9 Month Follow Up Yesterday.. advice needed please

Hi Ladies.. I could really use your advice one more time.. Again thanks for being here, I love this forum and all the advice you offer.  Especially since many of us don't get any time with our nuts or might have questions beyond what our nuts/docs can answer or have time for. I had surgery 12/4/06.  I had my 9 month follow up yesterday.  I weighed in on their scale clothed in the afternoon at 155.  I was 152 commando haha.. today though I am 150 commando so now I officially have a "normal" BMI for my height of 5'5".  I am also 30 years old. I started at 328 lbs preop.. lost 48 before surgery and then was 280 on surgery day.  I am still losing faithfully 10 lbs a month.  I posted about my rate of loss a while back and got some great feedback.  So I guess this is more of a post to see if you agree with what the PA at my office is saying.  I am just a bit confused. They have told me since 3 months out my loss would slow down but I have consistently lost 10 lbs a month through the whole course of this journey.. thrilled yes!!!! Anyway.. I asked her about calories since I do run 2 miles 4-5 days a week (Lately this past month not as much as I have had some traveling and now sick for a week with an upper respiratory infection so more walking this month).  She said 1000 no more, then at 1 year go to 1200 and stay there for LIFE.  I was surprised but kinda remember her saying this before.  I said even with my activity level...she said yes. I also do some light 5 # weights and floor resistance exercises.. light stuff 3 times a week and ab crunches.  All I know is at 1000 cals I am still losing steadily.. so she said I could go as low as 135 now.  I can't imagine another 20 lbs but great if I do!  I asked her about thinnerself.com and those other sites that tell u about how many calories to maintain and your BMR's she says those are just "guides" which I agree with that.  Said that WLS patients have different metabolisms which is why we can maintain our weight on 1200 calories for life... interesting.  Does this sound accurate to you?  Also i get in 90-95 proteins a day, always have.  She doesn't mind this b/c of the running I do.  Normally she has people on 50-60 and not even at 1000 calories at 9 months out.. so she said I have been on the high end for months now.. said I could have 1000 at 6 months out which I have been basically doing. I guess our bodies find that set point eh?  I hope to be able to handle maintenance without any problems.  Just wanted your opinion on the cal portion of it all.  I am not trying to weasel more food out of them but I just want to make sure this is accurate.. then great!  I am also very compliant to a healthy diet.. I haven't tested the waters with fried foods, sugar etc.  Only good carbs, whole grains, nonfat or low fat diary, lean proteins.  Very few processed foods. I follow the RNY rules to a "T". Log it all on fitday and watch all my portion sizes and breakdowns of fats, carbs, proteins.. its become a second job for me honestly but one I do not mind committing to at all.. I want to always be successful at this.  Any advise you can offer would be great! Oh and here is my pattern of loss each month since surgery! Surgery Weight - 280 1 Month ---------- 258 (down 22 pounds) 2 Months -------- 244 (down 14 pounds) 3 Months -------- 228 (down 16 pounds) 4 Months -------- 215 (down 13 pounds) 5 Months -------- 206 (down 9 pounds) 6 Months -------- 190 (down 16 pounds) 7 Months -------- 179 (down 11 pounds) 8 Months -------- 169 (down 10 pounds) 9 Months -------- 158 (down 11 pounds)  and down 8 lbs for this month so far.. 10 month anny Oct. 4th.

First of all congratulations! You are really a great example of how this surgery can change lives forever. On to your calories. It is so hard to say what will be YOUR calories forever.  I'm not sure that I agree with your PA but I can understand the rationale behind their thinking.  Let me try to explain. If you look at your weight loss (steady at 10 lb per mo)  I can understand why you would think that your calorie increase would need to be more than 200 total. If you also consider that many people begin to plateau in their weight loss at about a year - and about 10 lb above their goal weight, then you can understand why the nutrition advice from your PA calls for small increment increases in calories.  You may find your body reacting differently in the coming months - so pay attention to that. You are active and with a little resistance exercise have the capacity to add muscle, this could change your calorie needs.  You are losing at 1000 calories - ok, great.  You  may have to experiment with the calorie level that keeps you at a maintenance weight - it may be 1200, it may be 1300 or maybe more.  You are going to have to play with that a little - (with your track record, I don't think it will be that hard for you).  You will need to monitor your weight over a few weeks while you are increasing your calories.  It takes 3500 calories + or - to gain a pound or lose a pound.  So you up your calories by 100 or 200 and watch the results for a month, if you continue losing then you will up the calories another 100-200 and watch the results. The only way to evaluate your basal energy needs is to have it measured using indirect calorimetry - otherwise you can use the old fashioned method of trial and error.   You will probably want to start this process as you get closer to your goal weight (like 5 lb away or so).  Ultimately, there are many factors that can affect metabolism and set calorie levels.  As we get older, calorie needs can drop - so I don't know if I agree with 1200 forever. Do you think the PA is just trying to reinforce that the changes you made need to last for the rest of your life? Again, congratulations! I'll mention to Melania (our exercise guru) to also take a look at this & see what she thinks. Best of luck! Danielle Halewijn RD eNutritioncare.com

Thank you thank you Danielle!  This is my feelings exactly.  I want to be able to adjust it accordingly.. little by little till it is right.  And I will do this very open-eyed and logically.  I also want my metabolism testing to know for sure and plan on doing that.  I would love to hear what Melania has to say also.. I appreciate everything you guys offer us here, you are such an assest.  Me being an RN I tend to overanalyze stuff but I wanna make sure I am doing this right.  This is my second chance and I am not blowing it this time!!  *hugs*

Melissa, I believe that I answered you previously regarding increasing your caloric intake with all your exercise and continued weight loss (you were afraid of the weight loss continuing until who knows when).  Was that you or am I thinking of someone else? I agree with Danielle in terms of metabolism being affected by many factors including age, exercise, caloric intake, etc.  If you really want to know your BMR, I would suggest finding someone who has as MedGem indirect calorimeter, which will measure this for you.  I have and use a MedGem which is very accurate in all types of patients.  However, many of the RNY patients that I have measured have very low BMR's due to chronic dieting.   As for following a 1200 calorie diet forever, I don't think that anyone should make a blanket statement such as this as our needs change over time.  Sometimes patients are told to follow say a 1200 calorie diet with the hope that they will not go over 1400 calories.  (Most people underestimate how much they actually eat). Hope this helps!

Hi Melania.. yes you did reply to me before and I thank you again for replying again.  I will look into this MedGem calorimeter.  I am in a rural area in Iowa so it might be hard to find.  I asked the YMCA and they didn't do it neither does my PCP or surgeon so it might be kinda tricky.  I kinda had the same thoughts about the blanket statement and I agree that we don't account accurately for food intake and usually go low.. I tend to shoot high b/c I am afraid of going over.. I tend to round up.  So I will keep that into consideration also.  Thank you so much for taking the time to reply to me again, I appreciate all the help.  We are so lucky to have you guys here!

Hi Melissa I am an accountant.  Mathematically I say you burn 14.4 calories per pound of you.  If you want to maintain 135 lbs and keep your exercise the same you can eat 1944 calories.  If you change your metabolism ( sinking into starvation mode or adding muscle) this will not be accurate. 1000 cal a day for 30 days is 30000 calories per month food eaten. 10 lbs weight loss per month is 3500 x 10 = 35000 calories per month your own body fat eaten. 65000 calories per month is 65000 / 30 = 2166 calories per day eaten to weigh 150 lbs. 2166 cal/150 lbs is 14.4 cal/lb of you 135 lbs x 14.4 = 1944 calories per day I maintain 185 lbs at 1850 cal.  I am tryting to get to 165 lbs eventually so I am eating 1650 calories and it is working.  (I am a big eater). This depends on your calorie count being accurate. good luck, Linda