Best friend had weight loss surgery...losing too much weight

My best friend had some sort of weight loss surgery about 1-1/2- 2 years ago. It wasn't lap band but the same premise. It was a relatively new type of surgery from what I understand. She was close to 200 pounds but not morbidly obese. She has always been curvy, but the 200# mark really freaked her out. She's on the short side but not petite. She also has mobility problems due to arthritis, back issues, knee issues and a mild form of MS. She's 58. I think that is why she went forward with the surgery as she could not move much, spent most of her time in her recliner and does not work outside the home. She also recd the surgery for almost nothing because they were going in to fix something else. That raised a lot of red flags with me.

I'm very happy she lost the weight, but her eating habits are a real concern for me. I know she could not and can not eat a lot or she'll get sick. I thought that would go away eventually, but it still persists. When I visited her last, all she would or could eat was a couple of teaspoons of canned tuna, maybe one part of an english muffin and cranberry juice with seltzer water...all day. Even her orthopedic dr told her to eat more. I found out yesterday she's going to start an exercise program, not to increase her mobility, but because she has lost so much muscle mass. She says she keeps losing weight and cannot eat more, too much makes her sick. Oh, and the dr has never tightened her band, but I have no idea if he loosened it. I don't think so.

As you can tell, I know nothing of this type of surgery. Can anybody help me with understanding this and is this normal? I'm extremely concerned and she's very defensive about the surgery, insisting it was the right thing to do. I've always had my doubts, but now it's really threatening her health, more than the being overweight. With her other issues, she cannot afford not to eat healthily. I understand she and the drs do not want her to gain back alot of weight as that will affect her mobility. Is there a happy medium somewhere in this? Thanks!

What does her surgeon say about her weight loss?  Does he think she's lost too much?  If all she can eat is a few spoonfuls of tuna all day, that sounds very unusual.  She should be able to eat small amounts of food several times a day.  But I think she should follow her doctor's advice.  It sounds like you don't even know what type of surgery she had, let alone what her post-op meal plan is supposed to be.  I understand you want to help her, but she should have a doctor and a dietician whose job that is.

I absolutely agree and I don't know exactly what type she had. I did not mention, should have, that's she's 1000 miles away and did this without telling anyone, not even her husband or daughters(and yes, they live there or nearby).She didn't tell anyone until several weeks later. She swore me to secrecy initially. I know this all sounds very odd, but it's true. 

It sounds like I may be against weight loss surgery, but that's not the case at all. I'm concerned about her particular situation and wanted to know if anyone else could shed some light on the post operative issues she might encountering. She won't tell me other than she can't eat much at all, keeps losing weight and now muscle mass. She won't divulge much else. I have no idea what her surgeons and gastro's say, she won't tell me other than everyone wants her to eat more.

I'm trying to educate myself on what some of the problems might be and I won't hold anybody liable for opinions or theories. I would love to talk to her doctors, but you know that's not possible.

If she won't tell you what they say, other than to eat more, I'm guessing she doesn't really want your help with this issue.  And it's pretty hard to help when someone doesn't want your help.

If she had a lap band, it sounds like the band is much too tight if she really can't eat more than that once a day.  The answer would be to remove some of the fill in the band, so it was not so tight.

If she had gastric bypass, it could be that she has a stricture, which means the opening between the stomach pouch and the small intestine is too small.  But that would typically be causing a lot of vomiting, too.  If that's the case, the solution is for the doctor to go down her throat into the stomach pouch with a tiny camera and a balloon-like device and stretch the opening so it's big enough (which is not as horrible as it sounds, they sedate people well for the procedure).

I'm sure there are many other possibilities.

A temporary solution, which she works with her doctors to solve the problem, would be to use protein shakes two or three times a day to get in some protein and calories.

Regardless of what type of surgery (you indicated some type of band), at almost 2 years out, yes, she should be eating MUCH more than you indicate and if she truly physically cannot eat more than that, it is NOT normal. I personally suspect that, based on her defensiveness, it isn't a case of her not being able to eat more than that, but a case of her choosing not to eat more.  I think there is a psychological issue involved."

She has muscle wasting because she is not getting anything even remotely close to enough protein and her body is taking what it needs to function each day from her muscles.  Once the body exhausts the major muscles as a source of protein, it will turn to the ultimate muscle: the heart.  Most anorexics die from heart failure, and if your friend has been eating this way for almost 2 years, she may already have done irreparable damage or her heart.

I would encourage you to suggest to her that she get a cardiac clearance before beginning any exercise because it could potentially be dangerous for her to do anything that strains the heart.

Unfortunately, there really isn't much you can do, especially since she is so defensive, other than express concern for her physical and emotional health.  She needs to reach out for help on her own.  You can suggest that she consult her surgeon or PCP to get a full examination, and you can express your concern about how much she eats (she needs to be getting about 60g of protein per day, and even if she ate an entire 3 ounce can of tuna instead of just a couple of bites, it would only be about 25% (15g) of that protein requirement), but she is likely to ignore you (and, potentially resent you, if you continue to push the issue).

Lora

Thank u both. I'm going to email her right now. Now very worried as she was diagnosed with afib a couple of months ago, may have nothing to do with eating issue, but who knows. I appreciate the input. Learned quite a bit today.

Exercise CAN build muscle, but ONLY if you are eating enough calories and protein to do so. Otherwise, the only thing exercise will do is increase the breakdown of existing muscle.

We really have no idea what is going on here, since your information is so incomplete. But one thing that happens VERY often, is friends and family of those with WLS think that they have lost too much, and are wasting away, when in fact they are not. But because of the big difference in before and after, it is perceived as such.

Again, we have no way of knowing if she has lost too much, or just that you think so.

Thanks, I can only go by what she has told me and what little I observed 6 months ago. I think her current, actual  weight is fine and I do agree with the exercise as she is very sedentary due to her other health issues. She just told me she is trying to eat more but it's not helping. I'm going to try to talk to her again and I appreciate everyone's input. This is part of her email conversation and what started my questions to the community.

                                                                                I'm just weightlifting want to build muscle as I'm wasting away. I'm down to 133 lbs. not good :( 

I'm really trying to eat much more. Doesn't seem to help. Pasta Vegetables y alittle meat / fish. 

If she has the band, pasta is one of the things she should NOT be eating and tuna is often very difficult to get down or keep down (instead of vomiting it back up).

If she is short 133 would be a normal healthy weight and exercise will probably help her feel better because she is probably a puddle of skin with not a lot of muscle tone.  I doubt she is going to starve herself to death, most people underestimate what they are actually eating everyday until they start to truly track.  If she is eating unhealthy the only person she is hurting is herself, but she is an adult and needs to take responsibility for her own actions, the ones that got her MO, the ones who got her to surgery and now her after-care.  She is probably defensive because she doesn't want people to tell her what to do, which I would stop even trying to do.  There is nothing you can do nor should you do in this situation, she needs to do this on her own.