More Whining.....

Hi Everybody,
I've been reading through different threads and, as always, am so amazed at how supportive and kind you people are.
Im2tired....I can so relate to some of the things you said...especially about crying. I've shed a few tears (ok...LOTS of tears) over this but it does get better. I've finally found 2 masks that I like. I highly recommend the Activa and the Swift for everybody.
Ok...here's my whining. I saw my Dr. today and told him that I'm having alot of success using the machine but that I'm disappointed that I'm still so tired. Well, he dropped the bomb....he told me I'm a prime candidate for bariatric surgery. To me, bariatric surgery is an absolute last resort to losing weight and something I never ever wanted to consider. I just started crying which surprised him. He said most people are happy with that option. I'm terrified of that surgery...it's too risky in my opinion. He said the risk of having the surgery is less than the risk of not having it. Well, I left his office (still crying) and then had to go to the eye doctor. By then, my eyes were all red (and leaky) and all my eye makeup was gone. Luckily the people in the office are very very kind and nobody made an issue over my distress. They just handed me some tissues and told me to relax.
Have any of you tried this surgery? I do not want it which I think makes me a terrible candidate. I'm convinced it would kill me (maybe that's irrational but I can't help it). Sometimes I get a sort of 6th sense about things and I've got that feeling about this. I really didn't need him to say this to me right now....I have enough stress in my life.
Thanks for listening and please let me know if you've had this surgery....I want to know the good and the bad.
Amy

I can see where you would be worried. Have you been hospitalized to see what diet and excercise plan will allow you to loose weight? Bariatric surgery is just not a sugerical procedure, it will also require a complete change to your diet and eating habits after the surgery. Many people have a great deal of trouble doing this. Have all the diets, exercise and eating habits plans been tried, all resulting in failure. Have you seen a psychiarist and tried some of the antidepressants that can help reduce your hunger urge, or isolated why you just achieve the satisfaction of eating in your life? Norprorimin comes to mind as one that can have this as a side effect. If you can just work into your lifestyle that it is important for you to take a walk and enjoy your neighborhood and the things in might make you feel better.

My husband knows two people who've had this surgery...one is saying it's the best thing she's ever done, and the other is very sick all the time because she's not getting good nutrition for some reason. I would be too scared to have it too, but you need to do what's right for YOU. If you don't feel comfortable with it, don't do it. If it were me considering this, I'd talk to as many people as I could get my hands on about it to see how they did with it. If your doctor is so "gung-ho" with this, he had best better be able to give you hard evidence that it works and is safe IMHO

My personal opinion, after doing research, is that bariatric surgery should be the very last resort, for when someone is very very large and their health is in immediate danger, and the risks of the surgery are less than the current risk to their health. This is mainly for gastric bypass and the more invasive types of surgery - the lap band is a fair bit safer because it can be removed, but still a fairly serious option that has its risks.

This is a pretty good site - http://obesitysurgery-info.com/. It has a lot of info on the surgery, things that bariatric surgery websites tend to either leave out or minimise. It's got articles by bariatric surgeons and specialists as well as patients, basically outlining how it is a serious and relatively risky surgery that will require a strict lifetime commitment, it is not a quick fix.

Amy, don't go into surgery until you feel good about it.

But do remember that a certain level of obesity can be very dangerous to your health in the long run, and do look for good, reliable, information.

The following was publish in the New England Journal of Medicine in Dec. 2004. The NEMJ is considered a very respcected journal internationally.

The added emphasis in the conclusions is mine. The bottom line: for the severely obese, doing it is better than not doing it.
O.


N Engl J Med 2004; 351:2683-2693, Dec 23, 2004.

Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery

Lars Sjöström, M.D., Ph.D., Anna-Karin Lindroos, Ph.D., Markku Peltonen, Ph.D., Jarl Torgerson, M.D., Ph.D., Claude Bouchard, Ph.D., Björn Carlsson, M.D., Ph.D., Sven Dahlgren, M.D., Ph.D., Bo Larsson, M.D., Ph.D., Kristina Narbro, Ph.D., Carl David Sjöström, M.D., Ph.D., Marianne Sullivan, Ph.D., Hans Wedel, Ph.D., for the Swedish Obese Subjects Study Scientific Group

ABSTRACT

Background Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk, but whether these benefits persist over time is unknown.

Methods The prospective, controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched, conventionally treated obese control subjects. We now report follow-up data for subjects (mean age, 48 years; mean body-mass index, 41) who had been enrolled for at least 2 years (4047 subjects) or 10 years (1703 subjects) before the analysis (January 1, 2004). The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years.

Results After two years, the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group (P<0.001). After 10 years, the weight had increased by 1.6 percent and decreased by 16.1 percent, respectively (P<0.001). Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period. Two- and 10-year rates of recovery from diabetes, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, hypertension, and hyperuricemia were more favorable in the surgery group than in the control group, whereas recovery from hypercholesterolemia did not differ between the groups. The surgery group had lower 2- and 10-year incidence rates of diabetes, hypertriglyceridemia, and hyperuricemia than the control group; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable.

Conclusions As compared with conventional therapy, bariatric surgery appears to be a viable option for the treatment of severe obesity, resulting in long-term weight loss, improved lifestyle, and, except for hypercholesterolemia, amelioration in risk factors that were elevated at baseline.

Thank you so much for all of your information. I didn't realize there were antidepressants that suppress appetites. I do take antidepressants but I think the ones I take tend to make you gain weight. There is a very strong psychological link to my weight...all the way back to my childhood. My mom was always on my case about my weight so I thought I was obese back then. Looking back at pictures, I wasn't overweight at all...I was very attractive. I have tried tons of different diets, diet centers, weight watchers (4 times)...everything I could think of. I was often successful but only for a limited time. The weight always came back and now I'm at my heaviest weight ever. I'm at least 100 lbs over weight. I hate it..I hate myself for not being able to do something about it. My Mom and siblings are all thin which makes it even harder for me. I won't let anybody take my picture because I can't stand to look at myself. In my mind, I'm still a thin person so when I see pictures...I can't believe what I look like.
Ozij, I agree with you...I don't think anybody should have surgery if their mind isn't feeling positive about it and I don't think I will ever feel positive about this.
I talked with my hubby about all of this. He is also very much overweight with a bunch of health issues, Diabetes type2, high cholesterol, heart disease, high bp...etc. so he needs to lose weight too. We're going to try and do this together. Exercise is a little hard for us because we're both having a lot of knee pain, but we're going to do what we can. We're also going to talk to our kids too about not having junk food around the house anymore. My daughter's leaving soon for college so she doesn't care but I think my son will be bummed but I know he'll support me...he's a good kid. Plus, it will be better for his health too. My health isn't that bad..my bp is always very good, my knees hurt, I have lots of back pains (even when I was thin), my cholesterol is only a little high, and I have OSA. My weight certainly adds to my depression but is not the sole cause of it...I've dealt with depression since I was a kid.
I guess I'll use my fear of surgery as my motivation to losing weight. If I still can't do it, maybe I'll have to finally give in to the idea of surgery...but not until I read everything I can gets my hands on. Thanks again for listening and giving my material to start reading.
Amy

Amy,
I know what you mean about being hounded about your weight since childhood...

Take a look at http://www.beyondashadowofadiet.com

Try to get hold of "Susie Orbach on Eating" its a small short book, which I found very helpful. Wanting to eat is a very natural, physical feeling, that has been messed up dreadfully for some of us. Orbach's book helps in refinding that connection.

As for exercise: While I don't believe in slimness as an aim, I would recommend Miriam Nelsons' "Strong Women Stay Slim" because her excersises take into account the difficulties fat people have in excersising - and her instructions about the whole process of getting into it are excellent.

Good luck to both you and your husband!
O.

Thank you Ozij...I'll check them both out. Just to clarify...I gained the 100 lbs. over the last 6 years. I was a normal weight up until then. My mother made me think I was overweight as a child when I really wasn't...but I believed her so I've always had a very negative self image.

HI Amy:

I dont know how long youve been on your CPAP, but if it hasnt been a long time, you may want to give it a little time to see if you can lose with a regular diet.

The reason i'm saying is that I too gained a ton of weight (also in the last 6 years) and was not always heavy prior to that . Possibly, your weight gain was caused by sleep apnea and once its in control you can lose on your own. For 6 years, i gained weight every time i stepped on the scale. 1 1/2 years ago, i was diagnosed with severe hypothyroid, which is now under control. HOwever, I was still soo sooo tired and still gaining weight.
Finally, my doctor suggested a sleep study, and here in June 2005, I find myself with severe sleep apnea and oxygen desaturation. I have been on the cpap for only 5 weeks and am still having trouble getting used to it. I do feel somewhat better though and am hopeful that my progress will continue. i have actually started to lose some weight now that i'm not so very very tired anymore and can actually get out of bed in the morning.

Yawn,

As long as the bariatric surgery is laproscopic (sp?) then I'd not be afraid for a moment! My wife had the laproscopic bariatric surgery and immediately afterwards, her blood pressure was NORMAL and she quit snoring after a couple of nights. She sleeps better than ever, though she still takes Ambien and Clonsepam to keep her legs from moving.

The surgery was painful and I sat with my wife in the hospital for two days while she was out of it. For about three days afterward she was in pain and wondered if she had made the right decision to have the Bariatric Surgery done... but on the fourth day she was feeling better and she's never looked back.

So - we well know the dangers of Bariatric Surgery. My wife, if she had to endure the pain again would have the same surgery done in a minute, no questions asked.

Here are some excerpts from a USA TODAY article I found very interesting. Note they are addressing sleep deprivation in general, so their recommendation to simply 'get more sleep' is for those who can voluntarily do so. For those of us with OSA, maybe CPAP therapy will allow us to do so too!

Posted 12/6/2004 9:54 PM Updated 12/6/2004 10:28 PM

Sleep loss may equal weight gain By Nanci Hellmich, USA TODAY

Too little sleep can make you fat.

That's the conclusion of some groundbreaking research, including two new studies released Monday.

Scientists have found that sleep deprivation increases levels of a hunger hormone and decreases levels of a hormone that makes you feel full. The effects may lead to overeating and weight gain.

It could explain why so many Americans who are chronically sleep-deprived also are overweight. And it could be part of the reason sleepy college students, new parents and shift workers pack on pounds.

Researchers say getting enough shut-eye might be a critical component of weight control. And nutritionists one day might routinely advise dieters to "sleep it off" as well as to cut calories and increase exercise.

"We know the obesity epidemic is due to overeating — too big portions, too much rich food and too little activity — but why do we crave too much of these rich foods?" says Eve Van Cauter, a University of Chicago sleep researcher who is the lead investigator on one of the new studies. Maybe, she says, it's because "we are sleep-deprived and unable to curb our appetites."

Sleep does indeed appear to be an important piece of the weight-control puzzle, says Stanford University sleep researcher Emmanuel Mignot, who also is releasing new research.

If that's true, it might be part of the solution to the nation's obesity problem. Sixty-five percent of Americans are overweight or obese, which increases their risk of heart disease, type 2 diabetes, cancer and other diseases.

This percentage takes on a special significance when balanced against the fact that an estimated 63% of American adults do not get the recommended eight hours of sleep a night, according to the National Sleep Foundation. In fact, the average adult gets 6.9 hours of sleep on weeknights and 7.5 hours on weekends, for a daily average of seven hours.

Van Cauter has spent 25 years doing research on the hormones that are affected by sleep. She says sleep deprivation activates a small part of the hypothalamus, the region of the brain that also is involved in appetite regulation. She is especially intrigued by, and has done several studies on, two critical hormones involved in regulating food intake: ghrelin and leptin.

They influence eating in different ways. Ghrelin is an appetite-stimulating hormone released mostly by the stomach. When ghrelin levels are up, people feel hungry, Van Cauter says. On the other hand, leptin, considered a satiety or fullness hormone, is released by the fat cells and tells the brain about the current energy balance of the body.

When leptin levels are high, that sends a message to the brain that the body has enough food, and the person feels full, she says. Low levels indicate starvation and increase appetite.

The hormones "have been called the yin and yang of hunger," Van Cauter says. "One is the accelerator for eating (ghrelin), and the other is the brake (leptin)."

Link found to body mass index

Findings:

• People who routinely slept five hours a night had a 14.9% higher level of ghrelin and a 15.5% lower level of leptin than those who slept eight hours.

• Those who regularly slept less than 7.7 hours had a slightly higher body mass index (BMI).

In a way, the latest findings seem counterintuitive "because most people think that sleeping too much contributes to making people fat, but we found the opposite is true," Mignot says.

"We believe the changes in appetite regulation are way in excess of the calories needed for the extra hours of wakefulness. We are testing this rigorously in the laboratory now," she says.

Obesity experts are intrigued by these findings. "We've known that people use food as a pick-me-up when they are tired, but now it appears they are hungrier than we realized, and there is a hormonal basis for their eating," says Thomas Wadden, director of the Weight and Eating Disorders Program at the University of Pennsylvania in Philadelphia.

Samuel Klein, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis, says it looks as if "we should tell overweight patients to get more sleep. This is advice that's easier to follow than eat less and exercise more. "

"It means watching a little less TV at night and getting to bed earlier," Klein says. "Who on earth would argue about getting more sleep?"

Van Cauter believes that some people might be extra-sensitive to sleep deprivation, which "makes it very hard" for them to control their appetites.

"Our body is not wired for sleep deprivation," she says. "The human animal is the only one that does this."
_______________________________________________________________________

For the entire article:

Sleep loss may equal weight gain

Guest....that article makes alot of sense to me. I know that when I'm really really tired, I'm also starving...it's like I can't get enough food. I sure hope you're right, that I might start losing weight when I get more sleep. I'm really going to try and eat better and get more exercise. If I still can't do it by myself, then I'll have to think long and hard about the surgery.

Old Sea Rock...what can your wife eat now...is her diet anything like what a "normal" size person would eat? I told my Dr. that I had heard that one teaspoon of food a day would completely fill up a person after having the surgery and he said that was pretty accurate. I don't want to eat just a teaspoon here and there...I want to eat like a normal person...sigh.

I appreciate the info. everybody has given me. I definitely need to do more research.
Thank...Amy

Amy, I'll try to find the link to the medical report that explains the hormonal changes that occur with sleep deprivation. It might be heavy reading for some, but it is a rather definitive treatment of why we get hungry when we are short on sleep, even if we'd had enough to eat. There are other hormonal imbalances at work that are also discussed.

Yawn,

My wife can eat most anything! She can't do caffeine, sugar, carbonated beverages and a couple of other things... but on the whole, she eats what she wants.

Initially, a teaspoon of mashed potatoes would fill her up. Now, since her "pouch" has expanded somewhat, she can eat a small piece of pizza and be full. She doesn't eat much but she eats more often. At night she may eat 3 or 4 slices of cucumber and a little later eat a small (silver dollar sized) rice cake and water.

Her diet initially was restricted and after a couple of weeks she graduated to "harder" foods. We bought a small blender and she would take hamburger meat and puree it, with something else. Now she can eat whatever she wants, just very small portions.

Outside of the obvious health benefits, our food costs have gone WAY DOWN, especially when we eat at restaurants.

I can't say enough positive things about her experience with the surgery, even with the pain and discomfort she had initially. She would be the first to highly recommend the surgery IF and ONLY IF it is the laproscopic surgery. Her physician was wonderful and told her that he could learn to do the "banding" technique, etc. but that he would never do that - the laproscopic surgery is the only way to go for many reasons.

WAFlowers wrote:Amy, I'll try to find the link to the medical report that explains the hormonal changes that occur with sleep deprivation. It might be heavy reading for some, but it is a rather definitive treatment of why we get hungry when we are short on sleep, even if we'd had enough to eat. There are other hormonal imbalances at work that are also discussed.

I thought that's what the above referenced article from USA TODAY was all about:

Van Cauter has spent 25 years doing research on the hormones that are affected by sleep. She says sleep deprivation activates a small part of the hypothalamus, the region of the brain that also is involved in appetite regulation. She is especially intrigued by, and has done several studies on, two critical hormones involved in regulating food intake: ghrelin and leptin.

They influence eating in different ways. Ghrelin is an appetite-stimulating hormone released mostly by the stomach. When ghrelin levels are up, people feel hungry, Van Cauter says. On the other hand, leptin, considered a satiety or fullness hormone, is released by the fat cells and tells the brain about the current energy balance of the body.

When leptin levels are high, that sends a message to the brain that the body has enough food, and the person feels full, she says. Low levels indicate starvation and increase appetite.

The hormones "have been called the yin and yang of hunger," Van Cauter says. "One is the accelerator for eating (ghrelin), and the other is the brake (leptin)."