40 BMI. Weightloss on NHS. Gastric sleeve?

[ScabberPig]

I'm mentally preparing to go to my GP and ask about assistance with weightloss.

My BMI is 41.
Nice guidelines say that that puts me in category obese III and coupled with a 237cm waistline (guidelines say over 88cm is very high) means doctor should consider drugs and surgery.

I have been doing this for 16 years now. Since 20 years old.

I've printed out all reciepts and emails starting from 2006.
Multiples of the following:

Weight watchers memberships
Slimming world
Gym
Hypnotherapy
Personal trainers
Exante
Slim and save
Lipotrim with Drs
Saxenda weightloss injections

.. as evidence that I've struggled with this and really tried so many times

I've also got a record of my weight fluctuations on my fitness pal. In the last 18 months I've lost and gained the same 20lbs 3 times :(

I'm just wondering what to expect realistically.

I just need help.

Sorry 137cm waist!

Has anyone been Dr's for this?

I advise on this at my practice although I'm not a GP. I think you are doing the right thing taking the proof of what you've done so far to yet and help yourself. A lot of patients just say 'yeah yeah tried that' to any suggestions we make.
You will probably need to ask outright about bariatric surgery options which would most likely be a referral.
Do you have any form of private healthcare or are you in a position to take some out? NHS will be a long road at the moment.
They may also steer you down the route of a dietician.

May I ask honestly, why do you feel all the options you've tried before have failed?

There is a link to the NHS weight loss service here:

www.nhs.uk/live-well/healthy-weight/start-the-nhs-weight-loss-plan/

I appreciate you may say you don't feel it will work but it's something the clinician may discuss as an option with you.

They may also suggest prescriptive exercise.

There is a drug which is rarely used but you may wish to explore on nhs prescription. It's called Orlistat.

I think any clinician worth their salt would begin by doing some basic bloods too such as TFT (thyroid) to just check there isn't an obvious underlying condition which may be at play.

No, it would have to be NHS. I am on ESA and have zero savings.

I fail because I have depression and anxiety which is tied into my weight. When I am in a good place I can go to the gym and handle my calories but when I feel shit I can't. My depression doesn't allow me to leave the house. Let alone go to the gym.

Nothing in my life is consistent but I feel. Like a lot of my depression and self-loathing is related to my weight.

I think if I was a normal weight I would be so much better mentally and more level.

Yes I've had orlistat prescribed before. And bought XLS medical (the commercial version) myself many times.

I had a thyroid test and I am in the normal range but heading towards hypothyroidism. They want a repeat test in 3 months.

How did you find the orlistat? I have to admit a friend had it and it gave her some embarrassing side affects so it's not something I would want personally.

What has the GP said before? Have they ever suggested surgery may be an option?

Can I be honest with you? I think the best option is to try and tackle the depression and anxiety side of the issue. I know it's not easy and it's a very long road but I honestly don't know whether the NHS would approve bariatric unless they've really helped with your mental health side of things.

May I also ask if you have anyone around you in terms of friends and family? How do they react when you are trying to lose weight?

I've been on depression medicine for 12 years and had therapy, CBT the lot.

For me, I believe its a chemical imbalance. Not something that can be 'cured'.
When I am not medicated I cannot function normally. I am bitter, angry, have public outbursts, I rage, I cycle from positive to suicidal.

I need the medication I am on the function and that also makes me prone to weight gain.

I know some people have curable depression but I truly believe that mine is related to my brain and a lack of chemical function. I dont think any amount of taking therapy or courses would be able to do what my medication does for me physically.

And orlistat just made me have orange runs. It was awful

Weight loss surgery is not an easy recovery and doesn't always work long term. I would tackle your mental health issues and use a calorie controlled diet plus exercise. It works - I lost 2.5 stone in 2 months eating prepared meals weekdays and family meals on the weekends. The hairy dieters cookbook is a good option for cooking yourself.

My issue I know is portion control and impulsive eating. Most weight loss is with your head

In my area (Greater Manchester) you're not just referred for the bypass. You have to attend at least a year on the More Life program which are weekly sessions with specialists to encourage healthy eating and a positive mind set. During this you also attend monthly sessions with the bariatric surgery specialists. You must also lose at least 5% of your starting body weight. We had a bariatric session last night and were told the Covid back log means people who have been cleared have been waiting since 2019 for surgery dates and that list is growing ever linger as elective surgeries are pretty much on hold for the NHS.

So basically, unless you can pay then you're in for a long wait and have to jump through quite a lot of hoops.

Believe me @ScabberPig I do not underestimate mental health struggles at all.

I should add I have lost 5 stone myself, I was 16 stone obvs upon a time and only stopped being 'the fat one' well into my adult life. So when I talk to people about weight loss it's not just that I've read it from a textbook, I've been through the hell that is weight loss.

I think you need to just be honest with your GP about the weight but also about your mental health situation. I think if you are honest about known me the bariatric isn't a miracle cure but you know you need to be helped for both conditions, you may find the GP is much more understanding. Not that they aren't but you know what I mean.

I would be interested to see what happens for you. Do you have an appointment booked for a consultation?

I'm willing to jump through hoops. I've been doing this since I was 20.

Ive done calorie counting.I spend 3/4 of the year on a diet. I've done everything. This just feels like my only option, this or just accept I will always be fat and probably get fatter.

Sorry its just frustrating having people say just calorie count. If that worked for me I would have sorted this out in 2001 and have spent the last 16 years happy.

The reality, excuse me if I'm being blunt, but is reducing calories and moving more works. It can't not. Even with underlying conditions it should work.
It's the underlying conditions that you know are causing the issue. I think you have done well to acknowledge that.

I'm not saying a calorie deficit doesn't work. I'm saying I cannot stay in a calorie deficit and active consistently enough for me to loose 7 stone.

Once I get to around 1.5 stone I am fed up and defeated and spiral back into not going out etc...

Obviously a gastric sleeve is for people who have issues with food and normal diet or else why would people have them?

If I was able to eat 1200 cals a day and exercise I wouldn't need a sleeve. Noone would if everyone was that capable.

Isn't that what they are there for? People who can't do it in their own? And need that permanent restriction?

I think you should ask about it, yes. The NICE guidelines exist for people in your position who feel they have tried to get to a healthy weight many times and for a long time.

I know someone who had bariatric surgery and while it was incredibly tough, she did lose a great deal of weight on it.

Sounds like the first step is having a frank conversation with the GP.

Good luck

I completely get you @ScabberPig and I think you've proven that you understand the science but it just doesn't work for you and you know why.
Please let us know what the GP says and I wish you luck regardless of whichever option you take x

I am in Manchester actually. I'm 36. If I have had surgery before my 40th birthday I'll be happy tbh.

I have had surgery. It worked me. It is not an easy option and there are lot of hoops you have to jump through if you want on the NHS.

It is not an instant referral to surgery. If you have it on The NHS you will have to attend groups around food and undergo a number of psychologist appointments this is because once you have the surgery you will still have head hunger and need to be able to cope with that mentally.

You also need to evidence to wms that you have done everything possible to lose weight yourself.

It is a life changing decision and you need to look at pros and cons. It is irreversible, unless you have a gastric band. Be aware of sugar dump too that will make you really ill if you have too much refined sugar after surgery.

Good luck

I've been referred to the bariatric team in the last week.

My BMI is 45.

I'm nearly 39 and have been on several diets repeatedly since my twenties, I've been on orlistat (christ alfuckingmighty!) and have previously been to gyms and taken up physical activities.

I'm physically disabled and despite the help I'm slowly receiving for the main issue with my spine, I'm never going to be able to do much moving about, period.

I miss being able to use a cycling machine or cross trainer.

My eating issues are complex because of more than one eating disorder. There's about three different eating issues. I was referred to the diabetes nurse because I'm pre-diabetic, and I explained my issues and how they seem to work and what I have to do, and as far as I understand, why they happen.

So its not straight forward, the GP then rang to take me through the referral and it sounds like theres four stages - managing it yourself, using diet groups etc, a third stage and surgery is stage four. He couldn't give me more information on what three is because it didnt give him that info.

But I expect I'll have to have appointments and have my issues analysed.

Hi Scabberpig, have you seen this thread?
www.mumsnet.com/Talk/weight_loss_chat/4023261-Why-We-Eat-Too-Much
It's about the book by bariatric surgeon Andrew Jenkinson. All your posts completely resonate so much with both me and everything he says in the book. Absolutely worth a read if you haven't already!

I was going to recommend the same book as pp - if nothing else it may help you understand why you find it hard/impossible to lose weight and underline that this absolutely isn't your fault. Jenkinson is a bariatric surgeon so perhaps it's not surprising that he is an advocate of surgery but he explains why this can be effective.

The book is a good come-back to the 'eat less move more' mantra that I can see has already appeared on this thread. Even if you are in a mental place to be able to do that, there are biological reasons why it just doesn't work for everyone.

Best of luck whatever you decide.