To ask you if I should have bariatric surgery?

[Lobsterteapot]

I have struggled with my weight all my life and until recently I was super morbidly obese (25 stone) When I hit the particularly low point of being diagnosed with type 2 diabetes I asked to be referred for surgery (this was in 2023) - I’ve just been offered a date for Feb.

Thing is. I’ve been on Mounjaro and over the last 12 months I’ve lost 7.5 stones and I am no longer diabetic having changed my whole lifestyle. I’ve been on a relatively low dose during this time (5mg) so while it’s done some suppression I’ve had to work hard at it.

My worry is putting the weight back on. Which I desperately don’t want to do. I also don’t want to lose much more (maybe 2.5 stones) My risk is much reduced (I probably wouldn’t meet the NHS guidelines now) to consider such invasive surgery but what will happen when I come off Mounjaro? Or should I accept that I’ll need to micro dose for life?

What would you do?

Continue with mounjaro.

Dont have surgery.

Stay in low dose mounjaro for as long as you feel you cant control your eating and appetite.

Thank you @toomuchfaff

Just to add - I’ve lost weight before (6 stones) on Slimming World and managed to put it back on and more 🙈

Being absolutely brutal, major surgery carries a far more significant risk of death. Is it actually worth risking death under anaesthetic when a relatively cheap, carefully monitored, little injection (or in future, possibly a pill) has done the job for you just fine?

I had a gastric bypass 8 years ago. My highest weight was 32 stones and I am now under 8 stones so the weight has gone, but the bypass is the worst decision I have ever made and I would not do it again if I could go back in time. The first year post surgery was great but then I developed serious complications. My bowel became twisted and often blocked, ive had 2 long stays in ICU and more hospital admissions than I can count. I now have a stoma and cannot tolerate any solid food at all. I can only consume calorific drinks prescribed by a dietician.

I have 2 friends who also had bariatric surgery. They haven't had serious complications, but after a large initial weight loss they have both regained a lot of weight. If not totally in the right mind set it's easy to work around the bypass and consume high calorie food, even if in smaller quantities.

This is only my experience and there will be others who have more success post surgery, but I'd choose injections over the operation every time.

What is your BMI now? Do the bariatric team know you have lost this much weight?

I personally would not have surgery. It’s a risk in itself as others have already said, just the anaesthetic and the actual surgery itself. I would be happy to continue on whatever dose of Mounjaro you need to lose weight and then maintain. However long that might be for. I am probably biased on that though, as I have lost a lot of weight on Mounjaro and intend to take it for as long as necessary, even if that’s indefinitely.

Does the NHS team offering the surgery know that you’ve lost 7.5st and are no longer 25st? Presumably you’re around 17.5st stone now, and maybe not in the morbidly obese category any more? Would they really go ahead with the surgery regardless?

Bypassed 2.5 years ago, zero regrets.

I’m not sure you’ll be eligible given how much you’ve lost. I certainly wouldn’t do it with that little to lose. Had Mounjaro been more widely available when I had the bypass, I might have done that instead, but 11st down, I really can’t complain. I went through Vitality when they only made you wait a year (it’s now 3 years).

I’m another Slimming World person who lost 9st then piled it all back on, stopped smoking, had a nasty accident, couldn’t do the extreme amount of exercise or maintain the crazy strict diet anymore.

Please update your team, there’ll be another desperate person very keen to have the operation on the waiting list.

I had surgery nearly 3 years ago and it has been the best decision of my life. There are many possible complications (as previous posters have said) and it is a lifelong commitment. Without a shadow of a doubt I would do it again! It gave me a whole new life.
A side note- it is possible to use GLP-1 RAs after bariatric surgery too if needed.
My advice: speak to the bariatric team and get their perspectives as they will have heaps of experience and will know your medical history/risk profile best. Good luck with your decision!

Bypass here 3 years ago. Lost 8 stone and have managed to keep it off. know I could lose that amount on mounjaro but in reality I wouldn’t have kept it off. I had no off switch and need the physical reduction of stomach size to keep me on the straight and narrow.

I know it’s a big operation but I had absolutely no issues due to the actual operation. Figuring out what you can and can’t eat afterwards can be hard but oh so worth it. I’d do it all again in a heartbeat.

Bypass in 1999. No regrets at all. BUT I don't think I would have it now with medication being a more straightforward treatment. Even if, as for many will be the case, it means staying on it for life.

You don't stop taking other medication that is controlling other conditions. Why would you stop taking obesity treatment when, whilst taking it, your body is getting what it needs to help you eat in a more healthy way

You have to decide which is the lesser of evils - the pain of surgery and recovery with associated risks, or potentially being on WLI for the rest of your life, which at the moment is something of an unknown quantity in terms of long-term side effects and how long it will continue to be effective for any individual.

Are you paying privately for Mounjaro or do you get it as an NHS prescription? That would influence my decision (and if getting on NHS, the likelihood of being able to continue getting it on the NHS even when you have a healthy weight).

I think if it were me I'd choose surgery, but good luck on your weight loss whichever you do.

I had a bypass in 2023, best decision I've ever made, lost 7 stone, no complications. A lot of people in the bariatric groups I follow on FB, use Mounjaro to lose the last bit of weight , however I'm reluctant to do so , as once you stop the weight goes back on quicker, my Sister lost 4 stone on mounjaro, as soon as she stopped it , she put a stone back on in the first month. Other people in the groups I follow have reported the same thing, so I would advise surgery as a possible long term solution.

Sorry you had complications. I would wholeheartedly endorse your 'verdict' that it was not a solution (for me). I gave up on the endless procession through categorisation in NHS and spent inheritance from my Mum on private treatment. Weight went, and then is back. I have v small appetite, but also have mobility issues (not due to being overweight) so can't exercise. And weight creeps on.
Also one doesn't realise how much social interaction is linked with food, and ot seems a real waste to go 'out for dinner' and only manage a starter.

This medication has given you a chance to delay the decision, you can use it to try to maintain for a couple of years and then decide. Or maybe by then see what other options there are or are on the way.

Thank you everyone for your kind and considered thoughts. I really appreciate you all sharing your stories.

The team do know and my surgeon (Roger Ackroyd) said he would do it if I wanted it as my loss shows I’ve really committed to change. My BMI is 37 - with type 2 diabetes the NHS will refer you for surgery over 35. I think it’s 40 for a straight referral on weight.

I’m really anxious to future proof staying this size. I could afford to privately microdose Mounjaro in the long term. I am worried about the stories about putting weight straight back on (this does seem to be a common theme)

I’m so sorry to hear this @Happypotter77 Thank you for sharing. I appreciate the dose of realism - a lot of the bariatric surgery groups I follow on social media make it look all sunshine and rainbows. It’s important to recognise what can go wrong in the long term

The point about “you wouldn’t stop taking meds that were controlling other chronic issues” is so so true.

I think if you can afford to continue on the injections essentially forever then that is probably the better option.

It depends on the cause of over eating really because I have a family friend who had the surgery, had no complications and did in the short term lose weight and was really happy with the surgery and outcome. We’re now I think 6 years on from the surgery and she is back to her pre-surgery weight, she uses food as a crutch and is an emotional eater so all that has happened is she’s gone back to that and her stomach has stretched again, she does have pains and discomfort from over eating but that doesn’t stop her and so she is now looking at the injections anyway and regrets getting the surgery having initially been really happy with the results

I can’t believe the NHS will do major surgery on you but not give you WLI.

I think stay on mounjaro or try wegovy to maintain. I wouldn't have surgery.

Listen to this weeks sliced bread on Radio 4 - really interesting professor talking about WLI and saying that the next step will be a formulation which can be made into tablets which will bring the price down massively. His opinion was that most people need to take these meds for a very very long time. I intend to microdose when I get to that point.

The Mounjaro is working g for you even with a small dose. I'd simply continue on the small dose if you are still losing weight. Also they are bringing out the Mounjaro pills which will be much cheaper than the injections. What does it matter if you have to pop a pill each day to maintain or lose weight, as long as you feel ok and are healthy? I'd not risk surgery because of risk of unpleasant endings like poster up thread had.

I’d stay on the mounjaro rather than have surgery. I certainly plan to stay on it.

hopefully there are cheaper versions coming soon.

I don’t think having surgery will future proof you. While a lot of people do well to start with it becomes possible to over eat your calories again by eating calorie dense food. My friend had surgery and lost a lot of weight. She then put quite a lot (though not all of it) back. She is now on mounjaro and doing well.

i would stick with the injections. Go up for now if 5mg isn’t helping enough and plan to taper off and micro dose if needed once you get to a lower weight. I plan to do this. While I can’t afford to stay on it for life, I do plan to come off gradually and keep a very close eye on my weight.