Thursday, 11/14/2019

Weight: 141.6
Veggies/Fruits: 3
Macronutrients: 2,179 cals, 215 carbs, 82 fats, 124 proteins, 17 fiber
Sleep: 7'44" (says my Fitbit - thanks to two Tylenol PMs I took because I was tired of being tired)
Exercise: 5,088 steps and 18 active minutes, which is what happens when I drive 4 hours in one day

Those trips to The Big City are not conducive to exercise or eating cleanly. C'est la vie.

My Year Five follow-up visit yesterday with the bariatric nurse practitioner (whom I respect a lot) earned me high marks again, even though my weight was up 4 pounds from 2 years ago and up 7 pounds from last year. BTW, it turns out that I was reading my blood test results incorrectly, and all is good on the blood work front, so no changes are needed in supplementation going forward, and that's good news.

She did urge me to go back to the pool three times a week, especially since my "good knee" has been pinging me lately.

She had some other long-term sleeve outcomes that she shared with me from her bariatric practice's overall patient base, specifically that the majority of their WLS patients are regaining quite a bit of weight post-surgery (she means half of all excess weight lost and more). Understandably, she's having trouble getting them to come back for follow-up visits. Of the patients she does see for follow-ups, she says that the weight gain she sees is primarily due to:

(a) grazing between meals,

(b) continuing reliance on fast food (drive-throughs are a daily food source for many Americans)

(c) not remaining physically active long-term, although many patients start out post-op quite gung ho,

(d) drinking liquid calories, i.e., sugary sodas, high-calorie coffee drinks, sweet tea, etc.

So there you have it. Simply put, the majority of their post-op bariatric patients are NOT changing their lifestyles. At all. To me that means it's not good news on the bariatric surgery front. And given how marketplaces work, I predict that soon another class of "obesity solutions" will appear. I predict it will be fecal / gut hormone transplants.

In the meantime, here we are doing our dead level best to do our dead level best. And for the record, I don't think we're a typical cohort of WLS patients. From Devon who exercises like a beast to all the sporadic or regular My Fitness Pal'ing we do to the ways we use this board and other tools to support each other in so many ways tells me we're fighting the good fight and fighting it well.

Since today is almost over (today was another crazy-busy day that started early), I'm offering no daily theme--just thanks to each of you for being here and supporting me.

(a) grazing between meals,

(b) continuing reliance on fast food (drive-throughs are a daily food source for many Americans)

(c) not remaining physically active long-term, although many patients start out post-op quite gung ho,

(d) drinking liquid calories, i.e., sugary sodas, high-calorie coffee drinks, sweet tea, etc.

I believe I have c and d down pat. I get a fair amount of exercise (about 180-200 minutes per week of "vigorous" exercise). I've never been a regular soda, sweet tea or sweet coffee drinker. My liquid calories are an occasional sip of Ron's coffee concoctions or one of his milkshakes.

Now... a and b are huge problems for me. I am a grazer in the afternoon. However, I know from past experience I am also FINE with a meal in the afternoon after work. My grazing lately has revolved around sugar items, too, which is not good. (I define lately as "consistently over the past year or two"). Not good because as a self labeled sugar addict for lack of a better description, once the sugar is ingested the flood gates open demanding more and more until the glucose and hormone levels are raised significantly to satisfactory levels.

Reliance on fast food is sadly a larger part of my life than I would like to admit here or anywhere. My definition of fast food is probably much broader than most people's. In fast food I include all restaurant prepared meals, packaged meals from the grocery store, and other non whole foods prepared by someone other than myself. I know this is not most people's idea of fast food, but for me convenience is a huge factor in eating because my life is fairly loaded with work and dogs and my attempts to focus on self care. (Right now self care is making sure I get those 180-200 minutes of exercise in each week and going to my twice monthly therapy sessions.)

As an example of an average busy day, yesterday I taught a regular school day, held 3 parent teacher conferences after school (one of which had to be rescheduled to a later time, pushing back arriving home by 30 minutes), got home did a few chores, went to the gym, came home fed the dogs, and then Ron and I went to the store to get a few things we needed in the house. By the time we were done with shopping it was 8:45. Didn't feel much like cooking, so we stopped and got a chicken dinner and brought it home. FAST FOOD. Probably way higher in fat than I would make, higher in sugar, etc...

Sugar, grazing and foods of convenience are the triumvirate of my disordered eating.

Ann, I am so grateful that you posted your NP's conclusions. I enjoyed working through the thoughts your post triggered in me. The timing is really quite perfect!

I'm so glad my post was helpful to you, Devon.

My problem is definitely a). Especially at night. But I was doing well for a couple of weeks before all the company arrived. This week my eating has not been great with a lot of snacky food in the house.

Company is a tough situation for me too, Liz.

I am pretty good at cleaning out the house. But when I supplement the larders with "company foods" I suck at resisting them.

I think that will be my next big eating project--actually RESISTING temptation. Removing temptation is one thing. Resisting temptation is a whole other thing.

I only know 2 people IRL who had bariatric surgery. I may know others, but like me, they never made that info available to the world at large. Anyhow, the 2 I do know, one had a bypass about 8 years ago. He has some regain, but still is much leaner than before surgery. Another had a sleeve 3 years ago. She was somebody who I discussed my surgery with, in keeping with my promise to support other obese people if they asked me. She did great the first 6 months, then her forward trajectory stopped, and the regain started. I don't know if she is any better off than before in terms of any health measures. She did tell me she has started working with a trainer once a week, which seems very positive. Obesity is one tenacious disease.

I hope the fecal implant hormonal treatments etc do turn out to have efficacy. I am always so grateful for my surgery, that there was a treatment to help me. Maybe there will be multiple layers of treatments for a multi faceted disease.

"... multiple layers of treatment for a multi faceted disease."

Yes!

For sure, one of the biggest *other* treatments I've had access to in combination with WLS is my therapist, whom I've been seeing regularly now for almost six years. Although I have no actual data about this, I'd wager that the great, great majority of my bariatric surgeon's patients do NOT have access to ongoing therapy.

And yes ... if gut hormones were proving efficacious, I'd get in line, too.

A.

Hmmm, gut hormones and fecal transplants. If that becomes a true thing then some people will go around eating $---.

Ann I think you are right about therapy and/or support being important to success in wls. Your nurse practitioner should add that to list. This group is a group therapy project for us all.

In just a few days I will be 10 years out from wls. I have about 30 lbs regain from my ideal but am still down by more than twice that. The last couple of years have been kind of hard on the eating but life has been kind of hard. Still have no explanation for the fact that I was not at all hungry for the first few years. DS