Discussion: Maintainance

I was told that the BMI chart does not account for extra muscle. Like A personel trainer  probable has extra muscle from working out more. 

Debra, I think this is a great post and a concern all of us have, regain.  I'm 2 years, almost 2 months post op and I everyday worry about regain.  I am up from my lowest of 119 lbs, today I weigh 126.5 lbs.  My surgeon's goal was 130 lbs (I'm 5'1") my goal is 125 lbs so I'm over my goal and I've been stressing about it.  I just had plastic surgery and OMG my weight climbed to 138 lbs, this about caused me to have a stroke, even though I know it's from swelling it has been unbearable.  It brought about lots of fear. I am still pretty diligent most of the days in what I eat, however, when PMS is here I really struggle.  I'm a boredom eater so I try my best to stay busy, or you guessed it......I'm grazing like it'll be my last day of eating. I think we must always remember where we came from and I'm also a firm believer in weighing, even though I don't always like what the scale shows (especially if I'm doing extra well in my choices), I concer the scale a tool just like my pouch is a tool.  If I use that tool (scale) to monitor my progress then I SHOULD be able to stay in control 95% of the time. I do believe that therapy is necessary for some of us, there is a reason the majority of us self-medicate with food.....it's a deep reason that we cannot always find without help.  I strongly recommend therapy to those that are struggling right now.....I sometimes feel the need for therapy myself, there are things I can't deal with myself......unfortunatly my insurance doesn't pay for therapy and right now financially I cannot afford it.  I'm trying to self-help myself and in the near future my insurance is changing, I do pray then I'll have the option of an experienced therapist to deal with my life issues. Just remember, the tool is that, a tool; we have to use the tool but also relearn healthy eating, I feel some people don't optimize the tool in the honeymoon stage as it should be used.  Getting back to basics will help but it takes allot of work the further out we are.  I sympathize with those that have regained and I am scared to death as most started the regain where I'm at now.  Seeing 126 lbs isn't good for me.....but it definitely makes me aware of what I put in my mouth.

Hi Debra.. I am 2 years 4 months out.. I have always been very very diligent with what I eat/drink.. I stopped all sugars 2 months before surgery and never went back and I have never to this day ever tried anything with sugar in it. I know its my weakness there for I stay away!!! I never made it to goal, I am 30-40lbs away. I really beat myself up about this, I weigh every single morning. I have not gained any weight but never got to goal.  Recently I found that my hiatal hernia had returned and in a big way, causing a lot of problems. Surgeon sent me in for tests and found my pouch, even for 2+ years out is way to big.  This is not the same surgeon who did my original surgery,(funny I have 2 friends who went to him and never made it to goal either). This is the surgeon who did my husbands WLS so he knows what he's talking about.  He has recommended when he repairs my hernia that we do a revision. I have agreed and my insurance has approved it.  I am scheduled for 6/6/07. I think when we dont make it to goal we need to make sure there is nothing wrong so we are not defeating ourselves and giving up.  I also believe that 5lbs gained is 5lbs to much.. 5 leads to 10 to 20.. which is why I get on the scale everyday.  If I see scale movement in the wrong direction, I increase my water and do an all liquid day and for me that usually takes care of it.  I am very active and do all kinds of activities so excersize is not a problem for me.  As we get farther and farther out I believe we start to relax in what we are eating and we need to be even more diligent than we were in the early days.. I am sure there's not much here that really helps.. but wanted to share my experience.. because frankly I would cry all the time wondering why I never made it to goal.. I guess my hernia coming back was a blessing in disguise :) Good luck Debby

Hi Deb,  I too am a CORI alumni. I had my surgery by Dr. Wood 8/19/03 I am almost 4yrs post-op. I am post-op TT since 2/05 with Dr. DiNick. I lost the last of my weight after my tt. I know you are a couple of years behind me, but when I went to CORI they offered NO pre- or post-op nutirtion counceling, We were falsely lead to believe this was permanent, that there had never been a revision on a micro pouch..... (I personally know a few). well I beg to differ. Very sad but true. Don't get me wrong, I loved my surgeon, I picked him after much research, I wanted the best if I was going to go thru this life altering process. But I was sold on my surgeon and not on the program (CORI). CORI was not a good program, I never went back after my 6mo. check up that was such a feasco(sp). I lived 2hrs. away, and the last time I went I waited 31/2 hrs and I seen him for literally 2min. I was very upset to say the least!!! Well now that CORI is no longer. I have an appointment with Dr. Wood for next month. Hopefully I will get to the bottom of some of my issues. I have posted about some of them already so I won't bore everyone with the details again.  Well, I guess it is time to face your questions, to be totally honest, I was angry when I first begun to read it. You said or did NOTHING WRONG!  You where honest and you asked thought provoking questions that I do appreciate, I just came from a board that where many are at your stage of the journey or less and Things are still honky dorey, Those of us that are struggling are being slammed and looked at as weak. Instead of support we where getting that holier then thou attitude. I know many that won't even post to the board anymore because of it. Sad but true, we are here for support. That is why I was so glad to find this board, I finally found others who are struggling many for different reasons, as well as physical problem. Sometimes we feel like we are the only ones dealing with these problems, but we are not. Well back to your questions....LOL.  1. I didn't gain until after I was in the hospital the last time with my "mystery pain" which was last august. After I was discharged from the hospital I gained 20 lbs with in 1 mo. I was up 20lbs at my check up, then I have gained another 14lbs since the end of the year. I am trying to figure out how and why I am gaining. I wasn't exercising very consistantly for some time, I thought that must be it, Sooo I kicked it up, well no change. I still am exercising. So then I looked to my eating. Well, I do my best to eat healthy EVERY meal. I never eat sugar ie, cake, desserts made with sugar etc. I am not saying I am perfect. I just never tested those waters. I HATE to throw up!!!! I also figured out a few years ago that I have an allergy to wheat, so that helps to keep me on the straight and narrow in the dessert food department. I eat protien, fruit and veggies as my main eating. I get in my fiber ie. oatmeat w/ flax seed and fiber sure. Everyday I take many vitamins and suppliments ( a handful 2x a day)....LOL. Well a recent post had brought a thought to me that I hadn't thought of. I do eat rice and potatoes, not a ton but I do everyday.  She called them bad carbs, I hadn't thought of them as bad carbs, I guess when I think of "bad carbs" I think of junk food....lol, but I am probably wrong. In the beginning of my journey I didn't eat any of those. when I was close to my goal I intoduce them back. I was figuring that since I was in the maintance part of my journey, I could enjoy them again, just as long as I didn't eat them as I did pre-op, well I don't. I watch the protion size. Heck, preop I would eat 3/4 of a plate would be potatoes and with a tiny piece of meat or no meat at all. Needless to say I was a carbaholic!!! Maybe I will never be able to eat them, but on rare occations. We will see. I have noticed if I like something to much, even if it's healthy I will over endulge, not in one setting, but I will eat it until I realize that it is becoming a problem. When I have to go to the store JUST because I may be out of that Item, then I know it's a problem and I refuse to buy anymore.ie. I found a wheat free/ sf chocolate chip cookie that I loved, I could see if I continued to buy them It would be a big problem and that was long before I gained any weight!! Go figure....LOL.  When I recognize things I am doing wrong I try to correct them, but sometimes" we don't see the forest beyond the trees! " I thought as long as I eat healthy everything else would be okay.....WRONG! 2.Then the next thing I had to look at was my sleeping habits. I was averaging 2-4hrs a night. I HATE TO SLEEP weird huh?I have recently found out that a lack of sleep will cause anyone to gain weight. I am not sure exacty why, but it does make since.  I have real issues in that part of my life that I think, no I know I need to deal with. They seem to be getting worse lately. I have to conciously take 3 tylenol pm to get to sleep, I have to be sooo drousey before I will even go to bed. Sometime I will fall asleep with my computer in my lap. It's a miracle I haven't dropped it. 3. I am sure this one is my big problem, but until I figure out how to fix problem 2. I am not going to be able to fix this one. I night eat! There I said it! I don't eat bad thing but I am still eating very late. Why, To stay awake....yes....stupid huh! I guess I am a freaking nut case....LOL. In the beginning of my journey it didn't matter because, I had to eat 6-8x a day. I would save much of that for night eating. 4. My surgeon never gave me a goal, but I set my personal goal for 135. I made it to 140, then I went back to 143-145 that is where my body seem most comfortable. I was happy with that. I looked good. I felt great! At least until I started with the mystery pain that comes an goes. I haven't had a problem with it since last aug. which is a blessing. Sadly I am at 174. I can barely fit into my jeans anymore. I refuse to buy any bigger!!! So unless I want to where these until they fall apart I better figure out what is going on. 5. I do feel like I am able eat sooo much more then I should be able to, but nothing like I could eat pre op, but more then early out.  I do drink after meals. To be honest I kinda forgot about the waiting. I guess I have become complacent.  Writing this I am wondering to myself, why have I let it get this far. I thought if I where eating right that everything else would be okay, but I am seeing that it takes soooo much more. I had been so busy trying to defend my eating that I didn't see some of the other things I am doing wrong. I guess the sad part of all of this is I am a support group leader!!! Lousy leader huh? Well I hope I can get this figured out, cause I don't know how I can continue to lead others when I am not a very good example anymore. Thanks for bringing this to us. IT IS TIME TO PAY THE PIPER.

Debra, I "get" what you're saying.  I used to ask the SAME thing but in terms of how does anyone ever get FAT in the first place?  *ahem*   I mean -- I always lost weight as soon as I gained a few pounds.  I have been thin for the majority of my life.  Being raised in an environment with VANITY as such a huge factor, I simply couldn't comprehend how someone could let it get *that* far.  *ahem*    Well -- one day I woke up and was 252 pounds!!  *ahem* I want to add a slightly different perspective to this post because weighing on the scale seems to be the premier way to monitor "goal."  I don't weigh myself at all anymore.  Truthfully, it's not healthy for me.  I don't have realistic numbers in my mind.  I do know how much I weigh because I am weighed at the doctor's office.  At one point, I had lost too much weight and stopped weighing because I was plain scared and didn't want to know how far down I was dipping AND because another side of me *wanted* those low numbers.  The truth is that at those low numbers (the lowest I know is 128), I looked HORRID.  I was way too thin!  In my mind, I want to weigh 120 BUT I'm not 20 years old anymore and I am 5'5".  I've had three 9 pound babies blah blah blah.  My husband fusses all the time that I am too thin.  My doctors want me to gain weight but I am comfortable here and I have purchased a lot of nice clothes!  So, how do I maintain my weight if I'm not weighing?  First, I can FEEL it.  Secondly, my clothes start talking to me.  I can start to FEEL it at 5 lb and my clothes start talking to me at 10 lb.  I know this because I WAS weighing and keeping *track*.  When I feel it, I try to start to do something about it right away but I don't always succeed but then my clothes start talking to me and I pull back.  That's the ultimate warning for me.  Also, my weight fluctuates 10 pounds during the month (it has been that way ever since I can remember) so I can really make myself crazy if I'm focused on the numbers and trying to stay within say 5 pounds.  I think we should also ask, what is "goal?"  When I went for my 6 month follow-up, realizing that I didn't have a "goal" from my doctor, I asked him, "What is my goal?"  He answered, "What is your goal?  Well, you're no longer hypertensive, your blood work is fantastic, you are the picture of perfect health, and you look fantastic! I say you've reached goal!"  At that time, I weighed 168 pounds.   Finally, perhaps we should consult what is considered the successful bariatric patient's weight loss?  If I recall correctly, it's losing and keeping off 50-75% of the excess weight.  I had 100 pounds to lose (going in at 237) so I could be maintaining a 50 pound weight loss at 2+ years out which would have me weighing 183 pounds and be considered successful!  Therefore, a lot of post-ops who consider that they have never reached "goal" are actually considered a success within the medical field of Bariatrics.   I hope this helps!

WOW.  All I can say is wow.  Well, no, I can (and probably will) say alot more. Thank you all so, so much.  This discussion is exactly what I was hoping for, I send a hug to all of you.  I think you've understood that I am not finger pointing (thanks, Toni, I've followed your posts on the Michigan board for years, and thought you have been extremely supportive to members there).  I am just trying to understand the how and why of regain. If one never reaches a realistic goal while following all the rules, I think it is a good idea to find out if there is a medical reason, such as the pouch being too big or stomal stretching.  The question of what is goal is also a valid one.  My surgeon wouldn't give me a number, and the one weight I chose for myself was simply to have a normal BMI.  I realize this is a totally arbitrary number, but it was one that made sense to me.  How would I know where my natural setpoint weight is?  I am still asking myself that. For some reason, I couldn't be satisfied with the medical profession's definition of success, 70-80% of excess weight loss.  I didn't want to always feel I needed to lose some more weight.  I feel I have been one of the fortunate ones to have lost so much weight.  Please note that I am not saying I am a better person, or better patient, I am just lucky.  When I read how hard so many of you work to lose your weight and can't, it makes me wonder, why me? I feel like a newbie all over again.  A newbie at maintainance.  I figure it's like being a WLS grad, I will have to maintain at least a year before I can even begin to think I know anything about maintainance. I appreciate all of the thoughful comments I have read thus far on my post. Debra M.

Debra, I feel like you FORTUNATE, LUCKY whatever we might call it to lose 100% of my excess weight.  It wasn't terribly hard for me to lose the weight, and I sympathize with those that have had to struggle just getting out of the gate.  It's definitely a metabolism issue for the majority I think. I also believe the size of our pouches and stoma play into the equation.  I often wonder about the mechanics of ones surgery initally when they find themselves eating larger than typical amounts and never feeling full.  That is one thing the bariatric community doesn't go into enough detail about.  We can infact follow the program to a T but if the mechanics aren't working then by golly we won't have a chance in hell to reach a goal.  There are also cookie cutter surgeons that perform the same exact procedure on everyone.  Depending on the amount of weight needed to be lost, the amount bypassed will help.  For example, I had 130 lbs to lose.  My surgeon did an 80cm proximal bypass on me with a 1/2 oz pouch, it worked.  Say a 400 lb. person had the same bypass, a person with more weight to lose would benefit with a different amount bypassed.  Malabsorption plays a roll especially early out. First things first, when someone finds the weight coming back on and they are following a good program then I hope they insist on being scoped to determine how the pouch is working.  There are 3 factors I always ask:  Is the stoma stretched, were you transected, how much were you bypassed?   I know I'm babbling here, but I feel everyone needs to know that many regain through no fault of their on.....the surgery can fail you.  You can bet though, most surgeons will not tell you this.......as with any other weight gain we've experienced in life.....it's always our fault *sigh*. Ok, I'm off my soapbox, I hope I made a little sense with this post.

I think this discussion has been interesting, thank you.  But it also begs to ask:

WHAT IS GOAL?

Is it the number on a scale [and we know how that goes, my scale, the doctor's scale, naked first thing in the a.m., after a b.m. LOL]?

Is it a size of clothes [once again, am I a 10 in regular or an 11 in Juniors?]?

I think for many of us, goal was getting years back of our lives, getting off meds and rid of conditions that made us SICK, living life again as a participant instead as a spectator.

But how to measure?

My WLS didn't give me a goal weight, he said he expected me to lose 'about a hundred pounds' [I have lost 155 to date].  My PCP considered me a success when I was off the CPAP, off B/P meds and my diabetes was in remission.  I, quite frankly, was thrilled to fit into my pre-pregnancy jeans.  But, sure, I still have a number I'd like to see on the scale.  And imagine what sizes I may wear some day.  I am not at my goal yet, and what does that mean?

We all need a goal, " the end toward which effort is directed."  To help give us direction, to have something to work for, but should it be the point where we measure success? Probably not.

Is there a WLS patient out there who doesn't worry about getting to goal, or about regain? 

Have we looked at the numbers and gone from seeing our success to seeing failure?

Yes, for me having a goal to work for has made me work harder, but just as important, if not more, I make the effort to remind myself every day that regardless, I am a success.  If I never reach goal, if I never wear a size 7, I am a success and I deserve good things.  I think as long as we continue to TRY and never give up, we are all successful.  And sometimes, when one loses sight of this, one can forget that we deserve good things.  Eating well, exercise, never giving up - that IS being good to ourselves!

JMHO.

Debra, what a fantastic discussion.  I don't usually post on the grads board, but I read all the time.  This one inspired me to add my two cents worth.   Personally, I am nearly 3 years post-op.  It took me 13 months, but I reached my goal of 140 pounds and maintained it for a year.  Now, I have gained about 5 pounds and I am NOT happy about it.   This is what I know about myself: 1.  My eating has not changed.  I have weighed and measured my food since day one.  I average about 1400 calories per day.  Sometime more, sometimes less. 2.  I don't exercise anymore.  I am a full-time student and mother.  I would have to get up at 4:oo in the morning to fit it into my schedule and I am not going to do that.  My choice. This is what I know about the WLS:  After about 2 years, the villa and microvilla of the intestine (this is where nutrient absorption occurs) grow back.  Not all that was removed, but the body is trying to recover from trauma and malnutrition.  It thinks something is wrong with it and is trying to fix it.   This is what I know about nutrition: 1.  Not all carbs are equal (i.e. BAD).  The brain and nervous system cannot use any other food source for fuel.  They MUST run on glucose (carbs break down into glucose).  When there is not enough carbs in the diet, the body uses protein to make glucose.  This is what causes us to lose lean muscle tissue.  When it becomes dangerous to continue using protein, it turns to the fat stores and converts fat into ketone bodies.  The brain and nervous system can use that as a fuel supply in times of starvation.  We go into ketosis and lose weight, some of it lean tissue and some of it fat.  Sounds like a dream come true, right?  Unfortunately, after being in ketosis for a while, the body slow metabolism down!!  And we don't lose weight as fast anymore. 2.  So, we really need a certain amount of carbohydrates in the diet, a minimum of 150 grams per day to fuel the brain and nervous system.  Preferably, about 300 grams.  That amount will actually HELP with weight loss.  I think that maybe those who don't reach goal are not eating ENOUGH total calories or ENOUGH carbs!! So, even though I am not really eating anymore than I have for the last year, my body is now able to absorb more of what I am eating.  And I am no longer walking 3 miles per day, like I did for the first 2 years.   I am not happy about my 5 pound weight gain, but I am monitoring my diet and will start walking again as soon as this semester is over in May.  Then I know I WILL lose those 5 pounds.  However, I still consider myself I success!!  I no longer have high BP, I no longer have chronic pain in my knees and lower back, and I no longer fear that I will get diabetes.  I don't take 10 prescription medications in the morning and evening.  I am healthy, happy, and able to sit on the floor without help getting up.   XOXOXO, Sharyn

Hi Sharyn,  Thank you for the information. I can't say it wasn't a bit shocking. Something so different then what I was told when I had surgery. When I had surgery my dr. had us follow the Atkins diet. We were on 20 gram of Carbs for a Loooong time. I think I ate that way for at least a yr. Now I would say I eat about 150 or so. You mentioned that all carbs are not created equal, but you never elabarated. I do know that there are good and bad carbs, but I guess I always though any carb that was natural i.e. veggies, fruit, potatoes, and rice would be okay, at least at maintanence. I guess I was  WRONG!!!  It is probably more then just the potatoes and rice that are a problem. As I mentioned in my last post, This discussion has given me a lot to think about, and face many of my demons. Eating well is not the only answer. From what I am reading from others, our only true salvation is going to be exercise....GRRRR....LOL. I will be doing some research. It is just so difficult. One dr. or nutritionist will tell you one thing and then the next 3  each will tell you something totally different. It truely can be frustrating. Thanks for posting and the info, it is very interesting.