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That was sweet of her, I hope you guys kept in touch. I mean even if my bf doesn't say anything, I ask him things like if this changed or is that is noticeable, ect. I've already landed myself back in the hospital once due to critically low potassium and the symptoms I had were obvious. So now I'm trying to be more aware so I can spot signs earlier. But yeah I do have to keep in mind that it could seem rude to say something without me bringing it up first. I just saw my therapist and after I said I had surgery, she said I could tell by your collarbones (its a televisit so the view is just to mid shoulder). You're so right about the body dysmorphia! I'm trying to find a balance between: not being obsessive about how much or quickly I'm losing and remembering to appreciate even the smallest change. I've never really taken pics or measurements even prior to surgery, but I did buy this body fat scale I saw another bariatric patient suggest. I am taking the information with a grain of salt, but it is satisfying to see the numbers trend downwards. Aside from that, it is strange to have to tighten my shorts and be able to wear shirts that are a size smaller. I don't want to celebrate too early then hit a stall/weight gain and spiral. But the idea of being able to wear that one dress that's been sitting in my closet?? Talk about a dream come true! Did you go out and strut when you got to that point?

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It's nice to see I'm not the only one Nepenthe44 to break down the science for them and yes that when you do they view it as noncompliance and being difficult. I've even had it suggested that if there's not enough time in my day - wake up and drink a few sips during the night. Science states we as humans require uninterrupted sleep more than those few sips of water. So Nepenthe44 I hate to agree because there will be those that say they really do care, but I do, what people fail to remember is the dieticians are doing a job, one most likely they've never personally experienced for themselves; being a bariatric patient vs. nutritional counseling for bariatric patients having never experienced bariatric struggles. I finally suggested the next time she had the stomach flu and was nauseated and exhausted - wanting to vomit picking up a glass and start drinking water and to make sure to get her 80 grams +- of protein in and getting down 60+ ounces of water, she finally "understood." What is a requirement on paper doesn't always equate to what actually works for people much less a bariatric patient. Its all theory. A body is set up that when you need water lo and behold you feel thirsty! I realize the nutritional requirements for the human body per weight/sex are all fairly similar but the comparisons/suggestions for likes/wants vs needs on food replacements isn't even close E.g. heart of palm noodles vs Thai noodles - in NO way are they taste comparable. So to suggest when I say I miss Thai noodles - heart of palm noodles as a replacement is absurd. That's like suggesting when I say I want a hamburger to replace it with a 3oz of fish - not equal! I didn't say "I miss protein"! They don't understand the struggle and since its their job, not a family member or a true friend they really don't "care." Lastly, I realize they are trying to help and its their job to help me achieve my goals in a healthy way (for those who are thinking this as they read this), but in reality they don't really have a personal investment in my success. I do as they suggest, for the most part, but I also decide what goals are obtainable realistically and which aren't based on consumption quantity vs. time in my day vs. work schedule vs. my employers needs.

I did the 4 wk liver shrinking, it wasn’t a problem for me. I couldn’t eat anything just my protein drinks 800 cal. Some Bariatric Drs don’t do 4 wks just 1 to 2 wks I did 4 weeks befor and 2 wks after

I'm so glad you got to see this even though it is annoying to wait for a leak test post op! It really is amazing how quickly the stomach can empty of fluids. I expect for those with the bypass it is even faster because of the lack of a pyloric valve to slow things down. It is such an outdated "rule" that so many people (and doctors and dieticians) push without realizing the science doesn't really back it up. It is one of the downsides to there not being a standard set of rules from a governing body of bariatrics that actually has to use science to back up what they advise!

I'm glad you are feeling better!! Learning to eat slow is definitely a challenge. I still catch myself sometimes. I get food bored too so I try to eat a variety of things. I don't usually weigh out my food, but I do portion it out/estimate the portion and log it to make sure my macros are on target. It is crucial for DS patients to get enough protein in and if you aren't tracking it you might not be getting enough. It'll eventually show in your labs, but once your protein level drops in labs it is a huge pain to get back up. So it is best to just track it... You don't have to be as exact as weighing, but a good estimation is worthwhile and will also teach you how to understand what correct bariatric portions are for you. My surgeon likes his patients to stay in ketosis for a while so I aim for 120 grams of protein, less than 50 total carbs (usually less than 40 total carbs for me to be safe), and I aim for about 100 grams of fat for good brain health. I don't eat at specific times. That's too much planning. LOL I drink a protein shake as soon as I wake up, then eat a meal about an hour later, and eat every 3 hours after that until I go to bed! I usually end up eating about 5 times a day. I ascribe to the "eat less more often" method and so does my surgeon. I discovered soon after surgery that I need to eat within 3 hours, anything past that and I start to feel exhausted and have no energy and get moody. I feel my best if I eat within 3 hours of my last meal throughout the day... Sometimes eating is a protein snack like a bag of protein chips and a few pickles. Sometimes eating is more meal-like like keto chicken tenders with steamed asparagus. But I always eat by that mark or I pay for it. I also pay for it if I don't get enough fluids in a day, so I watch that. Monitoring your food and water can feel triggering for some people due to past diet attempts. But it is important to reframe it as a caretaking behavior as much as possible, especially for DS patients because our dietary needs are so important to be on target with.

I recommend Dr Matthew Weiner (pound of cure) as an excellent source of all information bariatric. He has videos, podcasts, website, instagram & books. He’s been doing a few podcasts on GLP-1 meds lately you may find interesting. Dr John Pilcher is also a great source of straight forward factual information. John Pilcher: https://m.youtube.com/channel/UCA4do-4YA82-BMYBp-WRwVA Matthew Weiner: https://www.poundofcureweightloss.com/ (podcasts can be found via menu) https://m.youtube.com/user/DrMatthewWeiner/videos

Hi there!! Thanks for sharing your experience! I will let you know that mounjaro does make my reflux worse!! because it slows down my digestion. It also causes constipation in some people. But if you don’t have these issues it’s good! I have not had it yet but I’m going to get vsg. However I do wish I could get the SADI but my insurance won’t cover that one. I have heard people do so well with the weight loss and reversing diabetes. It’s just expensive without insurance. But would if I had the financial freedom! Bypass is also very successful too! Check out some podcasts like “the skinny truth” or check out Dr. Roller’s instagram. I listen to “Core Bariatrics” and “The Bariatric Grind”! They’re good listens in the car and super informative. Of course following your trusted surgeon’s recs are #1!

The Bariatric Hospital I went to has a very good post op program. They have in person monthly and weekly online support meetings. The Doctor that started the program many years ago is the moderator. He said they started out the pre liquid diet at 2 days. But they ran into issues with the liver being too big. In one instance he said he went to move the liver and it split because it was so big. So, that's why they will not work on anyone that has less than a 2 week pre op liquid diet to shrink the liver. If they go in to do the surgery and someone didn't follow the 2 week diet, they wouldn't do the procedure. They are very safety conscience and take it seriously along with their follow up program. I would go into what all is done but it's fairly lengthy. I'm just a few days from being a month out. I started the Puree'/soft food phase about a week early. Because I was having issues with constipation and needed to get in some fiber. MiraLAX alone wasn't doing the job. Ever since, I've not had an issue. I've even cooked up some ground chicken. But you will fill up fast. Half a cup and I'm full. One scrambled egg with a 1 tsp of salsa & 1 Tsp Mashed Avacado and I can just get it down then I'm done. I've been trying to eat to meet my protein goals, but that is just impossible. I have one shake (premier protein) and I'll mix 60 Grams of Chobani greek non fat yogurt, with one scoop of powdered Premier protein and 1 tsp of PBfit2 to get a chocolate peanut butter yogurt. Don't forget the Sugar free popsicles, it really helped my stomach. Hot food or broth seemed to hurt my stomach a little. But the cold didn't. My Insurance doesn't pay for a Dietician either, however with the Bariatric program it only costs $25 per visit. Between the Surgeon and Bariatric hospital they charged my Insurance $75K so I'm sure they use part of that to cover some of the cost. Do you use the Baritastic app?

Good morning! I am so happy that I found this group! I have been lurking for a month or so. There is a lot of information to be gained here😁. I had VSG Nov 2014 and lost 80 lbs. I was down to 170 lbs. I am 5’9 so I was quite content there. As we all know life throws curveballs and my weight has steadily climbed. I am now 60 years old and weigh 225. My A1c is high and I have been diagnosed with type 2 dm. I have been nauseated for months and last month I had an upper GI that showed severe acid reflux and a moderate hiatal hernia. Omeprazole has not helped at all. I have an EGD scheduled this coming Friday. Revision to bypass has been brought up by the nurse practitioner at the bariatric surgeon’s office. I also just met with my new PCP who gave me a prescription for Mounjaro. Bariatric surgeon said not to start the Mounjaro until we resolve my reflux issues (due to the possible side effects of nausea). I am unsure if I should go with the revision to bypass with hernia repair or just get the hernia repair and hope that fixes my reflux issue and use the Mounjaro to help with weight loss and lowering my A1c. I am not sure if just repairing the hernia will fix my relax issue. I will discuss all these options with my surgeon after the EGD. What are your thoughts/experiences?

I was searching the Bariatri Pal Store and found my favorite Quest Protein Bars. They have various. sugar alcohol amounts. Is it ok to eat one of them with 5 sugar alcohol?

Same. I also get the hic ups sometimes. They don't tell you its not a "normal" pre surgery full feeling, they should so we know what to expect. Then again most haven't gone through it who are dieticians/doctors. I just switched doctors (my old doctor decided to be inpatient only) and my new GP had bariatric surgery in 2019 (said she normally doesn't share personal info but figured it would be helpful) and she agreed, most of the bariatric journey isn't with practitioners who understand.

They should do this for all bariatric patients! It brings it home seeing it yourself!

Yes! In fact, my entire weight loss since surgery has been slooooow. I don't recommend kicking the scale - it hurts 😋 I even talked to my bariatric "team" who just didn't seem concerned. It only added to my anger..to go through all this to lose 4" lbs a month 3 months in and still at 6 months! Where did my honeymoon period go?? Only 80 lbs since starting the pre surgery weight loss portion... 80 lbs in 9 months, that's less than 10 each month! 😠 So yeah, I understand your frustration. I at this point wouldn't be to worried, you retain lots of fluids for several weeks following surgery, plus the standard response you'll read on here is the "your body is going through a lot and could be doing a self check reset reevaluating" at this point. I'd give it at least a month and as long as you're hitting nutritional goals and nothing feels off you'll be fine - (sigh) slow or not..its a downward trend. 😀

Take a few deep breaths, and then watch this video for reassurance from a bariatric specialist:

So I am 5 years and 2 months post-op RYGB. I made it beyond my goal weight of 170lb to 160lb. Technically I was as low as 145lbs because I was very sick in 2020 then again in 2022, but after getting better, I stabilized at a steady 160lb. Last July I started online streaming/socializing with people. I started snacking more because of nerves and also began drinking quite heavily because being silly tipsy in front of strangers is fun! I had NO IDEA how many calories was in alcohol. Over the course of 5 months, I gained 20lbs. Even more, I noticed that I can eat almost a "normal" plate of food the same size as my family's. I broke the rules and had started drinking fluids with my meals. I think I thought I could get away with breaking rules because I was at a stable 160lbs. Now I am FREAKING out! I hate exercise. I never did it, even with my prior weightloss. I am using a tracking app my husband's VA dietician told him to use called Fat Secret. I am trying to stick to 1600 calories, which is super hard. I feel hungry all the time now. I think I caused pouch dilation. I refuse to be heavy again. My clothes are already getting tighter than I like. I was doing research today on weight gain after years post-op. I basically am reading that I need a bariatric reset. I am going to do a 2-week "Pouch Reset Diet." It's not to make my pouch smaller, but it's to retrain my body to feel full with smaller portions again. I need to go back to the basics, and it's really hard. I also don't get DS with sweets like I used to. Don't get me wrong, I still get sick, but I noticed that my sugar tolerances have changed. It really worries me. 40% of bypass patients fail and bounce back to within 10% of their original weight pre-surgery. I will NOT be a part of that 40%. My support system at home is tricky. On one hand, my husband does support me outwardly. But he himself weighs 415lbs and isn't doing much about his weight. He watched my struggles and drustrations and outright refuses surgery for himself. He's on some stupid intermitent fasting diet, but he still eats way too large portions at meal times. My 15 y/o son is pushing 285lbs, and his only exercise is video games. For me, it's like living around all these food temptations is a struggle. It's like being an alcoholic and living at a bar. I just ordered a crap ton of protein powder so I can jump start this Pouch Reset Diet. I started to push myself on working out at least a little bit. I have a mini stair stepper and an eleptical bike. Anything is better than nothing. I am just wondering if I am alone in my struggles?

I am just starting Zepbound tomorrow! Ihave had a long journey. I was lapbanded in 2002. I lost 130lbs. In 2014, after not seeing any doctors for 5 years, I went to a local bariatric surgeon just for a checkup. He found my esophagus had expanded. My band was too tight and I was packing my esophagus..didn't even know..no pain. Immediately unfilled and gained 30lbs in a month..eating NOTHING! LIke almost! I was refilled after about 3-4 months and then developed an infection..and to cut to the chase..band was removed in 2018 and revised to sleeve. By then I was up 50lbs. Since then I gained another 50lbs..so the sleeve did nothing. Between covid, bad eating habits and menopause, I cannot get this weight off..I tried keto..lost a few lbs..tried intermittent fasting..lost a few more..but my body just won't move the weight down..so broke down last week and saw my new primary doctor and she prescrived Zepbound..well orginally Wegovy but that is harder to find and Costco had Zepbound. I will start this Saturday.

I agree with @NickelChip, this seems quite off. I've seen 800 calorie plans for bypass patients in the active weight loss phase, but most people are in the 1200 calorie range for maintenance... And your portion size will naturally increase a bit over time as you are able to eat more as your pouch heals. It won't be as much as a "matured sleeve" can eat, but it won't be a few tablespoons either. At the bariatric clinic I go to I attended nutrition class with sleeve patients and bypass patients, even though I'm a DS patient. We were all told to keep each meal to 10 grams of fat or less (general aim at 1 year out is 60 grams of total fat as per the ASMBS guidelines for a year out), and 10 grams of carbs or less, for less than 50 total grams of carbs a day, as they want us in ketosis during the active fat loss phase (this amount will double to about 100 grams of total carbs in maintenance). And protein varies for each group but bypass was to aim for 80 grams of protein a day, since they malabsorb some compared to the sleeve patients. NONE of us were given a calorie goal, only macro goals. We were ALL told to aim for 5-6 small meals a day for consistent energy, aiming for 4-5 meals if we go to bed early or get up late. So we were encouraged to eat about every 3 hours, allowing 2-3 hours between our last meal and bed. And told a fair amount of our carbs should come from high fiber, low carb vegetables and low sugar fruits, with a fiber supplement (SunFiber is amazing and non-bloating) and Miralax as needed to maintain regularity.

I'm so sorry you are experiencing this!! This isn't a you problem!! If you aren't losing sufficient weight you are either being given poor advice from your nutrition team, poor medical support from your surgeon, or it is possible your body is under significant stress for whatever reason and isn't losing weight. There are rare cases when someone with a sleeve doesn't respond but often those are people who have low starting weights. If they had a high starting weight and don't respond to the sleeve surgery, these people generally end up revised to bypass or a DS/SADI, and then lose weight, but again, that should be a convo being initiated by your surgeon as a future possibility if food modification and medications don't work. Some people take GLP-1 meds to help jumpstart their weight loss if the surgery hasn't triggered it, but again, at the 6 month mark this should be something the surgeon initiates conversation about. You shouldn't be living in fear of your appointments with them. If you aren't feeling supported you might consider getting a second opinion from another bariatric surgeon in the area not affiliated with this practice. I strongly believe in second opinions when talking things like surgery... It may sound like I'm being harsh on your team, but lets be clear. They made a nice chunk of money off of your surgery. You deserve good aftercare!! Some surgeons, like my own, believe that the best way to lose weight in the first 6 months to a year after surgery is through being in ketosis. This involves a good protein intake (60-80 grams with the sleeve) and carbs below 50 total carbs or 30 grams net carbs. You can get pee strips to test if you are in ketosis. Once in ketosis you should go through regular periods when you lose some weight, followed by periods where you lose none as your body stabilizes from the previous loss and recalibrates. If this doesn't happen, I'd definitely be communicating with the surgeon about it! What dietary advice did your team give you? Hydration is important for weight loss. If you aren't able to eat enough calories or drink enough water your body will go into starvation mode like @summerseeker mentioned. This is a huge stressor to the body!! And huge stress will cause weight loss to stop. Sleep is also crucial to weight loss, often more important than exercise. If you aren't getting regular sleep for enough hours per night, this can stall your weight loss. Physical activity of some kind is important, but it accounts for less weight loss than proper nutrition and sleep. And if you are under calories and under hydrated exercise will just further stress out your body.

Honestly, this seems way off-base, with the exception of 60-80 grams protein, which is completely sufficient for most people (but not all!). Your calorie estimations are much too low for the vast majority of people in maintenance mode. So rest assured, you won't be on 650 calories for life! Also, 25g carb is extremely low carb and not a lifestyle most people are eager to embrace. If a doctor insisted on 25g carb for life as the only way to succeed, I would seek out a second opinion for sure. From what I see people saying around here, 1200 to 1500 is a much more realistic calorie range for the long term, although that is for maintenance, not for weight loss or for early days after surgery. If you eat to maintain your current weight right now, that would seem to go against your goal of losing 20-50lbs more. I have two suggestions. First, check out some bariatric cookbooks because they will tell you appropriate portion sizes for maintenance as well as give you some ideas for what types of foods to be eating. My favorite is Kristin Willard's Bariatric Meal Prep Made Easy: 6 Weeks of Portion Controlled Recipes to Keep the Weight off. She's a registered dietician specializing in bariatrics and every recipe has a gorgeous color illustration. Second, take a look at the Portion Perfection brand bariatric plate. It's kind of expensive, so you may not want to buy it, but the concept is really good. Basically it's an 8 inch plate (with a one inch rim all the way around, so a 6 inch circle of eating space). There are lines and illustrations to divide up the plate and show you where to put your foods and how much. If you're a visual person, this may really help. Other than that, you may want to check out some of the nutrition videos as well as the weekly podcast done by Dr. Matthew Weiner (Pound of Cure). I find them so insightful and he and his dietician, Zoe, are very keen on plant-based nutrition, which may be perfect for you. Edited to add: Here is a link to a dietician article about post-op goals that might help: https://www.mybariatricdietitian.com/mbd-blog/portion-sizes-after-weight-loss-surgery

It really is amazing to see how all the different doctors approach the pre diet, surgery, out patient vs hospital stay, post diet length of phases, what you can eat, what you can't in each phase. Of course we probably all think / hope that our own doc is doing it right. I'm trying hard to follow my doctor's course, even though when I read where some of you are, it gets difficult. Had first puree tonight (cheated by starting 12hrs early.. Oh well!) It was really good but really surprising how different your stomach reacts to it. I was definitely full after a few teaspoons as compared to eating pudding. I have a nutribullet, so you really end up making many servings so there's enough volume to puree. The mental part of the recovery has been awful. Hoping that being on the puree for the next two weeks will start to bring up the mood. FYI.. My insurance doesn't cover a nutritionist/dietician. Some of my doctor's dietician appts are considered part of the procedure and thus discounted cost. I paid almost nothing for the procedure itself, but not the dietician part. I looked online and found Health Loft. Many insurances cover them, including mine. They advertise as services for eating disorders, but they also have specialists for bariatric. It's virtual. Now I can use a dietician and get some counseling for many more visits as I try to change my life. Even though I've known for decades how I should be eating, I need all the help I can get.

I am enjoying the chicken soup flavored shake from Bariatric Fusion, which is funny because when I tried it pre-op, I thought it was terrible and nearly threw it out. Now, it's great. Celebrate and Unjury also make protein shake soups. I was also able to mix the unflavored Syntrax Nectar into a cup of organic tomato soup and it blended really well.

I’m really excited about the progress being made in pharmacology to manage obesity! This medication works well but is still generally considered a lifetime or long term treatment. Some can manage to keep the additional weight lost off with intensive lifestyle changes. However its so new there is much data on this for our population. Check out Dr. Weiner, he covers the topic extensively on his podcast and has additional info on his website. https://youtu.be/eu6Zt0LTg14?si=_rPWlf8DlrhGh3u6 https://www.poundofcureweightloss.com/glp1-medications/ Please connect with a Bariatric/weight management team that supports this. Unless you are T2D, you’ll likely be prescribed Zepbound. Make sure to check your insurance coverage and download the coupons. https://zepbound.lilly.com/coverage-savings

Try the Bariatric Fusion soft chews. They come in multi, iron, and calcium. They are all the texture of a Starburst candy. I was given samples by my dietician and they were wonderful. I would have opted for them if they weren't the most expensive option. I went for just the calcium as a soft chew and did the chewable, chalky type instead for the multi and the iron to save money, but if you need a really palatable option, these are the way to go.

Hey Bariatric family!! I’m four weeks post op and the thought of food makes me sick. Protein and water are my best friend. I have had some puréed stuff and a tiny piece of white fish. Once I eat something and put it up for “later” the thought of it disgust me. Will this go away?? Any food ideals?? Besides chili and fish?? The thought of chicken makes me want to pass out. I’m feeling good and everything is going well , just scared that this will not go away. Thanks in advance for all replies . These forums have gotten me through some of the hardest times of my life after vsg surgery.