9 months out with questions about weight loss...

Hi there!  I am hoping one of the dieticians can help me!  I am a nurse but don't have the knowledge and expertise in the nutrition world that you all have so would appreciate any feedback you could give me!!!  It is so awesome you are here! I am now 9 months postop and I am continuing to lose 10-12 lbs a month.  In the past couple days I have dropped another 4 lbs.  I am NOT complaining.  I am THRILLED.  However.. if this continues I can see myself going way past my goal and then fighting to keep weight on.  May not happen but could.  I am 154 as of this morning.  My docs goal was 165 and my personal goal 140, thinking of lowering to 130-135 to leave me some room to move a bit.  More than anything I want a NORMAL BMI and lose 100 percent of my excess weight after WLS.. I know most do not accomplish this but all me an overachiever this has always been my goal and I know I will make it as a normal BMI for me is 4 lbs away at 150 lbs. Ok so this is where my concern comes in.. say I get down to 130-135 over the next couple of months should my body continue to lose like it has.  At that point I will find myself adding more calories to maintain.  I am getting 1000 now pretty religiously so I will toy with it till its right going up 100-200 a week to find my maintain mode".  However I know our colons get smarter at around 18 months out and every calorie just starts counting and then I might find myself fighting not to gain.  What a battle.. Or I could be freaking out for nothing... and it will stop where it is supposed to here in the next month or two and all will be fine other than me finding out how many cals to consume to maintain.  I know my pouch isn't done "stretching" meaning I can eat 4 oz of dense meat and a small side salad or soft veggies or 1 cup of more liquidy stuff like chili.. it has been this way for months tho for me.. like since month 5-6.. so not sure I am gaining a lot of room and honestly don't really want to either.  I am pretty strict on my diet.. no white flours, sugars, pasta, breads, refined carbs.. i don't sit there and test a bite of this or that.. just don't want to.  The worst thing I do is drink an EAS shake everyday and a homeade SF latte using skim milk (the only thing giving it the calories.. decaff also).   I keep to 1000 cals, protein 90-100, carbs 60's or below and all good complex carbs, fats 30-40 is where it always lands no matter how hard I try to get it lower prolli b/c of the higher protein amount.  I do 30 mins of cardio 4 times a week usually running 2 miles..  I also do light hand weights and some floor exercises and ab crunches a couple times a week.. again nothing too extreme.  I am 150cm bypassed too btw.  I asked my doctor about calories at my 6 month visit they said 1000 especially since I exercie (run 2 miles) most days that at a year I could increase to 1200.  How does one stop losing with this little amount?  When I go to sites like thinnerself.com and calculate my BMR it says 1400 something and 2200 something to maintain.  How does one stop losing then with 1000-1200 calories?  Are those sights figuring BMR's on those that have no had surgery?  Are we different and require less as a postop?  Sorry for all the questions..I know this is an "odd" concern but I was told by my doc at my 3 month appt and then again at my 6 month appt to expect things to just start slowing down.. it hasn't one bit which again I am thrilled as long as I can control it when it is time to stop losing.  Thanks for any help/feedback you can give me!

Hi Melissa: Congratulations on your continued weight loss!  However, I do understand your concern that if the current rate of weight loss continues, the fear is that you might not be able to stop losing.  This is a problem many of my patients say they would love to have, but it can be scary and it is the other side of the weight management coin.  The general rule we use for 'reasonable weight loss' at 6-12 months post-op is 1 pound per week or 4 lbs per month, but again everyone loses at a different pace.  Given your execise regimen, which burns calories too, 1000 calories per day is likely too low. I would increase to 1200-1400 Calories per day for 2 weeks to see if your weight loss slows down.  Also, following a low carbohydrate diet of 60 grams per day is quite low to follow long term. Remember that our brains exclusively use glucose (carbohydrate) to function with the MINIMUM amount of 120 grams per day needed.  Otherwise, the body begins to break down muscle for energy, which is not healthy; this is counterproductive with your exercise.   I would start to add in more fruits & vegetables, small amounts of whole grain breads & cereals, i.e. whole wheat bread, brown rice, etc.  It will be easy to increase your carbohydrates this way as each serving of carb (1 slice of bread, 1 piece of fruit) contains 15 grams of carb.  Your goal should be to try to eat the minimum of 120 grams of complex carbs per day. Also, drinking the EAS protein shake and SF latte is just fine.  After all, you DO deserve a treat every now and then!  In terms of your other questions, it is likely you will continue to lose weight with your current exercise regimen while eating only 1000-1200 calories.  The other way to slow down weight loss is to stop exercising, which I do NOT recommend.   In terms of the sites that calculate your BMR, there are several equations that can be used but the majority of them are for non-WLS patients.  Additionally, when I have measured actual RMR's using the MedGem for my post-op WLS patients, their BMR or RMR is lower than that of a non-surgical patient.  This is also the case with chronic dieters who have been on very low calorie diets and fad diets for many years..metabolism is a very tricky thing.   Hope this helps! M Behrens, MA, RD eNutritionCare.com

Hi there Melania! Thanks so much for all the information!  It is so hard to wrap our heads around the fact that we need to eat more calories and up our carbs.. amazing to me.  I am gonna try this I think once I get into the 140's here soon.  I also see my doc on the 19th.  I called them last week and they told me to stay at 1000 for now.. argh so I guess I will till I lose a bit more and/or see them.  Thanks for the advice.. I am also gonna start some aggressive muscle strengthening as well.