Confused and stuck... Need advice from the experts...

So here's my update.  Lost 175 lbs since February 2008.  145 since April 2008.  Done pretty well but have basically been stuck at 285 for nearly 2 months.  All the other crapola is gone (diabetes/hypertension/apnea/etc and except for the weight, the health is great.  Called the Dr.s office and got the usual BS, the weightloss will slow at around 8 months, probably in a plateau, just stay the course.  Not what I want to hear. 

I have been eating right, kicking ass with the exercise and watching my intake like a hawk.  Averaging around 1400-1500 gross intake cals a day.  Good protein intake at 120+ grams a day.  Keeping fat and carbs to 30-40g and 150g or less respectively.  Finally went to see a nutritionist.  Got my BMR tested and it came back an astounding 2610 cals a day. 

SOOOO, here's my dillemma.  I was told, I have to eat  more, no less than 1800 cals a  day and do  not let net cals fall below 1000-1300 depending on exercise.  Currently I a burning 600-1200 cals a days on exercise.  As BMR falls, I'll have to kick  up the exercise more or eat less.  The other stuff was no surprise.  Vary the exercise regimen and kick up the water.  Oh, and eat more veggies (hate em). 

After months of watching what I eat, I have to eat more.  So just frack with my mind why dont ya.  She also said that I am likely losing much of the malnutrition benefit the surgery provided and am entering the  really tough phase of the weight loss program.  Most folks reach there goal by the time  this happens but because I started at such a high weight (462), I am losing the benefit at at a weight where most folks would be starting there journey.  I know I'll be carrying around an extra 20 or so lbs of skin.  If I am to get to my goal, I need to lose another 70-80 lbs.  Man this is gonna be tough.  Its too early to think revision.  Really looking forward to my 1 yr checkup.  Interested in seeing what the WL doc says.  For now, will stay the course and try to follow most off what the nutritionist said.  Will try to increase my cals some.  Can probably get the extra 300 cals with a milk based  protein shake.  We'll see. 

What do you guys think of all this??  Is this a line of BS or does it sound right?

Dalton

Hey Friend!

As I was reading your post, before I got to part where you said you had your BMR evaluated and it came in the mid 2K range, I thought that you weren't getting enough calories. Isn't it the strangest thing?! For so many years we've been taking in more calories than a normal person could possibly burn in a day and now you are active and fit and you are actually burning too many calories. I know that it seems counter-intuitive, but I think there is more than a little to be said for this. When I was losing and would let my calorie count get too low, then I'd plateau and I think is what's happening for you. I do know of others that have started with high weights and have lost... Do you remember Jaime Roughton? She's the beautiful blonde woman whose husband is a physical trainer. She also started with a BMI similar to yours and is doing very well. She'll be at the support group meeting on Saturday. Why don't you make sure to talk with her and with her DH Shannon? He has some great input on exercise, burning fat, keeping your caloric intake high enough to continue to lose, etc...

I guess, I'm saying that I think that it may be that you might have too much of a caloric deficit as opposed to not having the malabsorption work for you. Even as the malabsorption wanes, I think you'll be able to leverage the power of the pouch, but you'll need to be fueling your body to a point that it stays out of starvation mode where it hoards your fat stores instead of giving 'em up.

BTW... I'm no expert, especially as it relates to Over 50 BMI issues, so you might consider cross posting this thread to the over 50 BMI forum and to the Diet and Nutrition forum to see if you get some input from those who have experience with the loss patterns with high BMIs or the nutrionist/dieticians that moderation the nutrition forum.

Wishing you all the best and I am sure continued success.

Hang in there my friend.

Thanks Barb...

As always, I knew I could count on you for excellent advice.  See you and Ben on Saturday... If the cold weather doesnt get me.  Its gonna be a *****illy this weekend. 

D

 Dalton, 

Would you say you were in much better health than you were a year ago? If the answer is yes pat that back. It could be possible you may think a great deal like I do about the weight. Since my surgery I have been on this great down hill slide on the scales. Granted you have lost a whole person and that in itself my friend is worth the gold medal. I do know that I have to intake more workable carbs when I get on my extended hikes and activites. I found that I loose more weight when I have that one little extra meal when my body is in full tilt work out for several hours at a time. If you are doing long work outs of more than say an hour to three hours even if you break you may be burning up a great deal more calories than you intake. I had to change my intake to more protein prior to starting out but it helped overall to have some real fat with protein like peanuts or cashews on every break. I may be in the same rut with you in a year wanting to rid myself of those last few pounds as well.  Just keep up a good plan on exercise and when you have heavier days try out that extra intake of something that is good has carbs and burn some of the calories. The more muscle you get to add to your body the higher your metabolic rate increase according to my doc. It must be frustrating to get right to the last corner and work your butt off to get around it and hit the wall every time. I so remember how 285 was when I had gone three months of hiking every blessed day and only lost three pounds in three months prior to surgery. It was one of the crowning moments to get this WLS done. At some point and time I know Im going to have to deal with the last load on my waist as well so keep us posted on how your progress is going. My wife is two years out and struggling to get the last 15 off to hit goal. I think she will make it one day at the rate she is going. Life is good and be good to your life. 

You have already gotten some excellent advice from Barb for sure.. and I was thinking the same thing about calories.  Maybe it is that you aren't getting enough versus getting too many.

I just wanted to comment on what was said about losing your malabsorption.  Ive asked my surgeon about that before.. He told me that there are no studies or proof that the malabsorption goes away after so long. 

I am sure you will be back on track soon.  And hey!  We have both lost 175 pounds!!!  YAY!!

Dalton,

I want to second Jennifer's comment about malabsorbtion because it was something that I specifically asked the folks at Duke about. They said that the malabsorption that we experience is the malabsorption of 'micronutrients' such as iron, calcium, B vitamins, folate, etc... Not macronutrients such as protien, carbs, and fats. The nutritionist at Duke said that studies have been done and do not show a malabsorption of macronutrients, so you don't tend to gain or slow your losing because you are malabsorbing calories.

Another thing that he said, that you might find interesting is that those of us who burn more calories, need more to lose. He said you have to keep the engines stoked with enough calories or your body will think it's going into starvation and will radically conserve. I think you may want to see what you can do to boost your calorie count by say, 100 calories a day to see if you can 'break the dam' and cause the flow of weight loss to start again. I know that it can be scary to do that, but you can find healthy ways to do it.

Wishing you all the best and continued success. I do not believe that you are done... I think you have hit a significant bump in the road.

I'll see you Sat!

Thanks for posting this question. I've been dealing with a similar issue and after much research, I too figured out that I wasn't eating enough...except I don't think I can physically eat much more than I do. I work out 4-5days/week for 60-90mins. and my nutritionist had told me to stay between 1000-1200 calories (although she also said to increase my intake when I work out). I generally will eat about 1400-1500 on days I work out, but I wear a heart monitor while working out to see how many calories I've burned and many times I end up with a daily net calorie intake of <500. I've only lost about 5 lbs in the last 3 mos. I was feeling a bit discouraged except I have noticed I've lost several inches and gone down a pants size. I've had to console myself with other ways of measuring progress and I've started to try to finds some protein rich, calorie dense option to kick up that intake. Good luck and keep up the good work! I know how much you want to see the numbers change (I do too!), but congratulate yourself on all the hard work you're doing in adopting a healthy lifestyle forever.

Hi Sabrina,

I had a similar, but different issue... I kept losing when I didn't want to... The similarity being that I had too much of a calorie deficit. At any rate, I started adding a 'meal' and adding more carbs and fats to my diet. My weight has actually been steady since October. If you want to share 'tips' more, please feel free to PM me or give me a call.

Dalton,

This response to your post came in under one of my responses to you, so I was alerted to the response and knew that you might not see it... so, I'm posting it here... It's from "GOAT" (Goddess Of All Things) aka Sabrina... and I thought you'd want to see it.

Barb

Thanks for posting this question. I've been dealing with a similar issue and after much research, I too figured out that I wasn't eating enough...except I don't think I can physically eat much more than I do. I work out 4-5days/week for 60-90mins. and my nutritionist had told me to stay between 1000-1200 calories (although she also said to increase my intake when I work out). I generally will eat about 1400-1500 on days I work out, but I wear a heart monitor while working out to see how many calories I've burned and many times I end up with a daily net calorie intake of <500. I've only lost about 5 lbs in the last 3 mos. I was feeling a bit discouraged except I have noticed I've lost several inches and gone down a pants size. I've had to console myself with other ways of measuring progress and I've started to try to finds some protein rich, calorie dense option to kick up that intake. Good luck and keep up the good work! I know how much you want to see the numbers change (I do too!), but congratulate yourself on all the hard work you're doing in adopting a healthy lifestyle forever.

Hey Dalton,

Ok, I had the same problem...  I lost my first 150 lbs real fast and then at about the 8 month point I hit a stall for a couple months, I'd be eating right and excersizing to boot but nothing... then after about 2 months I'd start loosing again.  During this time I would loose inches though and it seemed my weight was shifting around or something.   My loss slowed down but at least I was still loosing.  This happened for about the next year for me, until I was about 20 lbs from goal and I'm sure was skin.  Now I'm over 6 years post op and have gained about 25 lbs back, still feel great and look good but I want to get that 25 off again.  Anyway, I think you should just keep doing what you're doing, add a bit more protein, but veggies are good for you too... lol!  I'm sure you'll start seeing the scale go down again. 

Good luck!  Keep up the great work!!!