Regain after hitting goal,

I want to explore the topic of why if people are going to regain, they start to do so within the first year after hitting goal.  This was a statement made by Dr. Cirangle.  I know that he is currently in the process of putting the data together for the long term study and he must be looking at the statistics.  Here are my thought on why this might be happening and I would love to hear your thoughts.  I think when we are losing weight, we are on a high emotionally.  We become addicted to the scale successes, the compliments on our achievement, and the the ever changing clothes sizes.  We are focused on our mission to reach goal as an end all in itself.  We push ourselves to our limit to achieve the zenith we are striving to ascend.  Then we take a little while to stand on top of the mountain, beat our chests (figuratively) and declare mission accomplished.  As time passes, we no longer have the emotional highs under our wings that brought us to this peak.  Friends stop commenting, clothes fit just fine, the scale stops moving.  We are left to deal with the collapse of the grandiose emotions we experienced during our losing phase.  Like a great souffle (please excuse the simile), our ego's begin to deflate.  This never feels good, as a matter of fact, compared to our earlier emotional state this feels rather unnerving and uncomfortable.  What do food addicts do when we feel uncomfortable, we eat.  The weight gain begins, we feel ashamed, hopeless, depressed about it and punish ourselves with more food.  The food, like any other drug, relieves the pain for a short time, but we feel worse later, the cycle is now complete.  So my question is this, besides understanding the cycle, where is the best place to intervene.  I believe that the best place is actually in the very beginning, the losing phase.  I think that if we are able to enjoy and celebrate the weight loss milestones but keep the perspective that the ultimate goal is the learning of new eating behaviors, developing a new relationship with food and learning how to deal with setbacks when they happen, we would eliminate the psychological high that sets us up for the eventual lows.  That is my take on it.  What do you all think?

I think that it would be hard to boil the reason(s) for the regain down to one thing. I think it's many different factors, although loss of having the highs of weight loss may be a part of it. I honestly think that for many though, that this is due to a mixture of physical and emotional factors.

I know for me the factors that got me fat were both emotional and physical. The VSG is very effective at helping me with one piece of the puzzle.. portion sizes, but does little to nothing for the emotional eating and the quality of my food.

The smaller you get, the smaller the amount of calories you need to sustain yourself, so regain may be happening because at about that point the difference between how many calories a body needs, and how many can be comfortably taken in is very small.

So for example, let's talk in terms of calories. Pre-op I was probably taking in somewhere in the neighborhood of 4-5000 calories a day. The larger I got, the more calories I was able to take in with a stabilized weight, so let's say that I burned somewhere around 4000 a day hypothetically.

If I have a small surplus of calories I will gain slowly over time. So if I take in 4200 cals a day but burn 4000, my weight gain would be very slow with only 200 extra calories a day. A common way of calculating your calorie expenditure (rough estimate) is 10-12 (multiply by higher numbers if you are more active, and lower numbers if you are less active) times your current body weight.

So I would have been burning 3800-4580 approx. each day if we use this rough formula. Now say I get an operation and at first I can only eat 500 calories a day. Since my body is still burning ~4000 calories a day because of my high weight, my deficit each day is 3500 calories equaling about a pound a day loss.

Now say I lose down to 250 pounds.. at that point using the same formula I would be burning approximately 2500 calories a day. Now let's say I am further out and I can eat more so I eat 1200 calories a day. Now my deficit each day would be about 1300 which would mean I only lose a pound approx. every 3 days.

Now say I weigh 150 pounds, and burn 1500 calories a day, but have gradually started eating more and now eat 1800 calories a day. Now I have a surplus again and I will start gaining. This is just looking at the issue from a caloric point of view, but there is also the quality of food that you eat, and I think for people who are further out it becomes harder to stick to avoiding carbs, because maybe earlier on they didn't have to restrict much, or they are a food addict or what have you.

So I think the regain comes from too many calories and the wrong foods, perhaps because the relationship with food was not completely changed. The VSG doesn't change our relationship with food automatically for everyone.. some people still have a lot of behaviors to change. I really think the behavioral changes ALONG with the operation is what makes for long term success, plus support, accepting and acknowledging what needs to be changed, etc.

I worry about the people who do not stay grounded and think that they don't need to deal with this stuff now, because they might find further out that just the VSG alone does not do it all and that they will be worse off then if they were a bit more conservative and tried harder to work their tool earlier on. I'm sure that's not the case for everyone, but for many I think that is the case.

I agree with your math, and I think that ultimately we gain when we eat more calories but many of us can keep it together to get to goal and then things fall apart.  Do you think there is a common reason why things fall apart at that particular time, or are the differences in people so great that no common thread can be teased out of it.  I suspect the answer is both physical and psychological.  Why can so many people maintain the calorie deficit to lose, but not to maintain?  What is changed?  Is is just the longer time period, or is it the lack of purpose and internal as well as external reinforcement that causes us to fail? 

All good thoughts.  When I first started researching, I went through every post on this board back to the first one.  With every one that started "HELP, I AM x OUT AND HAVE GAINED x" I copied and pasted it, and I copied and pasted their "why". This was one time I really wanted to take someone's word for the danger, and wanted to not HAVE to touch the stove to know it was hot.

A common theme was that some folks that  just got caught up in being normies and when life squeezed them, they did not have a plan for what to do then - so they went back to what they know.  How

Like how easy it is to turn back to hold habits, drinking, face picking, fingernail biting, smoking, et cetera.

I lost that document in one of my computer crashes but had printed it out - I tucked it away in a safe place :} (you know what that means) but I will try and remember what safe place that was and seif I can scan it!

Wow, Branilynn, it's funny you should say this.  I did the same thing when I was looking into VSG, only I looked for all the positive posts to see what made them succeed.  I think it makes a great deal of sense to look at the less than stellar performance posts to also find the commonalities.  I think you are right, a great deal of it comes form forgetting who we are, (not were) and believing that we are now normal.  After all, just how normal is it to cut out most of your stomach for ****s and giggles.  None of us are "normal" if we got to the point that WLS was the only option.  I cringe a little whenever I read a post on the VSG board saying something like, " I did this surgery so that I could eat normally".  I think we have to redefine a new "normal" for us as individuals and stick to it for life, with adjustments as needed. 

I think that the motivation is stronger when the scale is moving faster as the scale provides positive reinforcement. That reinforcement comes less and less often the further out you get, because of the calorie math I used above.

When you get to goal, maybe some people don't get that positive reinforcement or good feelings, so they turn to food to make them feel good again? Or they think they can get away with more, or deserve a reward or think they can catch themselves if they gain a bit too much and lose again.

I think it's important not to become complacent with maintenance just as many people say that their "naturally" thin friends keep an eye on things too. The psychological reinforcement of numbers on the scale is HUGE.

This is why I love my BodyBugg because it also gives me a huge psychological reinforcement in numbers of calories burned each day and seeing an actual goal that I can realistically complete each day. But I can imagine that later further out without seeing the numbers on the scale and other reinforcements it can seem burdensome to always stay on top of it.

What I always found hard about losing weight to a certain point is I would just lose momentum since I had to do so many things and spend so much time and energy on it. All of the calorie counting, meal planning, support groups, time spent on the scale, weight charting, body fat testing, measurements, vitamin taking, regular gym trips, etc.

It's exhausting to keep up and who wants to live like that? Especially when you have other things effecting you like the death of a loved one.. all of that time and energy will crumble and good habits will crumble.

This is one of the reasons I love to simplify things as much as possible. For example cooking once a day in a batch for the day, using a tried-and-true recipe that I know the calorie/carb counts for and that is easy to make. A routine at the gym that is easy and enjoyable, and just basically habits that are easily maintainable.

I can tell you when I lost weight in the past, I also white-knuckled it and I spent so much time on it that it became very difficult to manage and maintain. I can totally understand why people would get to goal and feel like they deserve to stop all the charting, weighing, measuring and all of the time consuming burdensome things that go along with the weight loss phase.

But I think it is those things that keep us on track and accountable, and to some degree I think we need to do these things for life.. how much depends on the person. For example your method is simple.. weigh every day and deal with any fluctuations immediately. That to me is an easy recipe for success.

I just love this post ...love love love love it ...I can totally understand what your saying .  Had the lap-band 4 years ago lost 105 lb , gained 20 back  now at 223 ....about to get sleeved next month.At this point I have totally let loosing weight consume most of my aldult life ...Hell who am I kidding ..ALL of my aldult life and most of my childhood.  What will it feel like to be thin and not worry about what I put in my mouth?  I think that kind of thinking is also what gets most in trouble once they hit goal.

Elina I think you are on to something. Maintaining at normal weight is just not as exciting as the weight loss phase and sooner or later real life sets in. Plus, in the earlier phases we can eat so little and many of us had virtually no interest in food for some months or more. And it was easy to follow Dr.'s instructions exactly during weight loss phase because they were so specific. The insturctions for maintenance are a little more amorphous as we are all different in our long term nutritional needs.

  So maybe we need to make some maintenance milestones and make as big a deal about them as we do our weight loss milestones. Lets think about doing that on this group. Start posting when you have remained within 3 lbs of your goal for six months. This way we can keep some of that peer support and pressure working for us.

One of the things I discussed with the shrink in my psych consult is that I was worried I was getting this surgery because I was sort of bored and needed a project. I always seem to need a project or a mission or some goal i am working toward. He said "what happens when you finish this project" and i said "then I will find another project".  So I am now trying to make maintenance my "project" though I have other ones going on as maintenance as a project is sort of like having breathing as a project. It just has to be. Fortunately my weight loss has enabled other projects as my martial arts stuff and doing more and better art. But I am going to start thinking of maintenance as a project in 6 month increments and maybe see Dr. C at those times as part of it or at least check in with dietician.

Today there was a birthday party at the studio and i was offered a piece of birthday cake and without even thinking i turned it down. It was automatic - didn't think about it. But later I wondered if a year or two or three from now I will be so automatic about declining unhealthy items. Hope so.   Diane

Diane you are right on the money.  I love the idea of celebrating together our maintenance milestones.  We should brainstorm how best to do this and honor each other for reaching them.  That would help keep the motivation alive.  I love this group.

I am almost a year out and I can already see how easy it would be to become complacent with my diet. For one thing, I can eat more and more often than earlier out. I also experience hunger periodically now (wake up hungry sometimes, for instance). But i still have really good restriction, it's just that my sleeve empties faster.

I also think that people don't continue to set goals. Their ultimate goal was reached, then they focus on something other than their body. I have fitness goals which keeps my diet in line or I know I will never reach those goals. And they are goals that never end and can take a lifetime to achieve (building muscle).

Also I think the further out we get, the more foods we allow back into our diets. I know I will eat anything now, whereas before I had some foods that I would avoid. I need to keep in mind that there are still foods that I need to avoid and that just because I can eat them doesn't mean I should eat them.

And not to sound insulting, but I think if people spent more time researching and studying nutrition, they would make better choices and have a healthier relationship with food..in most cases. But the reality is that most of us are also food addicts who used food to cope, and it's very easy to fall back on that. Old habits die hard.