NickelChip

It sounds like your resources are limited for getting support in your local area, so I wanted to recommend looking into the Pound of Cure nutrition program, which is run by Dr. Weiner in Tucson, AZ (he also has a couple books and YouTube channel with bariatric educational information). It's $49 a month and allows you to attend unlimited online support groups with their dietician and peer leaders, as well as a few sessions per month that are run by Dr. Weiner. I've subscribed for a while and go to at least a few of the groups per month as my schedule permits. Many times there will just be a few people in the group and you can really get a chance to ask your questions and get some good advice. Just for example, there's a group for the first year post-op, for emotional eating and stress management, and even one for surviving the holidays and travel. They've been in this business for many years and I'm betting they could think of dozens of patients who felt exactly how you do right now but went on to be successful.

Honestly, your food pictures all look pretty healthy, so no notes there. I would watch out for any mindless snacking, just in case you have fallen back into a habit of popping a handful of nuts when you walk past your pantry (guilty!) or adding a lot of cream to your coffee. You know, the type of thing your brain may not even be registering. I had a friend who thought his coffee was fine because he didn't put sweetener in it, but he put a ton of half and half, along the lines of a full cup per day, or an extra 300 calories he forgot about! But other than that, plateaus are normal. I am approaching 9 months post-op and for the past 6 weeks, I have been bouncing up and down by about 2 lbs but never dropping lower than the lowest weight I hit in early October. From everything I've heard and read, it's part of the process and is pretty common the closer you get to a normal weight and the farther out you are from surgery. There are a few things you might try, though. First, increase your protein so you are at 80-100 grams instead of the minimum 60. Try to make that from real food and not a shake. You might also increase your non-starchy veggie intake, which will provide more fiber. Add in another 32oz of water each day. Go to bed an hour earlier if you can. It's counterintuitive, but increase your calories by 100 and cut back on your exercise a little to see what happens. Sometimes, your body starts to conserve too much energy because it fears starvation and giving it a little more while asking it to do a little less breaks that cycle. Also, the fact that you fit into clothing at 195 lbs that your family members wore at 30 lbs lighter suggests that some of your weight is not fat but "infrastructure." When we get very heavy, our body grows more bone and muscle to hold it, and bigger organs to carry out their functions on a larger scale. When we lose weight in a hurry, all that architecture remains in place for quite some time, adding to the number on the scale. You may look now like you did at 10, 20, or even 30 pounds lighter back in the days before you ever became obese. If you have some old photos of a time when you were the goal weight you have in mind now, try doing a side by side comparison. You might already look really close to where you are trying to be even if the scale says otherwise.

Just because you are allowed to eat anything does not mean you, personally, are able to do so. There are a few likely culprits to your issues with discomfort and vomiting. You may be eating too much, too fast, not chewing enough even though you think you are, or the food you are eating is too difficult for your system to handle right now. Check your portion sizes, how fast you are eating, and focus on soft foods. You may need longer between eating and drinking. Some people can handle 10-15 minutes. Some need 30 minutes. If I feel a stuck feeling even an hour after eating, I do not drink anything because it will make me sick. I had enough issues with vomiting that my doctor put me back on liquids at around 4 weeks and I did that a couple weeks just to give my body more time to heal. Even almost 9 months out from RNY, I sometimes get sick. It's usually texture/dryness related. It's gone from once a week to just once in a while, and instead of all the food coming up, it's usually just mucous now. I try to pay attention to why so I can adjust. Basically, you need to listen to your body and make changes based on what is working and not working for you because we're all different.

It is on the DS board, but it also shows up on the recent topics list, which everyone sees without knowing which board it is on, so that's why you are getting responses from people with other surgeries. Although, since the switch includes the creation of a sleeve as one half of the procedure, those answers are probably closest to what you should expect capacity-wise, with bypass experiences being maybe a little different.

So, there's a normal meal and then there's what you get in a restaurant or what we've been taught to think is a normal meal. At about 8 months out, I can eat a full serving of chicken breast. That's defined as being between 3-4 oz. And in the same sitting, I can also eat a serving of broccoli, which is about 1 cup. I don't tend to eat grains often, but if someone gave me a serving of brown rice, which is 1/2 cup cooked, along with the chicken and the broccoli, I could probably eat about half of that on a good day, but not touch it on a day when I have a smaller appetite. Personally, I would be more likely to substitute a second veg or a fruit. What I've just listed would be considered a "standard" meal by a nutrition expert. It has about 280 calories and 24 g protein, and provides balanced nutrition from several food groups, along with fiber. But most people would probably think it was way too small, and if you went to a restaurant, you would get 4x that much food, plus half a gallon of fat and sugar laden sauce on top. And probably cheese, just for good measure. Could I eat that? No. And hopefully I will never be able to. A sandwich is tricky because of bread. I find bread too filling. I was out this weekend at a sports stadium and had to order my lunch from a food truck. I chose the grilled chicken pita wrap and ate all of the insides but treated the pita like a plate that got thrown away at the end. I do the same with a soup and half sandwich combo from a restaurant, eating the sandwich filling and the soup but ditching the bread.

The answer to that question is it is different for everyone. It depends on how your metabolism responded to the surgery, how much exercise you get, your body composition (fat compared to muscle), and even what kinds of foods you eat. Some people must maintain at a lower than average caloric intake while others can eat much closer to a "normal" amount and do just fine. It's very much a trial and error process to find what works for you, and you may need to make adjustments as time goes on, too.

As others have said, absolutely not. Fruit, veg, and lean protein is essential to good health. I had protein shakes for the two weeks before surgery to shrink my liver, and for the first few weeks after as my insides healed. I would never want to rely on them beyond that. I can't even imagine how horrible and unfulfilling that would be. I've continued to have maybe one shake a day as a supplement when it's difficult to hit my protein goals. Tonight I'm having a protein hot chocolate from Premier Protein because it's chilly outside and a nice treat. But mostly I eat real, minimally processed foods. It's important to remember that supplements and vitamins and minerals are only able to provide the nutrients we know about, the ones scientists have discovered are directly responsible for diseases and disorders if you don't get them. But there are countless thousands of compounds in natural foods that we need and that are absent from shakes and supplements because they haven't been studied. The only way to get that is to eat a wide variety of real whole foods.

Taking care of your mental health doesn't have to cost money. You can talk openly with trusted friends or family about your body image issues and low self-esteem. Or you can post here in this forum where you will find hundreds of people who share a lived experience of navigating the world in larger bodies. You can heck self-help books out of the library. Or buy a notebook from the dollar store and start journaling about your thoughts. You can meditate with the help of free YouTube videos. Or listen to relevant podcasts. You can find free sources of help if it's important to you and you want to make a change. Then again, I don't know you, so I could be completely misreading the situation. You can ignore this advice if you think I'm wrong, or if you just don't think anything I've suggested is worth trying. But after reading your original post, I thought it was important to say that if you can't immediately reverse your weight gain, it doesn't mean your life can't be really good.

Chewing for 22 times or 22 seconds is fine. But then wait at least that long between swallowing and taking the next bite. That's how you make your meal last 20-30 minutes. Very small bites, lots of chewing, and pausing between bites to let your fullness signals have a chance to catch up. It's hard to explain how small your bites will need to be after surgery to remain comfortable and not make yourself sick early on. After surgery, I bought a set of cocktail forks and demitasse spoons. They are tiny, like something you would use for a doll. For the first three months, I ate with those. My bites were the size of a pea. Picture your golf ball size meal. Mentally cut it into 20 pieces. Or literally get yourself a 3 oz meatball and actually divide it into 20 pieces. Right now, you don't have any restriction, so it will feel crazy to do this, but after surgery, you can consume one piece per minute and you will most likely feel great. Faster and you risk feeling bad, at least for the first many months. I just made the mistake of eating about 1/2 cup of raw baby carrots too quickly because I was distracted by work, and I am filled with regret. And belly pain. I feel like I've gorged myself on Thanksgiving turkey and all the trimmings and gotten it stuck halfway down my throat. I now get to reflect for the next few hours about why that was a bad idea to not slow down. It's a learning process, even well after surgery.

Hooray! 199 absolutely should be celebrated!

You definitely have a serious issue, but I don't think it's your weight. Your weight isn't going to kill you, at least not at the size you are right now, but your mental health might. And it certainly is robbing you of the joy in life that you deserve to experience. That's tragic. And unfortunately, surgery or weight loss isn't a cure. Gaining weight can take a toll, both mentally and physically. I understand, because I went from 5'6" and 127 lbs at age 16 to weighing 225 lbs by age 32 and hitting 250 lbs by 49. I tried many diets. I exercised. I worked with a dietician for about 7 years and tried many medications, including Saxenda and Wegovy. I developed high blood pressure and became prediabetic. For 33 years, I gained weight, lost a bit for a while, and kept gaining more. But I also lived a fairly happy life. I got married, bought a house, had two children, started a career I enjoyed, traveled to lots of places I had always wanted to see, learned new hobbies, spent time with friends and loved ones. Was I frustrated that I had to buy clothing in the plus department? Yes. Did I sometimes look in the mirror and feel sad at how I looked? Absolutely. But that wasn't my identity and it didn't dictate what I allowed myself to do or experience. Feeling like your life is destroyed, that life is a cruel joke, and reaching a point where you do not wish to continue living is an extreme and unhealthy reaction to gaining weight. It's a huge red flag that something else is going on with your mental health. That, in my opinion, is way more pressing to take care of right now than reducing the size of your body. I had surgery because I knew it was what I needed for my health. It would clear up physical issues and help me live a longer life with more activity and less pain. I did it because I loved myself and I knew I deserved to get every ounce of joy from life that I could. But a year ago, 80 lbs heavier than now, I loved myself exactly as much as I do today. I don't love myself any more now because I'm thinner, even though I do love how I look. And I love myself now way more than I probably did when I was downright skinny in my youth. There's no magic number on the scale that makes you worth loving. You're worth that at every size, shape, and age. I'm not saying to give up on losing weight or on getting weight loss surgery. If it's important to you, you can find a way. There are some amazing and affordable self-pay surgery options available in Mexico, for example. You could start saving a little bit of money each month now if it feels worth it to you. I hope this won't happen, but if you continue to gain weight, you will eventually qualify for surgery through your health care. In the US, it's at a 35 BMI with comorbidities and at a 40 BMI based on obesity alone. I assume the standards in Canada are similar. But no matter what you do, I would encourage you to find help with your mental health and self-image. You deserve to be happy with who you are and not to have how you feel about yourself be based primarily on something as arbitrary as a number on the scale or the tag inside your jeans.

Okay, first, once you have the surgery you will not physically be able to eat that fast without throwing up and/or being miserable with pain. So you'll learn real quick to slow down when the time comes. Trust me. In the meantime, here is what you do to practice and start training yourself. First, if you can, make a commitment to only eat from a real plate while sitting at an actual table for the next two weeks. No eating standing up in the kitchen with two minutes to go before you have to leave or grabbing a handful of something from the pantry as you walk past. Second, get yourself a timer. It can be a kitchen one, or one of those little sand ones that go for a minute, or just the timer on your phone. Whatever works. When you sit down to eat, take a small bite of food. This means something about the size of your thumbnail, or even half that size. Set the timer for one minute. Put your fork and knife down. Chew. Keep chewing. Chew more than you have ever chewed before in your life. Your food will be like paste. You should feel no lumps in your mouth. At this point, swallow. If there is time left on your timer, sit and wait. Only when the timer goes off do you pick up the fork for another bite. Before you take that bite, ask yourself if you feel like you need another bite. Presurgery, your answer is probably going to be yes. But post surgery, this is a point where you might start to think wait, I feel pretty satisfied. This is when you want to stop eating, because with a limited capacity, you will fill up really fast and might overshoot and feel ill. If that's all you do, you will be fine. If you want to be more mindful, ask yourself some questions as you eat. Maybe ask what you like about this food and think about that. Think about the texture and taste. Think about how your body is responding to eating. Do you feel tense? Are you relaxed? Are you feeling any emotions as you start eating, and do those emotions shift as you eat? Use some of your time between bites to write down some observations. You don't really have to do all of that, but on the other hand, you might be surprised by what you learn if you do. Also, I will say that I struggled a lot with this presurgery but the slow eating is second nature now. When I forget, I don't feel well, so I have a lot of incentive to slow down. You will too! Just do what you can to practice now so your nutritionist is happy with your progress. I will almost guarantee if you keep a notebook for the next week or two with what you ate and when, how long it took from start to finish, and some reflections on the food and how your body was feeling while you ate, you will pass with flying colors.

I think you're looking very healthy! Glad your numbers are looking good and I hope your energy will start to improve as your body adjusts to maintenance. Also, I think it's funny how different we all are in size vs weight. I'm an inch taller and 10 lbs lower than you and I am still mostly in a size 14!

Can you explain what you have to do to "pass" mindful eating? What is the nutritionist going to do to determine if you pass? This will definitely help in figuring out how to get you to the next step.

Yeah, I usually use spinach along with frozen fruit. I don't notice the spinach much and it's a nice way to get in some veg.