Need advice as to why I’m not losing
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Replies
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I am not 100% sure but swelling indicates water retention try lowering your salt intake and drink more water and remember weight loss is not a quick fix it’s a lifestyle1
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covevendor wrote: »The weight loss procedure was done years ago and the removal of likely an adjustable gastric band is a very minor procedure and would not need increased protein to allow for healing from the surgery as some people have stated. I agree that half of 1350 kcal per day would be way too little, but our experience is that most people are very bad about estimating calories without help or very carefully logging things. It is not uncommon in the first week or two to be consume little and this calorie estimate may be right. Agree with the comments above regarding "starvation mode"...what you are referring to are changes in the non-exercise activity thermogenesis (NEAT) which is not likely to be a factor here (a long technical side discussion if people are interested).
Some suggestions:
1. Continue to follow a diet. The one you mention sounds reasonable. Multiple studies have shown that following a diet is useful especially in the long term. It does not seem to matter so much which diet you do since trials comparing different diets have usually found weight loss to be similar but better than people who were just counseled regarding weight loss but not given a specific plan.
2. It is important to set realistic goals and think of this as a long term process. I find it really frustrating that I can only lose 1.5 to 2 pounds per week but I have to remind myself that the weight came on slowly and your body will only allow you to remove it safely at limited rate. Trying to push weight loss beyond about 2 pounds per week is just not sustainable in my experience, and we worry about the long-term health effects.
3. Consider cutting out highly processed foods (sodas [including diet], fast food, chips, etc). This was a study out of Stanford University last year where people did that and either followed a low carb or low fat diet, and they achieved good weight loss without counting calories (I think it was on the order of 12 pounds over the study).
4. I personally think it is best to weigh yourself frequently - every day or at least once per week and put the result in one of may programs online that will show you a trend line (or you can do it in Excel). There is considerable daily variation in weight based on fluid retention alone and this is especially true in your case where you have some leg swelling. This can result in several pounds of weight swing up or down and can be very discouraging if you are retaining more fluid than usual or lead to unrealistic expectations of weight loss achieved if you are on the lower end. I find it useful to keep a careful track of calories consumed and activity (easy with a Fitbit or Apple Watch). Taking this along with my basal metabolic rate (estimated through a number online calculators) I graph out in Excel what my weight actually is predicted to be. What I have noticed is and my weight will swing up and down around the true weight. This difference can be several pounds. It is quite common for people to it have a very dramatic weight loss in the first week or 2 and unfortunately this is primarily due to changes in fluid retention (due to a number factors including the decrease in glycogen in muscle which is only temporary). However, real weight loss is occurring so hang in there.
5. Keep a log of what you eat. I find keeping a log of what I eat easy to do with phone apps or online programs, and I think it is helpful. For me it helps me make better food choices.
6. Medically supervised weight loss is not all the same. In this case it sounds like your physician has given you a diet, but he or a dietician is not meeting with you frequently, tracking your progress carefully, and adjusting your diet as can be done. I think this later approach is more effective, but insurance does not pay for this usually and few people can afford it out of pocket.
7. The procedure I suspect you had is years ago was a laparoscopic adjustable band or less likely a vertical banded gastroplasty or other similar procedure. These just reduce the stomach size, and weight loss has been very disappointing from such procedures especially long term. There are multiple reasons for this, but the biggest is that they do not impact the hormones that signal hunger and feeling full. If your obesity is bad enough (class II or III) then a Roux-en-Y gastric bypass (the most common procedure) may be something to think about especially if you have health problems related to obesity. This surgery makes a smaller stomach that is connected to the esophagus (swallowing tube) and intestines. It also rearranges the intestines so you can absorb less of the calories from the food you eat. The gastric pouch can stretch out over time (as it likely did with your gastric band), but with a Roux-en-Y the intestinal bypass is still there (the "malabsorptive component") that will help lose weight.
8. There are a number of medications that can assist in weight loss such as Contrave or topiramate. Talk with your doctor about these if you have not lost weight after a couple more months. They are not miracle drugs, but they will help cut your appetite.
9. Your edema is a bit concerning. I'm assuming that you have been checked for obstructive sleep apnea or are already on treatment with CPAP.
OP was bed ridden from complications for a month and had a poor diet prior to the removal. It is not uncommon for the edema she is describing to be related to low protein/low albumin. Additionally, many post-op complications are a result of poor protein intake needed for proper healing. Of course, her doctor is the most appropriate person for her to be discussing this with.12 -
covevendor wrote: »The weight loss procedure was done years ago and the removal of likely an adjustable gastric band is a very minor procedure and would not need increased protein to allow for healing from the surgery as some people have stated. I agree that half of 1350 kcal per day would be way too little, but our experience is that most people are very bad about estimating calories without help or very carefully logging things. It is not uncommon in the first week or two to be consume little and this calorie estimate may be right. Agree with the comments above regarding "starvation mode"...what you are referring to are changes in the non-exercise activity thermogenesis (NEAT) which is not likely to be a factor here (a long technical side discussion if people are interested).
Some suggestions:
1. Continue to follow a diet. The one you mention sounds reasonable. Multiple studies have shown that following a diet is useful especially in the long term. It does not seem to matter so much which diet you do since trials comparing different diets have usually found weight loss to be similar but better than people who were just counseled regarding weight loss but not given a specific plan.
2. It is important to set realistic goals and think of this as a long term process. I find it really frustrating that I can only lose 1.5 to 2 pounds per week but I have to remind myself that the weight came on slowly and your body will only allow you to remove it safely at limited rate. Trying to push weight loss beyond about 2 pounds per week is just not sustainable in my experience, and we worry about the long-term health effects.
3. Consider cutting out highly processed foods (sodas [including diet], fast food, chips, etc). This was a study out of Stanford University last year where people did that and either followed a low carb or low fat diet, and they achieved good weight loss without counting calories (I think it was on the order of 12 pounds over the study).
4. I personally think it is best to weigh yourself frequently - every day or at least once per week and put the result in one of may programs online that will show you a trend line (or you can do it in Excel). There is considerable daily variation in weight based on fluid retention alone and this is especially true in your case where you have some leg swelling. This can result in several pounds of weight swing up or down and can be very discouraging if you are retaining more fluid than usual or lead to unrealistic expectations of weight loss achieved if you are on the lower end. I find it useful to keep a careful track of calories consumed and activity (easy with a Fitbit or Apple Watch). Taking this along with my basal metabolic rate (estimated through a number online calculators) I graph out in Excel what my weight actually is predicted to be. What I have noticed is and my weight will swing up and down around the true weight. This difference can be several pounds. It is quite common for people to it have a very dramatic weight loss in the first week or 2 and unfortunately this is primarily due to changes in fluid retention (due to a number factors including the decrease in glycogen in muscle which is only temporary). However, real weight loss is occurring so hang in there.
5. Keep a log of what you eat. I find keeping a log of what I eat easy to do with phone apps or online programs, and I think it is helpful. For me it helps me make better food choices.
6. Medically supervised weight loss is not all the same. In this case it sounds like your physician has given you a diet, but he or a dietician is not meeting with you frequently, tracking your progress carefully, and adjusting your diet as can be done. I think this later approach is more effective, but insurance does not pay for this usually and few people can afford it out of pocket.
7. The procedure I suspect you had is years ago was a laparoscopic adjustable band or less likely a vertical banded gastroplasty or other similar procedure. These just reduce the stomach size, and weight loss has been very disappointing from such procedures especially long term. There are multiple reasons for this, but the biggest is that they do not impact the hormones that signal hunger and feeling full. If your obesity is bad enough (class II or III) then a Roux-en-Y gastric bypass (the most common procedure) may be something to think about especially if you have health problems related to obesity. This surgery makes a smaller stomach that is connected to the esophagus (swallowing tube) and intestines. It also rearranges the intestines so you can absorb less of the calories from the food you eat. The gastric pouch can stretch out over time (as it likely did with your gastric band), but with a Roux-en-Y the intestinal bypass is still there (the "malabsorptive component") that will help lose weight.
8. There are a number of medications that can assist in weight loss such as Contrave or topiramate. Talk with your doctor about these if you have not lost weight after a couple more months. They are not miracle drugs, but they will help cut your appetite.
9. Your edema is a bit concerning. I'm assuming that you have been checked for obstructive sleep apnea or are already on treatment with CPAP.
Did you actually read the OP?? It's clearly stated that this person is under eating by quite a bit. They don't need medication to curb their appetite.
This is the second time I've seen you suggest completely unwarranted weight loss medication.13 -
Well thanks for all the disagrees folks. Not sure on what aspect. Very motivating to spend time trying to help people and get the negative feedback (0 likes and 7 disagrees), but whatever. With my schedule think this will the last post I do since I really don't have time for all the flames and was just trying to help.
A few comments on your reply:
1. Not sure what your topiramate dose is. Find for some that increasing it further to twice per day or 2 in the morning and 1 in the evening helps.
2. Phentermine should be cycled on and off. Typically 3 months on and 3 months off since it loses effectiveness after a couple of months.
3. The diet choices you made after your lap band are unfortunately quite common with that procedure. Due to the narrowing of the stomach from the band is common for people to make those choices since they are the only things that stay down. This (and the lack of weight loss) are why the band has fallen out of favor. With the gastric balloons that are used now we find that pretty intense counseling before and after the procedure is very important to help people find a diet they can tolerate.
4. I would consider switching to an alternative sandwich to the Whopper or at least getting it without cheese, mayo, and ketchup.5 -
"OP was bed ridden from complications for a month and had a poor diet prior to the removal. It is not uncommon for the edema she is describing to be related to low protein/low albumin. Additionally, many post-op complications are a result of poor protein intake needed for proper healing. Of course, her doctor is the most appropriate person for her to be discussing this with.[/quote]"
I really doubt from her description that she has hypoalbuminemia. In addition, I have not noticed waxing and waning edema to be commonly due to low protein since it more typically causes persistent swelling. This is a minor laparoscopic procedure to remove it and it would be uncommon to be bed ridden from complications from the removal.1 -
"Did you actually read the OP?? It's clearly stated that this person is under eating by quite a bit. They don't need medication to curb their appetite.
This is the second time I've seen you suggest completely unwarranted weight loss medication."
Thanks. Yes I read their post. Did you look at my reply? Did you read what the poster said? I think not. We actually do not know how much she is consuming based on her not keeping a careful log. I doubt that we are truly at 1/2 that goal, and I think it would be useful to keep a careful log. I mentioned medication (which it turns out she is on...read her post) since it is an option depending on her degree of obesity. I have made 2 posts by the way so thanks for reading them. I think in both cases medication to assist in weight loss is an option especially if we are going to the point of surgical intervention, but as I mentioned it should be discussed with her physician.4 -
covevendor wrote: »I really doubt from her description that she has hypoalbuminemia. In addition, I have not noticed waxing and waning edema to be commonly due to low protein since it more typically causes persistent swelling. This is a minor laparoscopic procedure to remove it and it would be uncommon to be bed ridden from complications from the removal.
My ability to predict OPs lab values seem to be a bit less sophisticated than yours. It seems to me that you are against protein and for medications. While I don't really care about your disagreement on protein, I find your recommendations on not only medications but actual dosing to be reckless and inappropriate. You don't know this person other than what she's posted here. I'm sorry you find it difficult that people might disagree with you. While some of your advice was helpful, I think some of it was reckless and some was dismissive.14 -
covevendor wrote: »Well thanks for all the disagrees folks. Not sure on what aspect. Very motivating to spend time trying to help people and get the negative feedback (0 likes and 7 disagrees), but whatever. With my schedule think this will the last post I do since I really don't have time for all the flames and was just trying to help.
A few comments on your reply:
1. Not sure what your topiramate dose is. Find for some that increasing it further to twice per day or 2 in the morning and 1 in the evening helps.
2. Phentermine should be cycled on and off. Typically 3 months on and 3 months off since it loses effectiveness after a couple of months.
3. The diet choices you made after your lap band are unfortunately quite common with that procedure. Due to the narrowing of the stomach from the band is common for people to make those choices since they are the only things that stay down. This (and the lack of weight loss) are why the band has fallen out of favor. With the gastric balloons that are used now we find that pretty intense counseling before and after the procedure is very important to help people find a diet they can tolerate.
4. I would consider switching to an alternative sandwich to the Whopper or at least getting it without cheese, mayo, and ketchup.
Are you a medical professional? Or did you stay at a Holiday Inn?
See, this is the issue. Someone who appears to be telling people what to do as in this previous post of yours is only appropriate if you state the credentials you hold in order to be making them in the first place, which is something I haven't seen in your previous posts. And if you *are* a medical professional, surely you can see the inappropriateness of giving such specific advice to a 'patient' over the internet with whom you have no professional affiliation?
That is likely why you're getting the pushback, here.
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Wow, didn’t realize I’d cause such a commotion. I kind of resent being told I’m not keeping an accurate food log, because I am. I do all the cooking in my house and I log the recipes in this app so my nutrition is accurate. And I have not eaten fast food, ice cream, chips, dip, or nachos since my lapband came out. Thank you to the respondent who also had their band out and wanted broccoli first thing! I wanted grilled chicken. When I got my band I was 221 lbs and when I got it out I was 271 lbs. When I had my one month post op check up, I had not lost nor gained weight since removal. My doctor was very encouraged. This was before I was put on medication or my special diet. I was just generally eating healthier and keeping my portions small. He said most patients a month after removal have gained ten to fifteen pounds already. I felt pretty good about that. So now I just want to lose the weight and get on with my life again.5
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I'm sure your nutrition is fine and dandy. The question was "are you using a digital food scale?"6
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Wow, didn’t realize I’d cause such a commotion. I kind of resent being told I’m not keeping an accurate food log, because I am. I do all the cooking in my house and I log the recipes in this app so my nutrition is accurate. And I have not eaten fast food, ice cream, chips, dip, or nachos since my lapband came out. Thank you to the respondent who also had their band out and wanted broccoli first thing! I wanted grilled chicken. When I got my band I was 221 lbs and when I got it out I was 271 lbs. When I had my one month post op check up, I had not lost nor gained weight since removal. My doctor was very encouraged. This was before I was put on medication or my special diet. I was just generally eating healthier and keeping my portions small. He said most patients a month after removal have gained ten to fifteen pounds already. I felt pretty good about that. So now I just want to lose the weight and get on with my life again.snowflake954 wrote: »I'm sure your nutrition is fine and dandy. The question was "are you using a digital food scale?"
This^^^. @Rowdib - you won't truly know how many calories you're consuming unless you use a food scale. If you don't already have one, it's the best $20 you'll ever spend on yourself!
You can get a somewhat accurate idea by using the information off of nutrition labels as to what a serving size is. Problem is - especially with packaged foods - the contents will often weigh more than what it says on the label. That's because manufacturers tend to give consumers a bit more than what's on the label, because giving them less gets them into all kinds of trouble re false advertising (aka ripping off the consumer, not giving them what they paid for, etc.). So, if a label states that the contents weigh 100 gr, for example, the package will contain *at least* a 100 gr. But many times, it weighs more. Multiply that by the number of different foods eaten in a day and you could unknowingly be eating hundreds of extra calories per day, all the while thinking your intake is accurate. As well, using measuring cups and spoons are very inaccurate. The only true way to know how much you're really eating is to weigh it out.
And the commotion wasn't your doing. It's just that a lot of us who have successfully lost the weight we needed to, (and kept it off) and have stuck around to try and help newbies avoid making some of the mistakes we did. We also took plenty of wrong turns along the way to get there. Did some pretty stupid things, too, (I'm looking at you, Apple Cider Vinegar!) in the hopes that it would be the magic bullet we were looking for. Tl;dr? There *are* no magic bullets.
My personal red flag gets raised when someone attempts to gives medical advice - couched in a way that gives that poster false authority - because, aside from all of the useless miracle and magic diet shortcuts that get posted here daily, those are the most potentially dangerous.
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Wow, didn’t realize I’d cause such a commotion. I kind of resent being told I’m not keeping an accurate food log, because I am. I do all the cooking in my house and I log the recipes in this app so my nutrition is accurate. And I have not eaten fast food, ice cream, chips, dip, or nachos since my lapband came out. Thank you to the respondent who also had their band out and wanted broccoli first thing! I wanted grilled chicken. When I got my band I was 221 lbs and when I got it out I was 271 lbs. When I had my one month post op check up, I had not lost nor gained weight since removal. My doctor was very encouraged. This was before I was put on medication or my special diet. I was just generally eating healthier and keeping my portions small. He said most patients a month after removal have gained ten to fifteen pounds already. I felt pretty good about that. So now I just want to lose the weight and get on with my life again.
There's nothing to resent here. Logging isn't something we're born knowing how to do. Most of us give advice on logging errors because we've made them ourselves and then figured out how to log better.
Cooking your own food doesn't guarantee that your calorie estimates are accurate. Creating your own recipes doesn't guarantee that your calorie estimates are accurate. Not eating nachos doesn't guarantee that your calorie estimates are accurate.7 -
Wow. I’m an educated woman, and in my way of thinking, if I’m cooking my own food at home, at least I know what is going into it and how it is cooked. And so from what I’m gathering here, if I open a can of black beans to use in a recipe, the nutritional information in the side of the can is not to be trusted?? That just doesn’t seem right to me. And if you can’t trust the nutritional information on the packages, then where do you get it? The nutrition fairy?? If I go to a restaurant I have no reassurance of exactly what is in my food, how much exactly is there, or how it was cooked. Or am I supposed to trust their handy nutritional guides? Come on. And btw, by not eating nachos, I know damn well I haven’t consumed a days worth of empty calories in one setting. And that my friend, is all the accuracy I need when it comes to nachos. I think these boards could use a little more positivity and a little less criticism. I know I asked for advice, but good grief, I never thought people would be this negative. It’s hard enough to do what we’re doing, a little encouragement goes a long way.1
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The nutritional information is accurate for the weight of product stated, how much the product actually weighs is what is often inaccurate. Your 200g (or whatever) can of black beans may actually contain 220g of black beans, for example. Now, on its own, that may not be a huge difference (actually around 20 cals), but all those little bits add up.
People aren't being negative, they're taking time out of their day to try to help you.15 -
Make sure you get enough sleep and avoid overthinking and stressing on your weight. It fluctuates on daily basis. If you want to reduce the swelling of your leg, try to eat food that has diuretic property like parsley and cucumber. Eating broccoli also helps since it removes excessive estrogen in your body which is link to fluid retention.2
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Wow. I’m an educated woman, and in my way of thinking, if I’m cooking my own food at home, at least I know what is going into it and how it is cooked. And so from what I’m gathering here, if I open a can of black beans to use in a recipe, the nutritional information in the side of the can is not to be trusted?? That just doesn’t seem right to me. And if you can’t trust the nutritional information on the packages, then where do you get it? The nutrition fairy?? If I go to a restaurant I have no reassurance of exactly what is in my food, how much exactly is there, or how it was cooked. Or am I supposed to trust their handy nutritional guides? Come on. And btw, by not eating nachos, I know damn well I haven’t consumed a days worth of empty calories in one setting. And that my friend, is all the accuracy I need when it comes to nachos. I think these boards could use a little more positivity and a little less criticism. I know I asked for advice, but good grief, I never thought people would be this negative. It’s hard enough to do what we’re doing, a little encouragement goes a long way.
By weighing your food and applying the nutritional information you're given to the amount that's actually in the container.
You seem oddly resistant to the idea of weighing what you eat, even as a trial. Why is that?8 -
Wow. I’m an educated woman, and in my way of thinking, if I’m cooking my own food at home, at least I know what is going into it and how it is cooked. And so from what I’m gathering here, if I open a can of black beans to use in a recipe, the nutritional information in the side of the can is not to be trusted?? That just doesn’t seem right to me. And if you can’t trust the nutritional information on the packages, then where do you get it? The nutrition fairy?? If I go to a restaurant I have no reassurance of exactly what is in my food, how much exactly is there, or how it was cooked. Or am I supposed to trust their handy nutritional guides? Come on. And btw, by not eating nachos, I know damn well I haven’t consumed a days worth of empty calories in one setting. And that my friend, is all the accuracy I need when it comes to nachos. I think these boards could use a little more positivity and a little less criticism. I know I asked for advice, but good grief, I never thought people would be this negative. It’s hard enough to do what we’re doing, a little encouragement goes a long way.
I'll add to the chorus....why do you keep talking about nutrition? It's the CALORIES that count. If all that wonderful, nutritious food that you're cooking is not the right amount of calories for you, you won't get where you say you want to go. You can eat nachos (if your doctor says so), but you have to know how many calories are in them. You say you want encouragement, but you came on here with a problem. Why refuse the solution or the key to the solution?9 -
When I switched from eye balling and using measuring cups to weighing out my food serving on a scale I noticed my weight loss picked up again.
I read labels and use the scanner feature on my phone but I also weigh even pre-packaged foods because often there is a discrepency between the serving listed on the package and the amount I actually eat. So it's not that you can't trust the nutritional information - it's the serving size that needs to be verified.
For example - a whole wheat english muffin. The nutritional content on the bag listed 130 cals for 57 grams. When I weighed my muffin it was 62 grams and another day it was 57 bang on. This may not seem like a big deal but done over and over even with all the healthy food we are eating means our calorie counts are off and we don't have the most accurate picture of what we are actually eating. With more high calorie items like cheese, this can mean being off even by 10 grams can add up and whittle away at your calorie deficit.
It's hard to weigh everything depending on where you are and other circumstances but if you can weigh your food whenever possible you will be more accurate and likely see results. This has worked for many many people.
I wish you success!
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Wow. I’m an educated woman, and in my way of thinking, if I’m cooking my own food at home, at least I know what is going into it and how it is cooked. And so from what I’m gathering here, if I open a can of black beans to use in a recipe, the nutritional information in the side of the can is not to be trusted?? That just doesn’t seem right to me. And if you can’t trust the nutritional information on the packages, then where do you get it? The nutrition fairy?? If I go to a restaurant I have no reassurance of exactly what is in my food, how much exactly is there, or how it was cooked. Or am I supposed to trust their handy nutritional guides? Come on. And btw, by not eating nachos, I know damn well I haven’t consumed a days worth of empty calories in one setting. And that my friend, is all the accuracy I need when it comes to nachos. I think these boards could use a little more positivity and a little less criticism. I know I asked for advice, but good grief, I never thought people would be this negative. It’s hard enough to do what we’re doing, a little encouragement goes a long way.
It's not negative to point out that logging is a skill that most of us *learn* and that the vast majority of us realized, with guidance, that we could do it better.
Yes, you know what is going into your food. But how are you estimating exactly how much of it you're eating? When you open a can of black beans, are you eating the entire can yourself each time? How are you accounting for the variance in package weights, which according to food laws, can be up to 20%?
I know when I'm eating foods, I'm sometimes eating the whole package and I'm sometimes eating part of it. I know when I prepare foods, I sometimes eat the entire dish at once, but sometimes I split it over multiple servings or share it with other people. This is the stuff that you learn how to log more accurately if you're open to the possibility that even a good education doesn't teach you everything you need to know in life.
Sometimes other people can help when you're stuck. If you decide you want the advice you asked us for, we'll be here.7 -
I can't help but wonder why, when acknowledging that one isn't losing weight and asks for help, that one then gets upset when they don't like the suggestions that get made by others who are responding to that request for help....
Some products do actually give you less than what it says on the package; my local grocery store brand of peaches, for instance, says that there are "about 3.5 servings per container". When I've weight it out, I've found as much as 3-3.25 servings, not the 3.5. But they said about, right?7
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