Weight Gain after RNY

I am with Lora on that.  I know a lot of naturally skinny people, and most of them don't eat a lot.  Post op RNY - I still eat more than some of my skinny friends. And...I have many days that I want more... 

It may be metabolic, or whatever you want to call it, but what and how much I eat determines if I gain or maintain. 

It's really funny, the power of our cognitive distortions to protect our egos, and psychologists are just as vulnerable as the rest of us to such impulses.  You all lost a ton of weight after you had surgery -- reality is sitting right there in front of you starring you in the face.  Yet now you're acting like you just willed it to happen...well, why didn't you just will it to happen before the surgery?  

I understand this impulse so well and am not being judgmental.  This impulse to take all the credit exists because (how ironic given our present debate) you need to reclaim your dignity after having it so unfairly insulted by society for so long before the surgery.  Yes, I worked very hard too before and after my surgery to hasten the weight loss, and I feel the strong impulse to be given all the credit now.

This is why so many of us never even tell our friends and coworkers we had the surgery.  If morbid obesity were correctly viewed as the disease it is to begin with, we wouldn't feel the need to cling so emotionally to these fictions after receiving proper treatment.

Perhaps one advantage I've had in seeing the light is that I was able to lose 100 lbs before the surgery.  I ended up eating grass and twigs and riding a bike an insane amount, yet I was struggling against regain while clinging for dear life to 265 lbs.  Then I had the surgery, and then another 100 lbs just fell off of me while getting to eat much more freely than I had been.  The fact is that if any of us were to go and have the surgery undone tomorrow, we would all regain a ton of weight, and neither malabsorption nor restriction has anything to do with that reality.  The difference is that some would blame themselves every step of the way during that regain, and some would accurately recognize that their medical treatment had been removed.

****rogirl, I'm not going into the weeds because you are clearly wedded to your position.  I just supplied you, directly and via the noted sub-references, with over 30 valid scientific studies showing that malabsorption and restriction have little, if anything, to do with RNY weight loss.  Yet you rushed to skim the studies so as to come up with some shallow points to claim rebuttal.  I can see it's one of those 'you can lead a horse to water' things.

I'll just quickly comment that you misunderstood the groundbreaking Harvard study as to energy expenditure.  The increased metabolism with RNY is in response to eating food, which the study makes incredibly clear, i.e., the increased metabolism is not in the fasted state (a huge distinction).  I also supplied you with several studies showing you the same type of increased energy expenditure in humans, as well as animals.  BTW, though I'm opposed to animal research like this, the fact is that the other mammal studies are superior precisely because of, and not in spite of, the fact that these mammals were immune to psychological bias.  

Here is the big picture point that cuts through all the distractions.  In the Harvard study, e.g., those with RNY lost twice as much weight as the controls who were fed the exact same diet those with RNY ate ("pair-fed").  Think about the massive implications of that fact.  And the reason for this difference had nothing to do with malabsorption or restriction, a fact they proved in the study.  The actual reason was the primarily the fact that the energy expenditure after each meal increased a phenomenal amount after RNY.  This mechanism is actually why some RNY patients notice they can literally break out in a sweat after an overly large meal.  That metabolic effect is not the only effect going on in RNY, but it is a very big one and likely the primary one.

I'll say it again -- in addition to being incorrect, the schema that people have "free will" over this disease only encourages feelings of self-hatred and depression.  And what a luxury for someone to promote this view after receiving a powerful medical treatment to largely treat the disease!  It reminds me of a guy helping to sell Chuck Norris' "Total Gym" on TV -- this guy lost hundreds of pound while using the machine (but secretly had gastric bypass surgery first, as he admitted elsewhere).  Amazingly, the Total Gym ads continued using this guy for years after his admission, never mentioning this little fact of his surgery during the commercials.

"It may be metabolic, or whatever you want to call it, but what and how much I eat determines if I gain or maintain."

Yes, but now that you've had RNY, the weight at which you struggle is drastically lower than it used to be, right?

We are all in agreement in supporting and congratulating Troy.  Here is where I differ from many, though.  Troy can forgive himself and let go of any feelings of guilt and self-hatred over the years and focus with a clear head on what works now.  People without this disorder struggle with 20 pounds over their lifetime, not 200.  To most of those healthy people without the disorder, we are all weak-minded buffoons for letting our weight get out of control.  

And my wife is one of those healthy people.  She gets to eat more calories each dinner than I eat all day, yet she weighs 125, and I weigh 175.  She admits she used to think like ****rogirl's position, because for her diet and exercise work quite well to keep her as thin as she wants.  But then she met me.  Now she has seen first hand that it is night and day for people who have the disease, and she has shed her toxic judgmentalism.  If she had the disease of diabesity, she would weigh over 500 lbs given how much she eats, and that is no exaggeration.

The only "victims" are the individuals subjected to this toxic judgmentalism you keep advocating, ****rogirl, with all respect.  The only person it "empowers" is the person doing the judging.  Psychologists used to blame bed wetters (and a whole list of order disorders) on psychological weaknesses, but now they know it is physiological (and ditto re that whole long list).  

I agree we'll have to agree to disagree.  But I know someone will one day pick up the mantle of trying to overturn all the myths that live on in this forum and the WLS community, starting with the silly malabsorption and restriction myth as public enemy #2 and "morbid obesity is not a physical disease" as public enemy #1.  Fortunately, even the AMA has come around to my view recently as to public enemy #1, as it is now officially a disease.

To this day, people continue to think that depression is the result of a simple chemical imbalance because of a silly Zoloft commercial decades ago.  Research has long since refuted this silliness, but the myth lives on.  And for decades, people blamed depressed people as being weak, just as they blamed people with ADHD as being lazy, just as they blamed people with leprosy for being sinners, just as they now blame the morbidly obese for being weak-willed and self-destructive, and on an on.  

In time, I'm confident mainstream views such as the judgmental one you advocate, ****rogirl, will yield to what is now known by researchers -- morbid obesity (aka diabesity) is a physical disease in every sense and one that cannot be overcome by diet and exercise or will power or lifestyle choices or any other silliness.  The disease must be treated with powerful medicines, and the most powerful one we have now is bariatric surgery.  In the future, there will be pills.  Until then, after WLS the best thing people can do is go low-carb and low-guilt.  And the best thing everyone else can do is go low-judging.

 ps - No, I'm not the guy who "said he was everything from a doctor to a physical trainer..."  Think twice or look at prior posts before resorting to ad-hominem attacks, please.  Let's keep this respectful, as I've tried to do.  I respect ****rogirl, as I've made clear.  We have a difference of opinion, perhaps opinions we hold with some fervor, that's all.  Personal attacks are pitiful substitutes for actual arguments and really damage forums like this.

I'm not sure where in the world you got the idea that ANYONE here is saying that we just "willed" our weight loss to happen! I have been here almost 9 years and have never seen anyone here say that!  That is very different than saying that people need to find ways to exert some control over what they eat!

Of course the surgery gives us a BIG advantage in trying to maintain our weight. When did anyone here say otherwise?!? Would I gain weight if I were to have my RNY taken down?  Absolutely, but that is partially because I wouldn't be able to feel full after only 4-6 ounces of food!  Would I get back up to over 300 pounds?  No, because I have significantly changed my eating habits from what they were 10 years ago. 

It seems like you are making lots of assumptions about what people here think without actually having been here long enough to know what anyone here thinks. The majority of people here (although certainly not all) are very open about the fact that they had surgery to address their weight issues... So I am not sure why you are assuming that many of us feel ashamed.

You also assumed (incorrectly) that I just skimmed that first article.  I actually went out and pulled up two of the additional studies it cited. you are claiming that these things say that restriction and malabsorption play NO role in post-RNY weight loss and that is simply NOT what they say (even in the studies on rats). When you have a study on human beings instead of rats, let me know.

I guess I have the same criticism of you that you had of me: I am baffled by the fact that you seem so invested with finding some magical thing to replace the malabsorption and  restriction components of RNY.  So much so that you are willing to accept studies in rats as completely applicable to humans when there is clearly a psychological component in humans that does not exist in rats.

I'm not going to waste any more time on this, except to say that 1) studies in rats are still studies in rats, and to deny that psychological components often contribute to obesity is ludicrous

2) it seems like you have some kind of a huge chip on your shoulder when it comes to psychology (and a misunderstanding of many aspects of it as evidenced by your claim that "people" (not sure who those people are... no one that I know of)  think depression is only caused by a chemical imbalance (and even more ridiculously that it is based on a Zoloft commercial!) -- you seem to have a lot of "all or nothing" thinking -- and that bedwetting is purely physiological (yes, in some cases it is, but in many cases it is a reaction to trauma) and your assertion that psychologists blamed bedwetting on "psychological weakness" (I guess if YOU view trauma as a psychological weakness, you might see it that way, and maybe somewhere along the line you had a bad experience with a terrible Psychologist... but no mental health professional I know would blame or shame a child who is a bed wetter.

I actually did include a study re humans that supported the other findings re energy expenditure in my post:

- Increased Postprandial Energy Expenditure May Explain Superior Long Term Weight Loss after Roux-en-Y Gastric Bypass

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjourna l.pone.0060280

And I referenced other studies in humans negating restriction and malabsorption as the primary mechanisms for RNY weight loss.

Here is yet another (from June 22, 2015 for those who believe studies are graded by their dates of publication):

- Roux-en-Y Gastric Bypass Surgery Increases Respiratory Quotient and Energy Expenditure during Food Intake

"RYGB surgery up-regulates RQ [Resting Quotient] and EE [Energy Expenditure] after food intake resulting in an increased contribution to total EE over 24h when corrected for total tissue."

http://www.ncbi.nlm.nih.gov/pubmed/26098889

I could keep posting more studies like this all night, but you have to ask yourself if any amount of evidence would convince you? Are you truly open minded or are you subconsciously defending a position you've publicly held for some time?

People interested should go back and read my earlier posts above and all the referenced studies for themselves.

I think you are just plain wrong that restriction and malabsorption play significant roles in RNY weight loss.  Malabsorption of 4% is dramatic, really?  How many people with proximal RNY have seriously fatty stool for life?  I don't feel any restriction and never did, yet I lost 100 lbs after my surgery -- why?  Why doesn't the lap band produce enormous weight loss for life (massive restriction)?  Why does a plastic sleeve that bypasses the proximal duodenum produce drastic weight loss and most of the same metabolic benefits as RNY almost from day 1, yet without any restriction whatsoever?  Why does tightening the pouch not improve weight loss or prevent regain?  These are the sorts of questions true problem solvers must challenge themselves with in order to arrive at an internally consistent view of such a system.

Just because most people believe something to be true does not make it true; likewise, just because something "feels" corrects does not mean it is.  This is the point of the concept of cognitive distortion -- one has to logically challenge these assumptions and feelings.  Top researchers long ago dismissed restriction and malabsorption as real players in RNY weight loss, even though these were the initial "intuitive" explanations.

My point of stressing the absurdity of claiming diet explains weight loss after getting treated with WLS is that recognizing this contradiction highlights the fallacy in assuming that the regain that consistently occurs about 2-3 yrs after RNY for so many must likewise be because of diet.  Diet isn't what made you lose all the weight (you've made it clear the surgery made the difference vs before), so why assume diet is the cause of the regain?  Inconsistent.

Having cited studies with sufficient power, there is one case where a study of 1 person is that most powerful study of all -- and that is when that 1 person is you!  

To this point, my wife just laughed at this whole debate after reading through it a few minutes ago.  You see, after my RNY surgery, within the first year, we were dining out frequently and enjoying pasta dinners for the first time in many years.  I wasn't gorging, but I finished my meal just like a normal person.  I ate carbs just like a normal person.  I was in harmony with food just like a normal person, and it was wonderful.  I lost 100+ lbs doing this and kept it off.  But around the year 2, I noticed I had to become increasingly strict with calories to maintain the same goal weight.  And around year 3, I realized I had to cut out virtually all carbs to maintain the same goal weight (almost back to the insanely restricted and unnatural diet I had before surgery).  But I've kept the same weight because I became a champion dieter and serious cyclist before my surgery.  The surgery changed, and it is all that changed; any argument to the contrary is so silly for someone who experienced my case firsthand like my wife (and me).  

It is like telling someone with cancer that the chemo didn't fail them and lose efficacy over time; they failed their chemo.  Why are we so quick to make callous conclusions about those with the disease of diabesity, compared with cancer?

Having argued all I have about the bulk of WLS patients, let me agree that there are absolutely cases where psychology is the primary contributor to major weight gain.  One such example is in rape or childhood molestation, where a woman might feel her added weight shields her from being viewed as sexual.  

Having noted the above, have you considered that in many of the cases (perhaps even most) where you see evidence of psychological stress over eating and food choices (unlike explicable cases as with the above), that the disease produced the psychology, rather than the other way around?  I would love for you to design a carefully blinded study to test this debate -- please let me know after you publish the results!  You simply cannot be certain you don't have it backwards at this point, though.  Part of my point of citing all the historical examples (not current as you mistook them) of where psychologists got it wrong, is that there is a pattern of jumping to the conclusion that the illness results from psychology, rather than the other way around.

Again, the study of one when that one is you:  For most of my life, before my genetic time bomb went nuclear, I was thin.  But by my late 20's, I knew I had a major problem, even though I was still thin.  I was barely eating and exercising a lot, and clearly exerting scores more self-discipline than the healthy people around me.  It got harder and harder, and my diet became stricter and stricter, but I held my ground with my weight.  Finally, ten years later my biology won out, and I started gaining.  I ended up gaining 200 lbs, and the ensuing psychological battles were terrible.  Food had finally become my nightmare; people treated me with contempt (none more so than physicians), and everyone wanted to lecture me on how to eat.  

Now I'm just amazed that what is so clear from my experience after RNY (and what happens even to lab animals), that people still want to blame regain on diet and will power.  I'm still at my goal weight, but I'm open-eyed enough and honest enough with myself to see that the surgery has partially (not mostly) worn off.  That is life, it's not all fair or what we wished for.  I'm still grateful I had the surgery, and hopefully in the next 5-10 yrs there will be weight loss pills that actually work via sound mechanisms that I can take to augment the surgery.  Then I will be able to restore the healthy relationship with food that nature intended (you eat normal portions of healthy food just when you are hungry without bizarre restrictions).  Until then, I will just have to endure this awful no-carb, restricted-calorie meal plan in order to maintain my goal weight.

As to psychologists, I actually majored in psych and have great respect for the field.  But you may want to check your history books to the 1960's, which is what I was referring to re bed wetting before you shrug off the relevance of my points thereto.  BTW, most major depression in not at all (you act like it partly is) caused by a chemical imbalance in neurotransmitters (another myth), though creating such a chemical imbalance in a targeted fashion with medicines may certainly help treat it.  I was simply trying to throw a bunch of historical examples of the exact same sort of pattern of mistaken assumptions taking on a life of their own that had yet to be undone decades after years of research had revealed otherwise.

I will end (my part in) our short yet spirited debate with something I've observed for years.  I read a lot of scientific studies and articles every day, and I don't know how many times a day I come across this description of the findings in a summary article: "Scientists used to believe [X], but now realize [Y] is actually the case."  Why people then act surprised and defensive the next time this happens is one of the great mysteries of life.

As we agree, we'll just have to agree to disagree.  

Wow, away from the computer a few days and lots to read when I get back. :) There are two separate but valid sides to this discussion.

 

I believe that Brian is exactly right in that they have no idea whey RNY works like magic. It is not simply caloric restriction or mal absorption. One of these days they will figure it out and it will be the key to non surgical weight loss. My own completely non scientific idea is that it is something the stomach is contributing, for about a year, eventually stops due to non use.

 

I also do not regret having the surgery. I understand that it will take very hard work from here on out, that is just the way it is. The thing is, prior to the surgery, I was almost never full, and now I am able to be. I have friends that are just like I was prior to the surgery and they are frustrated. But when they ask if it is something they should do, I fall back on the "that is a decision only you can make" answer. Personally I cannot imagine dieting the way I am now, with the inability to ever feel full. I was never going to the lose the weight to begin with without RNY and I will never lose it again without taking responsibility and working at it.

 

Thank you for all the encouragement. I have lost 2 more pounds since I posted this, so that brings me in at 279, each day is just little victory, but I am up for the challenge.

So how much have you regained, Brian?

I don't think the op was beating up on himself. Like many of us he admits he ate the wrong things, a lot of it & gained weight, & now he's going back to the basics & is losing weight again. How is that not being realistic? How is that "idiotic self-flagellation"?

You mention that he had a metabolic disease, how exactly do you know this? I don't remember seeing anything in his original post stating that he had this disease, on the contrary his Drs performed tests on him & said he was ok. That was what led him to believe that it wasn't a fault of the surgery, just his bad eating habits.

I think it's the continual use of denial that leads people to believe that its everything else except themselves as the reason they gain weight. Your post seems to encourage that way of thinking.

Thank you for putting this out there.  As I get closer to goal, I feel that I need to read these cautionary tales, because so far the surgery does seem like "magic," and I need to remember that it's possible to outeat the surgery.  And you've made a great start!

This is an excellent post.  I applaud you for taking an honest look at what's going on (and I belusive that you'll be successful in getting the weight back off because you know what the issues are).

We have a lot of people who come on here and complain that they have regained but that they are still eating exactly the way they have been and that they're doing what they're supposed to do... yet when people here ask them to post a coupes of days worth of menus so we can see where they might be going astray, they never respond.... or when we suggest that they measure and track their food for a couple of weeks, they just disappear.   

Your post definitely WILL help others! Thank you for sharing.

Lora

Kudos to you on trying to get the weight back off again. I'm glad you realize that it's bad eating habits that was the cause of your regain & not the surgery, sadly some people never come to realize that fact. Good Luck to you & I hope you will be successful this time around.