My Light Weight Story-

I had my RNY on March 29th, of this year. I weighed 208 and I'm 5'4" tall.

ALL of my friends and family discouraged me from having such a drastic surgery. EVERY SINGLE PERSON insisted I could lose the weight through diet alone. But I'd been over weight for 15 years, moving between Morbidly Obese and Obese, only occasionally dipping down to "over weight" and then it was with extreme effort. I knew that if diet and exercise alone was my path to health, I'd have achieved it already because I'm a pretty determined kinda girl. I'd investigated bariatric surgery a few times, but never followed through because I too thought I should "do it the healthy way" then spent another few years with my very unhealthy body weight. I promised myself that the next time I slipped into the morbidly obese range I would go in for an actual appointment at the clinic.

Comorbidity- I was diagnosed with sleep apnea in 2004, and had been using a CPAP since then. I had just started taking medication for my high blood pressure in the past year.

When I first visited the Bariatric Center, I was so relieved to discover that they didn't act like I didn't belong there. The surgeon reviewed my medical history, listened as I described a pretty physically active lifestyle and said something that changed everything for me: (paraphrased) 'Listen, with your metabolism, it's pretty clear you're making a huge effort to lose weight, otherwise you would be fifty pounds heavier than you are today. This surgery will allow you to lose your excess weight and maintain a healthy weight without extreme effort your making today just to lose another ten pounds.' WHAT???

I went to the bariatric clinic (Center of Excellence at Summa Health in Akron Ohio) in September of 2016, and completed the required per-surgery work by the end of the year. My insurance was approved on the first submission but due to a delay I didn't get scheduled for surgery until the end of March. Because I was right on the edge of being morbidly obese, I wasn't asked to lose any weight, just to record every bite of food I consumed and to be compliant with all my medications and CPAP machine (I was compliant anyway, and I'd been tracking my diet on MyFitnessPal since 2010.)

I joined ObesityHealth in January of 2017, and started following the RNY Menu boards. Honestly I was super disappointed to see how strict and restricted the posters were with their daily menus, especially the folks who were several years out. I'd thought that the malabsorbtion part of the RNY surgery would mean that I could eat more calories and not absorb them, so that I should be able to eat MORE calories after surgery to maintain my new low weight. None the less I listened and learned and did more research. When I shared sample menus from the RNY Menu board with the nutritionists (NUTS) at the bariatric clinic, they were very shocked and insisted that these veterans were eating far to few calories than they should be eating. I knew that the truth was probably less academic and that the sample size of active veterans is small here on OH so I shouldn't weight their antidotal experiences too high. Part of the reason for this disconnect between what I expected to see, and what I am seeing is due to my status as being a light-weight WLS patient. If I'd been maintaining my weight at 300 lbs on a 1500 calorie diet, the shift in caloric needs at 150lbs would be less than what I would experience having maintained at 1500 calories with a body of 200 ish pounds.

Rate of weight loss as a light weight- First big lesson, everyone loses at a different rate. The bigger a person is, in general, the faster that first fifty pounds will come off. I had set more physical fitness goals than weight goals, and this meant I was ramping up my physical exercise starting the first couple of weeks after my surgery. Building muscle requires more protein than just trying to slow muscle loss... muscle weighs a lot more than fat so losing fifty pounds of fat can be masked when you gain ten or fifteen pounds of muscle. All of this is to explain that while I have wanted to lose faster than I am, I've made choices that will make my weight loss slower. I'm eating far more calories than most on the RNY menu board - usually between 700 and 1000 per day, verses the standard 450/day for the weight loss phase. At my current rate of loss, given that it tapers the farther out one gets, and the closer one gets to goal weight, I am likely to take an entire year to lose the ninety pounds I'd like to lose, and it will take at lest a full seven months to reach my surgeon's goal of 63 lbs loss (I'm 8 lbs away from that today). There are folks on the OH boards who are SMO and lose 60 lbs in the first couple of months! But that's not generally how it works for us light weights...

Protein needs for light weights- Your body can not manufacture protein out of body fat. As you "starve" your body of incoming calories, you need to continue to provide it with sources of protein to allow it to function. You will literally NOT HEAL from surgery if you don't consume protein. All the EAT MORE PROTEIN messages are real and need to be followed! None the less, some of us need more dietary protein than others, and frankly, as light weights, we REALLY need more than a SMO patient. If we look at ambulatory weight loss patients, the heaver the patient the MORE muscle mass they will start with because it takes a whole lot of muscle to move 300 or 400 lbs of weight around a grocery store! As extremely heavy patients lose body fat, they no longer need this extra muscle to move their lighter body about, so unless they are actively working to maintain the same muscle to though weight bearing exercise, the body will begin to lose muscle mass as their weight drops. This no longer needed muscle is re-purposed by the body as needed. For us lightweights, we don't have this same ratio of muscle so there is less available for our body to raid as we restrict our intake post surgery. We need to make sure we are eating plenty of easily metabolized protein to supply what is needed to be healthy. If we combine our weight loss with increased exercise we have to add even MORE protein into our diet to allow the building blocks for repairing our worked muscles, and also to build new muscle. Good quality protein will have associated calories, and thus this one reason I'm eating higher calories. I am trying to get much of my protein from "real" foods, like meat, eggs, dairy, but to make the numbers I need I'm also incorporating whey isolate protein in the form of powders and ready to drink (RTD) protein shakes.

Food addictions - Many of us lightweights think we don't have the same disordered eating as those who start at much higher weights. This could be true for some, but I know that the sudden, dramatic drop in caloric intake that happens as we adjust to our new stomach capacity exposed far more food issues than I ever realized I had! Most recovering obese folks will talk about their addiction to carbohydrates. I knew I loved bread, but I hadn't realized how intense my relationship with all things starch was until I had my surgery. I try to keep my daily intake of carbs around 25g, and I get very worried when I go over 50g in a day. I try to keep sugar under 15g. Things I didn't expect to crave: All things potato, pan pizza crust, warm from the oven biscuits, brown rice, quinoa, rye toast, sour dough bread bowls, root veggies, fresh fruit... the list goes on!

I have friends who have lost the same amount of weight that I've lost, over the same time period, through diet and exercise alone. I've lost a lot of weight through diet and exercise alone. The difference for me, is that as a relative light weight, this time it's for ever. I'm losing weight, feeling GREAT, no longer fighting physical hunger every single day, and I'm able to focus on building a sustainable life style that I will love to live for the rest of my life.

I wish I'd done this back in 2005 when I first considered the possibility!

The best advice my surgeon gave me was to go ten, twenty or even thirty under the goal that he set for me. That is to allow for the bounceback regain that happens when malabsorption goes away.

I looked too skinny for a while, but was shocked when regain happened during year three. I never looked too skinny after that.

I have found that my lifetime maintenance calories are about 9 to 10 calories a day per pound that I maintain. So at 150 pounds your lifetime might be 1500.

This is really helpful, thanks for sharing! Question - as a lightweight, why did you choose RNY instead of VGS?

I chose the RNY for two reasons:

1. I felt like simply "eating less" was never a major challenge for me, that for the past 7 - 10 years I had been doing a reasonably good job with portion control, that it was far more about my metabolism shifting ever downward. I was MO (at 205 - 208) and eating far less than I ever had eaten in my life. Not ENOUGH less to lose the weight, but far less than we were taught to think of MO people's diets. I was living with a friend who is six foot tall and exercises only occasionally, and she eats easily over 2000 calories a day - she's rail thin. I know that's just a fluke but even she would comment on how unfair life can be (as she ate her third slice of pan pizza).
2. The RNY generally shows a lower rate of regain. I wanted to go with the science and do what would give me the greatest advantage regain. It also provides a slight advantage in metabolism shift - which may give me a higher calorie level in maintenance. Even when my body adapts to the shorter intestine, there should be some net "gain" (as in lost calories) over the sleeve.

I'm packing up the apt I shared with my thin friend - and I'm just horrified at the food I am pulling out of "her" cupboard space. I generally tried to avert my eyes when digging through my side looking for that elusive can of black beans, but her side was chuck full of partially eaten treats like boxes of rice krispy treats, chocolate and brown sugar pop-tarts, cookies, raman noodles, packages of flavored instant rice, Mac&Cheese... Literally a highly processed carbohydrate junk yard! My side? Cans of beans, lentils, whole wheat pasta, sprouted grain flour, brown rice, sprouted grain oat meal, cans of tuna, salmon, sardines (which I hate but occasionally eat for the nutrients), dehydrated powders to add to recipes like cheddar cheese powder, peanut butter, spinach, milk, whey... The most processed stuff I had was canned soups and sauces like salsa, curry, and spaghetti. I'm no saint of course, but it was still kinda blatant as I cleaned out all the junk, how radically different we ate. Same with the freezer - my side things like chicken thighs, ground venison, ground chicken, whole veggies like spinach and green beans. Her side was processed foods like buffalo chicken balls, taquitos, loaded potato skins, mac&cheese bites, ice cream sandwiches... She loved it when I cooked dinner, which I did a lot, and she loved to eat healthier whole foods, but that wasn't what she would cook for herself, or purchase.

We're both fifty and had recently left decades old marriages, so sharing the cost of an apt was a great help, plus we worked in the same office building so we could save even more by car-pooling! I loved living with her and now that we're both moving on to new cities and new jobs I'm really missing her companionship but there were things like this food stuff that drove home how DIFFERENT our various metabolisms really are. The first time she had her kids over to our apt, I made lasagna - she was confused as to why I was browning ground beef. Turns out "making lasagna" to her meant baking the frozen Stoffer's version (I love that stuff too - not going to lie, but when she asked if I could make lasagna for her kids it didn't occur to me to buy a pre-made frozen one!) I am pretty confident she wasn't vomiting any food as the few times she had a stomach bug she was pretty dramatic and even called her mom to come over because she was throwing up.

Anyway - that's a LONG WAY OF explaining why I chose the RNY, but I'm happy that I did ;)

Congratulations on your success!