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  1. #1
    Gastric Sleeve Member DutchSleeve's Avatar
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    Dr. Pablo Enriquez Valens
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    Default Sleeve or gbp with over 350 lbs?

    I was just reading this thread: https://www.gastricsleeve.com/forum/...ad.php?t=63377
    And it blows my mind to see, how well all these people are doing, with their sleeve.
    But here is the thing:
    Where I live, when someone is around 350 lbs, a gbp is preferred over a sleeve.
    It is said, you loose better with a gbp.
    But after reading this, I think: why is this said?
    Why should a bypass be better than a sleeve?

    I'm just wondering, what the opinion is in the US.
    What is generally recommended with a higher weight?
    Is there any research backing this up?
    Ik would love to get some reading on this subject, prooving one or the other.
    I personally have no clue, why this is said.
    Please note: after months of reading I decided I wanted to be more active here and I want to write more. But please bear in mind, that English is not my first language, so I may and do make mistakes in my spelling, or say things oddly. Please ask me, if you want any clarifications. I am doing the best I can!



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  4. #2
    Gastric Sleeve Member RehabNurse's Avatar
    I have had a gastric sleeve.
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    04/20/2015
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    Dr. Smith
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    Default Re: Sleeve or gbp with over 350 lbs?

    First of all, many people who weigh more than 350 pounds lose successfully and attain their goal weights after having undergone gastric sleeve surgery, especially men.

    However, based on statistics (and anecdotal observations), a large number of people with starting weights of greater than 350 pounds never make it to goal with a gastric sleeve. This especially rings true for older females and those with hormonal issues such as PCOS.

    The gastric bypass has a malabsorptive component that often provides super morbidly obese women with a metabolic edge to lose the weight more rapidly and durably. The sleeve offers no malabsorption, so weight loss may be slower for some people.

    Super morbidly-obese men will lose regardless of which surgery they select because of higher muscle mass percentages that keep their metabolic rates fast.

    Super morbidly-obese women with more than 200 pounds to lose (e.g., someone hoping to go from 350 to 150 pounds) may wish to consider a gastric bypass.

    Again, there are females who started at 350+ pounds and made it to a normal BMI/body weight, but they tend to be the exception rather than the rule.


    10/23/14 Initial Consult 200 lb, 5'1 tall
    4/6/15 Highest Wt 225 (yes: 25 lb gain)
    4/20/15 Surgery Wt 218, BMI 41

    1 mo 203.0 -15
    2 mo 190.5 -12.5
    3 mo 184.5 -6
    4 mo 177.0 -7.5
    5 mo 171.0 -6
    6 mo 164.5 -6.5
    7 mo 157.5 -7
    8 mo 152.5 -5
    9 mo 149 -3.5
    10 m 143 -6
    11 m 142 -1
    1 yr 138.5 -3.5
    13 m 133 -5.5
    14 m 128 -5
    15 m 125 -3
    16 m 121 -4
    17 m 120 -1
    18 m 118 -2

    Dec '17: BMI 23.5; consumes 2000+ kcal/day

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  6. #3
    Gastric Sleeve Member DutchSleeve's Avatar
    Surgery date
    01/03/2017
    Surgeon
    Dr. Pablo Enriquez Valens
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    Default Re: Sleeve or gbp with over 350 lbs?

    Thank you!
    So, those are indeed the same arguments, that are used over here.
    I've actually never heard of someone with morbid obesety, who had a sleeve gastrectomie, so I just wondered.
    However, I do notice a tendency to perform more and more sleeves instead of bypasses.
    Still a lot of doctors, who are old school, don't do sleeves.
    Please note: after months of reading I decided I wanted to be more active here and I want to write more. But please bear in mind, that English is not my first language, so I may and do make mistakes in my spelling, or say things oddly. Please ask me, if you want any clarifications. I am doing the best I can!



  7. #4
    Gastric Sleeve Member simplyseahorse's Avatar
    I have not had a gastric sleeve.
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    Dr. Motamarry
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    Default Re: Sleeve or gbp with over 350 lbs?

    I would tend to agree - I am an RD (Nutritionist) but I do not specialize in bariatrics. However, I do know that there is less disruption with absorption of nutrients overall with the sleeve versus the gastric bypass. That is the main reason that I chose it. It is the most like your normal digestion - it actually IS normal digestion, just with a smaller amount.

    Again, this is not my specialty, but I did a lot of research, and I felt like for me, at my current weight and goal in mind, the sleeve was the best option. I just didn't want to "re-route" the way my body naturally worked if that makes sense. Maybe for a higher starting weight it does make a substantial difference, but you are right to look around and do your own research. Different surgeons and groups prefer different methods, so it is always good to "shop around" for the best fit!

    **Edited to say - you used the term morbid obesity, which clinically is a BMI greater than 40. I am sure there are plenty of sleevers who meet that criteria, myself included**


    I am a Registered Dietitian/Nutritionist but I have never practiced in the areas of bariatrics or weight loss. I am happy to offer ideas or tips, but please follow your own Nutritionist's advice - she is the expert in the area.

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  9. #5
    Gastric Sleeve Member RehabNurse's Avatar
    I have had a gastric sleeve.
    Surgery date
    04/20/2015
    Surgeon
    Dr. Smith
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    Default Re: Sleeve or gbp with over 350 lbs?

    Quote Originally Posted by simplyseahorse View Post
    you used the term morbid obesity, which clinically is a BMI greater than 40. I am sure there are plenty of sleevers who meet that criteria, myself included**
    Yes...since I'm short (5'1"), I was considered morbidly obese at a weight of 212 pounds (96 kilograms). I was sleeved at 218 pounds. 212 pounds is the minimum weight that placed me at a morbidly obese BMI of 40.


    10/23/14 Initial Consult 200 lb, 5'1 tall
    4/6/15 Highest Wt 225 (yes: 25 lb gain)
    4/20/15 Surgery Wt 218, BMI 41

    1 mo 203.0 -15
    2 mo 190.5 -12.5
    3 mo 184.5 -6
    4 mo 177.0 -7.5
    5 mo 171.0 -6
    6 mo 164.5 -6.5
    7 mo 157.5 -7
    8 mo 152.5 -5
    9 mo 149 -3.5
    10 m 143 -6
    11 m 142 -1
    1 yr 138.5 -3.5
    13 m 133 -5.5
    14 m 128 -5
    15 m 125 -3
    16 m 121 -4
    17 m 120 -1
    18 m 118 -2

    Dec '17: BMI 23.5; consumes 2000+ kcal/day

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  11. #6
    Gastric Sleeve Member Stacey03's Avatar
    I have had a gastric sleeve.
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    Edie
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    Dr Phil lockie
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    Default Re: Sleeve or gbp with over 350 lbs?

    They also in Australia seem to prefer bypass if there are co-morbidities like diabetes, high blood pressure and a bmi over 50.


  12. #7
    Gastric Sleeve Member Christie13's Avatar
    I have had a gastric sleeve.
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    Dr. Wright
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    Default Re: Sleeve or gbp with over 350 lbs?

    I have seen plenty of success stories with sleeves that had higher BMI's. I personally think if you can lose the weight without rerouting the intestines it would be better but I am not a medical professional. My sister started with a 46.9 BMI and was sleeved 6 years ago. She lost all her excess weight with no issues and has kept it off with no problems.



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  14. #8
    Gastric Sleeve Member Ann2's Avatar
    I have had a gastric sleeve.
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    Default Re: Sleeve or gbp with over 350 lbs?

    simplyseahorse -- good to see that you're a RD.

    From now on, you get to answer all the nutrition questions!

    (Teasing!)



    Consult: 235 lbs
    My and doc's preop diet: 216 -19 lbs
    M1 postop 205 -30
    M2 193 -42
    M3 184 -51
    M4 174 -61
    M5 167 -68
    M6 162 -73
    M7 156 -79
    M8 151 -84
    M9 148 -87
    M10 146 -89
    M11 144 -91
    M12 143 -92
    M13 142 -93
    M14 140 -95
    M15 139 -96
    M16 137 -98
    M17 135 -100

    First Surgiversary post

    Second Surgiversary post

    Third Surgiversary post

  15. #9
    Gastric Sleeve Member sraebaer's Avatar
    I have had a gastric sleeve.
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    Default Re: Sleeve or gbp with over 350 lbs?

    Talk to your doctor. Just from my observation, sitting in support group, it seems the ones in the higher weight ranges have the bypass, where most the sleeve. But that's just from sitting around talking to people! Both work, so continue researching and do what you feel will be best for yourself.

    The bypass always sort of scared me, rerouting your insides and such, along with dumping syndrome and some other not too nice side effects.



  16. #10
    Gastric Sleeve Member simplyseahorse's Avatar
    I have not had a gastric sleeve.
    Surgeon
    Dr. Motamarry
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    Default Re: Sleeve or gbp with over 350 lbs?

    HAHA - at first I wasn't going to let anybody know I was a dietitian, but I decided that if I can help, I will. Just want to be clear that it is not my specialty area though, so it is a bit like asking your plastic surgeon about diabetes - general knowledge is there but always best to get the most expert advice possible. I know that not every program has dietitians that are easy to talk to or get ahold of though........


    I am a Registered Dietitian/Nutritionist but I have never practiced in the areas of bariatrics or weight loss. I am happy to offer ideas or tips, but please follow your own Nutritionist's advice - she is the expert in the area.

  17. #11
    Gastric Sleeve Member
    Surgery date
    09/08/2017
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    Dr. Luis Montano (https://renewbariatrics.com/gastric-sleeve/)
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    Default Re: Sleeve or gbp with over 350 lbs?

    As this involves medical issue, better confide with your surgeon to know the intricacies of getting bypassed.

  18. #12
    Gastric Sleeve Member
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    Dr. Luis Cervantes (https://renewbariatrics.com/gastric-sleeve)
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    Default Re: Sleeve or gbp with over 350 lbs?

    I agree with some of our active commenters in this laudable forum that you need to talk to your surgeon. He has the expertise, is expected to sincerely provide you the best option for your ideal weight loss dream.


  19. #13
    Gastric Sleeve Member DutchSleeve's Avatar
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    Dr. Pablo Enriquez Valens
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    Default Re: Sleeve or gbp with over 350 lbs?

    Are you actually reading my posting or just the title of my posting?
    Please note: after months of reading I decided I wanted to be more active here and I want to write more. But please bear in mind, that English is not my first language, so I may and do make mistakes in my spelling, or say things oddly. Please ask me, if you want any clarifications. I am doing the best I can!



  20. #14
    Gastric Sleeve Member Ann2's Avatar
    I have had a gastric sleeve.
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    Ann2
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    08/18/2014
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    n.a.
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    Default Re: Sleeve or gbp with over 350 lbs?

    Quote Originally Posted by DutchSleeve View Post
    Are you actually reading my posting or just the title of my posting?
    Uh ... I think gefree might be a salesperson for a WLS surgeon in Mexico. So no, maybe he/she's not reading very carefully.



    Consult: 235 lbs
    My and doc's preop diet: 216 -19 lbs
    M1 postop 205 -30
    M2 193 -42
    M3 184 -51
    M4 174 -61
    M5 167 -68
    M6 162 -73
    M7 156 -79
    M8 151 -84
    M9 148 -87
    M10 146 -89
    M11 144 -91
    M12 143 -92
    M13 142 -93
    M14 140 -95
    M15 139 -96
    M16 137 -98
    M17 135 -100

    First Surgiversary post

    Second Surgiversary post

    Third Surgiversary post

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  22. #15
    Gastric Sleeve Member DutchSleeve's Avatar
    Surgery date
    01/03/2017
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    Dr. Pablo Enriquez Valens
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    Default Re: Sleeve or gbp with over 350 lbs?

    lol
    okay, I see...
    Please note: after months of reading I decided I wanted to be more active here and I want to write more. But please bear in mind, that English is not my first language, so I may and do make mistakes in my spelling, or say things oddly. Please ask me, if you want any clarifications. I am doing the best I can!



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