Regain after Gastric Bypass
jnmalsch
Posts: 21 Member
I am finding it hard to find information on how to deal with regain after gastric bypass. How does it come off, do you need to do anything different etc... I am here #1 looking for those going through the same thing because I feel pretty alone in this and #2 to find other who have succeeded in losing the regain. Join me here if you are going through the same thing http://community.myfitnesspal.com/en/group/123661-regain-after-bariatric-surgery
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This is a good group of people who have been through the surgery process and going through the same things http://community.myfitnesspal.com/en/group/637-gastric-bypass-vsg-lapband2
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Thank you garber6th! I wanted to find an active group.
Noel_57 have you had WLS? I dont think its quite the same considering dumping, hypoglycemia, malnutrition, portion sizes etc... we cannot drink when we eat, cannot have carbonation. I want to see what if anything is different the second time around. I dropped 160 pounds in 7 months. No way to do that now. I just want to see what its like after regain, is success possible etc....9 -
What information do you need? It's the same for WLS people as it is for non-WLS people. You have to eat less calories than your body needs to lose weight.
I think what ^^^^ said is pretty spot on. Especially if you had surgery and gained the weight back. You ate more calories than your body needed.14 -
at the time I was eating about 1000 calories a day. when I asked my nutritionist she said to cut it back down to 800 and that got disheartening. I know your metabolism slows way down right after surgery but can you bump it back up I don't even have a clue what calories range I should be in. Right now I am trying to hit the 1000 calorie mark again.14
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Thank you garber6th! I wanted to find an active group.
Noel_57 have you had WLS? I dont think its quite the same considering dumping, hypoglycemia, malnutrition, portion sizes etc... we cannot drink when we eat, cannot have carbonation. I want to see what if anything is different the second time around. I dropped 160 pounds in 7 months. No way to do that now. I just want to see what its like after regain, is success possible etc....
Those are tough issues, but have little to do with weight regain. If you are suffering, you should return to your medical care team and re-assess your dietary choices, supplementation, etc. Weight regain is still a product of calories. Success is absolutely possible. You still have the tool of surgery available to help you.8 -
I've had an RNY procedure. I'm about a year out.
Whether you like to think about it this way or not, it really isn't much different between us and those that haven't had surgery. The surgery affects our absorption and restricts the amount of food you can eat at one time, but the CICO concept does not change.
Our bodies eventually adjust and regain will happen if you overeat your calorie goals. Over time, you're supposed to increase your caloric intake to be a more "normal" amount. I'm a year out and I'm at about 1300 calories. I lost 150lbs in my first 9 months or so then stalled out but did not increase in weight at all when I increased my calories because my metabolic needs are still more than what I eat daily. Personally, I've lost rather slowly from my surgery in comparison to others but even with my increased calories, I continue to trend down because my intake is about 1/2 my maintenance calories.
There are many things they advise against to help prevent stretching the pouch and increasing the likelihood of ulcers but these things do not have any effective impact on what happens from a weight loss/dietary perspective. Non-surgery people can make these same choices. Surgery persons also can choose to drink and eat at the same time or have carbonation in moderation.
What do RNY patients do when they regain? They do a reset.
Meaning that they go back to a full liquid, all protein shake diet for 2 weeks, and re-dedicate to all of your vitamins. You also get back on board with your 1 hour per day activity directive. I don't see you mentioning anywhere in this thread what your cardio and weight lifting habits are, just mentioning diet... and diet is only a part of the post-op life equation.
Regain is very common and happens to people that do not stay strict with their regimen. Some people opt to have a revision done if they've stretched out their pouch too much. Others are able to do a reset with decent success. If you're within the first 3 years, you're likely still able to do a full liquid reset without much issue, unless you've been aggressively overstuffing your pouch.
All surgery is really intended to do is restrict your ability to take in and in some cases absorb calories. RNY will restrict absorption but frankly, if you eat a diverse enough diet after a while, you don't have too many shortcomings when it comes to deficiencies. Certainly not enough to make it vastly different from other people. I lost 140ish before surgery, and 150 after, and the biggest difference for me has been the fact that I have to choose more nutrient-dense foods because my volume is so low, and I have to chew/pace intake differently.
I also rarely get hungry so I eat on a schedule.
So what I'd suggest is go back to basics, which is effectively what every person I know of that has faced regain has been instructed to do... and that's what it sounds like you've been told to do too. They don't give you a calorie count because the reality is, you have to focus on protein first. At most, the change would be try a higher protein content, like instead of the standard 60g, upping to 80g+ which is completely doable within 800 calories and also shouldn't leave you wanting for much.
Surgery doesn't fix the brain hunger and it doesn't force your hand to keep you dedicated to the plan so if you're finding it difficult to do a reset and lamenting and being upset over this, it might be time to return to therapy if you've stopped your psychological counseling.
However, it's important to understand that a long-term post-op patient is looking at maintaining on no less than 1100 calories per day. If we're being 100% honest with ourselves about intake, we certainly should not be seeing regain on a count lower than that, especially if we are getting our protein count every day, taking vitamins and doing our activity. If you're missing any of that equation... again, it's back to basics. Treat yourself like you're getting ready for surgery again.
Worst case scenario, if a surgery patient is regaining and they are still exceptionally overweight, they will have you go through the whole pre-op process again and do a revision to shrink the pouch back... but all that does, again, is restrict the room you have to work with. It's up to you to monitor and restrict the calories you take in and how you do that. Regains are most commonly seen when patients figure out ways to eat around their restrictions.55 -
Not to be overly negative but the problems with weight loss surgeries such as gastric bypass is they use a method to lose weight that is not a method you can employ to maintain weight.
If you lose weight by teaching yourself how to eat a certain number of calories daily then over the years you are doing that you teach yourself routines and systems and management strategies for being able to eat an appropriate amount. It is those things that allow you to then transition smoothly into maintenance and keep at your goal weight. If instead you lose weight by stapling your stomach so you literally cannot eat more than a few bites then you aren't teaching yourself any habits or skills that you can carry over into maintenance. You will lose the weight but as your stomach stretches back and regrows you won't have put into place any strategies or routines whereby you will maintain your weight.
I guess my point is you need to count calories and learn how many calories you personally need to maintain your weight and then continue to count calories daily and stick around that number for as many months or years as it takes to build up the collection of habits necessary for you to no longer require counting. You will need to find what foods work for you that allow you to hit that calorie goal while remaining satisfied. That is as true of maintenance as it is of loss, its just people who lost weight by calorie counting have already taught themselves how to do that while those who lost by surgery haven't yet.17 -
I get where you're coming from. I had gastric bypass in 2007. I lost 130# and regained 40 in the past 4 or so years. I've read some statistics on why we regain the weight and that 90% of gastric bypass patients regain at least 25% of their lost weight. It's a real thing. Unfortunately, the surgery limited the amount of food we could eat at one time; but our food/sugar addiction remained. We learned to, what I call, "eat around" our surgery. Smaller meals, more snacks, slowly increasing sugar until we stopped responding negatively to it. Remember after surgery, we couldn't eat sugar: it physically made us sick. But for some reason, we kept eating it, tiny bits, then more, until finally, we were eating it just like pre-surgery. We have to get back to basics. I began keto about a week ago. It's most definitely a lifestyle change. No sugar/no processed foods, ultra low carbohydrate, high good fats and moderate protein. I've lost 7 pounds and it's been almost effortless. The few days to get rid of the sugar cravings and withdrawal were a small price to pay for the well being that comes with this way of eating. Remember those basics we learned right after surgery--eat vegetables, avoid sugar, drink fluids, exercise: all of those things are necessary for us to take control of our eating. I would recommend you doing some research on the ketogenic diet. I'm absolutely never hungry. I'm not ruled by my insulin spikes and drops. I'm not hungry period. The food I eat is very tasty, and I don't feel like I'm missing out on anything. It's working for me and I would challenge you to look into it for yourself. Be well. Friend me if you'd like some support.12
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Aaron_K123 wrote: »Not to be overly negative but the problems with weight loss surgeries such as gastric bypass is they use a method to lose weight that is not a method you can employ to maintain weight.
If you lose weight by teaching yourself how to eat a certain number of calories daily then over the years you are doing that you teach yourself routines and systems and management strategies for being able to eat an appropriate amount. It is those things that allow you to then transition smoothly into maintenance and keep at your goal weight. If instead you lose weight by stapling your stomach so you literally cannot eat more than a few bites then you aren't teaching yourself any habits or skills that you can carry over into maintenance. You will lose the weight but as your stomach stretches back and regrows you won't have put into place any strategies or routines whereby you will maintain your weight.
I guess my point is you need to count calories and learn how many calories you personally need to maintain your weight and then continue to count calories daily and stick around that number for as many months or years as it takes to build up the collection of habits necessary for you to no longer require counting. You will need to find what foods work for you that allow you to hit that calorie goal while remaining satisfied. That is as true of maintenance as it is of loss, its just people who lost weight by calorie counting have already taught themselves how to do that while those who lost by surgery haven't yet.
I think this comment basically assumes that all WLS patients refuse to learn through the classes and teaching that is a part of the process of having surgery. The fact that you state "stapling the stomach" to not be able to eat more than a few bites tells me that you know rather little about what the process entails.
If you are trying to go through insurance (in the US at least) it typically takes 6-12 months of pre-op training with a dietitian, a physiologist and a psychologist, along with routine bloodwork, weight loss goals and more, all structured around teaching new habits, a better relationship with food and how to determine whether a food will be good for you or not. Effectively, if you go about it the way you should, you are actually taught a very sustainable, routine/system/management style that can be maintained for LIFE. Typically, these programs also follow you for a year+ after surgery in order to make sure you maintain what you've learned and learn coping skills to address the issues that come up after the fact.
The problem is that there are many patients that don't take it seriously... Doing the bare minimum to get to surgery, or even worse, bypassing the pre-qualifying steps to go the elective route, getting a WLS procedure done through a service that doesn't provide any pre or post op services.
Surgical weight loss is supposed to provide restriction for the initial period to cause immediate weight loss but the stomach is supposed to expand over time. Eventually, it'll be able to tolerate a modest meal, and that's 100% what is supposed to happen. Will it ever expand to 40oz (the average stomach size) again? Probably not. However, no one ever said that you'd be restricted for life... and absolutely every step of the way for me, they stressed the importance of learning nutrition skills, setting exercise routines and figuring out the best way to do you.
Essentially, I equate it to taking an anti-depressant when you are having an acute depressive episode. They aren't intended to be taken for life for most people. What they are intended to do is treat symptoms immediately so that you can focus on learning coping skills and working with a therapist so that when you eventually take away the medications, you can rely on your skills to maintain. Some people take this very seriously and maintain without meds with success (for example, I am going almost 5 years strong now myself) but others assume that meds will just fix the problem, and are completely unprepared when normalcy comes back.
I have a book-thick binder of tips, guidelines, skill sheets, resources, I have a hotline I can call if I have concerns, I have a therapist I see weekly, I monitor my intake... I invested in this and taught myself a lot. I won't claim that I will never regain but I'm pretty confident in my choices and my skills. I eat mostly regular foods, I have desserts sometimes, I enjoy my LIFE.
I found the surgery process and my pure non-surgical weight loss to be pretty similar. Both required regular logging and attention to detail. Both require exercise, adequate sleep, good water intake and vitamins. Both require therapy and social support. The only real difference for me is that surgery broke a year long weight loss stall that I couldn't break on my own or with purely non-surgical methods assisted from medical personnel.
The way I see it is, surgery ultimately does exactly what we're all trying to do here, but just adds an undeniable physical limitation for most WLS patients (not all have stomach "stapling" done ya know). Just like a non-surgery patient, if you buy into a program to dictate all your steps for you without learning more about the details, you'll inevitably fail when you remove the program guidelines from the equation. However, if you take the time to learn the how, why and what of it all, you can successfully transition without much issue.
The average WLS patient might experience 25% regain, but that's the average. Some patients regain it all, some never regain a pound. We all typically gain weight as we age and our bodies and needs change anyway, so the vast majority of people on MFP will gain some of the weight they've lost here, regardless of how they did it. Talking about it like they are somehow completely different is not particularly accurate.17 -
Aaron_K123 wrote: »Not to be overly negative but the problems with weight loss surgeries such as gastric bypass is they use a method to lose weight that is not a method you can employ to maintain weight.
If you lose weight by teaching yourself how to eat a certain number of calories daily then over the years you are doing that you teach yourself routines and systems and management strategies for being able to eat an appropriate amount. It is those things that allow you to then transition smoothly into maintenance and keep at your goal weight. If instead you lose weight by stapling your stomach so you literally cannot eat more than a few bites then you aren't teaching yourself any habits or skills that you can carry over into maintenance. You will lose the weight but as your stomach stretches back and regrows you won't have put into place any strategies or routines whereby you will maintain your weight.
I guess my point is you need to count calories and learn how many calories you personally need to maintain your weight and then continue to count calories daily and stick around that number for as many months or years as it takes to build up the collection of habits necessary for you to no longer require counting. You will need to find what foods work for you that allow you to hit that calorie goal while remaining satisfied. That is as true of maintenance as it is of loss, its just people who lost weight by calorie counting have already taught themselves how to do that while those who lost by surgery haven't yet.
I think this comment basically assumes that all WLS patients refuse to learn through the classes and teaching that is a part of the process of having surgery. The fact that you state "stapling the stomach" to not be able to eat more than a few bites tells me that you know rather little about what the process entails.
If you are trying to go through insurance (in the US at least) it typically takes 6-12 months of pre-op training with a dietitian, a physiologist and a psychologist, along with routine bloodwork, weight loss goals and more, all structured around teaching new habits, a better relationship with food and how to determine whether a food will be good for you or not. Effectively, if you go about it the way you should, you are actually taught a very sustainable, routine/system/management style that can be maintained for LIFE. Typically, these programs also follow you for a year+ after surgery in order to make sure you maintain what you've learned and learn coping skills to address the issues that come up after the fact.
The problem is that there are many patients that don't take it seriously... Doing the bare minimum to get to surgery, or even worse, bypassing the pre-qualifying steps to go the elective route, getting a WLS procedure done through a service that doesn't provide any pre or post op services.
Surgical weight loss is supposed to provide restriction for the initial period to cause immediate weight loss but the stomach is supposed to expand over time. Eventually, it'll be able to tolerate a modest meal, and that's 100% what is supposed to happen. Will it ever expand to 40oz (the average stomach size) again? Probably not. However, no one ever said that you'd be restricted for life... and absolutely every step of the way for me, they stressed the importance of learning nutrition skills, setting exercise routines and figuring out the best way to do you.
Essentially, I equate it to taking an anti-depressant when you are having an acute depressive episode. They aren't intended to be taken for life for most people. What they are intended to do is treat symptoms immediately so that you can focus on learning coping skills and working with a therapist so that when you eventually take away the medications, you can rely on your skills to maintain. Some people take this very seriously and maintain without meds with success (for example, I am going almost 5 years strong now myself) but others assume that meds will just fix the problem, and are completely unprepared when normalcy comes back.
I have a book-thick binder of tips, guidelines, skill sheets, resources, I have a hotline I can call if I have concerns, I have a therapist I see weekly, I monitor my intake... I invested in this and taught myself a lot. I won't claim that I will never regain but I'm pretty confident in my choices and my skills. I eat mostly regular foods, I have desserts sometimes, I enjoy my LIFE.
I found the surgery process and my pure non-surgical weight loss to be pretty similar. Both required regular logging and attention to detail. Both require exercise, adequate sleep, good water intake and vitamins. Both require therapy and social support. The only real difference for me is that surgery broke a year long weight loss stall that I couldn't break on my own or with purely non-surgical methods assisted from medical personnel.
The way I see it is, surgery ultimately does exactly what we're all trying to do here, but just adds an undeniable physical limitation for most WLS patients (not all have stomach "stapling" done ya know). Just like a non-surgery patient, if you buy into a program to dictate all your steps for you without learning more about the details, you'll inevitably fail when you remove the program guidelines from the equation. However, if you take the time to learn the how, why and what of it all, you can successfully transition without much issue.
The average WLS patient might experience 25% regain, but that's the average. Some patients regain it all, some never regain a pound. We all typically gain weight as we age and our bodies and needs change anyway, so the vast majority of people on MFP will gain some of the weight they've lost here, regardless of how they did it. Talking about it like they are somehow completely different is not particularly accurate.
Serious questions, because I've never understood how this is supposed to work:
Suppose a WLS patient is perfectly compliant, does everything right, and reaches a healthy weight, eating 800 to 1000 calories a day. What do they do then? Surely they don't continue eating such a small amount and drift down to an unhealthy underweight situation? Do they have to have another surgery to reverse whichever WLS they had, so they can eat enough to maintain a healthy weight? Or do they then have to start eating eight or 10 times a day so that they can consume enough calories in the small "meals" that their post-op condition allows? What if they decide to become more physically active now that they have lost weight -- is it even possible to eat often enough in those small amounts to sustain an active lifestyle and, say, training for a half-marathon and not go on losing weight?
Also, if the prospective WLS patient learns all these great techniques and loses weight pre-op (which in my understanding is required to get the surgery, or at least to get insurance to pay for the surgery, to demonstrate an ability to adhere to the post-op regime), why can't the patient just continue with those techniques and continue losing weight without surgery, with taking on the risk of surgery (and all surgery involves risk)?19 -
lynn_glenmont wrote: »
Serious questions, because I've never understood how this is supposed to work:
Suppose a WLS patient is perfectly compliant, does everything right, and reaches a healthy weight, eating 800 to 1000 calories a day. What do they do then? Surely they don't continue eating such a small amount and drift down to an unhealthy underweight situation? Do they have to have another surgery to reverse whichever WLS they had, so they can eat enough to maintain a healthy weight? Or do they then have to start eating eight or 10 times a day so that they can consume enough calories in the small "meals" that their post-op condition allows? What if they decide to become more physically active now that they have lost weight -- is it even possible to eat often enough in those small amounts to sustain an active lifestyle and, say, training for a half-marathon and not go on losing weight?
Also, if the prospective WLS patient learns all these great techniques and loses weight pre-op (which in my understanding is required to get the surgery, or at least to get insurance to pay for the surgery, to demonstrate an ability to adhere to the post-op regime), why can't the patient just continue with those techniques and continue losing weight without surgery, with taking on the risk of surgery (and all surgery involves risk)?
1. A perfectly compliant WLS patient will not lose all of their weight on 800-1000 calories a day. A perfectly compliant WLS patient incrementally increases their intake to a normalized amount of food over time. I can only speak to a gastric bypass in detail, so we'll use that as an example... all my statements, as it were. Keep in mind that there are many different kinds of surgery, including a few that allow for no change to intake calorie amount.
Initially after surgery, a patient may have an intake of 0-300 calories per day, focusing on protein shakes and water only. As the first weeks go by, you add fluid ounces. At about a month out, you're looking at 3 shakes a day, which is hovering 400-600 calories per day, depending on your shake option. By 6 months, most people are in that 800-1000 range, but they don't stop there. Calorie intake increases as the volume increases for each meal. Initial meals are 1-2oz in size, by 6 months they are 4oz, and so on. No WLS patient following the protocol that seems to be pretty standard across the programs I'm familiar with would ever continue on an 800-1000 for longer than *maybe* the first year.
The FDA guidelines for post-op WLS patients is that a patient not maintain on a diet under 1100 calories, this being with heavy supplementation. The expectation is that with time, your stomach will naturally loosen, relax and expand to accommodate 8oz+ of volume at one time... which is still 1/5 of the normal stomach, but accommodating. Someone who gets a sleeve, for example, their post-op stomach is 6-8oz and they are immediately able to eat more and tend to stop losing weight earlier as their diet normalizes. To put it in perspective, your typical frozen dinner is 10oz. You have two of those plus some breakfast, you're already at 1100 calories easily, unless you're making a concerted effort to eat less than that.
Anyway, after only maybe 2 months, you are re-introducing normal foods stage by stage, and eventually will eat basically a smaller version of a well-rounded diet. Smaller particularly in comparison to pre-surgery diet, but not necessarily distinctly noticeable from the average diet. Plenty of normal people eat a routine 1600 calorie diet.
WLS is not intended to bring a patient to a healthy weight either. At most, with the most aggressive surgery available, you're talking about maybe an 80% excess weight reduction attributed to the surgery itself. All patients that reach a healthy weight did so out of perseverance and personal commitment to a healthy, balanced diet after their stomach and diet have normalized.
Just like non-surgical weight loss, the maintenance calories changes as the weight reduces... The intake number, however, is different. Non-surgical people routinely drop their intake to continue the loss pattern, whereas surgery people routinely and systematically increase their intake over time after surgery. As you get closer to goal, the difference between intake and maintenance numbers decreases, until they are one in the same. While it may be true that surgery lowers that maintenance number (this is not a founded statement, just a conjecture if anything, but it would make sense to me), it would not be down to anorexia nervosa levels (average AN patient eats 900 calories a day).
It's not as hard as you might think to add an extra protein shake or what have you on high exercise/activity days. Even at my stage, I'm able to accommodate if necessary.
However, it's rare to have a WLS reversal. Most of the surgeries cannot be reversed. My option of reversal is simply because I've had malnutrition issues in the past... so it came up as a concern. Most patients are able to go on and exercise, have babies, the whole deal of life without excessive concern of appropriate intake.
2. When it comes to a patient succeeding in the pre-op program, you have to remember that pre-op weight loss is very small for most. Most programs do require some weight loss... Some insurances put a number to that. However, most programs, at the least, require stable weight more than anything, and the majority of pre-op weight loss tends to happen in the pre-surgery prep diet, in the last 2-4 weeks before surgery, because you go from a balanced diet to full liquids (well, many of us do, this tends to depend on the program you're on).
If you were extremely successful before surgery with the training you get there, I think you'd actually be unlikely to get insurance approval for surgery, because it would be an indicator that all non-surgical avenues have not been exhausted and proven to fail. A patient that still insisted on surgery in this situation would possibly also fail their psychiatric evaluation because they would not be able to recognize important indicators of success and failure.
Standard requirement is that you have to have an established history of failed weight loss under monitored supervision... This is sometimes taken from the pre-op prep courses, yes, but failure would be weight loss that doesn't match the documented deficit. It does happen.
For example... I did pre-op diet for a long time rather than just 2 weeks. I did 2 protein shakes a day (breakfast and lunch) with a piece of cheese for a snack and a high protein dinner with veggies for 5.5 months. In that time frame, I lost about 10 lbs. I weighed 440lbs, and was regularly exercising as well. I switched to full liquids 2 weeks beforehand, and in those 2 weeks, I lost another 12 pounds. So, in the course of 6+ months of eating a major deficit, I lost only 22lbs, which was statistically, significantly less than what I should have lost. RNY changes how you metabolize sugars, carbohydrates and how you absorb some fats, along with the restriction, and that's what we attribute my weight loss change to, more than anything.
I hope this helps at least a little bit. I can't speak to why everyone chooses to do what they do... I can say that I've met a number of people that should never have been approved for surgery. I strongly believe that a person should go through counseling for more than just an evaluation pre-op... Have to really dig in to the why of their food habits. I spent 5 years overall preparing and considering surgery, but made the decision to do it a year and a half ago. I don't regret it at all.
Editing to add:
As with all surgeries, medications and procedures, utilizing the method is considered and determined to be in a state where the benefits outweigh the risks. You don't get to have WLS just because you asked for it, and you don't get to have it simply because you're overweight. Not all insurance companies are the same... Mine asked for a BMI of 35+ or 30+ with comorbidities... My BMI at the time was over 50 but I still got rejected initially because insurance said I wasn't sick enough... Even though there was no pre-op weight loss requirement or anything specific, that was all my surgery program. Insurance did eventually require me to prove that I quit smoking though.
Generally speaking, WLS is considered an option for the extremely obese or for those that have illnesses that warrant an aggressive approach to weight loss. Yeah, there are people with only 50lbs to lose that go have surgery (I know I said "only" but in comparison to some WLS patients, this is a tiny amount) but there are reasons for everyone. Sometimes the reason is that the weight loss simply cannot wait for standard approaches and Weight Watchers. For cases like mine, studies are demonstrating more and more that excessive obesity, at a certain point, practically requires medical intervention in some form.
Like me, even if I had never had WLS, I would still need medical help because I'll have to have my abdominal muscles tightened and a lot of skin removed. Overall though, I'm proud of both of my weight loss eras, and I feel the whole effort was worth it in the end.18 -
Aaron_K123 wrote: »Not to be overly negative but the problems with weight loss surgeries such as gastric bypass is they use a method to lose weight that is not a method you can employ to maintain weight.
If you lose weight by teaching yourself how to eat a certain number of calories daily then over the years you are doing that you teach yourself routines and systems and management strategies for being able to eat an appropriate amount. It is those things that allow you to then transition smoothly into maintenance and keep at your goal weight. If instead you lose weight by stapling your stomach so you literally cannot eat more than a few bites then you aren't teaching yourself any habits or skills that you can carry over into maintenance. You will lose the weight but as your stomach stretches back and regrows you won't have put into place any strategies or routines whereby you will maintain your weight.
I guess my point is you need to count calories and learn how many calories you personally need to maintain your weight and then continue to count calories daily and stick around that number for as many months or years as it takes to build up the collection of habits necessary for you to no longer require counting. You will need to find what foods work for you that allow you to hit that calorie goal while remaining satisfied. That is as true of maintenance as it is of loss, its just people who lost weight by calorie counting have already taught themselves how to do that while those who lost by surgery haven't yet.
I think this comment basically assumes that all WLS patients refuse to learn through the classes and teaching that is a part of the process of having surgery. The fact that you state "stapling the stomach" to not be able to eat more than a few bites tells me that you know rather little about what the process entails.
If you are trying to go through insurance (in the US at least) it typically takes 6-12 months of pre-op training with a dietitian, a physiologist and a psychologist, along with routine bloodwork, weight loss goals and more, all structured around teaching new habits, a better relationship with food and how to determine whether a food will be good for you or not. Effectively, if you go about it the way you should, you are actually taught a very sustainable, routine/system/management style that can be maintained for LIFE. Typically, these programs also follow you for a year+ after surgery in order to make sure you maintain what you've learned and learn coping skills to address the issues that come up after the fact.
The problem is that there are many patients that don't take it seriously... Doing the bare minimum to get to surgery, or even worse, bypassing the pre-qualifying steps to go the elective route, getting a WLS procedure done through a service that doesn't provide any pre or post op services.
Surgical weight loss is supposed to provide restriction for the initial period to cause immediate weight loss but the stomach is supposed to expand over time. Eventually, it'll be able to tolerate a modest meal, and that's 100% what is supposed to happen. Will it ever expand to 40oz (the average stomach size) again? Probably not. However, no one ever said that you'd be restricted for life... and absolutely every step of the way for me, they stressed the importance of learning nutrition skills, setting exercise routines and figuring out the best way to do you.
Essentially, I equate it to taking an anti-depressant when you are having an acute depressive episode. They aren't intended to be taken for life for most people. What they are intended to do is treat symptoms immediately so that you can focus on learning coping skills and working with a therapist so that when you eventually take away the medications, you can rely on your skills to maintain. Some people take this very seriously and maintain without meds with success (for example, I am going almost 5 years strong now myself) but others assume that meds will just fix the problem, and are completely unprepared when normalcy comes back.
I have a book-thick binder of tips, guidelines, skill sheets, resources, I have a hotline I can call if I have concerns, I have a therapist I see weekly, I monitor my intake... I invested in this and taught myself a lot. I won't claim that I will never regain but I'm pretty confident in my choices and my skills. I eat mostly regular foods, I have desserts sometimes, I enjoy my LIFE.
I found the surgery process and my pure non-surgical weight loss to be pretty similar. Both required regular logging and attention to detail. Both require exercise, adequate sleep, good water intake and vitamins. Both require therapy and social support. The only real difference for me is that surgery broke a year long weight loss stall that I couldn't break on my own or with purely non-surgical methods assisted from medical personnel.
The way I see it is, surgery ultimately does exactly what we're all trying to do here, but just adds an undeniable physical limitation for most WLS patients (not all have stomach "stapling" done ya know). Just like a non-surgery patient, if you buy into a program to dictate all your steps for you without learning more about the details, you'll inevitably fail when you remove the program guidelines from the equation. However, if you take the time to learn the how, why and what of it all, you can successfully transition without much issue.
The average WLS patient might experience 25% regain, but that's the average. Some patients regain it all, some never regain a pound. We all typically gain weight as we age and our bodies and needs change anyway, so the vast majority of people on MFP will gain some of the weight they've lost here, regardless of how they did it. Talking about it like they are somehow completely different is not particularly accurate.
I'll admit I have no experience and little knowledge about weight loss surgery. That said if one is capable of learning sustainable eating habits through coursework and practice then why is the surgery even neccessary?
I guess I am assuming that if someone resorts to surgery it is because they have not been able to control their weight just through willpower and self-imposed caloric restriction through self taught dietary habits. If a person was capable of that why elect to have surgery?
After the surgery occurs ones biology and ability to eat is altered in a way that one can no longer experientially learn proper eating habits simply because restrictions are in place due to the surgery that will not be there a year or so later when maintenance is required. So again if you are to learn the habits necessary for maintenance you'd have to do so before the surgery took place in which case why is the surgery necessary?
I have the same confusion about how appetite suppressants are supposed to help. If one learns to eat a reasonable amount while on appetite suppressants they haven't really learned how to eat a reasonable amount while not on appetite suppressants. Eventually they will have to stop taking the appetite suppressants in which case they haven't really been prepared for what will be required for maintenance and will either regain a lot of their weight while attempting to learn or they won't learn and will regain all of the weight.
Surgery and appetite suppressants just seem to be placeholders. Eventually, at some point, one has to learn proper eating without relying on them anyways...so why not start there and skip the dangers of surgery or appetite suppressants.
I do understand if it is a matter of life or death for someone morbidly obese surgery might be the best course of action but the rebound is still an issue.9 -
Aaron_K123 wrote: »I'll admit I have no experience and little knowledge about weight loss surgery. That said if one is capable of learning sustainable eating habits through coursework and practice then why is the surgery even neccessary?
I guess I am assuming that if someone resorts to surgery it is because they have not been able to control their weight just through willpower and self-imposed caloric restriction through self taught dietary habits. If a person was capable of that why elect to have surgery?
After the surgery occurs ones biology and ability to eat is altered in a way that one can no longer experientially learn proper eating habits simply because restrictions are in place due to the surgery that will not be there a year or so later when maintenance is required. So again if you are to learn the habits necessary for maintenance you'd have to do so before the surgery took place in which case why is the surgery necessary?
As I've stated a couple of times, there are many different surgeries. Several of them alter the process of digestion, which cannot be achieved without surgery.
You are assuming a lot, to think that a person resorts to surgery because they are incapable of learning skills or utilizing their willpower. Some people overstretched their stomach through poor habits that got them to their overweight space and thus it literally takes more to feel full because the stomach is larger than normal. They will have WLS to effectively have a stomach reduction. You cannot undo that damage without surgery, and no matter how hard you want to believe willpower can overcome physical emptiness... feel free to live the rest of your life without ever experiencing satiety as an example for me.
There are also a lot of psychological training benefits that happen with surgery that don't happen otherwise. Physical limitation being one of them... Fat rejection, sugar intolerance, these things cause negative consequences for poor eating habits that without surgery, can easily be excused.
However, if you think that "experiential" learning is the only way dieting and eating can work, then that's limited in my mind as well. Many of us can't rely on experience to dictate eating anyway.
Myself, I don't have normal hunger response and impulse, for a couple reasons. If I ate "experientially" I would rarely eat at all... Which I did for a long time in my life and it really screwed things up. I know a lot of WLS patients that came to be the same way, and we all do better with scheduled eating and don't pay attention to hunger.
But even so, I always find it interesting when people seem to want to criticize WLS patients for choosing a physical limiter as part of their process. So what if a person needs firmer boundaries for a while? It doesn't make the choice and dedication to that program any less valuable or valid for that person. The mere fact that you wouldn't choose the path another person chooses doesn't negate the value for everyone, it just negates the value for you.
Besides, it's a little bit of a moot point to come to someone who already had the surgery and is asking for help/support and tell that person they shouldn't need surgery.
But you want to know one of the biggest reasons why I had surgery? Because I could not get medical coverage for a comprehensive medically-guided weight loss program that was not surgical. I couldn't do the hospital's VLCD medically monitored diet option, I couldn't talk to a dietitian or any weight loss specialists. SO I talked to my surgeon about it, and decided to do surgery for a number of reasons, none of which had to do with the inability to stop myself from eating.
I'm editing again to tweak a little but I'm conscious of how person my responses are... It's simply because I can only speak to me, my decisions, and my knowledge. Why someone else did what they did, I cannot say... I can only say that I've met more people that I believe should not have had the surgery than those that I thought were right to do so.14 -
I read through Quasita's post. Thank you for explaining it. In her case she did go on pre-op diets, and in 6 months only lost 22 lbs. And she weighed over 400 lbs. Considering what MFP says, that one can lose 1% of one's body weight. At 400 lbs. + she should have been losing 4 lbs. a week, (16 lbs. in a month). In 6 months, she should have lost somewhere between 70-90 lbs. at her weight. Definitely, I can understand why the surgery was necessary in her case. Even under an extreme doctor monitored diet she was losing extremely slowly. At that rate, it would have taken her 4-5 years to lose 200 lbs--IF she could even do it without the surgery. And that's a big IF. With the surgery she lost 150 lbs. in just 9 months.4
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Aaron_K123 wrote: »Not to be overly negative but the problems with weight loss surgeries such as gastric bypass is they use a method to lose weight that is not a method you can employ to maintain weight.
If you lose weight by teaching yourself how to eat a certain number of calories daily then over the years you are doing that you teach yourself routines and systems and management strategies for being able to eat an appropriate amount. It is those things that allow you to then transition smoothly into maintenance and keep at your goal weight. If instead you lose weight by stapling your stomach so you literally cannot eat more than a few bites then you aren't teaching yourself any habits or skills that you can carry over into maintenance. You will lose the weight but as your stomach stretches back and regrows you won't have put into place any strategies or routines whereby you will maintain your weight.
I guess my point is you need to count calories and learn how many calories you personally need to maintain your weight and then continue to count calories daily and stick around that number for as many months or years as it takes to build up the collection of habits necessary for you to no longer require counting. You will need to find what foods work for you that allow you to hit that calorie goal while remaining satisfied. That is as true of maintenance as it is of loss, its just people who lost weight by calorie counting have already taught themselves how to do that while those who lost by surgery haven't yet.
I think this comment basically assumes that all WLS patients refuse to learn through the classes and teaching that is a part of the process of having surgery. The fact that you state "stapling the stomach" to not be able to eat more than a few bites tells me that you know rather little about what the process entails.
If you are trying to go through insurance (in the US at least) it typically takes 6-12 months of pre-op training with a dietitian, a physiologist and a psychologist, along with routine bloodwork, weight loss goals and more, all structured around teaching new habits, a better relationship with food and how to determine whether a food will be good for you or not. Effectively, if you go about it the way you should, you are actually taught a very sustainable, routine/system/management style that can be maintained for LIFE. Typically, these programs also follow you for a year+ after surgery in order to make sure you maintain what you've learned and learn coping skills to address the issues that come up after the fact.
The problem is that there are many patients that don't take it seriously... Doing the bare minimum to get to surgery, or even worse, bypassing the pre-qualifying steps to go the elective route, getting a WLS procedure done through a service that doesn't provide any pre or post op services.
Surgical weight loss is supposed to provide restriction for the initial period to cause immediate weight loss but the stomach is supposed to expand over time. Eventually, it'll be able to tolerate a modest meal, and that's 100% what is supposed to happen. Will it ever expand to 40oz (the average stomach size) again? Probably not. However, no one ever said that you'd be restricted for life... and absolutely every step of the way for me, they stressed the importance of learning nutrition skills, setting exercise routines and figuring out the best way to do you.
Essentially, I equate it to taking an anti-depressant when you are having an acute depressive episode. They aren't intended to be taken for life for most people. What they are intended to do is treat symptoms immediately so that you can focus on learning coping skills and working with a therapist so that when you eventually take away the medications, you can rely on your skills to maintain. Some people take this very seriously and maintain without meds with success (for example, I am going almost 5 years strong now myself) but others assume that meds will just fix the problem, and are completely unprepared when normalcy comes back.
I have a book-thick binder of tips, guidelines, skill sheets, resources, I have a hotline I can call if I have concerns, I have a therapist I see weekly, I monitor my intake... I invested in this and taught myself a lot. I won't claim that I will never regain but I'm pretty confident in my choices and my skills. I eat mostly regular foods, I have desserts sometimes, I enjoy my LIFE.
I found the surgery process and my pure non-surgical weight loss to be pretty similar. Both required regular logging and attention to detail. Both require exercise, adequate sleep, good water intake and vitamins. Both require therapy and social support. The only real difference for me is that surgery broke a year long weight loss stall that I couldn't break on my own or with purely non-surgical methods assisted from medical personnel.
The way I see it is, surgery ultimately does exactly what we're all trying to do here, but just adds an undeniable physical limitation for most WLS patients (not all have stomach "stapling" done ya know). Just like a non-surgery patient, if you buy into a program to dictate all your steps for you without learning more about the details, you'll inevitably fail when you remove the program guidelines from the equation. However, if you take the time to learn the how, why and what of it all, you can successfully transition without much issue.
The average WLS patient might experience 25% regain, but that's the average. Some patients regain it all, some never regain a pound. We all typically gain weight as we age and our bodies and needs change anyway, so the vast majority of people on MFP will gain some of the weight they've lost here, regardless of how they did it. Talking about it like they are somehow completely different is not particularly accurate.
I also have a question, if you lost 150lbs pre-surgery, why did you then continue down the surgical route (I understand losing prior is a requirement) instead of continuing as you were?
I also thought the stretching of the stomach was a myth, happy to be proven wrong.5 -
VintageFeline wrote: »
I also have a question, if you lost 150lbs pre-surgery, why did you then continue down the surgical route (I understand losing prior is a requirement) instead of continuing as you were?
I also thought the stretching of the stomach was a myth, happy to be proven wrong.
I think I stated above in one of my comments but I can explain in further detail...
Started at 535lbs. I had to refeed from an undereating situation at that time, as I was starving myself again (recurring problem for me in life).
I finally figured out what worked for me, and started losing weight rapidly. This caused me hormonal problems, triggered PCOS, and ultimately made me sick and required my first surgery. I had lost about 60lbs at that point, and regained 30 with that surgery. 3 months downtime for recovery, return to habits, continue.
Year after that, I was only 75lbs down from start, had re-lost what I gained back, and I got sick again. REALLY sick this time. I had repeated hospital stays, went septic, nearly died. Another surgery, that removed an ovary and other things, 6 months recovery, regained 30 pounds again.
What ended up happening was that with regains, illness, losses, I managed to lose 120lbs or so over a very long 5 year period. The last 20lbs of which was making me sick again, and we were looking at another surgery possibility. Every significant chunk of weight I lose, I get ill.
So I had a sort of come to Jesus chat with my doctors, after we tried really hard for a year to break a stall that settled in after my oophectomy. I needed to lose more weight before I could consider repairing my spine and the numbers weren't moving... Tried Rx, different diet structures... So I finally asked to talk to a surgeon and said I wanted to do it to try and lose the rest as fast as possible so that if I get sick again, it would only be one more time.
I actually had problems during the pre-op weight loss, and I made it 2 months out of surgery before having to be evaluated. Just recently, things got bad again and I had minor surgery to mitigate symptoms so we can avoid further belly surgery before my weight is more stable.
Basically, long story short, I chose surgery because I was looking at another decade or more of cyclical illness because my body isn't handling the estrogen release from weight loss well at all and it's extremely triggering to my fibromyalgia. I'll be honest that I got impatient and was tired of looking at this long road of "Maybe someday I'll feel like I'm not dying" where I couldn't see the end. Believe me, I didn't get there easily. I actually used to be vehemently opposed myself... but sometimes we surprise ourselves when hope is on the line.
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lynn_glenmont wrote: »
Serious questions, because I've never understood how this is supposed to work:
Suppose a WLS patient is perfectly compliant, does everything right, and reaches a healthy weight, eating 800 to 1000 calories a day. What do they do then? Surely they don't continue eating such a small amount and drift down to an unhealthy underweight situation? Do they have to have another surgery to reverse whichever WLS they had, so they can eat enough to maintain a healthy weight? Or do they then have to start eating eight or 10 times a day so that they can consume enough calories in the small "meals" that their post-op condition allows? What if they decide to become more physically active now that they have lost weight -- is it even possible to eat often enough in those small amounts to sustain an active lifestyle and, say, training for a half-marathon and not go on losing weight?
Also, if the prospective WLS patient learns all these great techniques and loses weight pre-op (which in my understanding is required to get the surgery, or at least to get insurance to pay for the surgery, to demonstrate an ability to adhere to the post-op regime), why can't the patient just continue with those techniques and continue losing weight without surgery, with taking on the risk of surgery (and all surgery involves risk)?
1. A perfectly compliant WLS patient will not lose all of their weight on 800-1000 calories a day. A perfectly compliant WLS patient incrementally increases their intake to a normalized amount of food over time. I can only speak to a gastric bypass in detail, so we'll use that as an example... all my statements, as it were. Keep in mind that there are many different kinds of surgery, including a few that allow for no change to intake calorie amount.
Initially after surgery, a patient may have an intake of 0-300 calories per day, focusing on protein shakes and water only. As the first weeks go by, you add fluid ounces. At about a month out, you're looking at 3 shakes a day, which is hovering 400-600 calories per day, depending on your shake option. By 6 months, most people are in that 800-1000 range, but they don't stop there. Calorie intake increases as the volume increases for each meal. Initial meals are 1-2oz in size, by 6 months they are 4oz, and so on. No WLS patient following the protocol that seems to be pretty standard across the programs I'm familiar with would ever continue on an 800-1000 for longer than *maybe* the first year.
The FDA guidelines for post-op WLS patients is that a patient not maintain on a diet under 1100 calories, this being with heavy supplementation. The expectation is that with time, your stomach will naturally loosen, relax and expand to accommodate 8oz+ of volume at one time... which is still 1/5 of the normal stomach, but accommodating. Someone who gets a sleeve, for example, their post-op stomach is 6-8oz and they are immediately able to eat more and tend to stop losing weight earlier as their diet normalizes. To put it in perspective, your typical frozen dinner is 10oz. You have two of those plus some breakfast, you're already at 1100 calories easily, unless you're making a concerted effort to eat less than that.
Anyway, after only maybe 2 months, you are re-introducing normal foods stage by stage, and eventually will eat basically a smaller version of a well-rounded diet. Smaller particularly in comparison to pre-surgery diet, but not necessarily distinctly noticeable from the average diet. Plenty of normal people eat a routine 1600 calorie diet.
WLS is not intended to bring a patient to a healthy weight either. At most, with the most aggressive surgery available, you're talking about maybe an 80% excess weight reduction attributed to the surgery itself. All patients that reach a healthy weight did so out of perseverance and personal commitment to a healthy, balanced diet after their stomach and diet have normalized.
Just like non-surgical weight loss, the maintenance calories changes as the weight reduces... The intake number, however, is different. Non-surgical people routinely drop their intake to continue the loss pattern, whereas surgery people routinely and systematically increase their intake over time after surgery. As you get closer to goal, the difference between intake and maintenance numbers decreases, until they are one in the same. While it may be true that surgery lowers that maintenance number (this is not a founded statement, just a conjecture if anything, but it would make sense to me), it would not be down to anorexia nervosa levels (average AN patient eats 900 calories a day).
It's not as hard as you might think to add an extra protein shake or what have you on high exercise/activity days. Even at my stage, I'm able to accommodate if necessary.
However, it's rare to have a WLS reversal. Most of the surgeries cannot be reversed. My option of reversal is simply because I've had malnutrition issues in the past... so it came up as a concern. Most patients are able to go on and exercise, have babies, the whole deal of life without excessive concern of appropriate intake.
2. When it comes to a patient succeeding in the pre-op program, you have to remember that pre-op weight loss is very small for most. Most programs do require some weight loss... Some insurances put a number to that. However, most programs, at the least, require stable weight more than anything, and the majority of pre-op weight loss tends to happen in the pre-surgery prep diet, in the last 2-4 weeks before surgery, because you go from a balanced diet to full liquids (well, many of us do, this tends to depend on the program you're on).
If you were extremely successful before surgery with the training you get there, I think you'd actually be unlikely to get insurance approval for surgery, because it would be an indicator that all non-surgical avenues have not been exhausted and proven to fail. A patient that still insisted on surgery in this situation would possibly also fail their psychiatric evaluation because they would not be able to recognize important indicators of success and failure.
Standard requirement is that you have to have an established history of failed weight loss under monitored supervision... This is sometimes taken from the pre-op prep courses, yes, but failure would be weight loss that doesn't match the documented deficit. It does happen.
For example... I did pre-op diet for a long time rather than just 2 weeks. I did 2 protein shakes a day (breakfast and lunch) with a piece of cheese for a snack and a high protein dinner with veggies for 5.5 months. In that time frame, I lost about 10 lbs. I weighed 440lbs, and was regularly exercising as well. I switched to full liquids 2 weeks beforehand, and in those 2 weeks, I lost another 12 pounds. So, in the course of 6+ months of eating a major deficit, I lost only 22lbs, which was statistically, significantly less than what I should have lost. RNY changes how you metabolize sugars, carbohydrates and how you absorb some fats, along with the restriction, and that's what we attribute my weight loss change to, more than anything.
I hope this helps at least a little bit. I can't speak to why everyone chooses to do what they do... I can say that I've met a number of people that should never have been approved for surgery. I strongly believe that a person should go through counseling for more than just an evaluation pre-op... Have to really dig in to the why of their food habits. I spent 5 years overall preparing and considering surgery, but made the decision to do it a year and a half ago. I don't regret it at all.
Editing to add:
As with all surgeries, medications and procedures, utilizing the method is considered and determined to be in a state where the benefits outweigh the risks. You don't get to have WLS just because you asked for it, and you don't get to have it simply because you're overweight. Not all insurance companies are the same... Mine asked for a BMI of 35+ or 30+ with comorbidities... My BMI at the time was over 50 but I still got rejected initially because insurance said I wasn't sick enough... Even though there was no pre-op weight loss requirement or anything specific, that was all my surgery program. Insurance did eventually require me to prove that I quit smoking though.
Generally speaking, WLS is considered an option for the extremely obese or for those that have illnesses that warrant an aggressive approach to weight loss. Yeah, there are people with only 50lbs to lose that go have surgery (I know I said "only" but in comparison to some WLS patients, this is a tiny amount) but there are reasons for everyone. Sometimes the reason is that the weight loss simply cannot wait for standard approaches and Weight Watchers. For cases like mine, studies are demonstrating more and more that excessive obesity, at a certain point, practically requires medical intervention in some form.
Like me, even if I had never had WLS, I would still need medical help because I'll have to have my abdominal muscles tightened and a lot of skin removed. Overall though, I'm proud of both of my weight loss eras, and I feel the whole effort was worth it in the end.
Thank you for all the information, and I'm glad you've had so much success.1 -
Yeah I'll just say without experience or a lot of knowledge of all the options and why people would opt to do something like this it is probably better that I don't weigh in. I'll admit I don't understand how surgery is a fix to the underlying issues rather than the symptoms, but that is okay this isn't about me understanding it is about you seeking advice from people who might have suggestions that do understand your situation. Since that isn't me I probably shouldn't have said anything so if I made you uncomfortable at all my apologies.13
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Aaron_K123 wrote: »Yeah I'll just say without experience or a lot of knowledge of all the options and why people would opt to do something like this it is probably better that I don't weigh in. I'll admit I don't understand how surgery is a fix to the underlying issues rather than the symptoms, but that is okay this isn't about me understanding it is about you seeking advice from people who might have suggestions that do understand your situation. Since that isn't me I probably shouldn't have said anything so if I made you uncomfortable at all my apologies.
The OP hasn't been weighing in. I'm someone who is commenting alongside this post.
Perhaps the problem is that you're trying to understand the actual surgery as a solution for the underlying issues. It isn't intended to be. It's not marketed as such. Surgeons don't say it will be. It truly, literally is a way to address the "symptom" of obesity. It is the training and surrounding therapies that address the underlying issue. The physical imposition of surgical alteration is simply a means to restrict and to cause rapid weight reduction, something that is unsafe without medical guidance and is unlikely to occur without medical assistance through diet and exercise alone.
That is why they make you go through all the training and everything. It's basically a two-fold situation. They help with the immediate problem (the weight) through surgery and give you the limitation to help reinforce the tools that are being taught so that it can be enduring. It's literally no different than signing up to another program for guided weight loss. If you don't invest and take the time to learn, you end up starting again. The concept structure is the same as just about every weight reduction program out there, so I'm not sure why this is hard to conceptualize.
The problem is ultimately thinking that is has to be one or the other in regards to treating symptoms and treating underlying causes. It addresses both, if you do the protocol the way you're supposed to.
If you rely on just the physical change of surgery alone, you will fail. They state this pretty clearly in every piece of literature, and my surgeon said it straight to my face. The surgery does not fix the whole issue. It only impacts the body... It is up to you to push forward with treating the habits, with learning nutrition and seeking counseling for emotional barriers.
Could you do this without surgery? Of course. What makes you think we didn't try? Some of us spent years and years doing it the "traditional" way and saw such limited progress that becoming that coveted success story just wasn't part of our story. As I stated in a previous comment, you literally have to have historical documentation that traditional means of weight loss were ineffective or failed entirely. Surgery is never the first choice, it's the last.5 -
I haven't had WLS but I believe that it is just one tool, though a helpful one I am sure to lose weight. Your mind, if you have a binge eating disorder, will still be the same. If doesn't change your brain. How often are people eating when they are not hungry in general? JMHO0
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Aaron_K123 wrote: »Yeah I'll just say without experience or a lot of knowledge of all the options and why people would opt to do something like this it is probably better that I don't weigh in. I'll admit I don't understand how surgery is a fix to the underlying issues rather than the symptoms, but that is okay this isn't about me understanding it is about you seeking advice from people who might have suggestions that do understand your situation. Since that isn't me I probably shouldn't have said anything so if I made you uncomfortable at all my apologies.
The OP hasn't been weighing in. I'm someone who is commenting alongside this post.
Perhaps the problem is that you're trying to understand the actual surgery as a solution for the underlying issues. It isn't intended to be. It's not marketed as such. Surgeons don't say it will be. It truly, literally is a way to address the "symptom" of obesity. It is the training and surrounding therapies that address the underlying issue. The physical imposition of surgical alteration is simply a means to restrict and to cause rapid weight reduction, something that is unsafe without medical guidance and is unlikely to occur without medical assistance through diet and exercise alone.
That is why they make you go through all the training and everything. It's basically a two-fold situation. They help with the immediate problem (the weight) through surgery and give you the limitation to help reinforce the tools that are being taught so that it can be enduring. It's literally no different than signing up to another program for guided weight loss. If you don't invest and take the time to learn, you end up starting again. The concept structure is the same as just about every weight reduction program out there, so I'm not sure why this is hard to conceptualize.
The problem is ultimately thinking that is has to be one or the other in regards to treating symptoms and treating underlying causes. It addresses both, if you do the protocol the way you're supposed to.
If you rely on just the physical change of surgery alone, you will fail. They state this pretty clearly in every piece of literature, and my surgeon said it straight to my face. The surgery does not fix the whole issue. It only impacts the body... It is up to you to push forward with treating the habits, with learning nutrition and seeking counseling for emotional barriers.
Could you do this without surgery? Of course. What makes you think we didn't try? Some of us spent years and years doing it the "traditional" way and saw such limited progress that becoming that coveted success story just wasn't part of our story. As I stated in a previous comment, you literally have to have historical documentation that traditional means of weight loss were ineffective or failed entirely. Surgery is never the first choice, it's the last.
Okay so now I am confused again. Based on what you said here in what way do you actually disagree with what I said? I was saying that the weight loss surgery itself doesn't prepare you for maintenance and if you opted to have surgery you clearly struggled with eating in a way that allowed you to lose weight consistently. That eventually you would have to come to terms with the underlying issues surrounding your weight gain or you won't be able to maintain after surgery. Based on what you said here it seems to me like you agree with all of that.
I was just telling the OP that her focus should be on learning the tools necessary that are used for weight loss (calorie counting, meal prep, figuring out ones TDEE) since they are also used for controlled maintenance. I was adding that I assumed if she opted for surgery she hadn't quite gotten a handle on those yet because if she had the surgery would not have been necessary. So what about that do you disagree with?
As for the OP not weighing in I understand that I just chose to apologize to the OP if I at all offended them because your posts did rightfully point out I don't have experience or full understanding of all that goes along with weightloss surgery. The OP was the one asking for advice not you so I apologized to her.7 -
Aaron_K123 wrote: »Yeah I'll just say without experience or a lot of knowledge of all the options and why people would opt to do something like this it is probably better that I don't weigh in. I'll admit I don't understand how surgery is a fix to the underlying issues rather than the symptoms, but that is okay this isn't about me understanding it is about you seeking advice from people who might have suggestions that do understand your situation. Since that isn't me I probably shouldn't have said anything so if I made you uncomfortable at all my apologies.
I had gastric sleeve surgery. Before the thought of surgery even crossed my mind, I decided to seek therapy, because in my mind, it was not normal to be pushing 400 lbs. I knew I had to sort out my emotional issues before I could effectively sort out my weight issues. After a year of therapy, my doctor suggested surgery and I accepted for a couple of reasons. First, I was not only pushing 400 lbs, I was pushing 50, and I knew I wanted to spend the rest of my life in good health so I could enjoy it. Second, I felt surgery would get me out of danger and healthy faster than if I did it on my own. I was fully aware of the changes I would have to make with or without surgery, and I made that commitment. The surgery is just a tool for me, part of my checks and balances, but at this point, (I am just over 4 years post surgery), the work is the same as it would be for anyone else. I watch what I eat, monitor my calories and macros, and exercise regularly. I still have almost all the restriction I had since the beginning, and not being able to eat large quantities of food does help me some days, as does my intolerance for certain foods. Losing the weight rather quickly was extremely motivating for me, and now my motivation is my health, happiness, and awesome quality of life that surgery helped me achieve.
ETA - @Aaron_K123 I appreciate you acknowledging that you don't have a lot of knowledge on this subject. I've seen a lot of people on these boards with lots of opinions based on zero experience on the subject.6 -
What lovely, articulate responses. I had the bypass. Not mentioned very often is that the re-circuiting of the bowels results in permanent metabolic changes. Including how ghrelin is released in to my system. I had immediate remission of my diabetes symptoms for instance. Some of it was because of the weight loss, but some of it is because of the surgery. Why this happens is not fully understood.
Meals are about the same as all my diabetic training, only smaller. Three years out I can eat about 3/4 of what someone else would consider a decent portion. I do not drink at meals; it's one or the other. Eat a variety of foods at each meal. I do not handle soft breads well so I've switched to coarse breads like sourdoughs or rye. Some post bariatric patients never do tolerate bread.
How do you sabotage the surgery? Calorie dense foods eaten frequently.10 -
Aaron_K123 wrote: »Yeah I'll just say without experience or a lot of knowledge of all the options and why people would opt to do something like this it is probably better that I don't weigh in. I'll admit I don't understand how surgery is a fix to the underlying issues rather than the symptoms, but that is okay this isn't about me understanding it is about you seeking advice from people who might have suggestions that do understand your situation. Since that isn't me I probably shouldn't have said anything so if I made you uncomfortable at all my apologies.
I had gastric sleeve surgery. Before the thought of surgery even crossed my mind, I decided to seek therapy, because in my mind, it was not normal to be pushing 400 lbs. I knew I had to sort out my emotional issues before I could effectively sort out my weight issues. After a year of therapy, my doctor suggested surgery and I accepted for a couple of reasons. First, I was not only pushing 400 lbs, I was pushing 50, and I knew I wanted to spend the rest of my life in good health so I could enjoy it. Second, I felt surgery would get me out of danger and healthy faster than if I did it on my own. I was fully aware of the changes I would have to make with or without surgery, and I made that commitment. The surgery is just a tool for me, part of my checks and balances, but at this point, (I am just over 4 years post surgery), the work is the same as it would be for anyone else. I watch what I eat, monitor my calories and macros, and exercise regularly. I still have almost all the restriction I had since the beginning, and not being able to eat large quantities of food does help me some days, as does my intolerance for certain foods. Losing the weight rather quickly was extremely motivating for me, and now my motivation is my health, happiness, and awesome quality of life that surgery helped me achieve.
ETA - @Aaron_K123 I appreciate you acknowledging that you don't have a lot of knowledge on this subject. I've seen a lot of people on these boards with lots of opinions based on zero experience on the subject.
I realize I risk being unfair and disrespectful by saying the things I am saying. I do firmly believe that unless one learns the skills necessary to maintain ones weight that one will put the weight back on. That those skills are the exact same skills that allow one to lose weight through caloric restriction. That surgery is not a solution to the problem, it is a way of addressing the symptoms as fast as possible in order to avoid catastrophic health failure due to morbid obesity. I feel like although I don't know anything about the specifics of weight loss surgery I can still understand its general purpose and what it can and what it cannot do for you. It can make you lose weight rapidly, it cannot teach you the skills necessary to maintain your weight over time. I think that is a statement most if not all people would agree with.
I wasn't trying to insult anyone I just wanted to emphasize that surgery itself is not training for maintenance and that training for maintenance takes a lot of time and personal experience attempting to eat a set number of calories related to ones needs. I was suggesting that someone who lost weight through caloric restriction would have been training themselves on those methods all along while someone who lost weight via surgery would not have been doing so (they may have read lots about it or thought lots about it but they weren't actively doing it). I was trying to state that learning how to eat while having had gastric surgery does not teach you how to eat after you recover from the surgery in the same way that learning how to eat while being on appetite suppressants does not teach you how to eat when you come back off of the suppressants. That someone coming off of weight loss surgery is likely going to have to put in just as much effort as someone just starting a diet in terms of learning how to control their weight.
If that is not at all the experience of people who actually had the surgeries then I guess I have to admit having not had it myself nor done much research into the topic perhaps I am way off base. I respect that those who have underwent the surgery have a perspective I do not have and they would be better positioned to provide advice.10 -
@Aaron_K123 I wasn't trying to call you out, I just wanted to share my perspective and acknowledge that I do think you are being respectful about the situation and I appreciate that.4
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I wasn't trying to call you out, I just wanted to share my perspective and acknowledge that I do think you are being respectful about the situation and I appreciate that.
Understood and thank you, I was just trying to explain myself further but I think I'm probably just repeating myself. I am glad it came across that I was trying to be careful to be respectful and recognize I may not have all the information.
5 -
What lovely, articulate responses. I had the bypass. Not mentioned very often is that the re-circuiting of the bowels results in permanent metabolic changes. Including how ghrelin is released in to my system. I had immediate remission of my diabetes symptoms for instance. Some of it was because of the weight loss, but some of it is because of the surgery. Why this happens is not fully understood.
Meals are about the same as all my diabetic training, only smaller. Three years out I can eat about 3/4 of what someone else would consider a decent portion. I do not drink at meals; it's one or the other. Eat a variety of foods at each meal. I do not handle soft breads well so I've switched to coarse breads like sourdoughs or rye. Some post bariatric patients never do tolerate bread.
How do you sabotage the surgery? Calorie dense foods eaten frequently.
I really feel like you're the "go-to" for wls on this site. It sucks seeing people go through such drastic measures and not be successful. You're a great example of using the tool properly. The best hammer won't get up and build a deck by itself. It takes someone with the right skills, education, quality materials, and a commitment to getting the job done.
I hope the OP understands that they can always brush up on their skills, pick that hammer back up and get the job done.10 -
Aaron_K123 wrote: »
Okay so now I am confused again. Based on what you said here in what way do you actually disagree with what I said? I was saying that the weight loss surgery itself doesn't prepare you for maintenance and if you opted to have surgery you clearly struggled with eating in a way that allowed you to lose weight consistently. That eventually you would have to come to terms with the underlying issues surrounding your weight gain or you won't be able to maintain after surgery. Based on what you said here it seems to me like you agree with all of that.
I was just telling the OP that her focus should be on learning the tools necessary that are used for weight loss (calorie counting, meal prep, figuring out ones TDEE) since they are also used for controlled maintenance. I was adding that I assumed if she opted for surgery she hadn't quite gotten a handle on those yet because if she had the surgery would not have been necessary. So what about that do you disagree with?
As for the OP not weighing in I understand that I just chose to apologize to the OP if I at all offended them because your posts did rightfully point out I don't have experience or full understanding of all that goes along with weightloss surgery. The OP was the one asking for advice not you so I apologized to her.
I disagree with the continued, underlying assumption that a person would opt for surgery because they have not gotten a handle on the tools necessary for weight loss and controlled maintenance. It's really incredibly assumptive and closed-minded, and for someone that has repeatedly stated he knows nothing about the process, it also comes off as insulting. A decent % of surgery recipients have proven successful adherence and small success in traditional CICO and that's precisely why they are considered optimal candidates for surgical intervention. You talk about it like a person just walks in and says "I'm fat, please fix me cuz I can't do it myself." when the reality of the situation is, patients walk in saying "I know I need professional help that is beyond my capacity to manage on my own, please help me be a healthier person." That management is NOT about eating habits exclusively, though for some it might be. In fact, if you struggle with compulsive eating disorder, have had uncontrollable binges, stuff like that? You don't get to do surgery.
A person cannot be successful with surgery without willpower, perseverance and dedication. PERIOD.
No, a patient didn't "clearly struggle with eating in a way that allowed you to lose weight consistently." There are many established medical reasons why surgery becomes a part of the equation, and not all surgical candidates are incapable of monitoring their food intake. Many candidates are doing it because all traditional methods are failing and thus, employing the changes to digestion (which again, nothing to do with eating style and you cannot do this without surgery) is what propels the weight loss more than anything. It's not a "clear" indication of struggling to adhere to a plan. It's a clear indication that more aggressive tactics are needed than plugging into a calculator and counting estimated calories.
I've repeatedly stated that there is more to it than restriction from a physical standpoint, and frankly, I'm not going to continue repeating myself.
Your initial message to OP was that your problem with it is that WLS does not provide a method that is sustainable for a lifetime of success. That's the very first thing you said in this thread. THAT, I have a problem with. I've yet to meet a recipient, other than those that travel to Mexico for elective procedures, that did not go through a rigorous and thorough education program and at least 2 years of medical monitoring. It's a serious, lifelong, life-altering procedure and I'm tired of people acting like it's for the lazy and those that can't control themselves... because the reality is? If you are considered lazy and unable to control yourself, you'll be disqualified as a candidate for surgery.
Now, please, go educate yourself on the subject. Thanks14
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