BED....who to approach?

What do you mean by having to "maintain a reduced calorie diet long term"? I don't believe there is any inherent need to maintain a "reduced calorie diet" post RNY/VSG. Of course, all bodies are different, and people have different caloric needs based on body weight, muscle mass, level of activity, age, genetics and a whole host of other factors. However, I maintain just fine on 1800-2000 calories/day as a 145lbs 5'8" male, which seems about normal. In fact, I had my RMR tested and it was ever so slightly above average for someone of my size/age.

Just checking on the word "reduced" as it's a relative term. If you mean, "reduced" below 3000-4000, then yes, I would agree (ultra-athletes aside).

I did a survey of OH'ers a while ago, and the people who were maintaining successfully (all women, IIRC) ate 1200 - 1500 calories in maintenance. I would consider that "reduced-calorie."

I'm not a doctor or a scientist, but that's a tough way to look at results. What were the average age of the woman? How tall were they? What did they weigh? How active were they?

if they were all 65 years old, 5'2" talll, weighed 135lbs and worked desk jobs that would align with what you'd expect for TDEE. If they were all 30 year old ultra athletes, 5'6", and weighed 175 lbs that would indicate a significant reduced calorie need. Then there are the well documented issues with self-reporting, etc. (Assuming these people were self reporting based on food logs as opposed to RMR testing)

On PubMed I've only been able to find four studies asssesing the impact of bariatric surgery on RMR (granted at least 2 were on banded patients), and none of them showed any long term negative effects on RMR.

I'm not saying it's impossible, and i certainly wish there were more valid studies out there. But it seems a bit of an overstatement to declare reduced caloric needs as a fact for RNY and VSG patients. Again, unless I'm misunderstanding his intent of the word "reduced"

If people have studies showing otherwise, I'm always happy to keep an open mind and read up on them

Jester,

FYI ... I also answered the survey that Julie posed (as I recall) early this year.

My own daily maintenance calorie budget, which I reported in my survey response, for the past 2.5 years of maintenance has been 1750 - 1850 and NOT in the 1200-1500 range she reports above.

FYI, I'm a 72 year old woman, retired, moderately active (yoga, aquarobics, walking at least 5X/week), healthy (no diagnosed diseases), and lead an active life (maintain farm property and travel extensively). I lost 100 pounds (from 235 to 135) over 1.5 years and have maintained my weight loss for the 2.5 years since reaching my weight loss goal of 135 pounds.

My own 1750 - 1850 daily calories budget is in line with information I see online about the typical caloric needs for someone my age and activity level, so I don't think of myself as having a "reduced caloric need." But please note that I'm not a registered dietitian or registered nutritionist or anything similar. I'm just a little OCD and can do arithmetic. ;)

BTW, I am confident that my self-report about caloric intake is accurate (or as close to accurate as one can be without testing all the food they eat in a laboratory) because I'm an assiduous food measurer and a daily My Fitness Pal planner/tracker.

Finally, I realize that this self-report is anecdotal information about only one person. I'm sorry it wasn't included in Julie's survey report. Not sure why.

Best,
Ann

Jester ...

P.S. My personal caloric report above by itself (which is purely about calories, not the balance of macronutrients that I eat or the specific foods from whence those nutrients come) is not very likely, by itself, to be all that revelatory about how I have maintained my weight thus far.

For instance, most of my daily 1750-1850 calories don't come from "empty" calories, e.g., sugar, alcohol, processed carbs. I'm a pretty clean eater and guesstimate (sorry, that's all I've got) that 80% of my daily calories come from animal and plant protein, vegetables, fruits, and whole grains.

Another topic that's very important about weight maintenance is the topic of hormones and how fortunate we each are in our body's production of some of those hormones, e.g., leptin, insulin, and others that regulate our metabolism very strongly. Donna L. (who's helpful here at OH in providing good information about all this stuff) posted not long ago about a video re metabolism at https://www.youtube.com/watch?v=zcMBm-UVdII that's been eye-opening to me. If you aren't following Donna L. here, you should -- she's well trained in several subjects that address obesity, weight loss, and weight maintenance, e.g., psychology, biology, nutrition, and more.

Bottom line is that I've seen personally that although my own weight loss and weight maintenance is affected by the number of calories I eat, it's not purely a calories in, calories out dealio for me. Currently, I think there are principles that we all should be aware of and follow. But I also think our bodies vary just enough that (I won't say "we") I must continue to experiment on a sample of one -- and that's me.

Damn, I used to think this stuff was so simple. The longer I deal with maintenance, the more complex it seems to be. Or maybe that's just a phase I'm going through right now. ;)

Using the DS to treat the symptom without addressing the underlying cause seems a bit foolish, but that's just one woman's opinion.

Well again, I had surgery many years before BED was a Dx.

On the other hand, if I was to have surgery today, and I knew I had BED, I would probably opt for a surgery that would give me the best chance at long term success and not a surgery that would depend on "self control".

That's not my point.

Shouldn't you treat the BED (therapy, medication, whatever) first? Rather than using surgery to mitigate the results of uncontrolled BED?

If you have an eating disorder that was untreated and then received a very good, but potentially very dangerous, surgery before it was addressed, then unfortunately the system failed you. It may not feel like it, however in order to be healthy we don't just need weight loss...we need psychological equilibrium. I say that both as a therapist that has worked with bariatric patients who is extremely pro-DS, and also as a BED patient, myself.

I am glad the DS worked well for you. I would encourage you to get help for the BED if it is actual BED, though. Even if things are kosher now, with true eating disorders, the true damage they cause to us isn't fixed by malabsorption or surgery.

Whatever you decide, good luck.

My surgeon admitted that he was pretty clueless about BED. I recommend starting with your PCP. Talking with a therapist who does CBT/DBT is also a good option to pursue at the same time.

And, hey, you're not stupid. BED really sucks and shame/hiding is all part of the package deal. If you want someone to talk to, feel free to PM me.