Anyone experience genuinely unexplained weight regain?

Dear Colleagues, I have a patient who is 2 years post op. She had transected Roux en Y. Her beginning weight was 341. She lost exactly 100 pounds. In the last 6 months she has gained 45 pounds. We met at length to discuss the unsatisfactory initial weight loss and then to discuss the regain. The patient is quite frantic. She is a well spoken, well educated and presumably well balanced woman. According to the patient there is no way she is consuming enough calories in a day to have had an initial unsatisfactory loss and the consequent weight gain. She has been scoped and it has been verified that her surgery remains intact with no excessive stretching of the pouch or fistula. We advised her to keep a food diary of everything that she ate or drank including water and even chewing gum. There is no reason to believe this patient would be less than honest. She presents with a genuine desire to follow a healthy nutrition program. She exercises approximately 2 hours per day. She is blind (the result of a brain aneurysm at age 15) and participates in the swim team for 2 hours per day - 2 days a week in practice. The other days she does recumbent bike, arm bike, treadmill and weights. Her trainer has substantiated her exercise regimen. The patient has low protein levels in spite of supplementing 60 grams of protein per day - Occasionally she will supplement 100 grams per day during heaving swim training. This equals a maximum of 600 calories a day in protein supplementation. A typical day's meal would be: 1 Apple for breakfast 1/2 turkey sandwich on pita bread with fat free cheese - no mayo or condiments Protein bar for break - 145 calories Dinner - 1 apple or orange This makes her total daily calorie intake around 1300 or less - certainly no more. She is also experiencing swollen ankles, excessive thirstiness (though her sugars are currently in the normal range) an enlarged heart (no course of treatment however) and PCOS. Realizing the amount of exercise the patient participates in it would facilitate heavier muscle mass - there is no way this patient should weigh almost 300 pounds. Speaking as a Roux en Y patient myself, and also as the coordinator of a large program - I am keenly aware that there are times when patients are not honest about their food consumption. However, it seems that it would not be completely unreasonable to believe that a select few patients could do all the right things and still not experience adequate loss and even experience weight gain - possibly due to other underlying health factors. Oddly - after meeting with the above referenced patient I had another patient call me today with almost identical complaints and health symptoms. Out of well over 2000 patients I have only had these two credible patients present with these complications and frustrations. Any input, direction or advice is tremendously appreciated. Wishing you all a healthy and prosperous New Year, Rona

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