Failure to lose much weight post-surgery

I was sleeved on August 10, 2020, so it has been a little over 6 weeks as I write this, and I have only lost 16 pounds, barely 2 pounds per week. Anything is better than nothing, but this is pretty disappointing because I hear of so many people with dramatic weight gain post op.

I did lose 36 pounds before surgery over two and a half months, and I get that I may have used up some of the 'easy' weight loss then, but I ate so little after surgery (fasted for a day, then liquid diet for two weeks, then purees and the gradual introduction of more normal foods with an average daily caloric intake between 800 and 850 calories -- and I log everything). For the last month I have been exercising 4-5 times per week for at least 30 minutes, and reaching 10,000 steps some days even when I don't get to my treadmill (much more than I was exercising pre-surgery).

I recently discovered online that a drug I have been taking for neuropathy (amitriptyline) is linked to weight gain (wish a doctor had mentioned that earlier!) so I am tapering it off and I'm almost finished with it. That could be a factor too.

For what it's worth, I also have been extremely hungry. It feels just like it used to when I would lose a lot of weight, then start feeling abnormal levels of hunger.

I am determined to stay the course, hunger or no, but I almost want to cry when I hear of people "forgetting to eat" or "unable to take more than a few bites before they feel satisfied". Not my experience at all.

Any ideas anyone, or similar experiences?

Thanks, Selene

Selene,

I'm sorry you're having a hard time! Have you spoken to your doctor/weight loss surgery team? They will have some helpful suggestions. Here are my thoughts, whatever they're worth.

1. It hasn't been very long since your surgery. Give yourself a break! It is too soon to be using words like 'failure'.

2. My surgery team (Mass General Hospital in Boston) discouraged counting calories. They said to focus on water and protein. The rest would fall into place. They also suggested we look into mindful eating. It sounded like a bunch of crap to me until I actually tried it. Counting calories and other dieting behaviors never worked for me, long term at least. So it was worth a try!

3. I suspect you are not physically hungry. This is something that works for me when I feel like constantly eating. When I want to eat something I ask myself a question. How long has it been since I last ate? Since surgery, I find that I need to eat every 2-3 hours. If it's been less than 2 hours, I am not physically hungry. So I do something to distract myself. I take a walk, read a book, knit/crochet, call someone. If I still feel like eating 20-30 minutes later, I eat something that's high in protein.

I hope this helps a little.

Kathryn

+1 The "hunger" you feel is not really hunger, it's excess stomach acid. I assume you were prescribed a PPI, so this should diminish over time, although it may not go away entirely. When you feel a "growly" or "rumbling" stomach, drink extra fluid and it should go away.

Post WLS, what is a reliable cue that you need to eat? I suspect this varies from person to person, but for me it's a sensation that I can't really describe. Whereas the growly stomach seems to demand immediate attention, and goes away when I drink water, I find that true hunger is more of a quiet signal that makes me realise it's been a while since I ate. And of course if I wait too long to eat, I start to feel faint. I think it took about six months for me to reliably recognise true hunger.

rate of weight loss can be influenced by so many things - age, sex, metabolic rate, activity level, starting BMI, whether or not you lost a lot of weight prior to surgery (as you know, a lot of initial weight loss is due to "water weight". Since you lost 36 lbs before surgery, that "water weight" was long gone....). The only factors you really have much - or any - control over is how closely you stick to your program and your activity level. It sounds like you're doing well with both of those.

I lost 16 lbs the first month, and maybe 22 or so by the time I got to where you are (at six weeks out). I started out at well over 300 lbs. So if you're lighter than that, you're probably losing at the same pace I did. I was a slow loser from the get-go, but I was very compliant that whole first year and ended up losing 100% of my excess weight. In the long run, your level of commitment is a much better predictor of your ultimate success than your rate of weight loss is.

I think a lot of people go into this with pretty high expectations, and I blame shows like "My 600 lb Life" for that. You need to keep in mind that those people start at MUCH higher BMI's than the average WLS patient does. Although I've never seen any actual medical research on this, I've been hanging out here on OH for about six years, and from what I can tell, the average weight loss the first month is around 15-25 lbs. Of course you will find people who lose more or less than that, but that seems to be about the norm. As long as your overall trend is down and you're committed to your program, you're good.

Even though there is no average weight loss, there is a very typical weight loss. Most people lose 100 pounds over the course of the first year. It breaks down like this:

Month 1 - 20 pounds
Months 2-6 - 10 pounds a month
Months 7-12 - 5 pounds a month

There is individual variation, but that is what you can reasonably expect.

The extreme hunger does not make sense at all. It is very likely acid reflux. That is common after VSG and mimics hunger. Are you on something like Prevacid? I was sent home with that. Talk to your surgeon about the hunger. It is not normal.

I'm going to ask what your daily meals look like. What are you eating and are you measuring stuff or just eyeballing. Honestly I wasn't eating 800 cals a day until almost 6 months out. It could be that you are eating more than you think.

What about fluids are you drinking enough?

As for the extreme hunger it very well could be an acid overload. Acid definitely mimic hunger.

Congratulations on your recovery. I wish you the best as reach for your your goals. I feel crazy hungry when I'm doing too much -- low calories and lots of exercise and stress. I like to take my time and focus one one area at a time and add the rest gradually.

Selene,

I am sorry you're having a hard time with everything. The main thing I want to say is relax. I too felt my weight loss was slow. I was on the scale every day and drove myself nuts. Even tho I was losing, I didn't feel or see it for months. I secretly worried that I wasn't going to lose much. Yet, here I am, 17 months out and almost 100 pounds lighter. Be patient, talk with your surgeon and make sure you address all your concerns but I'm willing to bet you will be great! Remember, it's only been two months since you had surgery. Your body is still healing and you are still learning how to manage the changes in your life. Drink your water! It matters on several levels. Cut yourself a break and enjoy already being over 50 pounds lighter than you were just a few months ago. What a wonderful start to your new life. Good luck and God bless!

Jinxy