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18-05-2021, 09:49   #46
big syke
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Originally Posted by I've had weightloss surgery, AMA View Post
I had the surgery in a large hospital in Ireland. It was covered by my health insurance.

Given the pre-op assessment required, the importance of having a good team around you, the risks to be considered, and the post-op follow-up required I would not have gone abroad.
May I ask why it was covered by your health insurance?

Was it to do with BMI?

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18-05-2021, 15:28   #47
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Hijacking a bit here too, but as a parent I find some of this extremely interesting. I fully believe that our parent's generational attitude of "you must clear your plate" has fed into some of this - as you say AMA you felt like it was almost a "sin" not to clear the plate. I absolutely refuse to insist this of my own children, I want them to realise when they are full, and that is the point they should stop eating at, and that it is ok to leave some food there.


There is huge psychology behind eating and weight loss, having struggled with it myself a lot over the years, I have learned this. I know somebody locally who had the same surgery as you OP, and the result is amazing. I think it is quite a brave thing to do in a way.
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19-05-2021, 06:29   #48
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There is huge psychology behind eating and weight loss, having struggled with it myself a lot over the years, I have learned this. I know somebody locally who had the same surgery as you OP, and the result is amazing. I think it is quite a brave thing to do in a way.
I'd like to jump in on this to, apologies shesty, obesity is deeply psychologically based, I fear not enough is being done to address this aspect of the disorder, and we default towards the more physical aspect in regards treatment. I have major issues with well known weight loss programs such weight watchers etc, even though I appreciate and acknowledge they do help many, but don't go far enough in their treatment, particularly psychologically, which in fact may cause some to engage in other maladaptive coping strategies post weight loss, such as other addictive behaviours, what are your thoughts, and well done on your weight loss achievements?
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19-05-2021, 13:37   #49
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Hello again everyone, I was planning to reply more regularly but the HSE IT crisis meant all hands on deck, hence the delay.
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19-05-2021, 13:39   #50
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Hello again everyone, I was planning to reply more regularly but the HSE IT crisis meant all hands on deck, hence the delay.
how is the IT crisis directly affecting your job? its a bloody nightmare, and disturbing at the same time
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19-05-2021, 13:54   #51
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How hard was it to convince your GP that you needed this?

Do you have to be above a certain BMI to be allowed to have this surgery?

Can you go off your own bat and just make the required appointments (psych, dietician etc) and do it all without a referral?

Asking because I've been pushing for a referral for 4 years from my GP, done the dietician etc but still nothing
My GP was fully on board. He has been my doctor for over 20 years and has seen my efforts to lose weight, so he knew I wasn't jumping the gun. He did caution me that the results weren't guaranteed.

You need a referral from a doctor and care is co-ordinated by an obesity team, so it wouldn't work to do each piece separately yourself.

As people have pointed out, there is more to it than just the operation - they spend a lot of time looking at all the non-surgical options and of course the individual patient's suitability, e.g. any current psychological or psychiatric problems.

For public patients the waiting list can be several years, although this has come down significantly recently. I believe they give priority based on certain criteria also (age, BMI, diabetes, etc.), so the time on the list can change.

If you go privately the waiting list can be much shorter, but even with health insurance you would have to pay a few hundred euro for some tests and assessments.
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19-05-2021, 14:21   #52
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It's strange to see something that is a compulsion being described as a disease.
A compulsion can be a disease. We are conditioned by society to separate mental health from physical health but when we are sad our eyes produce tears and when we are nervous we sweat or feel nausea. The brain is part of the body, so if it contributes to obesity that doesn't make it less of a disease.

There is no denying that obesity has serious effects on health. The causes of obesity vary from one person to the next and the reason is rarely (if ever) a lack of willpower. That is a myth that we have all bought into without examining the evidence.

It is also a myth that we always need to treat problems in the brain through therapy or some other non-medical method. Some people need anti-depressants and it changes their lives. Some people get dementia and the anti-dementia drugs help them to live much better lives. Bariatric surgery may be done on the stomach but the evidence is that it causes a reset in the hunger centres of the brain, so it is doing much more than changing the physical act of eating.

There is a tipping point when someone goes from overweight to obese. Physical activity becomes more difficult, muscle mass decreases, and then you have the background natural changes that affect our metabolism as we age - for example, it is much more difficulty to build and maintain muscle in our 50s than in our 30s. Muscle mass is key as muscle burns more calories so if you are more muscular you can eat more.

A friend of mine who has always been slim made some really good points about this when I asked her opinion on the surgery. She said it is so hard for average weight people to lose even 1 or 2kg. Why? Surely people should just be able to eat a bit less? The answer is that our brains and our various endocrine (hormone) systems decide for us whether we are hungry and whether we are the right weight. If people are a little bit overweight, losing the few kilos can be hard - if people are obese then it can be almost impossible by "willpower" alone.

If we try to cut calories, our bodies can ramp up the hunger signal until we are overwhelmed and give in. For some people, that system is perfectly balanced and they have a modest appetite that they can easily control. For others, the system is off kilter and even when they eat an adequate amount their brain and body insist that they are still hungry.

If I break my hip, I will not just be able to overcome the pain by willpower alone. I will need painkillers and an operation to fix it. When I was obese, it was taking a huge amount of my mental energy to eat less and I was frazzled by all of the other things life required of me. The surgery removed a huge amount of that mental strain and can now focus better on family, work, etc. It also allowed me to exercise more, so I now have more muscle mass to burn off calories and help me to control my weight.
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19-05-2021, 14:36   #53
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10-15 years ago it may have been, but studies have come on a bit since then.

For what it's worth, I've a higher BMI than the AMA guest, and although I don't think I wholly subscribe to the "it's all a disease and beyond your control" approach, I do understand and agree with a lot of the argument in favour of that.




For me personally, and this is where I'd like to put a question towards the AMA guest, I would characterise myself as having a sugar addiction of sorts, coupled with an ability to never feel full.

I can sit down to a massive takeaway, and although it may start to be uncomfortable, I will manage to eat it all, or of i do have to stop, within 15 minutes, I'll be back eating the remainder again.

I'd often have been in restaurants with people, and we'd order similar/same things, and everyone else would be busted after the dinner, some not finishing, whereas I'd be thinking "will i look bad if i get two desserts.. pretending i want to just see what they're like".

I've an insatiable appetite.



Did you, AMA Guest, have any of these issues at all? From reading your posts here, and I'm not trying to be a smartass or anything, it seems like you didn't really eat all that much (you mention going 24hours without food, and then the food you mention is mashed spuds and stuff, which on the surface of it, doesn't sound like the kinda diet that would leave you overweight, unless the portions were just huge?)


Also, I've lost significant weight before (for short periods), and gained it back (and more). Have you been through these cycles much, and did the people you were talking to about the surgery comment at all on these things?

Also, you mention loose skin not being a big issue - can I ask what weight/height you were, and your age? From looking online, joining facebook groups, etc. it seems a lot of the people that eventually cave and go for the surgery are nearing 50 by the time they've done it, and they get a bit of loose skin.

I've come to the conclusion that the younger you are, the more chance you have of not being afflicted with the loose skin issues, would you agree with this?


(I'm also considering Sleeve surgery, but I've been thinking about it for 12 months now and still haven't done a thing!)
I have had the same experiences as you. I always left restaurants feeling like a pig for eating so much and yet I was hungry again a short while later. It is only since the surgery that I actually know what people mean when they say "No thanks I have had enough" without being full to the point of discomfort. For example, yesterday I had half a sandwich and that felt enough. It is still a bit weird when I look at the plate and I just wrap the rest up for later on. A few years ago I would just have eaten it.

I wasn't going 24 hours without eating by choice, that was because work was so busy we didn't get breaks. When I had time off I was constantly eating.

I had lost large amounts of weight before but I always gained it back. I went through that cycle many times and that is the typical pattern for obesity - my body pushed me back to that higher weight and then I would plateau.

The obesity team went through all that with me and we discussed in detail the reasons for this and the risk of weight gain in the future. I check in with them every year to ensure I am on track and can see them more frequently if I need to.

The extent of loose skin depends on many factors, including age, gender, BMI, genetics, etc. I have plenty of loose skin but I just don't care very much. It would probably bother others but I'm not a naturist and anyway I think I look much better in the nip now than when I was bigger. To be honest it's a nice reminder of the success of the surgery and how much better off I am.

Everyone is different but for me I realised that the longer I left the surgery the fewer the benefits. Every year I was overweight meant more damage to my heart, kidneys, etc.
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19-05-2021, 14:43   #54
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Well done OP! That took strength and courage especially as a Doctor knowing the risk involved in surgery. It's no easy feat and appreciate you taking the time to answer questions.

May I ask if you were always overweight or did the urge to eat come as you got older?

Also - can this option be available for someone in their 40s or 50s?

Thanks again.
Thank you, it was the hardest personal choice I ever had to make. I asked a lot of opinions and advice, I was really trying to convince myself I didn't need it! One of the shocking moments for me was when I was at a talk and a colleague mentioned someone younger than me with a lower BMI having had the operation. I knew I was fat but I had never really considered myself obese before.

I was overweight my whole life but it was hidden by my frame and muscle mass. I always ate more than I should but I could get away with it in my 20s and maybe early 30s.

I was almost 40 when I had it done and I was towards the younger end, so certainly people in their 50s and older can be suitable.
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19-05-2021, 15:05   #55
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You have definitely made me think while reading your answers, thank you!

One thing I wonder though, you have had to change your diet significantly, you have changed the types of food you eat, the quantities and the frequency, and for that reason you have lost weight. Is it purely the side effects of not eating like that, that have forced you to change. As in, post op, you tried to eat a bag of chips but you felt sick if you did so, so you trained yourself to not do that. Is that an accurate summary?

I wonder is it a case of needing something that just means you have no option but to eat correctly. It is the ultimate form of motivation when all else fails.

Like others, I'd love to know your stats too like age, height and weight and the process of getting surgery done. would also love to know if you have amazing health insurance or is it just a standard kind of plan.

I very rarely drink soft drinks but when i do, it is a treat I enjoy, do you have things you miss?

I very rarely drink alcohol but admittedly I am probably a binge drinker so I wouldn't drink all year but if I went out two or three times a year I would have a good few drinks and enjoy myself, would nights like that be totally out for you now?

I suppose, ultimately I am asking, do you have any regrets at all?
No regrets, except maybe not making the decision sooner.

I was in denial that I was obese. I had fooled myself into thinking that I was some sort of superhuman who could lose weight and keep it off by dint of effort, as if I was somehow so different to everyone else who had tried the same and failed.

The surgery has a mechanical effect and a hormonal effect. It restricts my intake so I get full with less food. I didn't really have to train myself to stop eating but I did have to learn which foods were best to start eating (protein first) and to chew everything well. My taste in food changed, so I don't have the same cravings. I still eat chips and enjoy them just as much but I eat 5 or 6 instead of a whole bag.

My health insurance is something below VHI Plan B, middle of the road, costs about €100 a month. I was in a room with other patients, so not the full private experience. I think many of the insurance plans cover it but you do have to check with them beforehand.

I don't want to give too many descriptive details so that I can remain anonymous and give honest answers. I would just say I was around 40 at the time of surgery and had a BMI of over 40. Average in every other respect...!

Bingeing of any kind is out, whether food or soft drinks or alcohol. They go through that with you beforehand to make sure that you are safe for surgery. There is nothing off limits though, it is just about quantity. So I would have occasional coca cola, ice cream, and so on.
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19-05-2021, 15:12   #56
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I think that is fairly out of order from your patient. He may have been correct but it was also inappropriate in a patient / doctor relationship.
I can see how it might sound like that out of context but this was a patient I knew very well and she said it in a gentle manner. The doctor-patient relationship is two-way and it was the moment I realised that my own appearance was affecting how well I could connect with patients and gain their confidence.
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19-05-2021, 15:20   #57
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Clearly when you eat the the point that it's "uncomfortable" you're full, your body knows it and you know it.

This would indicate that you don't have any issue with satiety, or indeed appetite, you are just wilfully choosing to over eat when you know you've already had more than enough.

Similarly, it's not a shortcoming of your body that is causing you to order two desserts.
You know this isn't normal behaviour at any level but yet you go ahead and do it for some reason.
I can't speak for the poster you're replying to but this is an important point to clarify. Now that I have had the surgery, I get that feeling of satiety early. When I was obese, I got it too late, so by the time I was uncomfortable I had eaten way more than I should.

On paper we can measure out our calroies and eat the exact amount but in real life the body itself is the "some reason" that people overeat - the brain's hunger centres keep shouting for more. It's an unconscious desire similar to tiredness or thirst - very hard to ignore for long.
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19-05-2021, 15:24   #58
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I would feel uncomfortable, not 'full'. I'd still have a feeling of being hungry enough that I'd continue to eat.

For what it's worth, I'm not trying to pull the "it's everyone's fault but mine" victim card - I have lost weight before. Large amounts. I'd hover about 20st, and have gotten down to 14st before. In theory you'd assume that a smaller body would require less energy to keep it ticking over, but, as above, I still just always felt hungry.

I was very much 'swimming against the tide' in that after a period of time you'd just cave in and have to eat. binge like a mad man. Which is why I am looking at the bariatric surgery options, as they (supposedly) will physically restrict the amount of food you can swallow.
My obesity consultants explained to me that as I lost weight my body would see it as a bad thing and would try to conserve energy by burning less. So as you said, when I dieted in the past I used to expect to use less energy as I became lighter but that in turn meant that I soon found my weight loss slowed down. The surgery helped me to get over that hump and to maintain my long term weight loss without the constant hunger.
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19-05-2021, 15:39   #59
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Like KKV, I've always been a character known to "enjoy" his food and as I've gotten older and less mobile, the food I was eating has lead to me getting to the point that I need to look at a plan sooner rather than later. For me though the problem seems to be taste rather than what I'd believe I'd pinpoint as emotional eating.

I had dinner a few hours ago but about half an hour ago I got it into my head that I'd love a curry and I'm sitting here trying to convince myself I don't need one.

I am interested in what the OP was saying about starting with psychologist/dietician before going any further as, while I don't believe I'm able to blame anyone yet other than myself, if there IS a trigger or something I can use to help address the issue, I'll take all the advantages I can.

I spoke to a GP about issues before and he mentioned weight and had some printouts about Mediterranean diet but that was it. OP, is there a better set of resources to look at? I have health insurance and a decent job so I don't mind paying for something that will give me a better chance.
I used to judge other overweight people all the time while convincing myself that I had legitimate reasons for being fat. It was a weird form of denial combined with internalised fat shaming. Everyone who is overweight knows that they are overweight, although many of us are not aware of the extent or of the consequences. We also overestimate how much control we have over all of this. I now go out of my way to be kind to people about their weight and it is so much more constructive. People are sick of being judged for everything in their lives, we need to give each other a break.

Once I copped that I was dangerously obese my thinking changed from "Am I at fault?" to "How can I lose weight and keep it off?". The psychologists and dietitians were kind but ruthless - I had to be totally honest about my habits, feelings, motivations, etc. We were then able to deal with each one and make sure that whatever weight loss method I chose was safe and sustainable. In my case, surgery was an option and I was happy with the risks and benefits involved.

I cannot give you medical advice but there are several obesity management clinics in Ireland who are expert in this. If you have private insurance you should have most of the costs covered and your waiting time would be significantly reduced. My first step was to get a GP referral to an obesity surgeon who then linked me in with the full team for assessments. Some of the hospitals also run talks where you can get more information.
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19-05-2021, 15:53   #60
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During the calorie-restricted diet to shrink your liver did you ever think that you could continue to lose weight yourself and not going through with the operation?

(I ask as I'm a nurse with a BMI of 40+ but too ashamed to go for bariatric surgery because with all my knowledge I feel that I should be able to get control of my eating myself.)

Also, did you have any hair loss or thinning at any stage?
The pre-op diet was the hardest bit! I didn't even manage to do it properly for the short duration required and it reinforced that I could not do it by diet alone.

I didn't have hair loss but that is something they discuss as a possible side effect.

I know what you mean about being ashamed. It used to eat me up inside because I was disgusted at my weight, how I looked, how much I ate, the effect on my health, and then I was angry with myself for not just eating less. It was awful and it affected everything I did.

When I saw the surgeon I was half hoping to be told I was not a candidate but when they said yes and gave me a date, I actually cried like a baby. It was out of the blue and mortifying but they said it happens all the time.

Even though there were no guarantees I felt like I finally had a chance to be healthy, that I could exercise and be comfortable in my body. I had been doing the same things for decades and suddenly there was a new option. I think society attaches huge stigma to bariatric surgery to the point where people are missing out on a potential lifesaving treatment.

I don't want to come across as a true believer - it is not the solution for everyone but for those who are suitable it is important to know it is there and what the pros and cons are.
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