not looking for trouble but....

mjj79

So, I know the whole deal about eating too few cals, but my question is.... why does it work for people who have had bariatric surgery? They eat just several hundred a day and still lose? Why doesn't there metabolism stop working? (BTW< not trying to stir up trouble, really wondering.)

thanks

rml_16

People's understanding about eating less and metabolism is severely limited. If what a lot of people believe, anorexics would be fat.

The metabolism doesn't stop. It just slows down because if you're eating less, it doesn't need to work as hard. The problem comes after you've been eating less for a long time and then start eating more once you reach goal, so you gain more easily. You'll notice a lot of WL surgery patients end up regaining a good deal of what they lose. I have not yet met someone who had that surgery and is thin. They may not be as heavy as they once were, but they are still far from in shape. I've watched friends have the surgery, drop a bunch of weight and look great for about a year and then regain a good deal of the lost weight.

Also, everyone's different and will respond differently. When I did Weight Watchers, I lost more weight if I ate ALL of my points than if I left some over during the week, while other people would gain weight if they ate all their points. We're all slaves to thermodynamics, but our metabolisms respond differently. Some studies say this is due to the amount of brown fat one has.

LorinaLynn

I have a friend who had WLS and runs a facebook group on weight loss foods, and asked them.

First, they're super-duper meticulous about their nutrition. When you're eating very low calorie, every calorie has to count.

Also, the extreme calorie restriction is only for a few months, and some of that is because they're on a liquid diet immediately after while the surgery site heals. Now, over a year past surgery, my friend eats about 1200-1500 calories to maintain her weight. She's 5' tall and currently weighs about 115 lbs. If she had been able to lose weight through traditional means, her maintenance calories would likely be a lot higher, so her metabolism is lower. Most of the members of her group who are more than 3 months post op are eating 800-1000 calories. Remember, these are people with a lot of excess body fat to support a larger deficit, and under medical supervision.

WLS is (or should be) a last resort for people who's health is threatened by their excess weight. Many do have health problems as a result of their surgery and reduced food intake. My friend had to have her gall bladder removed, which seems to be really common. Another friend, who wasn't so meticulous about her diet, nutrition and exercise has a weakened immune system and has had pneumonia pretty much all summer. I know someone else who died from complications, but not the details.

poedunk65

The people i know that have had the surgery have had to do an exercise regimine also. Nothing is a magic cure, it is still a lifestyle change anyway you look at it.

TavistockToad

Peopl who have surgery generally have hundreds of pounds to lose...

If you have less than 30ish lbs you shouldn't have such an aggressive deficit.

yarwell

Peopl who have surgery generally have hundreds of pounds to lose...

What happens when they're slimmed down I wonder ? the fat's gone but the surgical modification remains.

HolyPeas

nurse here, because "starvation mode" only exists in long term extremes

UsedToBeHusky

The body is designed to carry a certain amount of body fat. If you are extremely obese, then you have excess that your body has been storing for potential periods of starvation (the body does not know how readily available food is). Once you have depleted excess stores, the body begins to presume that food is not readily available and triggers certain reactions to prevent against starvation. The brain will produce the hormones grehlin (causes the sensation of hunger) and cortisol (causes the body to use fuel more efficiently and avoid burning fat).

There are two reasons why bariatric patients use VLCD (very low calorie deficit):

1. Patients don't qualify for bariatric surgery unless they carry a significant amount of body fat.
2. The surgery is generally designed to reduce the capacity the stomach can hold, therefore, the stomach cannot hold that much food.

I'm just guessing on this, but I think the body will begin to produce grehlin and cortisol once you reach between 35% to 30% body fat. Then, adjustments to your diet are required to combat the production of these two hormones. I'm still learning about them myself, but I know for certain that there are at least three dietary concerns that help with this problem.

1. Eating enough calories - it is recommended to eat 300 calories below TDEE (total daily energy expenditure)
2. Make certain that your body gets unsaturated fats - Omega 3's and Omega 6's are found in fish, olive oil, nuts and there are some other sources.
3. Reduce caffeine intake - I only just recently learned about this one and I'm sad, but I'm going to give up my diet sodas soon.


Hope this helps.

MSeel1984

So, I know the whole deal about eating too few cals, but my question is.... why does it work for people who have had bariatric surgery? They eat just several hundred a day and still lose? Why doesn't there metabolism stop working? (BTW< not trying to stir up trouble, really wondering.)

thanks

In bariatric surgery, it's a combination of eating less-true, but it's also involving less absorption of calories.

Also, in obesity, fat comes off more quickly than in an average sized person. Your body usually has a preferred weight/normal weight when weight loss beyond that becomes difficult.

Does that make sense? it depends on what has been changed in bariatric surgery as well. To go from eating (I've seen in some people) upwards of 4,000 calories/day to eating less than 2,000 can be a HUGE difference and weight comes off quickly.

marcia724

nurse here, because "starvation mode" only exists in long term extremes

exactly. the whole "starvation mode" thing for regular dieters is a myth.

Iceman1800

So, I know the whole deal about eating too few cals, but my question is.... why does it work for people who have had bariatric surgery? They eat just several hundred a day and still lose? Why doesn't there metabolism stop working? (BTW< not trying to stir up trouble, really wondering.)

thanks

it works for bariatric patients because the food doesn't stay in them long enough to be absorbed. It's a plus in terms of calories but it also means he/she isn't getting the nutrients from the food either.

HogSandwich

chiming in to say that BS is only ever intended for people so big that exercise to lose weight is no longer an option. My dad's a Gastroenterologist, and he won't even consider the surgery for someone until they're over 200kg (about 380-400lbs) or have an additional complication that needs addressing fast.

He kind of hates it as a treatment. Apparently it's very hard for post BS patients to keep with their sudden weight loss, and the stomach (banded or otherwise) will begin to stretch again and will allow more food. Many wind up back where they started.

UsedToBeHusky

chiming in to say that BS is only ever intended for people so big that exercise to lose weight is no longer an option. My dad's a Gastroenterologist, and he won't even consider the surgery for someone until they're over 200kg (about 380-400lbs) or have an additional complication that needs addressing fast.

He kind of hates it as a treatment. Apparently it's very hard for post BS patients to keep with their sudden weight loss, and the stomach (banded or otherwise) will begin to stretch again and will allow more food. Many wind up back where they started.

This is true, mainly, because they patients really don't learn healthy eating habits with this surgery. Nobody can maintain a VLCD forever. Eventually, it affects the way you feel and your doesn't perform like it used to.

mjj79

Wow. Thanks for all the info (and for not slammming me for asking .

Yanicka1

nurse here, because "starvation mode" only exists in long term extremes

exactly. the whole "starvation mode" thing for regular dieters is a myth.

I like the term conservation mode better.

You become less fidgety, sleep more, exercise at less intensity. Everything your body can do to function with less calories.

auroranflash

nurse here, because "starvation mode" only exists in long term extremes

exactly. the whole "starvation mode" thing for regular dieters is a myth.

I like the term conservation mode better.

You become less fidgety, sleep more, exercise at less intensity. Everything your body can do to function with less calories.

Beastie Boys "Sabotage" just came on in my head when I read this.

FireBrand80

Peopl who have surgery generally have hundreds of pounds to lose...

What happens when they're slimmed down I wonder ? the fat's gone but the surgical modification remains.

I know a woman who's upper body was thin and her lower body remained the same size. Weird.

Wenchilada

nurse here, because "starvation mode" only exists in long term extremes

exactly. the whole "starvation mode" thing for regular dieters is a myth.

I like the term conservation mode better.

You become less fidgety, sleep more, exercise at less intensity. Everything your body can do to function with less calories.

Beastie Boys "Sabotage" just came on in my head when I read this.

THANK YOU for getting that song stuck in my head for the rest of the day. \m/

My mom had a crazy marathon of surgeries done all at once, 10 years ago when she was 52. It wasn't classified as bariatric surgery because it was done as emergency surgery to repair her completely wrecked digestive system, but it had the same effect. She had a severe hiatal hernia which she'd had for probably 30 years, through which her stomach had managed to nearly close off her wind pipe for several hours a day or two before the surgery. It also turned out that her esophageal lining was precancerous, likely due to decades of GERD. So, over the course of a few hours, they removed 90% of her stomach, repaired her diaphragm, took out 1/3 of her esophageal lining, took out her appendix for good measure (but they denied her request for a hysterectomy "as long as they were in there anyway"), and then reconnected the plumbing and sewed everything back up. I think they may have removed some of (or otherwise re-routed) her intestines somehow, too, but I can't remember now. She lost approximately 170 pounds in a year or two (she was 5'2", ~290 lbs before). She could not eat more than maybe a half-cup of food at a sitting, and threw up from eating quite often. It was not good, and she's the first to admit it was a terrible way to lose weight, but she has kept it off and has on occasion had difficulty keeping enough weight on. She's been pretty healthy ever since, all in all - and on the outside, she looks great. But it's a hell of a way to lose weight, and I really don't want to have to be faced with that imperative myself.

She still has trouble digesting certain foods, primarily beef, and if she overdoes it at a meal (i.e. more than 5-6 bites) or eats more than just a bite or two of steak, she will usually end up throwing up or wishing she could. I would guess that she eats maybe 1100 calories on an average day and has hung around 105-135 lbs ever since the initial weight loss, but her digestive process is really screwy now. It's kind of frustrating to dine out with her. Her eyes are way bigger than her stomach, so she'll order a bunch of stuff à la carte, eat a bite or two of each thing, then try to get us to eat the rest of it or take it home with us. She ended up selling and demonstrating VitaMix blenders at road shows (Sam's Club & Costco) for 3 years and was their top seller, and it worked out well for her both career-wise and with regard to her own nutrition.

Anyway, long story short, anything that is done surgically to your digestive system is potentially going to have a major effect on what and how you are able to eat. The calorie goals/restrictions can end up being very specific to the person due to surgical techniques, initial intention of the surgery, side effects/complications, and whether or not the procedure is reversible or otherwise able to be circumvented.