Barry W

I agree. We still need to do what we should do. But we shouldn't take results for granted, and to some extent, should be willing to take what our body's will give us - that's the way that I think about it - I try to learn all that I can and to make sure that I do my part in terms of getting sensible regular exercise, eating right, watching the scale like a hawk and counting calories when need be, but I am not overly invested in a particular result, because I know that I can't completely control things.

Hi folks - I am passing along an article from the NY Times science column which is reporting on a long term study of the contestant's of the reality TV show "The Biggest Loser". What has been found is that most people regained their weight. More interesting though, was the monitoring of their metabolism (which slowed significantly) and hunger hormones (which increased significantly) across the six years of the study. While this explains a lot, frankly it is a little daunting too, for someone who wants to achieve and maintain a large weight loss long term. After I thought on it for a little while though, I think it's much better to know what is happening, so you can strategize against these effects. For me, for example, this means monitoring my weight daily (whether I like the news or not, in fact - more important if the news isn't all good, to be aware of my status). To be mindful of what I am eating, even if it's much less than before, and, if I stop losing weight or gain some weight, to return to keeping a food/calorie diary. See: http://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html

Just putting in a plug for Viactiv Calcium Plus Vitamin D chocolates. They aren't as good as good chocolates, but as a vitamin or mineral supplement goes, they are actually pretty tasty. Sugar is pretty low at 3g per chew, and coadministration of 500IU Vitamin D with 500mg of calcium should provide good uptake. This product also contains 40 micrograms of Vitamin K, which they say promotes formation of bone Proteins and cite scientific articles from a prestigious source (Proceedings of the National Academy of Sciences) to back that up. It seems to be a quality product and is inexpensive compared to some alternatives as well - only about $12 per 100 count. They sell chocolate and caramel flavors - I have the milk chocolate, and rather than choking them down, kind of need to watch myself or I will keep eating them... P.S. Oops, looks like I misspelled the name - it's Viactiv

Thanks guys for your comments...

I think there are a lot of unanswered questions still. I did find this review article from 2013. A review article is not the results of a study - instead, they take an expert in the field and ask them to look across everything that is known at that point in time and to summarize it in one report. Review articles tend therefore to be more reliable than a single study. It's not right up to date, but it's fairly current. "Nutrition Care for Patients with Weight Regain after Bariatric Surgery", Carlene Johnson Stoklossa and Suneet Atwal, Gastroenterology Research and Practice, Volume 2013 (2013), Article ID 256145, 7 pages. http://www.hindawi.com/journals/grp/2013/256145/ If you read section 1.3 (Energy Requirements), you will see that they are reporting reductions in resting metabolic rate beyond what can be expected from weight loss alone, in patients having bariatric surgery.

Hi LondonHawke - on the metabolism side of things, I don't think we escape the slowdown - when you look at two factors: Weight loss rates gradually slow, and total weight loss tends to level off with time, at roughly 60% of excess weight lost, on average Patients eat a good deal less than would be expected for a person of their age, sex, height and weight I actually asked the guy who became my surgeon this exact question in one of the pre-surgery group info sessions - is the metabolism permanently slowed, given the above, and does that explain why people stop losing, and why they need to continue eating so little? He didn't really answer - not sure if he didn't know, or if he thought I wouldn't like the answer. I understand that as our weight drops the calories required to operate our body at rest should drop to match the actual calories we consume, but the article seemed to indicate that the TBL contests actually had a change in that their bodies metabolic resting rate was lower than the norm of an individual of the same size ie. their body lowered the resting rate in an attempt to help itself adjust back to its programmed weight. It seems to imply that even if they kept up their rigorous exercise routine they would have regained weight or had to increase the exercise level in order to maintain. My question is that TBL contests would technically have the same amount of grehlin in their body regardless of their existing weight, we don't our chemistry has been altered so will or do we suffer the same consequence. That's correct - metabolism slows during weight loss - this is well established - the body is trying to preserve your weight at your previous equilibrium point. What's new here is just how big the shifts were, and how long they lasted - for these people at least, they appear to be permanent, having lasted 6 years. The subjects had their resting metabolic rates measured repeatedly over the study, and they declined steadily - and yes, far more than the weight loss would be predicted to cause. Now, these people in the study had extremely rapid weight loss, of a very large amount, so bariatric patients won't necessarily be in the same position quantitatively - in fact most bariatric patients maintain most of the weight loss they achieve. However, I am almost certain that the same forces are occurring in us at some level though. That's why weight loss is slowing down over time and levels off normally. As a man of 56 at 6 feet tall and my current weight of 241 pounds with light activity, I should be able to eat 2300 calories per day and maintain weight, according to the calorie calculator at Mayo Clinic: http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/calorie-calculator/itt-20084939 ...I can't do that though, and yes, these calculators used to agree very well with my experience. Ghrelin affects hunger, but not metabolism. There is a whole suite of hormones producing the sensation of hunger, because that's critical for survival. The writeup mentions leptin, which causes you to feel satisfied - this declined in the study subjects.

Yep, what @@Christinamo7 said - eggs any style, a slice of whole grain toast with lite butter - Fiber enriched or Protein enriched breads are better. Whole grain/low sugar cereals with organic 1% milk. Low sugar oatmeal - fiber enriched or protein enriched are better. Fresh fruit. Lowfat/low sugar yogurt - greek yogurt a bit better. Some people seem to like homemade yogurt and fruit smoothies.

It sounds like some of the difficulties that you are having go beyond what most people are experiencing at 4 weeks - a teaspoon of tuna bringing pain and vomiting; being exhausted and thirsty all the time... and that would bum me out too. I would call the surgical team and describe your troubles and see if they can advise you over the phone or want you to come in.

@@jenn1 - thanks for sharing your experiences. I don't think they necessarily contradict the results of this study. I think each person's physiology will be different, and also each person's lifestyle choices will be different. Would you be willing to share what you average in calories per day? And what a typical week looks like for physical activity? Your ability to reach the healthy weight and sustain it over a long period is an inspiration to me as it shows that it is possible. :-)

Hi LondonHawke - on the metabolism side of things, I don't think we escape the slowdown - when you look at two factors: Weight loss rates gradually slow, and total weight loss tends to level off with time, at roughly 60% of excess weight lost, on average Patients eat a good deal less than would be expected for a person of their age, sex, height and weight I actually asked the guy who became my surgeon this exact question in one of the pre-surgery group info sessions - is the metabolism permanently slowed, given the above, and does that explain why people stop losing, and why they need to continue eating so little? He didn't really answer - not sure if he didn't know, or if he thought I wouldn't like the answer.

Awesome job - keep up the good work!

"Head hunger" is discussed a lot here, and while I am sure it exists, I am also sure that genuine hunger exists, and that it's very difficult to know what someone else is experiencing. Certainly, most of us are eating very little, so we have a sound physiological reason to be hungry. I realize that stomach-produced ghrelin is supposed to be reduced with the sleeve, but grehlin is not solely produced in the stomach, and there are other hunger hormones as well. I suppose at some level, one can say that it doesn't matter where it stems from - the brain or the body - you can't change what you feel, and denying it won't alter that We do have our goals though and so focusing on them can give us determination to ignore or distract ourselves from a sensation of hunger. I usually find that if I just ignore the feeling of hunger, or distract myself with thinking about something else or doing something to occupy me, it usually passes.... and I don't spend time thinking about yummy, calorie rich foods - that's a sure ticket to cravings for me.

I had frequent debilitating nausea after eating or drinking for three weeks post op. My doctor prescribed an anti nausea med as well as a pill that kept my stomach from cramping after I ate. They were prescribed to be taken as needed and worked like a charm. It was at about 3.5 months that I could finally stop the pills. Talk to your surgeon. As far as the potion sizes. I am still at 1/3 - 1/2 cup at most meals. My doctor and NP told me that this would be my forever norm. For me, this is my healthy portion, I just need to eat a little more frequently. Were you not warned of the same? The info I was given to kick off the "maintenance" phase, says about 1 cup to 1&1/4 cup portion size.

I think that keeping a food diary in real time - as you eat/drink things, and including calories, is a great way to raise your mindfullness of what you are taking in.

P.S. Perhaps I should have said that you then will be proudly, productively and profusely performing pooping in a perfectly normal process - about the most p-consonance I can come up with

To reduce fatigue, make sure you get your Vitamins - whether it's with liquid vitamins, chewable, or Patches. I think it helps to use a Protein shake made as a Meal Replacement shake too, which should have about 1/3 of the RDA of all vitamins and minerals - I know that SlimFast High Protein/Advanced Nutrition have that, but they are not the only ones. Some Protein shakes are basically just Protein though. It's also important to stay hydrated.

Thanks for sharing that. I am using the patch MD multivitamin patch, and haven't hit my followup labs yet, but have been feeling pretty good. My nutritionist wasn't keen on them, as she said "we don't have a lot of data on how they perform yet".. well that is one datapoint right there.

I am about 8 weeks post-op, and I will say that on the negative side, I never used to have discomfort or nausea after eating, and though it's not severe, I do experience something negative pretty frequently, and wish my sleeve had the capacity to eat healthy portions, not kiddie portions. However, before I lost 55lb, my joints were bothering me going down stairs, I labored around and breathed heavily after very little exertion. I had some early markers of diabetes. Overall, I feel much better now and look better as well, and I accept the tradeoff as worthwhile.

You are a star! Congratulations, con-con.

I propose that if you procure Miralax powder and take as directed, you will be pooping profusely pretty darned quick

Years ago there was a study that showed that coffee caused dehydration, and these results are often cited by nutritionists and doctors to this day. However, this was a small study, and numerous studies since then, have found no such association. Here is one recent study that found no link for moderate habitual coffee drinkers: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886980/

For me I think that was roughly 3-4 weeks. At first I didn't even like to lay on my side. Then lying on my side became okay first, then short periods of laying on my belly and finally I didn't feel discomfort.

I am using the patch MD Multivitamin and the Bariatric Advantage caramel Calcium/Vitamin D chews. I have also been using a Protein shake with a full complement of Vitamins and minerals, and eating a variety of fruits and veggies. So hard to tell what is doing it, but I haven't felt that fatigue many people complain about.

In the mirror, I tend to think I look better than I do *lol* - am so used to seeing myself in the mirror with a huge pot belly and bloated face, that now I think I look pretty in-shape... then I was walking down a city street and caught a look at myself reflected in a plate glass window and was surprised to still see a pretty big guy there! Mentally though, I focus on the positive changes. I don't expect my body to look like it did at 25, and at 56, my face and hair aren't going to roll all the way back to age 25 either - not realistic. But, I look *much* better now than I did 4 months ago, and I move around a lot better than I used to, much lighter on my feet. I have dropped one medication already. Still a good ways to go yet before I reach my goals, but this has been *big* progress.

I had a little bit if itchiness. Don't scratch your incisions though, until months after surgery - the scar tissue will be very weak after the bandages come off and is easily broken, and you don't want to risk infection. Did your program not give you instructions for the post-operative diet?