Donald Waldrep, MD

Klhan, 

You may be a candidate for surgery, despite your BMI. A weight loss surgeon in your area (Germany?) can tell you more specifically about whether you are - or whether she/he considers you to be - a candidate for surgery. You do have a set of symptoms that could certainly be related to extra body weight, but would best be evaluated by medical specialists to rule out conditions that may not require surgery. There is a spectrum of surgical techniques that differ in level of complexity (bypass, sleeve, band, plication) that may be available to you, even at your current BMI. 

Donald J Waldrep, MD, FACS, FASMBS
Weight Loss Surgery
Beverly Hills and Thousand Oaks, CA

Only_me2015

While it is possible that your insurance might cover weight loss surgery for a BMI below 35, it would likely require specific considerations and is uncommon. I believe there is a growing interest in WLS for lower BMIs as lower weight, but still overweight patients have many of the same daily concerns as traditional, heavier patients.
With a spectrum of surgical techniques that now include outpatient procedures (band, or plication) I see more patients in the 30-35 range, who would not have typically considered a more complex surgery. Not all surgeons will consider non-traditional BMI patients, but see one or more experts to get more information specific to your goals. Best wishes for reaching your goal.

Donald J Waldrep, MD, FACS, FASMBS
Weight Loss Surgeon
Beverly Hills and Thousand Oaks, CA

Briannalamar,

You have an option to have either procedure first. I do agree that overall, it would probably be best to optimize your weight loss first so the landmarks that the Plastic Surgeon will use will be stable and reliable. There are a range of weight loss surgeries and they vary in how "complex" they are. If you and your weight loss surgeon find you are a candidate, your choice of surgeries and timing will depend on several factors. You don't mention your current body weight or Body Mass Index, or how much weight you would like to lose. To be complete, your choice of surgery may allow you to have the bariatric and a plastic surgery to be done at the same time; for example, our clinic provides two types of outpatient procedures. Discuss these options with your surgeons. Best wishes in reaching your goals.

Donald J Waldrep, MD, FACS, FASMBS
Weight Loss Surgeon
Beverly Hills and Thousand Oaks, CA

Polarking,

Your concern is not unusual regardless of the type of weight loss procedure. There are two mechanisms at play; 1) the perception that the "pouch" seems larger, or the possibility that 2) the "pouch" really is larger. Even gastric bypass patients, whose pouch is typically the size of your little finger, will adapt over time and feel as though the pouch has stretched when perhaps it hasn't.

A plication can feel as though it can accommodate more food because of any number of changes: adaptation (a change in the sensation of fullness); "blame" on pouch stretching because of increased weight gain (actually due to eating more calories through smaller but more frequent portions); the in-folded portion becoming relatively smaller; the stomach space becoming relatively larger; and last, the plication becoming "un-done". Unfortunately, my experience indicates pouches don't shrink. A good first step in evaluating your stomach is to ask your doctor if an Upper GI x-ray is advisable that will show the relative size and shape of the stomach and your surgeon can assess if there have been any interval changes since the surgery. It may be possible to "re-WRAP" the stomach to re-establish the feeling of fullness, or other surgeries may also still be considered (bypass, band, sleeve) - though such decisions would be based on multiple factors that your physician and surgeon can address specifically. 

[Side-note] If you don't mind being asked, was your surgery done in Great Britain or elsewhere?

Donald J Waldrep, MD, FACS, FASMBS
Weight Loss Surgeon
Beverly Hills & Thousand Oaks, California

Starrr,

Congratulations on your 100 pound weight loss - that is quite an accomplishment! Your concern about hitting a plateau is very common and it would be important to know the time period for your weight loss and how long your weight has been stable. Fluctuations in weight loss, and even times when the scale seems stuck is normal... you are normal. The first step is always to look at the calorie count and see if there is "calorie creep", or minor - seemingly insignificant - calories are getting back into the daily routine. Working with a registered dietician may help someone reassess her intake. Sometimes structured commercial meal plans employed over a month or so may break some eating and behavior habits, and allow an encouraging change in weight.
Traditional BMI guidelines support surgery for a person with a BMI between 35-40 if that person has health conditions associated with extra body weight (for example, diabetes, high blood pressure, sleep apnea; but there are many others). In light of the growing number of people who battle extra body weight daily, I believe that many surgeons are becoming more accepting of treating lower BMI patients, especially with techniques that we provide that seem less complicated as band or plication. Again, great job on your weight loss so far and best wishes for your continued success.

Donald J Waldrep
Weight Loss Surgeon
Beverly Hills & Thousand Oaks, California