Why do some patients wait longer for Bariatric Surgery from the NHS Bariatric Team?

[ickihun]

OK I already know the answer for myself but I wanted to open up a DISCUSSION (no arguments, pls) about the reason why 'The weight loss programme' doesn't want it to result in a bariatric operation. Not always.

It is fully evident that the programme I'm on encourages weight loss by many means. I'll even go as far to say the low carb dietary need has its place in there. How much for none diabetes? I'm unsure!
I can only speak for myself and say its evolving, like it should, to help everyone who has a problem losing weight.
Hundreds never go onto needing surgery, or such evasive surgery as a full-bypass. In fact the band procedure has shown huge disappointment and even with a full surgical bypass many are left with permanent other health problems, which are documented.
Is it worth the trade? I'm hoping I'm about to find out for me, for my own personal health problems currently. I'm as clued up as I'm going to get. So I'm ready, I've been ready for months but I've had distraction of family life and winter lergies.
I want less insulin, less tablets and less side affects but most importantly not to feel sooo hungry on the correct calories for my bodies needs. In a lighter body.
I still had hunger on very low carb eating and this resulted me eating more and more. More protein and/or more of the amounts of other low carb foods. More snacks, larger handfuls. Low carb eating is fantastic for keeping your bgs to their lowest you can possible get them.... by diet.
As I've proven you can still be morbibly obese and have perfect longterm bgs and good hba1cs. Insulin therapy has conditions and one of those is NO too low of a hba1c for mortality reasons. Most type1s will understand this more than a diet only treated type2 diabetic.... Maybe.

So if you ever get the opportunity to be accepted on your regional Weight Loss Programme from the nhs..... I found its not low carb eating blind as you may have first suspected. Let your dietician be the judge of how low your carb needs should be if you're on insulin therapy but don't be afraid to challenge their safety perception or allow them to question on your behalf where that low carb boundary should be.
Hopefully they will take back the pressure from obese type2s to be on the correct diet, for them. A diet which is good bg level friendly.
I wish everyone luck in the current target winning aims and techniques.
We are all individuals so it's inevitable we all have our own plan of ACTION.

Fingers crossed for me getting a full-bypass operation date imminently.

Ps. Thankyou for all who support my own individual plan and my conviction to execute it.

Thankyou, again.

(I'm wriggled with pain and very restricted from the exercise, I love. I've accepted temporary defeat but I will continue to fight for better health. I'm never happy not walking for miles nor swimming under the water or teaching my children sports. That's just who I am or have been for 40yrs. I've trained with an ex-footballer in my youth and attended an excellent Secondary School which did have fantastic sports role models. This I've ensured for my children too.)

 

[DavidGrahamJones]

Fingers crossed for me getting a full-bypass operation date imminently.

I hope your wait will be over soon.

My own journey seems to be taking me off in a different direction. Something called Liraglutide which I will have to inject every day for a month. This is possibly my very last attempt to get to the bottom of the weight loss issues. Luckily the low carb diet suits me and doesn't cause hunger problems. I'll be able to continue with low carb and take Liraglutide (possibly in the form of Victoza which is prescribed for diabetics or Saxenda which is a higher dose and prescribed for weight loss). I have many reservations because when it comes to side effects I always seem to get them.

As you say we're all different.

All the best

 

[briped]

'The weight loss programme'

Is this the programme one is put on the lose weight and visceral fat pre-op?

We are all individuals so it's inevitable we all have our own plan of ACTION.
Fingers crossed for me getting a full-bypass operation date imminently.

I fully agree. I'm a firm believer in taking the necessary actions needed to improve one's quality of life. I don't consider barriatric surgery 'the easy way' at all. For some it's the best way, and I've no doubt that you and your surgeon know best. I may not post loads of insightful posts as replies to your posts, but I follow your progress with great interest and hold my fingers crossed for you.
In my own hospital notes it says that barriatric surgery was discussed with me. I think I'd have remembered if such a discussion ever took place. If it had I'd have refused the option point blank, simply because too many kgs haven't immobilised me or given me pain (apart from a slight back ache at times), so in my case the disadvantages would clearly outweigh (ha-ha) the advantages. They have taken a large chunk of life quality, but very few of them physical issues. I also know now that I'm one of the fortunate ones for whom it is possible to keep BG levels perfectly acceptable, even with too much weight to log around. Obviously you have other issues, and need to solve them your way.
I hope you get your date soon, and that your expectations to the result and your future life are realistic.

 

[ickihun]

I hope your wait will be over soon.

My own journey seems to be taking me off in a different direction. Something called Liraglutide which I will have to inject every day for a month. This is possibly my very last attempt to get to the bottom of the weight loss issues. Luckily the low carb diet suits me and doesn't cause hunger problems. I'll be able to continue with low carb and take Liraglutide (possibly in the form of Victoza which is prescribed for diabetics or Saxenda which is a higher dose and prescribed for weight loss). I have many reservations because when it comes to side effects I always seem to get them.

As you say we're all different.

All the best

Best of luck @DavidGrahamJones. I was vomiting on the higher dose of Victoza and felt very ill so I had to stop it, pre bariatric op.
I will be open to try some meds again to get rid of insulin after my weight has stabilised. My new system may be open to coercion.

I'm getting older so my tolerances are changing too. Insulin is my only tolerated med. I'm using Dapagliflozin til my op but thrush side affect is very anti partner friendly. It's horrendous but because I cannot currently tolerate metformin unlike I have for decades. Humf. No other reason. It helps me with about a stone less weight, rather 2st loss from metformin. Better than nothing, I suppose. Dapagliflozin also has me up through the night due to excessive peeing.
Yes side affects are a thorn in my side too. Unfortunately.

 

[ickihun]

Is this the programme one is put on the lose weight and visceral fat pre-op?

I fully agree. I'm a firm believer in taking the necessary actions needed to improve one's quality of life. I don't consider barriatric surgery 'the easy way' at all. For some it's the best way, and I've no doubt that you and your surgeon know best. I may not post loads of insightful posts as replies to your posts, but I follow your progress with great interest and hold my fingers crossed for you.
In my own hospital notes it says that barriatric surgery was discussed with me. I think I'd have remembered if such a discussion ever took place. If it had I'd have refused the option point blank, simply because too many kgs haven't immobilised me or given me pain (apart from a slight back ache at times), so in my case the disadvantages would clearly outweigh (ha-ha) the advantages. They have taken a large chunk of life quality, but very few of them physical issues. I also know now that I'm one of the fortunate ones for whom it is possible to keep BG levels perfectly acceptable, even with too much weight to log around. Obviously you have other issues, and need to solve them your way.
I hope you get your date soon, and that your expectations to the result and your future life are realistic.

Yes their programme is to get healthy weight loss.
My argument is for the size I am, is there such a thing as bad weight loss?
OK yes there is, DKA side affect for eg. I know.

I'm currently on the 800cals diet but at Xmas I had a day off but didn't over eat but just had sugary treats. I'm back on 800cals. I may be on a bit more due to filling myself up with raw carrots or cucumber sticks.
Ive not added any weight as a result but hba1c may be a fraction higher. Milkshakes have sugar in them and some of my meds are coated in sugar too. My insulin is expected to nil in fylde this sugar that's unavoidable.

I never thought in a million years I would have accepted such a drastic operation but my quality of life without it is really p-ants!

 

[briped]

Yes their programme is to get healthy weight loss.
My argument is for the size I am, is there such a thing as bad weight loss?
OK yes there is, DKA side affect for eg. I know.

I'm currently on the 800cals diet but at Xmas I had a day off but didn't over eat but just had sugary treats. I'm back on 800cals. I may be on a bit more due to filling myself up with raw carrots or cucumber sticks.
Ive not added any weight as a result but hba1c may be a fraction higher. Milkshakes have sugar in them and some of my meds are coated in sugar too. My insulin is expected to nil in fylde this sugar that's unavoidable.

I never thought in a million years I would have accepted such a drastic operation but my quality of life without it is really p-ants!

It's so difficult to get our bodies back in balance. I imagine it's like playing Dominoes, only way worse, of course, and the consequences of an imbalanced body are far greater.
My alarm just went of to remind me it's pill and victoza time. I get startled whenever it does that. Raises my BG I'm sure
Are you worried about the op itself?

 

[Daibell]

I will make a general point about weight and blood sugar loss. A low carb diet is normally very important BUT you must have enough fats, proteins, veg and non-tropical fruit to go with it. Without enough fats and proteins you will feel hungry. The NHS follows PHE England diet advice which is strongly influenced by the food companies and suspect 'research' about the harm from fats. I also always say to forget calories as the body does not behave like a test furnace; just think about each of the three main food types. Fats have twice the calorie content than carbs but due to the way the body processes fats they do not contribute the expected degree of weight gain and don't raise BS by much.

 

[NicoleC1971]

Out of interest has anyone see the Thin gene stuff based on Cambridge University research into the genetics of thin, normal weight and morbidly obese people?
We all intuitively know that some people can eat what they like and don't seem to easily store fat whereas some seem to immediately park food into their fat cells and/or have a larger appetite but this research has identified genetic differences between the 3 categories mentioned above. It did not explore why that is e.g. is it energy partition ( burn it/sstpre it) appetite differences or insulin sensitivity?
It is fascinating to me but I am truly sorry that as a culture we choose ot villify very obese people and glorify the naturally skinny in moral terms e.g. Abby Clancy (a natural skinny) claiming that yoga and walking were the secrets to her slender figure after having had 3 kids!)
Having surgery is no easy fix from what I have seen at a distance but does seem to be pretty effective and yes every option shoudl be considered prior to that point of no return. But in tandem with the NHS services to tackle obesity, thre has to be public health legislation to reduce the processed carbs from our food supply.

 

[bulkbiker]

Thin gene stuff based on Cambridge University research into the genetics of thin, normal weight and morbidly obese people?

I can't see how our genes have changed so much in the last 50 years to cause the growth in obesity (pun intended). I'm guessing that changes in the food environment have caused the "gene problems" to come to the fore... thus I don't believe its the genes per se but the food that is the root cause.

 

[Member496333]

It is true that many people simply do not have enough fat cells to become obese. It is why people like me became extremely insulin resistant without ever gaining an ounce. To become obese you need lots of fat cells which can become engorged as the body safely stashes away the unwanted glucose. Obesity is a protective mechanism from diabetes. It’s how we are designed to store fuel for later use. Some people don’t have that capacity, so perhaps this is what is being indirectly referred to.

 

[DCUKMod]

Out of interest has anyone see the Thin gene stuff based on Cambridge University research into the genetics of thin, normal weight and morbidly obese people?
We all intuitively know that some people can eat what they like and don't seem to easily store fat whereas some seem to immediately park food into their fat cells and/or have a larger appetite but this research has identified genetic differences between the 3 categories mentioned above. It did not explore why that is e.g. is it energy partition ( burn it/sstpre it) appetite differences or insulin sensitivity?
It is fascinating to me but I am truly sorry that as a culture we choose ot villify very obese people and glorify the naturally skinny in moral terms e.g. Abby Clancy (a natural skinny) claiming that yoga and walking were the secrets to her slender figure after having had 3 kids!)
Having surgery is no easy fix from what I have seen at a distance but does seem to be pretty effective and yes every option shoudl be considered prior to that point of no return. But in tandem with the NHS services to tackle obesity, thre has to be public health legislation to reduce the processed carbs from our food supply.

Nicole - A while ago (maybe a couple of year?) there was a TV programme (Michael Mosely or thr van Tullekens chaps) where they looked at folks who just didn't gain weight, no matter what they ate.

What they did was tracke them, with cameras (presummably IP cameras) at home, work, gym etc. What they found, in that instance was that those in that skinny no matter what might have mega eating days, but in balancing that they also had days when they ate sparsely.

They ate whatever they wanted, but just those wants varied on a day to day basais and over the study period they weren't overeating. The skinny no matter was, for them, a perception.

 

[ickihun]

It's so difficult to get our bodies back in balance. I imagine it's like playing Dominoes, only way worse, of course, and the consequences of an imbalanced body are far greater.
My alarm just went of to remind me it's pill and victoza time. I get startled whenever it does that. Raises my BG I'm sure
Are you worried about the op itself?

A little. Obviously how I'm going to be affected by far far less nutrients worries me until its perfect. I will push the multivitamins and iron (like I'm already doing).
My skin is extremely soft at the moment and has signs from the extreme swellings and extra stone that was readded but now I've lost.
I'm excited about losing weight and feeling lighter. I will get loose skin but I have a few pensioned due to me in 7yrs time so I will definitely know my new weight by then so I may pay privately to remove some. We'll see. My tummy has a huge scar from open surgery in my teens from a burst appendix. I'm led to believe it could make a tummy tuck, more expensive.
As expected the knowledgeable people in my personal life support me but a few cannot understand anything other than it's media coverage has previously show it to be a lifestyle choice. An operation for vanity or a short cut instead of normal dieting.
For me I know this op can leave huge amounts of excess skin. It is very very likely.
However currently I dress to get the best out of my shape and so I will continue to do that. There are some fantastic body socks now.
It will be challenging with swim wear but I may just buy a good skirted longsleeve swimsuit or a decent diving suit. Or even make my own.
I'm looking forward to a more energetic middle age for my children's sake too. Only one I've taught to swim or jog, play tennis or badminton. I miss our huge walking adventures.
I miss feeling free of a bad back and now neck to arm movement from another trapped nerve.
I'm confident I'll stop nearly half my meds and regain my freedom from my heavy body.

 

[ickihun]

It is true that many people simply do not have enough fat cells to become obese. It is why people like me became extremely insulin resistant without ever gaining an ounce. To become obese you need lots of fat cells which can become engorged as the body safely stashes away the unwanted glucose. Obesity is a protective mechanism from diabetes. It’s how we are designed to store fuel for later use. Some people don’t have that capacity, so perhaps this is what is being indirectly referred to.

I agree. Also once a fat cell is made it never dies. It can be emptied but never dies.

So maybe some make fat cells easier or faster than others. I guess some have better fat cells than others. Maybe I make cells very easily and if overeat fill them so my body makes more. (More reason to curb that from developing into a higher stage of obesity. For me this op can help with that. )

I understand its proven now that in teenage years whatever we develop doesn't change. It can be plumped out with fat but nothing more can affect what we develop into or shape/frame we have developed into with help of out parents genes. Hormones can shrink or encourage our organs but nothing can change the cellular structure made from our genes. Fat cells form the bulk of the human body and metabolism regulates speed of growth. So metabolism is the defect if cells grow too quick or are excessive.
Metabolism causes obesity. Metabolism doesn't cause insulin resistance or does it? That I'll keep for another thread.

 

[ickihun]

Well told a meeting then put on minimum 18wk waiting list.
I'm just carrying on losing as much weight as possible without being hospitalised.

 

[DavidGrahamJones]

I don't believe its the genes per se but the food that is the root cause.

Isn't that what epigenetics is all about. The genes expression and activity are changed by external or environmental factors.

 

[Member496333]

Isn't that what epigenetics is all about. The genes expression and activity are changed by external or environmental factors.

Yes. I think of my genes as the software - the operating system if you will - and environmental factors, food included, as the variables that determine the outcomes.

 

[Daphne917]

Well told a meeting then put on minimum 18wk waiting list.
I'm just carrying on losing as much weight as possible without being hospitalised.

@ickihun it seems to have been a long time coming - hopefully it will be just the 18 weeks you are waiting. Is there any chance that they will do it earlier if there is a cancellation?

 

[briped]

Yes. I think of my genes as the software - the operating system if you will -

Poor @ickihun . Are we talking Windows Vista? I'm glad there's a new version, or even better, an installation of latest, snappiest Linux

 

[Freema]

Yes their programme is to get healthy weight loss.
My argument is for the size I am, is there such a thing as bad weight loss?
OK yes there is, DKA side affect for eg. I know.

I'm currently on the 800cals diet but at Xmas I had a day off but didn't over eat but just had sugary treats. I'm back on 800cals. I may be on a bit more due to filling myself up with raw carrots or cucumber sticks.
Ive not added any weight as a result but hba1c may be a fraction higher. Milkshakes have sugar in them and some of my meds are coated in sugar too. My insulin is expected to nil in fylde this sugar that's unavoidable.

I never thought in a million years I would have accepted such a drastic operation but my quality of life without it is really p-ants!

I hope you’ll get the operation soon , and hope you’ll be among those that have very few complications then , I also am hungry on very low carbs sadly

 

[ickihun]

@ickihun it seems to have been a long time coming - hopefully it will be just the 18 weeks you are waiting. Is there any chance that they will do it earlier if there is a cancellation?

I was going to ask but had second thoughts as not all patients are so hugely insulin resistant and I'd prefer they were fully prepared for my unusual need.
One bariatric nurse has been taken aback by just how bad my IR is and how much insulin I need. I'm still struggling to walk. In fact my back has really kicked off today in the bitter cold. My warm bungalow is a huge help. I love being out though when I'm fully rested and not on Amitripyline painkillers.