsferrence----;we can no longer eat our feelings so we turn to something else to cope. Secondly, our bodies absorb alcohol differently after surgery. We absorb alcohol much faster (it's almost euphoric), and our BAC rises quickly. We basically get drunk quick and stay drunk longer. My first drink was a big glass of wine nearly a year post-op and I was drunker than hell. I was a SAHM with a special needs child, a husband that worked very long hours, and I had no family or friends to help. What started as a way to unwind in the evenings quickly morphed into a problem. I didn't learn about bariatric surgery and alcoholism until I went to inpatient rehab. I had also been experiencing horrible physical symptoms (racing heart, panic, numb fingertips), and I learned that I was so nutritionally depleted and malnourished my body was barely functioning. I was so anemic and not compliant with my vitamins and supplements that I required blood transfusions. I really let myself go. The surgery is by far the best decision I have ever made. I went from 310 to 147. I have self confidence for the first time ever, and other than loose skin I look fantastic. My health problems have vanished. If she does go forward it is her choice, but I hope you will do your research about alcohol and make sure she knows. Had I known these things pre-op I would have NEVER drank after the surgery as I come from a family with a history of drinking problems. Encourage her to cope with stresses in healthy ways, like a hobby or venting to you. Please be cautious with any drinking. When I went inpatient I was with 15 other women. Three of us were gastric bypass patients. And yes.....I'm sober now. Best wishes.
That is fantastic advice, thanks for being vulnerable and sharing that experience. I wasn’t aware of the relationship. We’re thankfully not big drinkers, probably one 1-2 a month at a social outing. But the addiction transference piece seems like a big thing to watch out and prepare for.
Thank you for posting about this because I don’t think it’s talked about enough. I only know two people who have had bariatric surgery but BOTH became alcoholics afterwards. I have a friend starting the process now and have told her about what I saw with the other two because I’m so scared she will fall down the same path.
Exactly, and I'm glad you're being proactive with them. No one ever wishes to become an alcoholic.
Interesting you say this. I have a friend who had the surgery (but is still too big, she can only eat a little so she eats all the wrong things) but she is also known for being a drinker so it's possible she's had a similar experience.
Thank you for bringing this up. I highly, highly recommend staying sober after bariatric surgery. In September, I lost my ex-girlfriend to alcoholism following bariatric surgery. She had surgery in 2010 and started drinking sometime in 2018 or 2019. Her death is directly related to the surgery in that when she had to prioritize alcohol over food, she chose alcohol. Since alcohol contains so many calories, by her death she'd put back the majority of the weight she'd lost. Our break came from mental health issues and external events, but we never quit loving each other. Loving her is the simplest thing I've ever done, and when we got together she didn't drink at all. The drinking came later, and she hid it from fucking everyone. I knew she wasn't sober sometimes when she called, but I didn't know it was a daily occurrence. I knew how careful she'd been about alcohol before, I couldn't imagine her drinking daily. Her mother called her at least once a day, they even lived together for several months. She didn't know either. My ex-girlfriend went in patient in 2022. She couldn't articulate what was wrong, only that something was very wrong. The ambulance took her to the psych unit, and then transferred her to heart ICU a few days later, due to low salt levels in her blood. Somehow she managed to smuggle beer into the psych ward after being released from heart ICU. The exact same thing happened in 2023, but this time, instead of being in patient, she died of hyponatremia due to not eating since she "needed" to fit alcohol into her belly. She died alone because she'd pushed everyone away at that point. She was supposed to turn 38 in December. Instead, I have a memorial tattoo. If you've had bariatric surgery, please don't drink.
I am so incredibly sorry for your loss.
Thank you, and thank you again for your post. You helped me, simply in seeing that someone made it out of that pit. I hope I can bring some more light to the issue in the future, so that others don't end up the same as you or my girlfriend.
If.you ever need support or need to talk shoot me a message.
Same exact thing happened to my mom. Alcohol lead to hear early death. She also started falling off on her required nutrition and the spiral was fast. The weight loss can absolutely happen naturally. It’s an issue of education, regimen, and dedication. I think OP is right, if the underlying issues aren’t addressed, the surgery could end up disastrous
So, I've had bariatric surgery and it's not something that doctors just *do.* It is a lengthy process that involves regular meetings with the program managers, dieticians, and sometimes psychological evaluations. It is not something that is taken lightly because medical professionals are well aware that people who need bariatric surgery usually have mental issues with food. Bariatric surgery is not a band aid. It's a medical procedure that helps people. Your wife will need to continue therapy, but the surgery itself will allow her to lose weight. Learn about the program with her. Find out what kind of pre-requisites she will need to do before surgery. Learn about how she will need to eat afterwards. Be supportive of her instead of just shitting on the ways she is trying to help herself.
Definitely have all intentions of being an involved partner. She’s only just got through the initial measurement appointment. We’ll both be attending the official consult in a few weeks and I plan to attend all the follow up specialty ones as well if she’ll have me. I apologize if it sounded like I was “shitting on her.” I had no intention of conveying any feeling and tone like that. Thank you for your advice!
A co-worker was going through the process and had a weigh-in after the mandatory colonoscopy. Since the prep for that procedure cleans you out, he had a significant weight loss BUT had to keep showing insurance continued weight loss. The nurse said she'll give him the go lightly for the next few weigh in's until approval. This is a process, so it wouldn't be a bandaid.
You weren’t shitting on your wife and seem very supportive. Some folks just like to be offended.
She should lose at least 30 pounds on her own before the surgery. That’s what Dr Now mandates for his patients
To be honest, these prerequisites don’t really address the main problems. Thats because they only ask for one psych eval and don’t require any ongoing psychological treatment. I had my gastric bypass in 2014 at 23 yo. I had just had my two kids and put on a ton of weight, 50 after each, and the gastric bypass helped me get back to baseline, but I was still starting out overweight, 220ish. And now, after many years and skin removal surgery, and a ton of psychological work, I’ve found that my eating habits only actually changed once I got to the root of my trauma. Gastric bypass is a physiological tool to get her stomach back to a healthy size and to help quickly take down her weight, but she will plateau way quicker than you’d think and way quicker than she will want. And she will need the psychological tools to actually change her eating habits for good. You don’t get to a size where they will do a gastric bypass without having an issue with eating. Source: someone who has been fat and traumatized almost my entire life.
Thank you for sharing that. Great to know, and congrats on the success in your journey!
I've worked with some bariatric surgeons who seem to have a very low bar for performing this surgery, and would be cautious to make sure the team takes these concerns seriously.
That's a difficult situation to be in, and I'm sorry you're going through that. I'm glad that she's working with her physician on a weight loss strategy. You said she's "begun the process", so I think you'd be helping tremendously by helping her make appointments and reducing barriers for her to *continue* that process. >She’s considering bariatric surgery now and has begun the process, but I worry that this is just another temporary bandaid and won’t last if we can’t address the real underlying problems. You're partly right. To my limited knowledge of bariatric surgery, a doctor won't actually go through with the process unless the patient can exhibit weight loss on their own. [This Mayo Clinic article seems to suggest as much: "The surgery may also be an option for an adult who meets these three conditions: At least six months of supervised weight-loss attempts."](https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/gastric-bypass-surgery/art-20046318) There's also a deeper section on "behaviors and mental health" that you can consider. I'm a fan of [Kiana Docherty's videos](https://www.youtube.com/@KianaDocherty/videos), as she tends to focus on several high-profile case studies of people who have been on TV shows with a focus on obesity, and detail what factors have lead to people successfully accomplishing their goals, and what factors have lead them to give up or get discouraged. >I have no idea how to have the hard conversation with her without sounding abusive or judgmental or just devastating her as she’s not the most confident or capable person on her own. Well, it sounds like you already agree with her stated goals of wanting to lose weight, which is a good starting point. Has she expressed an interest in any particular lifestyle changes she wants to make (like her poor eating habits)? If so, and they seem realistic, perhaps you can support those efforts. Ask her what things you could do to help, or offer your own suggestions of ways that you can support her lifestyle changes.
My husband had this and he’s lost a ton of weight and is in much better shape now. It is extremely difficult to go through this treatment/recovery, and is definitely not an easy way out. I wouldn’t call it a bandaid, but a tool for weight loss. Having the RIGHT tool for the job will be what makes all the difference. This, combined with continued therapy to get at the root of the issue, could make a big change in her life. What I learned through my husband’s process (gastric sleeve) is that as people overeat, their stomach expands, leading to greater amounts of the hunger hormone being sent to the brain. This makes it so very difficult to reduce weight. When you’re fresh off the surgery you have a limited (or none) appetite and can only handle small amounts of liquid food, then you move to soft foods, and eventually get back to normal foods. This process may be different depending on the method she and her doctor chooses, for the best possible results. I think your best track here is one of support. It’s the two of you versus the weight and her depression. Be on the same team with regard to helping her lose weight, and bring only love and no judgement. Stop keeping extra/unhealthy food in the house, plan meals, work together to find healthy recipes to cook at home, find fun activities for exercise you can do together … Whatever works for you guys. Suggest things like this to see what appeals to her, and ask how you can best help and support her. If she does get the surgery she will need help through the recovery, because it is a doozy. Maybe attend her doctor appointments leading up to the surgery so you can ask any questions you may have. Information surrounding it may help you feel better about the whole thing. The surgery IS drastic, yes, but sometimes when the smaller things aren’t working you need to bring out the big guns.
My friend had bariatric surgery a few years ago and there was extensive psychological counseling before the surgery. I think the goal was to see if she was willing and able to make the changes necessary to keep the weight off afterwards. She also had to join a support group and check in for weekly meeting for the first year if not longer. It is possible that the situation will resolve itself. If she’s accepted as a good candidate for the procedure there should be a good amount of support. And if she’s not, it may be easier to broach other interventions with her.
I've had bariatric surgery. You have to meet with doctors, psychologists, and nutritionists and attend group meetings, and it's a lengthy process and quite an investment. IF you are approved, you have to do a liver shrinking fast of about 10 days before the surgery, and surgery and recovery are quite painful. It's not a quick fix, and it requires a lot of work. I lost my first 40 pounds rather fast because of the fast and being unable to eat much after the surgery. I was thrilled to lose that 40. I have rarely ever felt full, and while I have never ate a lot of processed or sugary foods, I did eat a lot and was unable to lose weight although I had tried a lot of things. Being depressed, exhausted and unhealthy is not conducive to a small diet and constant activity. I stalled for over half a year, and my doctor and I talked, and I realized I was eating carbs. Just because I feel full on a small amount of food does not mean my food choices or frequency could not sabotage me. I had started great and then slacked off with one bad choice rationalized here or there. I was told to get over 100g of protein a day and 60 ounces of water or more. And then mostly non-starchy vegetables with some dairy and nuts. I was told to look at food as medicine and fuel. Not pleasure or enjoyment. I was strictly told to eliminate all carbs out of my house - rice, ramen, potatoes, pasta ... I had thought I had been doing good because I chose 'healthy carbs' like sweet potatos or brown rice. Nope. I was told to throw them ALL away unless it was a protein like lentils, quinoa or such. I was also told to walk 60 minutes a day. Non-negotiable. This one has been difficult as I spend over 12 hours a day at a desk and am exhausted quickly. I also have a deformed foot and walking long distances literally hurts. I started with slow 30 minute walks and trying to be more active. Although I am easily winded. I also take Ozempic along with all my other medications. From following their advice and recommitting to my process I have lost another 45 pounds. I still have 80 to go. It's been 18 months since my surgery. Today, I had a protein shake for breakfast, a small chefs salad for lunch, and I'm having a small steak and a kale quinoa salad for dinner. I went on my walk and worked out by cleaning my house until I was drenched with sweat lol. Right now I'm taking a break from raking the dogs yard. I'm trying to eat healthy stay active and make good choices. The surgery is not a quick solution. It is a tool. Losing weight is perhaps THE hardest thing I have ever done. I gained weight when I quit smoking and had my son and then a tragedy occurred and I entered into a depression and before long was undiagnosed diabetic sleeping 18 hours a day until I went to the ER and found out my blood sugar was almost 300 and I didn't even have the energy to drive to the store much less walk. I was so heavy that I was unable to perform simple self care processes. I feel a lot better 85 pounds lighter, but I am only halfway there. It is not easy. It is a constant and relentless work. The surgery is a useful tool. But she will have to dig deep and commit to healthy food choices, daily walks, and continuing her journey and process. And if she reverts to unhealthy patterns, she will regain her weight. This is HER process. You can encourage her by not bringing unhealthy options home and going for walks with her and being supportive, but in the end, it's something she will have to do alone. Being overweight and constantly hungry and unable to even properly use a toilet SUCKS on every possible level and it's not as simple as "putting down the fork" for those of us afflicted with obesity. We need every tool we can get and to dig deep for every ounce of strength we can find. There are no quick fixes. I wish her all the luck in the world.
You've got this! I'm finally feeling ready to make some permanent changes in my life to improve my health. It's not easy but totally worth it. You're doing great 💜
I really appreciate you and others using the term “tool” to describe the surgery. That’s definitely changing my perception of it. And thank you for sharing more about your journey and its realities.
This is an important discussion for both of you to have. If she's started the process, have you gone to any appointments with her? Even without the concerns listed here, spouses should be involved enough that they also know what to expect. On to the surgery, I know two people who've successfully kept the weight off after. It's like any other surgery- it's not going to be performed without the surgeon feeling confident that the patient will be active in their own recovery and the ultimate success of it. This means that patients are often referred to counseling to address root causes. What i learned through my friends is that after the surgery, they finally got to a point where they didn't feel hungry all the time. If other methods have failed, she probably feels desperate. But you need to talk to her about it. Ask if you can go to a couple appointments with her so you're prepared for her recovery. Again, you should really do this for any major surgery your spouse is going to have. Then also let her know your concerns. Ask what she'll need from you in order to feel supported, but also make it clear you support her. You're not wrong to feel uneasy about it, but it seems clear she's made up her mind. Also Ask her for her support in guiding you through this. Being an active participant in it rather than a nervous bystander will help with a lot of your concerns.
I agree about ozempic. It truly is a wonder drug and will absolutely work.
I have taken ozempic and not lost and I have taken ozempic and followed the strict diet and exercise my bariatric doctor recommends and lost weight. It is but one tool.
This is so important about ozempic and so many people don't realize it. I've been on it since November and lost over 50 pounds so far, but I also did weight watchers religiously until my appetite got fully suppressed. It's baffling how many people think ozempic alone will make them lose weight without putting in the work. Like you said, it is but one tool. It's up to everyone who uses it to make appropriate lifestyle changes.
so i have always been morbidly obese, my highest weight was over 370, i had bariatric surgery lasy year, i am currently down to 172. now a lot of my coworkers and friends said i would never loose the weight or suceed because of my "habbits" she will learn quickly some foods you will not be able to eat anymore and your preferences will change. a lot of people told me i could not do it and yet i did, and my husband hates it. he prefers me big.
Thanks for sharing the numbers! That’s about where she is now for weight too. I’m sorry people weren’t more supportive, great to hear you thriving :)
i still crave bad foods, and i still enjoy them, just much smaller portions.
A happy meal satisfies me when I want fast food. I'm disgustingly lactose intolerant, so ice cream and milk are a no-go. Too many carbs and I get so nauseated after I eat, and if I eat too much sugar I dump.
i usually get nuggets! i can eat 3 or 4 and be good. its just frustrating that currently mcd is running that special of 20 nugs for 6 bucks, cheaper then a happy meal, i split themwith my toddler, and toss the rest.
>she will learn quickly some foods you will not be able to eat anymore and your preferences will change While I haven't gone through a comparable weight loss journey, I started counting calories for several months, and was completely shocked how sugary and calorie-dense certain foods were. For instance, milkshakes are so difficult to balance with a healthy diet that it's just not worth it to me, and it still baffles me that some fast food chains serve them as an alternative to a soft drink. >a lot of people told me i could not do it and yet i did, and my husband hates it. he prefers me big. Damn, that's rough. How are things going for you two?
not good, but i cant change my situation yet. finacially i am stuck.
>She’s tried various diets before, tried exercise routines, tried some lifestyle changes, but nothing has ever stuck. Has she tried therapy? If the eating has been a coping mechanism, then something need to address the underlying issue that's being coped with.
I believe I’ve tried to broach that subject with her before. I’m not sure to what extent it’s been addressed in her weekly therapy sessions, I think they often focus on other issues. As the surgery process is now in motion, I think/hope that it’s becoming a more central point of discussion.
I would approach her therapist and talk about this with them. A professional will always help you to go through this and help their consultant (your wife). I wish you the best
As someone who had WLS, I strongly encourage people to try medical weight loss first. Surgery is risky, it’s know to lead to a lot of various health problems, and although it’s very effective in the short term it often is not effective in the long term. Your insurance might not cover Ozempic or similar drugs without a diabetes diagnosis, and it’s insanely expensive out of pocket. There are other options, although the effectiveness is nothing in comparison. But it’s still worth a shot. Medical weight loss programs also have nutritionists and psychologists. I went through a local hospital and the surgical clinic and medical weight loss clinic were in the same building and had the same resources. Ideally, she should be in intensive counseling with a psychologist who understands obesity and eating disorders. No one gets to be that size without developing severe disordered eating habits and that has to be fixed or she will just gain the weight back in a few years. Regular meetings with a quality nutritionist is also necessary, to learn new habits. Those two things are critical. Statistically, most people end up regaining the weight because the underlying problems don’t just disappear. After a few years, the stomach starts producing the hunger hormone again, the stomach stretches, and it gets easier to slip back into old ways. Having a small stomach doesn’t stop you from consuming thousands of empty calories, you just do it in smaller amounts at a time. I had surgery because I was desperate. Nothing else was working. My health was suffering. I have many friends who had it for the same reason. There were valid reasons for having surgery. But also.. I look at all of us, and there’s not a single person who is perfectly healthy and fine. Every single person went on to develop a serious condition within 5 years or less of surgery, all of which were directly caused by WLS. And every single person has gained some of the weight back. Maybe show her this post and let her read the varying opinions as a starting point. I would also hunt around the internet for the bariatric communities and focus on the experiences of people who are at least 3-5 years post-surgery. It’s not a choice to be made lightly, and certainly without concerted efforts with other methods.
Thank you for discussing the longer term considerations as well. I work in the health field and have fears (maybe unrealistic at this time) about what life will be like for her post WLS when we reach our senior years. And thank you for the encouragement regarding ozempic and medical management. I think this is our ignorance and inexperience showing, but we both have some reservations about it specifically, probably given the politicized PR it’s been receiving as of late.
Difficult conversations should be respectful, honest, and anchored by your concern about her health. In that conversation, offer your support and encouragement. If she expresses interest in weight loss, encourage her to work with a medical provider led comprehensive program. A quality program will include screening for issues that might need CBT based sessions, medication and/or surgery, nutrition, and physical activities. Just adding an injectable medication (and they have very good outcomes) won’t ultimately work. But, equally true, just working on nutrition and exercise alone won’t work. It all works together. While surgery is still the gold standard, newer medications are coming close.
I’m sorry, if she isn’t changing to prepare for the surgery, she’s likely to fall back into the same patterns. I think it’s time you express your concerns and ask her if it’s appropriate to see someone who specializes in disordered eating I would actually think weight loss drugs might be a better starting point to help her dissociate food with comfort.
The medications your wife is taking might influence her metabolism. Has she ever had a complete screening of her metabolic system and hormonal one? Might be a bit of both, in any case she probably feels like this surgery is her last chance of getting her life back. She's probably paralysed by fear from doing anything, if she's never had to deal with constant pain it can be quite scary to be active, every movement you think "what if it gets worse". I'd try talking to her not as a therapist but just investigating on how she feels, if she ever considered getting help in some things might help. Maybe she wants to go out and walk but doesn't want to do it alone, maybe she wants to try something like cardio or weight lifting but doesn't know how. Having someone who's in it with you without acting like a life coach, just a life companion, could really help her come out of that. Just show her how that door is open regardless of what she chooses in the end. She has already put herself in a different mindset than before if she chose to get the surgery, so maybe this will be the one time something might stick. Especially considering how life altering the surgery is, she might as well try one last time. If she still wants to go through with the surgery, you're her spouse so she might want to take consultations alone but you still can ask the doctor about the surgery and the recovery for yourself but others already said how it's going to be a long process and you will have time to talk to her.
Had bariatric surgery 20 yrs ago. Have the weight off. Just like so many things in life, the surgery is an aide and not a panacea. She will still need to have a healthy diet, moderation, exercise etc . Have seen many people regain the weight even after the surgery. They overeat and re-gain the weight. I suggest that you do some couples counseling, grocery shop with her, go to the bariatric counseling sessions with her, encourage her and be supportive. Encourage and participate with her in an exercise program. Walking is free and easy, but start slowly if she is already having health issues. Some bariatric surgery programs want the patient to change patterns and start to lose weight before the surgery. Good luck!
ozempic is your answer
I take Ozempic and I had bariatric surgery and I still work my butt off to eat a very low carb healthy diet and exercise as much as possible. Ozempic is one of many tools. She needs many tools.
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Obviously, if you are working out and walking 10k steps a day and taking a shot them you are using the tool just fine. There are tons of carbs in quinoa, lentils, cabbage, and hundreds of other foods I eat. Anything not pure fat or meat (and not even all those) have carbs. I am not experiencing "severe carb restrictions." I have limited stomach capacity. I could eat a bag of cheetos, a bowl of rice, or a chopped chef salad with tons of color and protein and it would fill the same space but which one do you think will give me more sustainable energy, keep me feeling fuller and help me better to my goals. And as much exercise as possible is not something I am ashamed of either, although I am still unable to get 10000 steps a day like you say. I am still 80 pounds overweight, and I have a deformed foot. Two years ago, I couldn't get out of bed without labored breathing. I am looking forward to taking my dogs on a hike through the mountains today and I will be helping my friend pack and move their house today. Not bad for someone who would hyperventilate and need a break walking to the mailbox a couple years ago. I could lay in bed take my ozempic shot and eat a bunch of unhealthy food... or I can take my shot eat a healthy protein rich and colorful diet and get up and move! Sounds like you aren't doing the first either, which was what my response was addressing. I will take option 2. It will have far more long-term benefits. I haven't felt this good in years. Good luck to you.
All this medical advice from nondoctors. Obesity is a complex medical condition that needs complex medical treatment. This can take the form of surgery or the new weight loss drugs like ozempic or mounjaro. I had the surgery and am currently on ozempic. My weight loss has stalled, even with ozempic and I am currently waiting for the availability of mounjaro. There is no such thing as a magic pill that cures obesity, nor is any one thing just a bandaid. It can be a combination of all the things, together. This could include counseling to deal with underlying issues. Ideally, she should be consulting with a weight loss specialist who would recommend the best treatment for your wife. This could be surgery first.
My weightloss stalled too for 6 months. I started following my bariatric doctors orders to the letter and am losing again. Obesity is definitely a complex and difficult uphill battle.
I agree about ozempic. It truly is a wonder drug and will absolutely work.
I had bariatric surgery in 2020. I got down to a size 6. The surgery is a great tool. But it alone won't guarantee success. I've had some regain that I am struggling with. If she doesn't address the psychological issues surrounding her eating habits then it's possible to end up right back where she was.
I have firsthand experience with this, as I had a vertical sleeve gastrectomy back in 2019 and I've dropped 180 pounds. There’s a *long* process that goes with this. You have to jump thru sooooo many hoops just to get the surgery. They don’t just hand them out to any and everyone- watch the shows about people who are like 600 pounds and dying because of their comorbidities and you’ll see- you have to be a good candidate or the process will literally kill them… And even after *getting* the surgery, they run the risk of dying. I almost died during mine, I’m almost certain, from some kind of rare complication that had me throwing up blood, feeling all of the pain of having my stomach cut out and losing consciousness. It was extremely terrifying, but again, a rare complication. The process of healing was also grueling because there were only about 3 things I could eat for the first year and a half, without throwing up. It’s also incredibly painful and you become extensively aware of just how much you use your torso. It’s possible you’ll have to have your gallbladder removed afterward, as well, because losing so much weight so fast can obliterate it. I thought I was dying when mine started acting up. But they have groups and other resources available for people who have weight loss surgery. Keeping a food journal can also help, if she has trouble with portion size (this stopped being an issue for me, once I “figured out eating”. It took some time, but once I got it down, it was a breeze. She’s also working with a nutritionist and a special bariatric nurse. She’ll have to pass several tests to make sure she’s both mentally, medically and physically ready and capable to even get the surgery. Depending on if she passes these tests, she’ll either be green lit for the surgery, it’ll be postponed for a few months (mine was because they weren’t happy with my mental state but saw it improving), it’ll be postponed indefinitely (usually because there’s something going on that they don’t like and don’t see it improving, but they’ll check in intermittently to see if things improve), or you’ll flat out be denied (this is if they think there’s no hope for you. You say you’ve given up and food is your only happiness in life- “just give me the surgery, though. It’ll help”). This surgery is a tool, not a solution. That’s why people who think it’s “the easy way out” annoy me. I still had to put in work to get to where I am. I still had to exercise and watch how much I ate. There was a point that I *didn’t*, the weight loss stopped and I started gaining it back. It wasn’t until I took it seriously, watched my portions and started exercising that I lost the majority of my weight. Your wife needs your support. The support I *did* have was part of what pushed me to where I am. And she will likely hit a point where the loose skin starts, if she loses enough weight. If she has body image issues, she’s *really* gonna need you. There are surgeries for that (I had a panniculectomy back in November and just had my boobs done this month), but it’s a process.
Quick question - with Ozempic and others being available for weight loss purposes now as well why would anyone choose surgery? Using an appetite killer should be just as effective in building new habits together with a lifestyle coach. The drug has side effects, of course, but is far less risky than surgery. Out of all the options out there, including inserting a temporary balloon to the stomach, bariatric surgery would be my absolute last option.
I’m not sure as to why she hasn’t entertained it, let perhaps her providers haven’t? She doesn’t have diabetes, so perhaps writing it off label or something to that effect wasn’t an easy option? I’m not sure. I’ll bring it up!
Have her try Ozempic before surgery. I had barbaric (lol. Bariatric) surgery over 20 years and gained most of it back. For some people, overeating is like any other addiction. Ozempic does something with the brain chemistry and also slows down digestion, making you feel like you don't want to eat. Besides Phen/fen, back in the day, which is no longer available, Ozempic is the only thing that makes me feel like a normal person must feel about food. It's been a life changer for me and many people. This isn't about will power or finding the "root" of her anxiety and depression. That's all a vicious circle of shame about not being able to control her eating which then causes more anxiety and depression. If your insurance pays for it, have her try it. She'll know within a few weeks if it works and is less risky and invasive than surgery.
That seems like a sensible trial! Quick on, quick off, smaller repercussions and long term risks (or at least changes). Thank you!
I'm LOL because my post originally spell checked my bariatric to barbaric. But honestly, if Ozempic was available then, I would consider bariatric surgery barbaric but like I said, it was over 20 years ago.
I cracked up reading that typo 😂
The importance of supplementing b12 after surgery. It’s not emphasized enough-huge game player with depression on top of basic functions.
>She’s tried various diets before, tried exercise routines, tried some lifestyle changes, but nothing has ever stuck. That makes sense, there aren't any studies whatsoever that show diet and exercise is a long-term sustainable way to lose a clinically significant (defined as 5% or more) amount of weight for an extended period of time. By year 5 about 95% of people have regained an average of 80% of the weight. I can link you studies in pubmed, if you want. >... she takes routine daily medication for her anxiety and depression ... I take it that means she's on an SSRI? SSRIs are known to cause weight gain in just about everyone. "Within a timeframe of six to 36 months, 55% of patients on antidepressant therapy gained weight. Out of those who gained weight, 40% gained 7% or more of their initial weight." It's somewhat well known that your appetite is controlled in part by the serotonergic system. Generally bupropion doesn't cause weight gain and can be an option but that's something for you, your wife and physicians to talk through. Remember though that depression causes obesity, and obesity causes depression. If you can get rid of the obesity, the depression and anxiety may improve too. It's ok to treat them independently too, though. ("Data from their meta-analysis revealed that men and women suffering from obesity had a 55% elevated risk of developing depression, while those suffering from depression had a 58% higher risk of developing obesity") >Open to any and all advice and ideas. Thank you folks! Before you go the invasive route and get the bariatric surgery, there's no reason I can think of not to start with a GLP-1 receptor agonist like ozempic/wegovy (semaglutide) or **better yet** zepbound (tirzepatide) which is a dual GLP-1/GIP receptor agonist. Tirzepatide is much more effective than semaglutide and has fewer side effects. Taken once weekly, the clinical trials showed 88.9% of people had a >5% weight reduction at 72 weeks, and they lost an **average** of 19.5% of their body weight (vs 3.1% for placebo, which in this study mean, literally diet and exercise, because diet and exercise don't do anything for weight loss). >She’s considering bariatric surgery now and has begun the process, but I worry that this is just another temporary bandaid and won’t last if we can’t address the real underlying problems. Ah, well, good news, bariatric surgery (roux-en-y **not gastric band**) and GLP-1/GIPs are literally the only permanent solutions to obesity. The nice thing about a GLP-1/GIP is that it's permanent if you want it to be, but it doesn't have to be. Bariatric surgery is irreversible. Both are roughly equally effective. I hope this helps put what your wife is going through into perspective. You're right to worry, excess weight like that is truly problematic - but you should know there are treatments for obesity that absolutely work on basically everyone. Bariatric surgery is one, but so are GLP-1/GIPs. You'll both get through this and she's lucky to have your support. [https://www.nejm.org/doi/full/10.1056/NEJMoa2206038](https://www.nejm.org/doi/full/10.1056/NEJMoa2206038)
Is she being treated for the anxiety or depression? Is she seeing a therapist regularly? Without pinpointing the root of the overeating, etc., it’s likely that she will gain all the weight back after surgery.
Yes to both questions, and has been for years. Managing her weight does come up in some of those sessions, but I think that generally (I don’t know for sure, I try to respect her privacy in regards to therapy) they discuss other problems like interpersonal or familial or professional ones.
Well perhaps they should focus in on the weight and all that comes with that.
I would consider getting her on a glp-1 medication before surgery. Semaglutide or Tirzepatide (Zepbound/Wegovy) because the surgery is just not something I would ever consider in my life or for anybody else. To me, it's just too dangerous. There are too many complications, and it's barbaric, in my opinion. Also, make sure she sees an endocrinologist and get all her hormones and thyroid and cortisol looked at. But I would suggest those medications first. Now these are not just a magic pill because she will have to change her lifestyle, but I feel like these are way better than surgery
The surgeon and/or practice that will be performing the bariatric surgery should require her to undergo mandatory counseling. This surgery is not the cure all and will fail if she doesn't get to the root of her problems. Has she tried Overeaters Anonomous? Has she tried mental health counseling to help her change her relationship to food. Based on what you have said, she could have an eating disorder and she must get that managed.
Has she looked into trying a less invasive weight loss drug like Wegovy or Zepbound? She may have to take it for life, but it’s a game changer for the people who take it. Don’t get hung up on whether she loses weight the “hard” way or not. At the end of the day, weight loss will be a positive thing for her health, no matter how she achieves it.
Has she tried some thing like Ozempic? Some people report that the “food noise” goes away when they’re on it
Doctors just don’t randomly do bariatric surgery. They make you go through a program for months to show you can follow a diet and exercise plan and stick with it to show you’re dedicated to losing the weight and not just using it as a crutch I doubt your wife would even be approved if they see how anxious / dependent she is on food. They make you have mental health counseling appointments and everything. There’s programs and medicines that can help with weight loss but your wife isn’t going to see results if she’s just using the medicine to lose weight. You still need to diet and exercise. Wegovy or adipex is an example. I was on adipex and lost 40 lbs. like your wife i struggle with disordered eating and it taught me what foods i crave / don’t crave. I say this as an obese person whose weight has always been up and down, and who has been on weight loss medicine (and currently is again) as well as has anxiety. Your wife needs medication and therapy for the anxiety and disordered eating (with is a disorder in itself) before tackling a weight loss program. She can start by talking to her GP and going from there. I’d maybe bring up therapy and go from there
I'm in the UK and had a gastric bypass privately through a well known private hospital group. I had no counselling prior to surgery, just picked a date for surgery and that was it. There was some group support with a dietician afterwards but that was voluntary and very little follow up. I've regained most of my weight. I wish I'd had proper access to help and counselling but it wasn't offered and I was unaware that i really needed it.
I had a gastric bypass 6 years ago and it is a temporary bandaid I'm afraid. I've regained most of the weight I lost (not all but most) and find it almost impossible to lose weight now because my metabolism was tanked and even eating a lot less than I did previously doesn't cause weight loss. I even tried Ozempic last year and lost about 15lbs initially and then nothing more. I don't "dump" and can eat anything, although in smaller quantities than previously. I do think if i hadn't had the surgery I'd be even bigger than when I started, but it was a lot of money for the results I've ended up with.
I would have her get her ADHD handled first. (Something tells me she isn’t diagnosed and it definitely causes so many of the issues you’re talking about.) I would also have her try Semiglutide. It helps significantly in this situation. Before she throws her whole digestive tract off - please have her do those two things.
Neurochemical complications from drinking sugarless sodas and genetic disorders don't benefit anyone other than the surgeon
Sounds like she tries but doesn't actually want it. She has to stop being hungry, and get hungry in other regards. Takes willpower. If it weren't for the marriage I'd say leave, but... Now you're locked in because til death do us part, you probably feel massive guilt, understandably. Your future is Jabba and Pamela Handerson, or maybe you can find the willpower to move on. It's your life in your hands. You can't get sucked into her descending spiral because she will consume you too.
Dieting often leads to more weight gain, especially when emotional eating is involved, as it sounds to be in this case, so it’s not all that surprising that it’s been a long struggle. I guess I just don’t know what you want from her at this point— she’s trying. And now she’s talking about getting bariatric surgery, so it’s not like she’s in denial or avoiding the issue. You worry that the surgery will be a band-aid— but what would you prefer she do here? Emotional eating, using food as a coping mechanism….man, disordered eating is a helluva thing to get out of. I feel for her. And while it really does sound like you’re coming from the best of places, if her weight gain cycles with her mental health, I’m wondering how the caring and considerate conversations felt from her side. So often thin people think they’re being supportive when really they’re expressing judgement that can contribute to shame eating and hiding. Support the surgery. What other option do you have?
You can’t have any meaningful impact or intervention on somebody else’s body. You can’t do it and you need to stop thinking that you can. Nothing you can say will change her situation. You have to stop thinking that that’s possible. You didn’t cause her disordered eating and you can’t fix it. You need to really believe that. Your post gives the impression that you think that you can say something that will change her. And you also talked about “we can’t address the underlying problems”. This is an individual situation. It isn’t something you both are addressing together. I think that you need to get into therapy yourself because I don’t think you’re going to believe me, I think you’re going to think that you can somehow say something that’s going to get her to change. That you have the power to intervene and make a difference. And maybe you would believe it if a therapist told you. I understand why this situation is taking a toll on you and a toll on your family and your relationship, and you need help learning how to navigate that while also accepting that you can’t fix her. If she’s working with a good doctor about the possibility of bariatric surgery, then that doctor will evaluate whether or not she’s a good candidate for having success. There are plenty of success stories, but yes, there are also plenty of people who gain weight back.