Gastric bypass vs Mounjaro injections

[fatnurseandmum]

Hello.
been on MN forever, NC for this.
I have done lots and lots of research and have found that I can have a gastric bypass for 3K.
My question is really do I go ahead and book it or shall I try Mounjaro first? I don't want to throw good money after bad so to speak!
What happens if you come off the injections? Does all the weight go back on?

For context, I'm 33, 5ft 2 and BMI of about 38. I have my physical appearance and have struggled with my weight since a teen.

Where can you get a bypass for 3 grand?
Was 12 grand 15 years ago in UK

Would you prefer the band because it’s permanent? My concern is side effects could also be permanent

I have no personal experience of the injections but if you are going down that route I do know from friends (some who take them for medical reasons) that getting hold of them can at times be a challenge due to high demand.

I had a gastric sleeve 2 years ago, it cost around £3k (abroad). Like you I've struggled with my weight all of my life. Starting BMI was 36, it is now 19.5. Best thing I ever did physically. Though it doesn't fix all of the psychological issues you will have picked up around self esteem over the years, so either way, do seek out therapy if you can x

I've never had supply issue, this seems to be NHS supply rather then private.

Mj is just a tool to aid dieting. Like any other weightloss technique you still need to find ways to maintain afterwards. There are some interesting studies showing less weight gain afterwards then with other dieting but there is still a significant risk. I would recommend mj for people who have successfully lost significant weight in the past, the 'almost' successful dieters as it works to give you a push basically.

If you are looking at financially then I would expect you to be spending about 2k per year on mj and need to spend at least a year on it, with no guarantee of weight staying off. So it seems more sensible to spend the 3k.

Personally I would be very put off by the risk and the side effects of surgery though. I appreciate the feeling of not having much choice.

I think, having also done lots of research, that most people will need to stay on Mounjaro for the long term in order not to put the weight back on. You would spend 3k in around 18 months if you find good deals/don’t need the higher doses. Maybe for maintenance you could use less and the prices are coming down gradually I think.

The advantage of the medication is that if it doesn’t suit you you can stop it or adjust the dose. The surgery obviously isn’t like that.

Yes I should add that whilst the surgery, for me, has been life changing, it's not without its own challenges. Even 2 years down the line I still struggle with portion sizes (ie I'll assume I can eat more than I do, plate up and then can only finish half!), going out to restaurants is tricky particularly if you're with people who you haven't told about your surgery.

And physically, there are issues people can experience post op. I believe I got off lightly with a bit of hair loss and acid reflux but some do have other issues.

Just do your research, particularly into your medical team if you're going abroad (at £3k it sounds like you are)

I'm on Mounjaro and deliberately chose it over surgery for the risk factor. I have a small child and I just can't take the risk of surgery. The effects of a gastric sleeve are permanent but so are the side effects. If I find Mounjaro no longer works for me or causes hideous side effects, I can stop taking it at any time. I also like the flexibility- with Mounjaro I can eat more on a special occasion if I want to, whereas a gastric sleeve greatly limits that.

We also don't know what the future holds for Mounjaro in terms of maintenance dosing. It might be approved soon for lifelong (or at least long term) maintenance use, meaning the weight will still stay off. In that respect, it becomes no different to any other medication for a lifelong condition. That might not be something you want if you've "only" gained up to BMI 37 so far in life, but for people who are prone to gaining a lot more it would be a desirable option.

Also, Mounjaro works because it mimics a hormone obese people aren't producing enough of. Thats what causes the "food noise" and obsessions, so a gastric band or therapy won't help with those issues. Id rather stay on a maintenance dose of Mounjaro for life that calms me mentally, than a physical restriction but still feel stressed and hard done by due to cravings.

I think a gastric bypass and a gastric sleeve do both affect the hormones which is why they work so well.

Do you find you have a lot of excess skin as a result? Or had that tightened up over time?

@zaffa I did have a lot of excess skin, although it has tightened up with time and exercise. My tummy is probably the worst but then I have had a twin pregnancy so I would have likely had that anyway.

A lot of people I know who have had the sleeve have had the skin lift/removal a year or so post surgery and the results look fab! I wouldn't mind a boob job because I do have excess skin there (again weightloss and pregnancy related) but I'll need to save for that.

I would try injections before surgery.
And I say that as someone who stopped injections because of how dreadful I felt on them.

OP didnt mention the band. And a band is not permanent. And NHS isnt doing the band anymore as its not as effective or user friendly as the other surgical interventions

OP, you wont get a bypass for 3 grand, possibly not even if you go abroad.

Have you thought about a sleeve as a comparison

My view is always try the injections first, if you have success on those AND then can maintain your weight loss, then you dont need to engage with surgery.

My BMI was not far off yours a year ago and now it’s 20. all I did was keto and then gym when I’d lost most of it.

you don’t need all this invasive treatment and by the time you’d got there, you could have lost a fair bit. AND saved ££££££

Try mounjaro first. Last year I decided
To try mounjaro as my last ditch attempt to avoid gastric surgery. I was already
Well up on the nhs waiting list but wanted to avoid the op ( free or not ) I've now lost 9 stone 4lb and am continuing to lose. I am just above the healthy range
Of the nhs bmi calculator. It's taken one year three months
You do have to be prepared to put the effort in too though OP , at lower doses it does require will power and listening to your body to still lose the weight .
Same with gastric surgery - no one tells you that you can still eat unlimited amounts of chocolate and ice cream as they melt into liquids . Mounjaro is worth a try 100%

Have you read the book Why We Eat (Too Much) by Dr Andrew Jenkinson? If you haven't I would recommend you do. He is a bariatric surgeon who has written this book about obesity and changes in the body.

In it he talks about surgeries and, I may be misremembering but I think he suggests gastric bands and bypasses may not be the best options. An article from the BMJ states: Although RYGB is an effective procedure, it has been estimated that 15%–35% of patients will not achieve satisfactory weight loss (≥50% excess weight loss) or will experience significant weight regain (gaining of ≥15% of the maximal weight initially lost).3–9 and stresses that quality of life after regain is often lower than before surgery. I know of a patient who came down from super-obese to a healthy weight then regained around 5 stone (despite counselling and nutrition advice), was then given a gastric band, lost some again then regained and is now pre-diabetic and on Ozempic.

There is no easy solution to obesity I am afraid. Bariatric surgery and GLP1 injections are all just tools you can work with, they help you to achieve a sensible diet and weight loss but it is all hard work.
Check out "The Dietologist - Van Patel", she works with patients both before and after surgery and you may find some useful insights on her page.

Knowing that surgery is not an easy solution and, bearing in mind the risks, personally, I would try the injections if you can afford it and keep surgery as a fall back option. Have you considered a gastric sleeve? I may be wrong but I thought that was now considered the gold standard treatment although even that is not always a permanent solution. I have a friend who had one about 10 years ago who is a lot slimmer than pre-op but still not at the level she should be and is now on Ozempic

My final piece of advice is to be very careful considering surgery overseas, many patients may be ok but a sizeable number come back with problems from the relatively minor (like lack of follow up and post-op advice) to major or even life-changing requiring treatment or even further surgery from the NHS. I have worked in this field and have seen some very sad cases to the point I would, personally, never consider it myself

Yes, this, surgery is a tool, like injections are a tool, like an eating plan is a tool. Sometimes you gel with one and not another, sometimes you need to combine them or chage as you get older

It takes a mindset change I think rather than lifestyle per se. I think this forum is extremely unhelpful in that way, there is lots of fat denial/body positivity narrative, not understanding that the amount we eat is the main issue, the size of the portions we have all got used to and think are normal for the average sized human

If you're planning on going abroad and paying £3k, please don't. If you're doing the Vitality health insurance route (whereby customers take out monthly insurance with the Vitality group and after 12 months can have bariatric surgery in the UK for 25% of the cost) then yes definitely.
I'm 14 months post bypass and although it's not easy at times, it's a change for life for me. 9 and a half stones down and still losing.

Caveat - I've never had the injections

I would never choose invasive surgery if there is another comparable option to try. Ive been on mounjaro for a month (bmi 37 now) and whilst i was nervous about it, my personal side effects have been minimal, and my food noise has gone. Whilst its not cheap (varies but about £150 pm average) , i probably am not spending much more on myself, because i no longer buy booze (dont really want it) meal deals, 'treats' etc.

My friend has gastric band. Initially she lost loads of weight. Actually too much as she didn't look well. She started to do exercise too. Well some years later no exercise anymore. She can't eat big portions but she snacks a lot and has gained a good portion of weight.

Bands are notorious for encouraging the 'wrong' type of eating though

When you have a procedure like this (I have a sleeve) your priority is nutrient and protein dense foods, followed by veg/fruit then carbs if there is any space, but good carbs like lentils, pulses, within the fruit and veg that sort of thing

But people really struggle to get high nutrient food down them after surgery, particularly with bands, it isnt comfortable, lots of discomfort and sometimes pain, lots going back and forth and getting the band adjusted, so it encourages you to just eat the things which are comfortable, which tend to be poor quality carby products like biscuits, cake, ice cream, crisps etc etc

This is why I think the NHS dont do them anymore and moved them to bypasses

Even with a sleeve and bypass, you have to diet and by that I mean watch what you eat, be cautious and mindful about choices you make. Its for life, not something you come off and on with.

Christ I wish I had heard of this, how does this work?

www.streamlineweightlosssurgery.com/vitality-members/

Yes I wish I'd known about it as well! I didn't learn about it until I became active on the Bariatric groups on various platforms once I'd planned my surgery and was well on the way.